Posttraumatic stress symptoms in pregnant woman with prior perinatal complications: A cross-sectional facility-based study
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Date
2019-11
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Addis Abeba University
Abstract
Introduction: Studies from high-income countries have shown that complications in a previous
pregnancy or at childbirth are associated with common mental disorders (CMD) and post-traumatic stress
disorder (PTSD) in the subsequent pregnancy. Even though pregnancy and obstetric complications are
more common in low- and middle-income countries, only a small number of studies have assessed PTSD
symptoms following childbirth in Africa and none have examined symptoms in the subsequent
pregnancy.
Objective: to test the hypothesis that previous perinatal complications are a risk factor for PTSD in the
subsequent pregnancy
Methods: Secondary data analysis was conducted using a dataset that is being collected as part of the
ASSET (Health System Strengthening in sub-Saharan Africa) study. As part of ASSET, a cross-sectional
facility-based study is being conducted among a sample of 2071 pregnant women as they present for
antenatal care at eight selected health centers in Meskan and Sodo districts, Gurage Zone, Southern
Nations, Nationalities and Peoples’ region. Data on socio-demographic background, depressive
symptoms, anxiety symptoms, substance use and intimate partner violence was collected in a direct
interview using structured and standardized questionnaires. Trauma symptoms were assessed using the
Life-Event Checklist (LEC) and Post-Traumatic Stress Disorder checklist for DSM-V (PCL-5), which
have been adapted for the Ethiopian setting. Data on clinical characteristics and complications of current
and past pregnancies was gathered from the clinical record using a structured form. For the analysis, the
primary exposure was considered previous experience of perinatal complications and the primary
outcome provisional diagnosis of PTSD using DSM-5 from PCL-5 (dependent variable).
Result: There were 844 participants in the study and around half of the women (50.6%; n=421) were in
the third trimester of pregnancy. The mean age was 25.7 years (SD= 4.7) with minimum age at
presentation 16 years and maximum 43 years. Nearly one-third of women (31%; n=258) were pregnant
for the first time; the mean parity was 1.76 (SD= 1.7) with a range of 0 to 8. Slightly more than half of the
participant (51%) had experienced one or more potentially traumatic events. From these 47.7% of women
reported to have directly experienced physical assault. Women endorsed having negative feelings (such as
fear, horror, anger, guilt or shame) more frequently than other PTSD symptoms on the PCL-5.The
prevalence of PTSD using different criteria including the DSM-5 criteria vary between 2.9%-4.4% in this
study. There was significant association between experienced number of potentially traumatic events and
provisional diagnosis of PTSD using the DSM-5.
Limitation: Multivariable analysis of the association between previous obstetric complications and PTSD
symptoms was not done because of the small proportion of obstetric complication. Data on other
symptoms of mental health conditions including depression symptoms and care, anxiety symptoms and
substance use were not included in the analysis and hence this factors was not controlled for.
Recommendation: Slightly over half of participant women reported having been exposed to one or more
traumatic event. Further research is needed to explore the effect of these possibly traumatic experience on
pregnancy and outcome Symptoms like having negative feeling, irritable behavior and sleep difficulties
were relatively frequent. Integrating mental health screening with ANC follow up may help improve and
the detection rate and care of mental health problems in pregnant women.
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Keywords
Posttraumatic stress symptoms , pregnant woman, perinatal complications