Top

Published in:

01-06-2018 | Original Article

Postpartum outcomes of a pilot prenatal care-based psychosocial intervention for PTSD during pregnancy

Authors: Linda Weinreb, Melodie Wenz-Gross, Carole Upshur

Published in: Archives of Women's Mental Health | Issue 3/2018

Abstract

This study examines postpartum posttraumatic stress disorder (PTSD) symptoms and secondary outcomes including postpartum depression and birth outcomes for pregnant women who screened positive for PTSD and received a psychosocial education intervention compared to women with PTSD in the usual prenatal care setting. All women entering prenatal care at two federally qualified health centers were screened for symptoms of current PTSD; one site was selected randomly to have prenatal care advocates deliver eight Seeking Safety topics for women with clinical or subclinical PTSD. Women were not blind to condition. Baseline and postpartum interviews, including demographic characteristics and assessment of mental health, social support, and coping skills, were conducted. Medical record data was collected to document preterm delivery and low birth weight. Of the 149 participants at baseline, 128 (86%) participated in the postpartum interview. Intervention women, compared to controls, significantly decreased PTSD symptoms, and showed a non-significant trend for improved social support. However, depression, coping, and birth outcomes did not differ. This study suggests some initial support for the Seeking Safety intervention in prenatal care settings and requires further research to determine the best approaches to its implementation.

Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46(3):399–424. https://doi.org/10.1080/00273171.2011.568786 CrossRef

Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR (2007) AUDIT-C as a brief screen for alcohol misuse in primary care. Alcoh Clin Exp Res 31:1208–1217. https://doi.org/10.1111/j.1530-0277.2007.00403.x CrossRef

Brand A, Walker DK, Hargreaves M, Rosenbach M (2010) Intermediate outcomes, strategies, and challenges of eight healthy start projects. Matern Child Health J 14:654–665. https://doi.org/10.1007/s10995-008-0421-6 CrossRefPubMed

Byatt N, Levin LL, Ziedonis D, Simas TAM, Allison J (2015) Enhancing participation in depression care in outpatient perinatal care settings: a systematic review. Obstet Gynecol 126:1048–1058CrossRefPubMedPubMedCentral

Carver CS (1997) You want to measure coping but your protocols too long: consider the brief cope. Int J Behav Med 4:92–100. https://doi.org/10.1207/s15327558ijbm0401_6 CrossRefPubMed

Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150:782–786CrossRefPubMed

Desai R, Haprez-Rotem I, Najavits L, Rosenheck R (2008) Impact of the Seeking Safety program on clinical outcomes among homeless female veterans with psychiatric disorders. Psychiatr Serv 59:996–1003. https://doi.org/10.1176/ps.2008.59.9.996 CrossRefPubMed

Desmarais SL, Pritchard A, Lowder EM, Janssen PA (2014) Intimate partner abuse before and during pregnancy as risk factors for postpartum mental health problems. BMC Pregnancy Childbirth 14:1. https://doi.org/10.1186/1471-2393-14-132 CrossRef

Foa EB, Riggs DS, Dancu CV, Rothbaum BO (1993) Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. J Trauma Stress 6:459–473. https://doi.org/10.1002/jts.2490060405 CrossRef

Forray A, Mayes LC, Magriples U, Epperson CN (2009) Prevalence of post-traumatic stress disorder in pregnant women with prior pregnancy complications. J Matern Fetal Neonatal Med 22:522–527. https://doi.org/10.1080/14767050902801686 CrossRefPubMedPubMedCentral

Gatz M, Brown V, Hennigan K, Rechberger E, O’Keefe M, Rose T, Bjelajac P (2007) Effectiveness of an integrated, trauma-informed approach to treating women with co-occurring disorders and histories of trauma: the Los Angeles site experience. J Community Psychol 35(7):863–878. https://doi.org/10.1002/jcop.20186 CrossRef

Giannandrea SA, Cerulli C, Anson E, Chaudron LH (2013) Increased risk for postpartum psychiatric disorders among women with past pregnancy loss. J Women's Health 22:760–768. https://doi.org/10.1089/jwh.2012.4011 CrossRef

Goodman LA, Corcoran C, Turner K, Yuan N, Green BL (1998) Assessing traumatic event exposure: general issues and preliminary findings for the Stressful Life Events Screening Questionnaire. J Trauma Stress 11:521–542. https://doi.org/10.1023/A:1024456713321 CrossRefPubMed

Goodman JH, Chenausky KL, Freeman MP (2014) Anxiety disorders during pregnancy: a systematic review. J Clin Psychiatry 75:1153–1184. https://doi.org/10.4088/JCP.14r09035 CrossRef

Green BL, Krupnick JL, Chung J, Siddique J, Krause ED, Revicki D, Frank L, Miranda J (2006) Impact of PTSD comorbidity on one-year outcomes in a depression trial. J Clin Psychol 62:815–835. https://doi.org/10.1002/jclp.20279 CrossRefPubMed

Grekin R, O'Hara MW (2014) Prevalence and risk factors of postpartum posttraumatic stress disorder: a meta-analysis. Clin Psychol Rev 34:389–401. https://doi.org/10.1016/j.cpr.2014.05.003 CrossRefPubMed

Griffin MG, Uhlmansiek MH, Resick PA, Mechanic MB (2004) Comparison of the posttraumatic stress disorder scale versus the clinician-administered posttraumatic stress disorder scale in domestic violence survivors. J Trauma Stress 17(6):497–503. https://doi.org/10.1007/s10960-004-5798-4 CrossRefPubMedPubMedCentral

Grote NK, Katon WJ, Russo JE, Lohr MJ, Curran M, Galvin E, Carson K (2016) A randomized trial of collaborative care for perinatal depression in socioeconomically disadvantaged women: the impact of comorbid posttraumatic stress disorder. J Clin Psychiatry 77(11):1527–1537. https://doi.org/10.4088/JCP.15m10477 CrossRefPubMed

Hein D, Rudnick Levin F, Ruglass L, Lopez Castro T, Papini S, Hu MC, Chen L, Cohen L, Herron A (2015) Combining Seeking Safety with sertraline for PTSD and alcohol use disorders: a randomized controlled trial. J Consult Clin Psychol 83(2):359–369. https://doi.org/10.1037/a0038719 CrossRef

Howard LM, Oram S, Galley H, Trevillion K, Feder G (2013) Domestic violence and perinatal mental disorders: a systematic review and meta-analysis. PLoS Med 10:e1001452. https://doi.org/10.1371/journal.pmed.1001452 CrossRefPubMedPubMedCentral

Kendall-Tackett KA (2007) Violence against women and the perinatal period: the impact of lifetime violence and abuse on pregnancy, postpartum, and breastfeeding. Trauma Violence Abuse 8:344–353. https://doi.org/10.1177/1524838007304406 CrossRefPubMed

Lee BK, Lessler J, Stuart EA (2011) Weight trimming and propensity score weighting. PLoS One 6(3):e18174. https://doi.org/10.1371/journal.pone.0018174 CrossRefPubMedPubMedCentral

Lipkind HS, Curry AE, Huynh M, Thorpe LE, Matte T (2010) Birth outcomes among offspring of women exposed to the September 11, 2001, terrorist attacks. Obstet Gynecol 116:917–925. https://doi.org/10.1097/AOG.0b013e3181f2f6a2 CrossRefPubMed

Loveland Cook CA, Flick LH, Homan SM, Campbell C, McSweeney M, Gallagher ME (2004) Posttraumatic stress disorder in pregnancy: prevalence, risk factors, and treatment. Obstet Gynecol 103:710–717. https://doi.org/10.1097/01.AOG.0000119222.40241.fb CrossRefPubMed

Lynch SM, Heath NM, Mathews KC, Cepeda GJ (2012) Seeking safety: an intervention for trauma-exposed incarcerated women? J Trauma Dissociation 13:88–101. https://doi.org/10.1080/15299732.2011.608780 CrossRefPubMed

McLellan AT, Alterman AI, Woody GE, Metzger D (1992) Treatment services review. University of Pennsylvania, Philadelphia

Modarres M, Afrasiabi S, Rahnama P, Montazeri A (2012) Prevalence and risk factors of childbirth-related post-traumatic stress symptoms. BMC Pregnancy Childbirth 12:88. https://doi.org/10.1186/1471-2393-12-88 CrossRefPubMedPubMedCentral

Morland L, Goebert D, Onoye J, Frattarelli L, Derauf C, Herbst M, Matsu C, Friedman M (2007) Posttraumatic stress disorder and pregnancy health: preliminary update and implications. Psychosomatics 48:304–308. https://doi.org/10.1176/appi.psy.48.4.304 CrossRefPubMed

Muzik M, McGinnis EW, Bocknek E, Morelen D, Rosenblum KL, Liberzon I, Seng J, Abelson J (2016) PTSD symptoms across pregnancy and early postpartum among women with lifetime PTSD diagnosis. Depress Anxiety 33(7):1–8. https://doi.org/10.1002/da.22465 CrossRef

Najavits LM (2002) Seeking Safety: a treatment manual for PTSD and substance abuse. Guilford Press, New York

Najavits LM, Hien D (2013) Helping vulnerable populations: a comprehensive review of the treatment outcome literature on substance use disorder and PTSD. J Clin Psychol 69:433–479. https://doi.org/10.1002/jclp.21980 CrossRefPubMed

National Health Interview Survey (1990) http://www.cdc.gov/nchs/data/series/sr_10/sr10_194.pdf

Olde E, van der Hart O, Kleber R, Van Son M (2006) Posttraumatic stress following childbirth: a review. Clin Psychol Rev 26:1–16. https://doi.org/10.1016/j.cpr.2005.07.002 CrossRefPubMed

Onoye JM, Shafer LA, Goebert DA, Morland LA, Matsu CR, Hamagami F (2013) Changes in PTSD symptomatology and mental health during pregnancy and postpartum. Arch Womens Ment Health 16:453–463. https://doi.org/10.1007/s00737-013-0365-8 CrossRefPubMedPubMedCentral

Prins A, Ouimette P, Kimerling R, Cameron RP, Hugelshofer DS, Shaw-Hegwer J, Thrailkill A, Gusman FD, Sheikh JI (2003) The Primary Care PTSD Screen (PC-PTSD): development and operating characteristics (PDF). Primary Care Psychiatry 9:9–14. https://doi.org/10.1185/135525703125002360 CrossRef

Ross LE, Dennis CL (2009) The prevalence of postpartum depression among women with substance use, an abuse history, or chronic illness: a systematic review. J Women's Health 18:475–486. https://doi.org/10.1089/jwh.2008.0953 CrossRef

Rowe H, Sperlich M, Cameron H, Seng J (2014) A quasi-experimental outcomes analysis of a psychoeducation intervention for pregnant women with abuse-related posttraumatic stress. J Obstet Gynecol Neonatal Nurs 43:282–293. https://doi.org/10.1111/1552-6909 CrossRefPubMedPubMedCentral

Seng JS, Oakley DJ, Sampselle CM, Killion C, Graham-Bermann S, Liberzon I (2001) Posttraumatic stress disorder and pregnancy complications. Obstet Gynecol 97:17–22PubMed

Seng JS, Low LMK, Sperlich M, Ronis DL, Liberzon I (2009) Prevalence, trauma history, and risk for posttraumatic stress disorder among nulliparous women in maternity care. Obstet Gynecol 114:839. https://doi.org/10.1097/AOG.0b013e3181b8f8a2 CrossRefPubMedPubMedCentral

Sherbourne CD, Stewart AL (1991) The MOS social support survey. Soc Sci Med 32:705–714CrossRefPubMed

Sit DK, Wisner KL (2009) The identification of postpartum depression. Clin Obstet Gynecol 52(3):456–468. https://doi.org/10.1097/GRF.0b013e3181b5a57c CrossRefPubMedPubMedCentral

Smith MV, Poschman K, Cavaleri MA, Howell HB, Yonkers KA (2006) Symptoms of posttraumatic stress disorder in a community sample of low-income pregnant women. Am J Psychiatry 163(5):881–884. https://doi.org/10.1176/ajp.2006.163.5.881 CrossRefPubMed

Smith MV, Shao L, Howell H, Lin H, Yonkers KA (2011) Perinatal depression and birth outcomes in a Healthy Start project. Matern Child Health J 15:401–409. https://doi.org/10.1007/s10995-010-0595-6 CrossRefPubMedPubMedCentral

The American College of Obstetricians and Gynecologists (ACOG) (2015) Screening for perinatal depression. The American congress of obstetricians and gynecologists, number 630. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Screening-for-Perinatal-Depression

Upshur CC, Wenz-Gross M, Weinreb L, Moffitt JJA (2016) Using prenatal advocates to implement a psychosocial education intervention for posttraumatic stress disorder during pregnancy: feasibility, care engagement, and predelivery behavioral outcomes. Womens Health Issues 26:537–545. https://doi.org/10.1016/j.whi.2016.06.003 CrossRefPubMed

Valentine JM, Rodriguez MA, Lapeyrouse LM, Zhang M (2011) Recent intimate partner violence as a prenatal predictor of maternal depression in the first year postpartum among Latinas. Arch Womens Ment Health 14:135–143. https://doi.org/10.1007/s00737-010-0191-1 CrossRefPubMed

Ware JE, Kosinski M, Dewey JE, Gandek B (2001) How to score and interpret single-item health status measures: a manual for user of the SF-8TM health survey. QualityMetric, Inc., Lincoln

Wenz-Gross M, Weinreb L, Upshur C (2016) Screening for post-traumatic stress disorder in prenatal care: prevalence and characteristics in a low-income population. Matern Child Health J 20:1995–2002. https://doi.org/10.1007/s10995-016-2073-2 CrossRefPubMed

Wosu AC, Gelaye B, Williams MA (2015) Childhood sexual abuse and posttraumatic stress disorder among pregnant and postpartum women: review of the literature. Arch Womens Ment Health 18:61–72. https://doi.org/10.1007/s00737-014-0482-z CrossRefPubMed

Yonkers KA, Smith MV, Forray A, Epperson CN, Costello D, Lin H, Belanger K (2014) Pregnant women with posttraumatic stress disorder and risk of preterm birth. JAMA Psychiatry 71:897–904. https://doi.org/10.1001/jamapsychiatry.2014.558 CrossRefPubMedPubMedCentral

Yost NP, Bloom SL, McIntire DD, Leveno KJ (2005) A prospective observational study of domestic violence during pregnancy. Obstet Gynecol 106:61–65. https://doi.org/10.1097/01.AOG.0000164468.06070.2a CrossRefPubMed

Yudko E, Lozhkina O, Fouts A (2007) A comprehensive review of the psychometric properties of the Drug Abuse Screening Test. J Subst Abus Treat 32:189–198. https://doi.org/10.1016/j.jsat.2006.08.002 CrossRef

Zlotnick C, Capezza NM, Parker D (2011) An interpersonally based intervention for low-income pregnant women with intimate partner violence: a pilot study. Arch Womens Ment Health 14:55–65. https://doi.org/10.1007/s00737-010-0195-x CrossRefPubMed

Title: Postpartum outcomes of a pilot prenatal care-based psychosocial intervention for PTSD during pregnancy
Authors: Linda Weinreb
Melodie Wenz-Gross
Carole Upshur
Publication date: 01-06-2018
Publisher: Springer Vienna
Published in: Archives of Women's Mental Health / Issue 3/2018
Print ISSN: 1434-1816
Electronic ISSN: 1435-1102
DOI: https://doi.org/10.1007/s00737-017-0794-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Postpartum outcomes of a pilot prenatal care-based psychosocial intervention for PTSD during pregnancy

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2018

Mother–infant bonding in the postpartum period: assessment of the impact of pre-delivery factors in a clinical sample

Maternal depression trajectories from pregnancy to 3 years postpartum are associated with children’s behavior and executive functions at 3 and 6 years

Teenage pregnancy and long-term mental health outcomes among Indigenous women in Canada

Psychiatric comorbidity and intimate partner violence among women who inject drugs in Europe: a cross-sectional study

Risk factors for unplanned pregnancy in women with mental illness living in a developing country

Health-related quality of life and coping strategies among people living with HIV: the moderating role of gender