Research Spotlight: Establishing the Validity of a Diagnostic Questionnaire for Childbirth-related Post-Traumatic Stress Disorder

Sharon Dekel, PhD, is founding director of the postpartum traumatic stress laboratory 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 the senior author of a recent study in the American Journal of Obstetrics and Gynecology, Establishing the Validity of a Diagnostic Questionnaire for Childbirth-related Post-traumatic Stress Disorder.

Summary:

Although childbirth is a happy event, a significant portion of American women have complicated and even traumatic deliveries. These experiences can result in developing posttraumatic stress disorder (PTSD), a mental disorder which is different from postpartum depression. Screening for maternal mental conditions after childbirth as part of routine perinatal care is to identify women with postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS). There is no recommended or routine screening for postpartum PTSD. We show that a simple patient-self report questionnaire that women can complete quickly can accurately identify women who suffer from PTSD related to a traumatic childbirth. This questionnaire known as the PTSD Checklist for DSM-5 (PCL-5) has been traditionally used to provide a provisional diagnosis of PTSD in veterans.

What Question Were You Investigating with this Study?

We examined the diagnostic validity of the  PTSD Checklist for DSM-5 for detecting PTSD in women who have had a traumatic childbirth . The PCL-5 has been validated in people exposed to various forms of trauma (often in male samples), but whether it can detect PTSD related to childbirth has not been tested. This is important because childbirth is different from other potentially stressful events.

What Methods Did You Use?

We included 59 women who had a traumatic childbirth experience in the study.

Traumatic exposure was defined in accordance with the qualifying exposure to a trauma per DSM-5 Criterion A for PTSD, viz., threat or potential threat to life, or serious injury, experienced or perceived, to the mother and/or newborn.

Patients completed the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 (PCL-5) and an assessment for co-morbid mental health symptoms.

They also underwent a diagnostic (~1hr) interview using the gold-standard tool (The Clinician-Administered PTSD Scale for DSM-5, CAPS-5) to evaluate traumatic exposure and PTSD endorsement and compare the PCL-5’s performance against this clinician assessment. A sub-group (n = 43) completed a second administration of the Checklist approximately five weeks from the initial one.

What Were the Results?

Assessment of childbirth-related PTSD using the self-report PTSD Checklist for DSM-5 shows excellent diagnostic accuracy in women who experienced or perceived threat to her life or the infant’s life, or serious injury with regard to childbirth. 86% of women were correctly diagnosed as having PTSD or not. A score of 32or higher on the Checklist suggests a very high likelihood of meeting diagnostic criteria for PTSD.  

The results indicate that the PCL-5 is a simple and brief patient-administered tool that provides a valid screener for PTSD related to traumatic child experience.

What’s Next?

Replications of findings in larger postpartum samples is needed.

Paper Cited:

Arora, I. H., Woscoboinik, G. G., Mokhtar, S., Quagliarini, B., Bartal, A., Jagodnik, K. M., Barry, R. L., Edlow, A. G., Orr, S. P., & Dekel, S. (2023). Establishing the validity of a diagnostic questionnaire for childbirth-related posttraumatic stress disorder. American journal of obstetrics and gynecology, S0002-9378(23)02031-8. Advance online publication. https://doi.org/10.1016/j.ajog.2023.11.1229

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.