Perceptual encoding of emotions in interactive bodily expressions.

For social species, e.g., primates, the perceptual analysis of social interactions is an essential skill for survival, emerging already early during development. While real-life emotional behavior includes predominantly interactions between conspecifics, research on the perception of emotional body expressions has primarily focused on perception of single individuals. While previous studies using point-light or video stimuli of interacting people suggest an influence of social context on the perception and neural encoding of interacting bodies, it remains entirely unknown how emotions of multiple interacting agents are perceptually integrated. We studied this question using computer animation by creating scenes with two interacting avatars whose emotional style was independently controlled. While participants had to report the emotional style of a single agent, we found a systematic influence of the emotion expressed by the other, which was consistent with the social interaction context. The emotional styles of interacting individuals are thus jointly encoded.

Predicting vasovagal reactions to needles with anticipatory facial temperature profiles.

Around one-third of adults are scared of needles, which can result in adverse emotional and physical responses such as dizziness and fainting (e.g. vasovagal reactions; VVR) and consequently, avoidance of healthcare, treatments, and immunizations. Unfortunately, most people are not aware of vasovagal reactions until they escalate, at which time it is too late to intervene. This study aims to investigate whether facial temperature profiles measured in the waiting room, prior to a blood donation, can be used to classify who will and will not experience VVR during the donation. Average temperature profiles from six facial regions were extracted from pre-donation recordings of 193 blood donors, and machine learning was used to classify whether a donor would experience low or high levels of VVR during the donation. An XGBoost classifier was able to classify vasovagal groups from an adverse reaction during a blood donation based on this early facial temperature data, with a sensitivity of 0.87, specificity of 0.84, F1 score of 0.86, and PR-AUC of 0.93. Temperature fluctuations in the area under the nose, chin and forehead have the highest predictive value. This study is the first to demonstrate that it is possible to classify vasovagal responses during a blood donation using temperature profiles.

Low awareness of past SARS-CoV-2 infection in healthy plasma donors.

Awareness of infection with SARS-CoV-2 is crucial for the effectiveness of COVID-19 control measures. Here, we investigate awareness of infection and symptoms in relation to antibodies against SARS-CoV-2 in healthy plasma donors. We asked individuals donating plasma across the Netherlands between May 11th and 18th 2020 to report COVID-19-related symptoms, and we tested for antibodies indicative of a past infection with SARS-CoV-2. Among 3,676 with antibodies, and from questionnaire data, 239 (6.5%) are positive for SARS-CoV-2 antibodies. Of those, 48% suspect no COVID-19, despite the majority reporting symptoms; 11% of seropositive individuals report no symptoms and 27% very mild symptoms at any time during the first peak of the epidemic. Anosmia/ageusia and fever are most strongly associated with seropositivity. Almost half of seropositive individuals do not suspect SARS-CoV-2 infection. Improved recognition of COVID-19 symptoms, in particular, anosmia/ageusia and fever, is needed to reduce widespread SARS-CoV-2 transmission.

New blood donors in times of crisis: Increased donation willingness, particularly among people at high risk for attracting SARS-CoV-2.

BACKGROUND: Traditionally, during crises the number of new blood donors increases. However, the current coronavirus disease 2019 (COVID-19) pandemic created additional barriers to donate due to governmental prevention measures and increased personal health risks. In this report, we examined how the pandemic affected new donor registrations in the Netherlands, especially among groups with higher risk profiles for severe COVID-19. Additionally, we explored the role of media for blood donation and new donor registrations. STUDY DESIGN AND METHODS: We analyzed new donor registrations and attention for blood donation in newspapers and on social media from January until May 2020, in comparison to the same period in 2017 to 2019. RESULTS: After the introduction of nationwide prevention measures, several peaks in new donor registrations occurred, which coincided with peaks in media attention. Interestingly, people with a higher risk profile for COVID-19 (e.g., due to age or region of residence) were overrepresented among new registrants. DISCUSSION: In sum, the first peak of the current pandemic has led to increased new blood donor registrations, despite the associated increased health risks. Time and future studies will have to tell whether these new donors are one-off 'pandemic' donors or if they will become regular, loyal donors.

Blood donation among individuals of African origin in the Netherlands: how are barriers and motivators associated with intention?

BACKGROUND: Blood donors of African origin are under-represented in high-income Western countries, while their extended blood types closely match chronic transfusion patients with similar ancestral backgrounds. To prevent alloimunisation, it is important to recruit and retain more African blood donors. The aim of this study was to gain insight into blood donation barriers and motivators of individuals of African origin, and to assess how these are associated with the intention to donate blood. MATERIALS AND METHODS: An online survey sample included 300 participants of sub-Saharan African, Afro-Surinamese and Afro-Caribbean origin living in the Netherlands. They ranked 25 barriers and 19 motivators on the level of impediment and facilitation in blood donation. We compared differences in barriers and motivators between ever- and never-donors and tested associations with the intention to donate blood using univariate and multivariate linear regression analyses, adjusted for gender, age, ethnicity, immigrant generation, educational level, and blood donation history. RESULTS: Receiving information about the donation procedure was a highly ranked motivator especially among never-donors (50%) and was positively associated with the intention to donate (p<0.05). Non-monetary incentives, convenience factors and awareness were other important motivators. Highly ranked barriers related to fears and not feeling healthy enough to donate, although only "believing donation is scary or stressful" (reported by 8% of the ever-donors and 25% of the never-donors) remained significantly associated with intention to donate in the multivariate model (p<0.05). Recipient preferences, religion and distrust were less often reported and were not associated with donation intention. DISCUSSION: The highest ranked barriers and motivators were not necessarily the best predictors of donation intention. These findings have valuable implications for future interventions focussing on individuals of African origin.

Unknown, so also unvalued? Blood donation awareness and attitudes of potential donors of Dutch and African descent.

BACKGROUND AND OBJECTIVES: Many Western countries face a shortage of African blood donors, while their specific blood groups are needed to transfuse chronic transfusion patients of similar ethnic background. Blood donation awareness and attitudes greatly impact the decision to become a blood donor, but how they are related and differ across ethnic groups is understudied. This study investigated blood donation awareness and attitudes of individuals of Dutch and African descent in the Netherlands. MATERIALS AND METHODS: Survey data of 257 African and 152 Dutch non-donors measuring donation awareness (i.e. being familiar with the Dutch blood bank organization and knowing others who donated blood), cognitive (evaluative judgements) and affective (emotional reactions) attitudes were included. t-Tests, chi-square tests, linear and logistic regressions were conducted to study differences and associations between donation awareness and attitudes. RESULTS: African individuals were less often aware of the Dutch blood bank organization (43%; p < 0·05) or others who donated blood (51%; p < 0·05) than Dutch individuals (55% and 68%, respectively). African individuals had lower cognitive donation attitudes compared with Dutch individuals (p < 0·001), but no differences were found for affective attitudes (p = 0·55). High donation awareness was associated with higher cognitive (p < 0·001) and affective (p < 0·05) donation attitudes among African minorities, but not among Dutch individuals. CONCLUSION: The lower donation awareness and cognitive attitudes of African minorities should be taken into consideration in donor recruitment. Raising awareness through effective communication strategies might be essential in the donor decision making process of this target group.

Ferritin measurement IN Donors-Effectiveness of iron Monitoring to diminish iron deficiency and low haemoglobin in whole blood donors (FIND'EM): study protocol for a stepped wedge cluster randomised trial.

BACKGROUND: Blood donors are at risk for reduced iron stores, because of which donor iron monitoring received increased attention in the last decade. Despite the importance for donor health, international consensus on an appropriate policy for iron monitoring is lacking. Therefore, we conduct a trial to evaluate to what extent ferritin-guided donation intervals are effective in increasing haemoglobin and ferritin levels, decreasing low-haemoglobin deferral, increasing donor return and improving the health of whole blood donors in the Netherlands. METHODS: Sanquin Blood Bank is implementing ferritin-guided donation intervals to prevent donors from increasing iron loss at repeated donations. Using a stepped wedge cluster randomised trial approach, the design involves a random crossover of 29 clusters of blood collection centres from the existing policy without ferritin measurements to a ferritin-guided donation interval policy. This new policy includes ferritin measurements for all new donors and at every 5th whole blood donation, extending donation intervals to 6 months if ferritin is 15-≤ 30 ng/mL and to 12 months if ferritin is < 15 ng/mL. We measure ferritin levels of whole blood donors from stored plasma samples and collect haemoglobin levels and information on low-haemoglobin deferral and donor return from the donor database before, during and after the implementation period. We measure donor health during and after the implementation period using questionnaires, assessing physical and mental wellbeing and iron deficiency- and donation-related symptoms. We use multilevel analyses to investigate differences in ferritin and haemoglobin levels, low-haemoglobin deferral rates, donor return and donor health from whole blood donors, between blood collection centres that have versus those that have not yet implemented the ferritin-guided donation interval policy. DISCUSSION: This stepped wedge cluster randomised trial will provide insight into the effectiveness of ferritin-guided donation intervals in lowering iron deficiency, decreasing donor deferrals due to low haemoglobin and improving donor health. We will evaluate a policy that is implemented nationwide in a real-life setting. Our study is therefore not limited to a small experimental setting and the results will guide policymakers seeking an appropriate policy for iron monitoring. TRIAL REGISTRATION: The Dutch trial registry NTR6738 . Registered on 29 September 2017. Retrospectively registered.

Impact of risk-dependent interventions on low haemoglobin deferral rates in whole blood donors.

BACKGROUND: Blood donors with a relatively low haemoglobin (Hb) level at their previous donation attempt have an increased risk of Hb deferral at the subsequent donation attempt. The aim of this study was to investigate whether the interventions prolongation of donation interval and/or a dietary advice decrease the Hb deferral rate. METHODS: 11 897 whole blood donors with Hb levels from below to 0·2 mmol/l above the cut-off level for donation received either no intervention, a prolongation of the donation interval to six or twelve months, a dietary advice, or both. Deferral rates for low Hb levels at the subsequent donation attempt were compared in the different intervention groups. Additionally, the effects of the interventions on Hb deferral risk and donor return for a subsequent donation attempt were analysed using generalized estimating equations. RESULTS: The Hb deferral rate was substantially lower in the group that received a prolongation of the donation interval to six months than in the Control Group (12·9% vs. 6·3% in men and 20·4% vs. 13·4% in women). However, the additional benefit of twelve over 6-month interval prolongation was small, and no benefit of a dietary advice showed up. On the other hand, receiving a dietary advice increased the likelihood of donor return for a subsequent donation attempt. CONCLUSION: Implementation of a protocol for the prolongation of donation intervals to six months for donors with Hb levels from below to slightly above the cut-off level for donation may reduce the deferral rate for low Hb levels while keeping donor lapse at a minimum.

Associations between single nucleotide polymorphisms and erythrocyte parameters in humans: A systematic literature review.

Individual variations in erythrocyte parameters are influenced by factors like sex, age, diet and season. Genetic variations have also been associated with erythrocyte parameters. The aim of this systematic review is to provide an overview of associations between single nucleotide polymorphisms (SNPs) and erythrocyte parameters in humans. A systematic review protocol was published at the international prospective register of systematic reviews (registration number CRD42016053052). Literature searches were conducted in Medline and Embase. Studies were included if: investigating a(n) causality/association/correlation; population-based; investigating a human population of Caucasian/mixed-ethnic descent; and written in English, Dutch or German. Study quality was assessed using the quality of genetic association studies tool. In total, 4385 studies were screened on title/abstract and 194 studies were screened on full text. Inclusion criteria were met by 13 candidate gene studies (n = 126-49,488) and eight genome-wide association studies (GWASes, n = 1664-116,666). One moderate and six good quality GWAS(es) identified 1237 SNPs located in/near 241 genes. SNPs in/near ten genes were found to be associated with one or more erythrocyte parameter(s) by multiple GWASes, namely HIST1H2AC, MPST, SLC17A1 and SLC17A3 with mean cell hemoglobin (MCH), HIST1H1T and KCTD17 with MCH and mean cell volume (MCV), HBS1L and MYB with MCH, MCV and red cell count (RCC), HFE with MCH, MCV and hemoglobin, and TMPRSS6 with MCH, MCV, hemoglobin and mean cell hemoglobin concentration (MCHC). Four genes were found across multiple erythrocyte parameters by one study in each parameter. Fourteen SNPs were associated with one or more erythrocyte parameter(s) in multiple cohorts, namely rs129128, rs17342717, rs228129 and rs5756504 (MCH), rs4895441, rs7775698, rs9376092 and rs9494145 (MCH, MCV, RCC), rs6569992 (MCH, RCC), rs1800562 (hemoglobin, MCH, MCV), rs130624 and rs198846 (MCH, MCV), rs4820268 and rs855791 (MCH, MCV, MCHC). Further research on these fourteen genes in erythropoiesis is recommended, especially eight whose role in erythropoiesis is unclear.

Determinants of blood donation willingness in the European Union: a cross-country perspective on perceived transfusion safety, concerns, and incentives.

BACKGROUND: Willingness to donate blood depends on personal characteristics, beliefs, and motivations, but also on the cultural context. The aim of this study was to examine whether willingness to donate blood is associated with attitudes toward blood transfusion, personal motivators, and incentives and whether these factors vary across countries in the European Union (EU). STUDY DESIGN AND METHODS: The sample consisted of 27,868 participants, from 28 EU member states, who were interviewed about blood donation and transfusion-related issues for the 2014 round of the Eurobarometer, a country-comparative survey, collected on behalf of the European Commission. Participants were asked whether they would be willing to donate blood and for which reasons (motivators) and which incentives are appropriate to receive in return for a blood donation. RESULTS: Willingness to donate varied significantly across countries and was positively associated with perceived blood transfusion safety. Furthermore, helping family or people in need were the most powerful motivators for blood donation willingness in almost all countries. In contrast, the number of participants who were willing to donate to alleviate shortages or to contribute to research varied widely across countries. The wish to receive certain incentives, however, did not seem to be related to willingness to donate. CONCLUSION: Perceived blood transfusion safety and personal motivations may be stronger determinants of willingness to donate than receiving certain incentives. EU-wide strategies and guidelines for donor recruitment and retention should take both overall and country-specific patterns into account. For example, education on the importance of donation could be considered.

The supply chain of migrant blood donors: an organisational interview study.

BACKGROUND AND OBJECTIVES: Migrant blood donors are underrepresented worldwide resulting in shortages of compatible blood products. Prior studies focused on individual barriers and motivators of potential blood donors, but no studies addressed organisational factors of the blood supply chain. This study explored the perceptions and experiences in recruitment and retention of migrant - and potentially rare-blood donors among staff members within the blood supply chain and identified obstacles and solutions in this chain. MATERIALS AND METHODS: The study was conducted at Sanquin, the national blood supply organisation of the Netherlands. Qualitative in-depth interviews were done among key staff members (N = 17). Expert validity was assessed in three feedback meetings. RESULTS: Seven staff members believed there is a shortage of migrant blood donors, while five believed there is not. However, there was a consensus that it may become a problem in the future due to demographic changes. The perceived obstacles to recruit and retain migrant donors were difficulties in determining how many migrant donors are needed and recruiting them, excluding potentially rare donors prior to donation, limited use of extended phenotyping and high blood typing and frozen storage costs. The possible solutions to increase blood pool diversity lay in registering donor ethnicity, specialised information provision for donors, reconsidering eligibility criteria and optimising blood typing strategies. CONCLUSION: Whilst recruitment of migrant blood donors is perceived by staff as difficult, various organisational policies and guidelines seem to hinder retention. Improvements in the blood supply chain may be achieved by addressing logistics, current procedures and registration of ethnicity.

Barriers and motivators of Ghanaian and African-Surinamese migrants to donate blood.

African migrants are underrepresented as blood donors in many Western countries, which can lead to shortages of specific blood types for transfusion. More insight in the reasons for this underrepresentation is required to improve blood donor recruitment and retention strategies. The aim of this qualitative study was to explore barriers and motivators for donating blood among migrants of African background. The research population consisted of first and second generation African-Surinamese (n = 20) and Ghanaian (n = 16) migrants living in the Netherlands. In semi-structured personal interviews performed in 2016 and 2017, their experiences and opinions regarding blood donation, barriers, and motivators to (not) become a blood donor and their suggestions to improve recruitment were explored. Data collection was continued until data saturation was achieved. The interviews revealed that although all participants knew about blood donation in general, only four had previously heard of the Dutch national blood bank organisation. Participants expected that if blood was needed, the blood bank would directly approach them, as in their country of origin. Other main blood donation barriers were fear (e.g., of needles, losing too much blood) and issues related to health and non-eligibility to donate. Main motivators were mainly of altruistic nature (e.g., saving a life) and an increased awareness of the need via personal recruitment appeals. It is concluded that expectations regarding donor recruitment-derived from the country of origin-and unawareness of the need for blood can act as important barriers in blood donation among African migrants. Contrary to studies in the United States and Australia, perceived discrimination and social exclusion did not seem to be a donation deterrent among migrants in the Netherlands. Creating awareness of the need of blood by actively approaching, and informing migrants about the donation procedure in the host country, should be considered by blood banks.

The Neural Basis of Individual Face and Object Perception.

We routinely need to process the identity of many faces around us, and how the brain achieves this is still the subject of much research in cognitive neuroscience. To date, insights on face identity processing have come from both healthy and clinical populations. However, in order to directly compare results across and within participant groups, and across different studies, it is crucial that a standard task is utilized which includes different exemplars (for example, non-face stimuli along with faces), is memory-neutral, and taps into identity matching across orientation and across viewpoint change. The goal of this study was to test a previously behaviourally tested face and object identity matching design in a healthy control sample whilst being scanned using fMRI. Specifically, we investigated categorical, orientation, and category-specific orientation effects while participants were focused on identity matching of simultaneously presented exemplar stimuli. Alongside observing category and orientation specific effects in a distributed set of brain regions, we also saw an interaction between stimulus category and orientation in the bilateral fusiform gyrus and bilateral middle occipital gyrus. Generally these clusters showed the pattern of a heightened response to inverted versus upright faces, and to upright, as compared to inverted shoes. These results are discussed in relation to previous studies and to potential future research within prosopagnosic individuals.

The Facial Expressive Action Stimulus Test. A test battery for the assessment of face memory, face and object perception, configuration processing, and facial expression recognition.

There are many ways to assess face perception skills. In this study, we describe a novel task battery FEAST (Facial Expressive Action Stimulus Test) developed to test recognition of identity and expressions of human faces as well as stimulus control categories. The FEAST consists of a neutral and emotional face memory task, a face and shoe identity matching task, a face and house part-to-whole matching task, and a human and animal facial expression matching task. The identity and part-to-whole matching tasks contain both upright and inverted conditions. The results provide reference data of a healthy sample of controls in two age groups for future users of the FEAST.

From personal fear to mass panic: The neurological basis of crowd perception.

Recent studies have investigated the neural correlates of how we perceive emotions of individuals or a group of individuals using images of individual bodily expressions. However, it is still largely unknown how we perceive the emotion of a dynamic crowd. This fMRI study used realistic videos of a large group of people expressing fearful, happy or neutral emotions. Furthermore, the emotions were expressed by either unrelated individuals in the group or by an interacting group. It was hypothesized that the dynamics between the people in a crowd is a more salient signal than merely the emotion of the crowd. Second, it was expected that the group interaction is of special importance in a fearful or "panic" situation, as opposed to a happy or neutral situation. Using a fast-event related design, it was revealed that observing interactive individuals, more so than independently expressive individuals, activated networks related to the perception, execution and integration of action and emotion. Most importantly, the interactive or panicked crowds, as opposed to the individually fearful crowds, triggered more anticipatory and action preparation activity, whereas the brain was less sensitive to the dynamics of individuals in a happy or neutral crowd. This is the first study to assess the effect of the dynamics between people and the collectively displayed emotion as an important aspect of emotional crowd perception.

The Body Action Coding System II: muscle activations during the perception and expression of emotion.

Research into the expression and perception of emotions has mostly focused on facial expressions. Recently, body postures have become increasingly important in research, but knowledge on muscle activity during the perception or expression of emotion is lacking. The current study continues the development of a Body Action Coding System (BACS), which was initiated in a previous study, and described the involvement of muscles in the neck, shoulders and arms during expression of fear and anger. The current study expands the BACS by assessing the activity patterns of three additional muscles. Surface electromyography of muscles in the neck (upper trapezius descendens), forearms (extensor carpi ulnaris), lower back (erector spinae longissimus) and calves (peroneus longus) were measured during active expression and passive viewing of fearful and angry body expressions. The muscles in the forearm were strongly active for anger expression and to a lesser extent for fear expression. In contrast, muscles in the calves were recruited slightly more for fearful expressions. It was also found that muscles automatically responded to the perception of emotion, without any overt movement. The observer's forearms responded to the perception of fear, while the muscles used for leaning backwards were activated when faced with an angry adversary. Lastly, the calf responded immediately when a fearful person was seen, but responded slower to anger. There is increasing interest in developing systems that are able to create or recognize emotional body language for the development of avatars, robots, and online environments. To that end, multiple coding systems have been developed that can either interpret or create bodily expressions based on static postures, motion capture data or videos. However, the BACS is the first coding system based on muscle activity.

The Body Action Coding System I: muscle activations during the perception and expression of emotion.

Body postures provide clear signals about emotional expressions, but so far it is not clear what muscle patterns are associated with specific emotions. This study lays the groundwork for a Body Action Coding System by investigating what combinations of muscles are used for emotional bodily expressions and assessing whether these muscles also automatically respond to the perception of emotional behavior. Surface electromyography of muscles in the arms (biceps and triceps) and shoulders (upper trapezius and deltoids) were measured during both active expression and passive viewing of fearful and angry bodily expressions. The biceps, deltoids, and triceps are recruited strongly for the expression of anger and fear expression predominantly depends on the biceps and the deltoids. During passive viewing, all muscles automatically activate during the passive viewing of anger. During fear perception, a clear activation can be seen in the trapezius, deltoid, and triceps muscles, whereas the biceps shows inhibition. In conclusion, this study provides more insight into the perception and expression of emotions in the body.

The human and animal baby schema effect: correlates of individual differences.

We investigated the animal and human baby schema effect (BSE) in relation to gender, parental status, and individual features. In three, independent online surveys, conducted during three consecutive years, (Ntotal=1389), ratings of photographs of human and animal infants as well as of adults, sociodemographic variables (age, gender, parental status) and personality attributes (empathy, attachment, interpersonal closeness, narcissism, and need to belong) were assessed. We demonstrated that humans are sensitive to the baby schemata of both humans and animals and that both are weakly positively correlated. BSE is positively associated with female gender and (affective) empathy. Higher interpersonal closeness and need to belong were additionally connected specifically to the human BSE. In contrast, narcissism and insecure attachment were not related to the BSE, suggesting a robustness of this phenomenon to possible negative influences of these two personality attributes.

Validation of the Turkish version of the problem areas in diabetes scale.

The Problem Areas in Diabetes (PAID) scale is a widely used self-report measure that can facilitate detection of diabetes-specific emotional distress in clinical practice. The aim of this study was to assess the factor structure and validity of the Turkish version of the PAID. A validation study was conducted among 154 patients with insulin-naïve type 2 diabetes. Participants completed the PAID, Centre for Epidemiological Studies Depression Scale (CES-D), Insulin Treatment Appraisal Scale (ITAS), and World Health Organization-Five Well-Being Index (WHO-5) questionnaires. Exploratory factor analyses yielded a 2-factor structure, identifying a 15-item "diabetes distress" factor and a 5-item "support-related issues" factor. The total PAID-score and the two dimensions were associated with higher levels of depression and poor emotional well-being. In the present study, the Turkish version of the PAID had satisfactory psychometric properties, however, the factorial structure was found to differ from factor solutions from other countries.

Posttraumatic stress following childbirth in homelike- and hospital settings.

OBJECTIVE: To assess the prevalence of posttraumatic stress disorder (PTSD) following childbirth in homelike versus hospital settings and to determine risk factors for the development of posttraumatic stress symptoms. METHODS.: Multi-center cross-sectional study at midwifery practices, general hospitals and a tertiary (university) referral center. An unselected population of 907 women was invited to complete questionnaires on PTSD, demographic, psychosocial, and obstetric characteristics 2 to 6 months after delivery. Prevalence of PTSD was based on women who met all criteria of the diagnostic and statistical manual of mental disorders, 4th edition (DSM-IV), whereas risk factors were determined using the severity (sum-score) of posttraumatic stress symptoms. RESULTS: PTSD following childbirth was found in 1.2% of the respondents (5/428 women, response rate 47%), while 9.1% of women (39/428) had experienced the delivery as traumatic. Posttraumatic stress symptoms were associated with unplanned cesarean section, low sense of coherence (coping skills), and high intensity of pain. Initial differences in posttraumatic stress symptoms between home and hospital deliveries disappeared after taking into account the (by definition) uncomplicated nature of home births. CONCLUSION: In this Dutch study, 1 in 100 women had PTSD following childbirth, with no differences between home- and hospital deliveries after controlling for complications and interventions. Emergency cesarean section, severe labor pain, and poor coping skills were associated with more posttraumatic stress symptoms.