Screening for post-traumatic stress disorder following childbirth using the Peritraumatic Distress Inventory

Kathleen M Jagodnik; Tsachi Ein-Dor; Sabrina J Chan; Adi Titelman Ashkenazy; Alon Bartal; Robert L Barry; Sharon Dekel

doi:10.1016/j.jad.2023.12.010

Screening for post-traumatic stress disorder following childbirth using the Peritraumatic Distress Inventory

J Affect Disord. 2024 Mar 1:348:17-25. doi: 10.1016/j.jad.2023.12.010. Epub 2023 Dec 7.

Authors

Kathleen M Jagodnik¹, Tsachi Ein-Dor², Sabrina J Chan³, Adi Titelman Ashkenazy³, Alon Bartal⁴, Robert L Barry⁵, Sharon Dekel⁶

Affiliations

¹ Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
² School of Psychology, Reichman University, Herzliya, Israel.
³ Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
⁴ School of Business Administration, Bar-Ilan University, Ramat Gan, Israel.
⁵ Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard-Massachusetts Institute of Technology Health Sciences & Technology, Cambridge, MA, USA.
⁶ Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. Electronic address: sdekel@mgh.harvard.edu.

PMID: 38070747
PMCID: PMC10872536 (available on 2025-03-01)
DOI: 10.1016/j.jad.2023.12.010

Abstract

Background: Post-traumatic stress disorder (PTSD) following traumatic childbirth may undermine maternal and infant health, but screening for maternal childbirth-related PTSD (CB-PTSD) remains lacking. Acute emotional distress in response to a traumatic experience strongly associates with PTSD. The Peritraumatic Distress Inventory (PDI) assesses acute distress in non-postpartum individuals, but its use to classify women likely to endorse CB-PTSD is unknown.

Methods: 3039 women provided information about their mental health and childbirth experience. They completed the PDI regarding their recent childbirth event, and a PTSD symptom screen to determine CB-PTSD. We employed Exploratory Graph Analysis and bootstrapping to reveal the PDI's factorial structure and optimal cutoff value for CB-PTSD classification.

Results: 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.

Limitations: In this cross-sectional study, the PDI was administered at different timepoints postpartum. Future work should examine the PDI's predictive utility for screening women as closely as possible to the time of childbirth, and establish clinical cutoffs in populations after complicated deliveries.

Conclusions: 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.

Keywords: Childbirth; Childbirth-related PTSD; Delivery, obstetric; Diagnosis; Factorial analysis; Postpartum PTSD; Postpartum period; Receiver Operating Characteristic; Screening; Traumatic childbirth; Validity.

MeSH terms

Cross-Sectional Studies
Delivery, Obstetric
Female
Humans
Parturition / psychology
Postpartum Period / psychology
Pregnancy
Stress Disorders, Post-Traumatic* / psychology

Abstract

MeSH terms

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