Research Spotlight: Screening for Post-Traumatic Stress Disorder Following Childbirth Using the Peritraumatic Distress Inventory

Sharon Dekel, PhD, is founding director of the postpartum traumatic stress laboratory and an investigator in the Department of Psychiatry at Massachusetts General Hospital and an assistant professor of Psychology in the Department of Psychiatry at Harvard Medical School, is senior author of a recent study in the Journal of Affective Disorders, Screening for Post-Traumatic Stress Disorder Following Childbirth Using the Peritraumatic Distress Inventory.

Summary:

A large sample of postpartum women completed a questionnaire about their emotional reactions that have experienced during and/or immediately after childbirth using a measure called the Peritraumatic Distress Inventory (PDI). They also completed an assessment of PTSD symptoms related to childbirth.

The vast majority of women who had PTSD and those who did not have PTSD were accurately classified based on their responses to items on the PDI.

Hence, a women's subjective emotional reactions to childbirth could offer valuable information about her mental health and chances of probable suffering from PTSD.

What Question Were You Investigating with this Study?

Post-traumatic stress disorder (PTSD) following traumatic childbirth may undermine maternal and infant health, but there is a lack of screening tools for maternal childbirth-related PTSD.

The Peritraumatic Distress Inventory is used to assess acute distress in non-postpartum individuals, for example in combat veterans and sexual assault survivors. Is it also suitable for identifying those at risk for maternal childbirth-related PTSD?

What Methods Did You Use?

We used a sample of 3,039 participants from a cohort of women aged 18+ who gave birth to a live baby within the last six months and were enrolled and provided information about their mental health experience via an anonymous web survey.

The sample in this study includes participants who provided responses on the Peritraumatic Distress Inventory (PDI), a 13-item self-report questionnaire measuring the degree of emotional and psychological distress after a traumatic event, and the PTSD Checklist for DSM-5 (PCL-5), a 20-item self-report questionnaire measuring the presence of PTSD symptoms and their severity.

What Were Your Findings?

Factor analysis revealed two strongly correlated stable factors based on a modified version of the PDI: (1) negative emotions and (2) bodily arousal and threat appraisal. A score of 15+ on the modified PDI produced high sensitivity and specificity: 88% with a positive CB-PTSD screen in the first postpartum months and 93% with a negative screen.

What Are the Implications?

Brief self-report screening concerning a woman’s emotional reactions to childbirth using our modified PDI tool can detect those likely to endorse CB-PTSD in the early postpartum. This may serve as the initial step of managing symptoms to ultimately prevent chronic manifestations.

What are the Next Steps?

We need to examine the predictive utility of the PDI when it is administered as soon as possible after childbirth to detect acute stress responses to childbirth and women at high risk for developing PTSD.

Paper Cited:

Jagodnik, K. M., Ein-Dor, T., Chan, S. J., Ashkenazy, A. T., Bartal, A., Barry, R. L., & Dekel, S. (2023). Screening for post-traumatic stress disorder following childbirth using the Peritraumatic Distress Inventory. Journal of affective disorders, 348, 17–25. Advance online publication. https://doi.org/10.1016/j.jad.2023.12.010

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. MGH is a founding member of the Mass General Brigham healthcare system.