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Association of postpartum depression with postpartum posttraumatic stress disorder in Korean mothers: a longitudinal survey

한국 산모의 산후 우울과 산후 외상 후 스트레스장애 관련성: 종단적 연구

  • Cho, Hyunjin (College of Nursing, Chungnam National University) ;
  • Koh, Minseon (Department of Nursing, Yeoju Institute of Technology) ;
  • Yoo, Hyeji (College of Nursing, Chungnam National University) ;
  • Ahn, Sukhee (College of Nursing, Chungnam National University)
  • Received : 2021.10.16
  • Accepted : 2022.02.18
  • Published : 2022.03.31

Abstract

Purpose: This study aimed to determine the level of postpartum posttraumatic stress disorder (PTSD) and postpartum depression (PPD) in Korean mothers with healthy babies and to explore the factors related to postpartum PTSD. Methods: This study used a longitudinal survey design to explore the levels and association of PPD and PTSD. Two hundred women were recruited during pregnancy and the data were collected via online survey from 166 mothers (84% retained) who gave birth to healthy babies, at two postpartum periods: Fear of childbirth was assessed at the 1st week; and spousal support, PPD, and postpartum PTSD were surveyed at the 4th week postpartum. Descriptive statistics, t-test, one-way analysis of variance, Chi square test, and multiple regression were done. Results: The mean age of mothers was 33.12 (±3.97) years old. Postpartum PTSD was low (8.95±6.49) with 1.8% (n=3) at risk (≥19). PPD was also low (6.68±5.28) and 30.1% (n=50) were identified at risk (≥10). The comorbid rate of PPD with PTSD was 6%. Mothers who did not have a planned pregnancy had higher scores of PPD (t=-2.78, p=.008), whereas spousal support and PPD had negative relationship (r=-.21, p=.006). The overall explanatory power for postpartum PTSD was 55.2%, of which PPD was the only significant variable (β=. 76, t=13.76, p<.001). Conclusion: While only 1.8% was at risk of postpartum PTSD at 4 weeks postpartum, PPD prevalence was 30.1% and PPD was the only influential factor of postpartum PTSD. Assessment and counseling of PPD are required as well as screening for postpartum PTSD. More research is also needed on postpartum PTSD in Korean women.

Keywords

Acknowledgement

This study was supported by NRF (National Research Foundation) of Korea (NRF No. 2020R1A2C201086512).

References

  1. Ayers S, Bond R, Bertullies S, Wijma K. The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework. Psychol Med. 2016;46(6):1121-1134. https://doi.org/10.1017/S0033291715002706
  2. Silverman ME, Reichenberg A, Savitz DA, et al. The risk factors for postpartum depression: a population-based study. Depress Anxiety. 2017;34(2):178-187. https://doi.org/10.1002/da.22597
  3. Liu X, Wang S, Wang G. Prevalence and risk factors of postpartum depression in women: a systematic review and meta-analysis. J Clin Nurs. 2021 Nov 8 [Epub]. https://doi.org/10.1111/jocn.16121
  4. Hwang JY. Reclassification of high-risk pregnancy for maternal-fetal healthcare providers. J Korean Soc Matern Child Health. 2020;24(2):65-74. https://doi.org/10.21896/jksmch.2020.24.2.65
  5. Leeds L, Hargreaves I. The psychological consequences of childbirth. J Reprod Infant Psychol. 2008;26(2):108-122. https://doi.org/10.1080/02646830701688299
  6. Grekin R, O'Hara MW. Prevalence and risk factors of postpartum posttraumatic stress disorder: a meta-analysis. Clin Psychol Rev. 2014;34(5):389-401. https://doi.org/10.1016/j.cpr.2014.05.003
  7. Yildiz PD, Ayers S, Phillips L. The prevalence of posttraumatic stress disorder in pregnancy and after birth: a systematic review and meta-analysis. J Affect Disord. 2017;208:634-645. https://doi.org/10.1016/j.jad.2016.10.009
  8. Kang JH, Rha DW, Kwon JY, Kim TY, Kim KR, Lee S. A study of reliability and validity on the Korean version of perinatal PTSD questionnaire. J Korean Soc Depress Bipolar Disord. 2011;9(1):24-29.
  9. Gankanda WI, Gunathilake IA, Kahawala NL, Ranaweera AK. Prevalence and associated factors of post-traumatic stress disorder (PTSD) among a cohort of Srilankan post-partum mothers: a cross-sectional study. BMC Pregnancy Childbirth. 2021;21(1):626. https://doi.org/10.1186/s12884-021-04058-z
  10. Dikmen-Yildiz P, Ayers S, Phillips L. Longitudinal trajectories of post-traumatic stress disorder (PTSD) after birth and associated risk factors. J Affect Disord. 2018;229:377-385. https://doi.org/10.1016/j.jad.2017.12.074
  11. Cook N, Ayers S, Horsch A. Maternal posttraumatic stress disorder during the perinatal period and child outcomes: a systematic review. J Affect Disord. 2018;225:18-31. https://doi.org/10.1016/j.jad.2017.07.045
  12. Boorman RJ, Devilly GJ, Gamble J, Creedy DK, Fenwick J. Childbirth and criteria for traumatic events. Midwifery. 2014;30(2):255-261. https://doi.org/10.1016/j.midw.2013.03.001
  13. Capik A, Durmaz H. Fear of childbirth, postpartum depression, and birth-related variables as predictors of posttraumatic stress disorder after childbirth. Worldviews Evid Based Nurs. 2018;15(6):455-463. https://doi.org/10.1111/wvn.12326
  14. Thiel F, Dekel S. Peritraumatic dissociation in childbirth-evoked posttraumatic stress and postpartum mental health. Arch Womens Ment Health. 2020;23(2):189-197. http://doi.org/10.1007/s00737-019-00978-0
  15. Agius A, Xuereb RB, Carrick-Sen D, Sultana R, Rankin J. The co-existence of depression, anxiety and post-traumatic stress symptoms in the perinatal period: a systematic review. Midwifery. 2016;36:70-79. https://doi.org/10.1016/j.midw.2016.02.013
  16. Dekel S, Ein-Dor T, Dishy GA, Mayopoulos PA. Beyond postpartum depression: posttraumatic stress-depressive response following childbirth. Arch Womens Ment Health. 2020;23(4):557-564. https://doi.org/10.1007/s00737-019-01006-x
  17. Park YK, Ju HO, NA H. Reliability and validity of the Korean version of the perinatal post-traumatic stress disorder questionnaire. J Korean Acd Nurs. 2016;46(1):29-38. https://doi.org/10.4040/jkan.2016.46.1.29
  18. Garthus-Niegel S, von Soest T, Vollrath ME, Eberhard-Gran M. The impact of subjective birth experiences on post-traumatic stress symptoms: a longitudinal study. Arch Womens Ment Health. 2013;16(1):1-10. https://doi.org/10.1007/s00737-012-0301-3
  19. Cho H, Ahn S. Do childbirth confidence, prenatal depression, childbirth knowledge, and spousal support influence childbirth fear in pregnant women? Korean J Women Health Nurs. 2020;26(4):358-366. https://doi.org/10.4069/kjwhn.2020.12.14
  20. Alipour Z, Lamyian M, Hajizadeh E. Anxiety and fear of childbirth as predictors of postnatal depression in nulliparous women. Women Birth. 2012;25(3):e37-e43. https://doi.org/10.1016/j.wombi.2011.09.002
  21. Kizilirmak A, Calpbinici P, Tabakan G, Kartal B. Correlation between postpartum depression and spousal support and factors affecting postpartum depression. Health Care Women Int. 2021;42(12):1325-1339. https://doi.org/10.1080/07399332.2020.1764562
  22. Salsabilla DA, Prasetya H, Murti B. The effect of unplanned pregnancy on postpartum depression: a meta-analysis. J Matern Child Health. 2020;5(5):500-513. https://doi.org/10.26911/thejmch.2020.05.05.05
  23. Beck CT. Postpartum depression: a metaphorical analysis. J Am Psychiatr Nurses Assoc. 2020 Sep 22 [Epub]. https://doi.org/10.1177/1078390320959448
  24. Bell AF, Andersson E. The birth experience and women's postnatal depression: a systematic review. Midwifery. 2016; 39:112-123. https://doi.org/10.1016/j.midw.2016.04.014
  25. Don BP, Mickelson KD. Paternal postpartum depression: the role of maternal postpartum depression, spousal support, and relationship satisfaction. Couple Family Psychol,. 2012;1(4):323-334. https://doi.org/10.1037/a0029148
  26. Shlomi Polachek I, Huller Harari L, Baum M, Strous RD. 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. Isr J Psychiatry Relat Sci. 2014;51(2):128-134. https://pubmed.ncbi.nlm.nih.gov/25372562
  27. Orovou E, Dagla M, Iatrakis G, Lykeridou A, Tzavara C, Antoniou E. Correlation between kind of cesarean section and posttraumatic stress disorder in Greek women. Int J Environ Res Public Health. 2020;17(5):1592. https://doi.org/10.3390/ijerph17051592
  28. Yoo H, Ahn S, Oh J, Park S, Kim J, Koh M. Depression and stress in Korean parents: a cohort study. Appl Nurs Res. 2021;62:151519. https://doi.org/10.1016/j.apnr.2021.151519
  29. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782-786. https://doi.org/10.1192/bjp.150.6.782
  30. Kim YK, Hur JW, Kim KH, Oh KS, Shin YC. Clinical application of Korean version of Edinburgh postnatal depression scale. J Korean Neuropsychiatr Assoc. 2008;47(1):36-44.
  31. Callahan JL, Borja SE, Hynan MT. Modification of the Perinatal PTSD Questionnaire to enhance clinical utility. J Perinatol. 2006;26(9):533-539. https://doi.org/10.1038/sj.jp.7211562
  32. Wijma K, Wijma B, Zar M. Psychometric aspects of the W-DEQ; a new questionnaire for the measurement of fear of childbirth. J Psychosom Obstet Gynaecol. 1998;19(2):84-97. https://doi.org/10.3109/01674829809048501
  33. Park S, Ahn S, Yoo H, Cho H, Kim SA. Validation of the Korean version of the Wijma delivery expectancy/experience questionnaire (W-DEQ). Poster session presented at: 30th International Nursing Research Congress; 2019 July 25-29; Calgary, AB. Calgary: Sigma Theta Tau International, 2019.
  34. Yang J, Jung IS. Convergence effect of spouse's support on postpartum depression and self-efficacy in primipara. J Korea Converg Soc. 2018;9(1):171-180. https://doi.org/10.15207/JKCS.2018.9.1.171
  35. Kress V, von Soest T, Kopp M, Wimberger P, Garthus-Niegel S. Differential predictors of birth-related posttraumatic stress disorder symptoms in mothers and fathers - a longitudinal cohort study. J Affect Disord. 2021;292:121-130. https://doi.org/10.1016/j.jad.2021.05.058
  36. Yoo H, Ahn S, Park S, Kim J, Oh J, Koh M. Factors influencing prenatal and postpartum depression in Korea: a prospective cohort study. Korean J Women Health Nurs. 2021;27(4):326-336. https://doi.org/10.4069/kjwhn.2021.11.17.
  37. Liu Y, Zhang L, Guo N, Jiang H. Postpartum depression and postpartum post-traumatic stress disorder: prevalence and associated factors. BMC Psychiatry. 2021;21(1):487. https://doi.org/10.1186/s12888-021-03432-7
  38. Gankanda WI, Gunathilake IA, Kahawala NL, Ranaweera AKP. Prevalence and associated factors of post-traumatic stress disorder (PTSD) among a cohort of Srilankan post-partum mothers: a cross-sectional study. BMC Pregnancy Childbirth. 2021;21(1):626. https://doi.org/10.1186/s12884-021-04058-z