Persistent symptoms of maternal post-traumatic stress following childbirth across the first months postpartum: Associations with perturbations in maternal behavior and infant avoidance of social gaze toward mother.

Recent literature identifies childbirth as a potentially traumatic event, following which mothers may develop symptoms of Post-Traumatic-Stress-Following-Childbirth (PTS-FC). The current study examines whether stable symptoms of PTS-FC during the early postpartum period may impose risk for perturbations in maternal behavior and infant social-engagement with mother, controlling for comorbid postpartum internalizing symptoms. Mother-infant dyads (N = 192) were recruited from the general population, during the third trimester of pregnancy. 49.5% of the mothers were primipara, and 48.4% of the infants were girls. Maternal PTS-FC was assessed at 3-day, 1-month and 4-month postpartum, via self-report and clinician-administered interview. Latent Profile Analysis generated two profiles of symptomology: "Stable-High-PTS-FC" (17.0%), and "Stable-Low-PTS-FC" (83%). Membership in the "Stable-High-PTS-FC" profile associated with perturbed maternal sensitivity, which was in turn significantly associated with infant avoidance of social gaze toward mother (Indirect effect ß = -0.15). Results suggest the need for early screening and inform the planning of early preventive interventions.

Short stay vs long stay postpartum psychiatric admissions: a population-based study.

About 1-2/1000 of postpartum women require psychiatric admission. Length of stay is variable, and little is known about short postpartum admission. From all women in Ontario, Canada, with a psychiatric admission within 1 year postpartum (2007-2012) (n = 1702), we compared women with admissions <72 h to women with longer admissions on sociodemographics, clinical characteristics and post-discharge mental health service use. About 37% of admissions were <72 h. These women were more likely to be adolescents (11.7 vs 7.3%), less likely to be employed (16.6 vs 25.9%) compared to women with longer admissions, and fewer had a prior history of psychiatric admission (16.7 vs 59.0%). Index diagnoses of alcohol or substance use (12.5 vs 7.8%) and adjustment disorders (15.8 vs 6.3%) were more common in the short vs longer stay group; psychotic (5.8 vs 19.5%) and bipolar disorders (2.1 vs 14.2%) were less common. Women with short admission were at higher crude risk for ED revisit 7 days post-discharge (11.4 vs 4.9% OR2.52, 95% CI1.74-3.66) and at lower adjusted risk for readmission at 365 days post-discharge (19.5 vs 28.8%, aOR 0.63, 95% CI 0.46-0.85). Women with short stay postpartum admissions are a clinically distinct group that may benefit from targeted intervention.

Sex Differences in Psychiatric Hospitalizations of Individuals With Psychotic Disorders.

We aimed to evaluate the association between sex and hospitalization characteristics in psychotic disorders. We identified all acute hospitalizations, between 2010 and 2013, for psychotic disorders in patients younger than 45 and older than 55 years (n = 5411) in the hospital's database. In addition, we identified patients who were prescribed with intramuscular risperidone (n = 280) or clozapine (n = 192) at discharge. The results showed that women younger than 45 years had lower proportions of hospitalizations (33.52% vs. 66.47%) and involuntary hospitalizations (33.85% vs. 45.55%) than did men in the same age group. Women older than 55 years had higher proportions of hospitalizations (57.22% vs. 42.77%) and similar proportion of involuntary hospitalizations. Women younger than 45 years were prescribed similar doses of intramuscular risperidone and lower doses of clozapine (345.8 vs. 380.2 mg) and women older than 55 years were prescribed higher doses of intramuscular risperidone (44.8 vs. 34.4 mg/2 weeks) and clozapine (164.32 vs. 154.5 mg) than were men in the same age group. Women in the reproductive years have better hospitalization characteristics than do men on these measures.

A simple model for prediction postpartum PTSD in high-risk pregnancies.

This study aimed to examine the prevalence and possible antepartum risk factors of complete and partial post-traumatic stress disorder (PTSD) among women with complicated pregnancies and to define a predictive model for postpartum PTSD in this population. Women attending the high-risk pregnancy outpatient clinics at Sheba Medical Center completed the Edinburgh Postnatal Depression Scale (EPDS) and a questionnaire regarding demographic variables, history of psychological and psychiatric treatment, previous trauma, previous childbirth, current pregnancy medical and emotional complications, fears from childbirth, and expected pain. One month after delivery, women were requested to repeat the EPDS and complete the Post-traumatic Stress Diagnostic Scale (PDS) via telephone interview. The prevalence rates of postpartum PTSD (9.9 %) and partial PTSD (11.9 %) were relatively high. PTSD and partial PTSD were associated with sadness or anxiety during past pregnancy or childbirth, previous very difficult birth experiences, preference for cesarean section in future childbirth, emotional crises during pregnancy, increased fear of childbirth, higher expected intensity of pain, and depression during pregnancy. We created a prediction model for postpartum PTSD which shows a linear growth in the probability for developing postpartum PTSD when summing these seven antenatal risk factors. Postpartum PTSD is extremely prevalent after complicated pregnancies. A simple questionnaire may aid in identifying at-risk women before childbirth. This presents a potential for preventing or minimizing postpartum PTSD in this population.

Prospective risk from prenatal anxiety to post traumatic stress following childbirth: The mediating effects of acute stress assessed during the postnatal hospital stay and preliminary evidence for moderating effects of doula care.

OBJECTIVE: Growing literature has identified childbirth as a potentially traumatic event, following which mothers may develop symptoms of Post-Traumatic-Stress-Following-Childbirth. The current study is the first to prospectively examine a pathway of risk from mothers' prenatal trait-anxiety, to Acute-Stress-Immediately-Following-Childbirth, and later symptoms of Post-Traumatic-Stress-Following-Childbirth, in a low-risk community sample. Auxiliary analyses explored whether doula care during childbirth moderated risk. METHOD: 149 pregnant women were randomly selected. Prenatal trait-anxiety was assessed toward the end of pregnancy, Acute-Stress-Immediately-Following-Childbirth at two-days post-partum, and symptoms of Post-Traumatic-Stress-Following-Childbirth at one-month post-partum. RESULTS: Results indicated a significant indirect pathway from prenatal trait-anxiety to Post-Traumatic-Stress-Following-Childbirth, through Acute-Stress-Immediately-Following-Childbirth. Two groups were generated ad hoc for auxiliary analyses: participants who opted to receive doula care during childbirth (n=21; 14%) versus participants who received care as usual (n=128; 86%). Analyses provided preliminary support for doula care as a potential moderator of risk. CONCLUSIONS: Results point toward prenatal trait-anxiety and Acute-Stress-Immediately-Following-Childbirth as significant risk factors for Post-Traumatic-Stress-Following-Childbirth. Findings inform preventive screening implicating the prenatal period as well as the postnatal hospital stay as important time windows for preventive screening. Finally, preliminary support for moderating effects of doula care suggest that preventive interventions administered during the perinatal period may effectively reduce anxiety-related risk for Post-Traumatic-Stress-Following-Childbirth.

A latent class analysis of brief postpartum psychiatric hospital admissions.

Almost 40% of postpartum psychiatric hospital admissions are brief, lasting 72h or less. We aimed to identify unique subgroups of women within this group to inform better intervention. All women in Ontario, Canada with a brief postpartum psychiatric admission (≤ 72h) (2007-2012)(N = 631) were studied using latent class analysis. We identified distinct subtypes of women and compared women within each subtype on post-discharge mental health indicators: physician visits, emergency department (ED) visits and readmissions. We identified four clinically distinct classes: (1)women with no diagnosed mental illness (2 years before delivery) (n = 179; 28.4% of the sample); (2)women with pre-existing history of severe mental illness (i.e. psychosis) (n = 161; 25.5%); (3)women with pre-existing history of non-psychotic mental illness (n = 211; 33.4%); and (4)adolescent rural-dwelling women with alcohol and substance use disorders (n = 80; 12.7%). In the 1 year post-discharge, women in classes 1-3 were more likely to have post-discharge physician visit than women in class 4 (p < 0.05) and were less likely to have a psychiatric ED visit (p < 0.05). Women in class 2 were most likely to be readmitted (p < 0.05). We identified clinically distinct subgroups of women with brief postpartum psychiatric admissions who may each benefit from differing targeted preventive strategies and post-discharge treatment planning.

Postpartum anxiety in a cohort of women from the general population: risk factors and association with depression during last week of pregnancy, postpartum depression and postpartum PTSD.

BACKGROUND: In contrast to postpartum depression, postpartum anxiety receives less attention, especially in the general population. Acknowledging the phenomenon is important, as it may lead to significant distress and impair maternal functioning. OBJECTIVES: To explore the phenomenon in a cohort of women in the general population and to investigate possible associated factors. METHODS: Within the first days after childbirth, women at Chaim Sheba Medical Center maternity ward were interviewed. Questionnaires included psychosocial variables, feelings and fears during pregnancy and childbirth, and the Edinburgh Postnatal Depression Scale (EPDS) (referring to the last week before delivery). A month later, subjects completed the EPDS, a modified Spielberger Anxiety Scale and the Posttraumatic Stress Diagnostic Scale via telephone. RESULTS: 40.4% had high anxiety scores. A significant association was noted between postpartum anxiety and depression during the last week of pregnancy, postpartum depression, as well as postpartum PTSD. Anxiety scores were almost 50% higher in those who suffered from postpartum PTSD compared to those who experienced postpartum depression. Associations were also found with fear of the birth, fear of death during delivery (mother and fetus), feeling lack of control during labor and less confidence in self and medical staff. Of women who developed postpartum anxiety, 75% reported feeling anger, fear or emotional detachment during childbirth. No association was found with birth complications. CONCLUSIONS: Anxiety symptomatology appears to be a common manifestation after childbirth. It is therefore important to inquire about depression and fears during pregnancy and childbirth and subjective experience in order to anticipate postpartum anxiety symptoms, even by means of a brief screening test. The finding that postpartum PTSD was associated with the severity of postpartum anxiety may be used in the future as a potential identifier of PTSD symptoms in women with high anxiety scores.