Archives of Women's Mental Health

, Volume 16, Issue 6, pp 453–463 | Cite as

Changes in PTSD symptomatology and mental health during pregnancy and postpartum

  • Jane M. Onoye
  • Leigh Anne Shafer
  • Deborah A. Goebert
  • Leslie A. Morland
  • Courtenay R. Matsu
  • Fumiaki Hamagami
Original Article

Abstract

Changes in mental health symptoms throughout pregnancy and postpartum may impact a woman’s experience and adjustment during an important time. However, few studies have investigated these changes throughout the perinatal period, particularly changes in posttraumatic stress disorder (PTSD) symptoms. The purpose of this study was to examine longitudinal changes in PTSD, depression, and anxiety symptomatology during pregnancy and postpartum. Pregnant women of ethnically diverse backgrounds receiving services for prenatal care at an outpatient obstetric-gynecology clinic or private physicians’ office were assessed by interview on symptoms of PTSD, depression, anxiety, and general stress up to four times, including their first, second, and third trimester, and postpartum visits. Overall, during pregnancy there was a declining trend of PTSD symptoms. For anxiety, there was no overall significant change over time; however, anxiety symptoms were individually variable in the rate of change. For both depression and general stress symptoms, there was a declining trend, which was also variable in the individual rate of change among women during their pregnancy. Visual and post hoc analyses also suggest a possible peak in PTSD symptoms in the weeks prior to delivery. While most mental health symptoms may generally decrease during pregnancy, given the individual variability among women in the rate of change in symptoms, screening and monitoring of symptom fluctuations throughout the course of pregnancy may be needed. Further studies are needed to examine potential spiking of symptoms in the perinatal period.

Keywords

Perinatal PTSD Mental health Symptomatology Longitudinal 

References

  1. Alcorn KL, O’Donovan A, Patrick JC, Creedy D, Devilly GJ (2010) A prospective longitudinal study of the prevalence of post-traumatic stress disorder resulting from childbirth events. Psychol Med 40(11):1849–1859. doi:10.1017/s0033291709992224 PubMedCrossRefGoogle Scholar
  2. Alder J, Fink N, Bitzer J, Hosli I, Holzgreve W (2007) Depression and anxiety during pregnancy: a risk factor for obstetric, fetal and neonatal outcome? A critical review of the literature. J Matern Fetal Neonatal Med 20(3):189–209. doi:10.1080/14767050701209560 PubMedCrossRefGoogle Scholar
  3. American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 4th edn. American Psychiatric Association, Washington, D.CGoogle Scholar
  4. Apter G, Devouche E, Gratier M (2011) Perinatal mental health. J Nerv Ment Dis 199(8):575–577. doi:10.1097/NMD.0b013e318225f2f4 PubMedCrossRefGoogle Scholar
  5. Ayers S, Eagle A, Waring H (2006) The effects of childbirth-related post-traumatic stress disorder on women and their relationships: a qualitative study. Psychol Health Med 11(4):389–398. doi:10.1080/13548500600708409 PubMedCrossRefGoogle Scholar
  6. Ayers S, Harris R, Sawyer A, Parfitt Y, Ford E (2009) Posttraumatic stress disorder after childbirth: analysis of symptom presentation and sampling. J Affective Disord 119(1–3):200–204. doi:10.1016/j.jad.2009.02.029 Google Scholar
  7. Azar R, Singer S (2012) Maternal prenatal state anxiety symptoms and birth weight: a pilot study. Cent Eur J Med 7(6):747–752. doi:10.2478/s11536-012-0078-9 CrossRefGoogle Scholar
  8. Beck CT, Gable RK, Sakala C, Declercq ER (2011) Posttraumatic stress disorder in new mothers: results from a two-stage U.S. national survey. Birth 38(3):216–227. doi:10.1111/j.1523-536X.2011.00475.x PubMedCrossRefGoogle Scholar
  9. Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR (2004) Prevalence of depression during pregnancy: systematic review. Gynecology 103(4):698–709. doi:10.1097/01.AOG.0000116689.75396.5f CrossRefGoogle Scholar
  10. Blanchard EB, Jones-Alexander J, Buckley TC, Forneris CA (1996) Psychometric properties of the PTSD checklist (PCL). Behav Res Ther 34(8):669–673. doi:10.1016/0005-7967(96)00033-2 PubMedCrossRefGoogle Scholar
  11. Bliese PD, Wright KM, Adler AB, Cabrera O, Castro CA, Hoge CW (2008) Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat. J Consult Clin Psychol 76(2):272–281. doi:10.1037/0022-006x.76.2.272 PubMedCrossRefGoogle Scholar
  12. Born L, Soares CN, Phillips SD, Jung M, Steiner M (2006) Women and reproductive-related trauma. Ann N Y Acad Sci 1071:491–494. doi:10.1196/annals.1364.049 PubMedCrossRefGoogle Scholar
  13. Brand SR, Brennan PA (2009) Impact of antenatal and postpartum maternal mental illness: how are the children? Clin Obstet Gynecol 52(3):441–455. doi:10.1097/GRF.0b013e3181b52930 PubMedCrossRefGoogle Scholar
  14. Breslau N, Davis GC, Peterson EL, Schultz LR (2000) A second look at comorbidity in victims of trauma: the posttraumatic stress disorder–major depression connection. Biol Psychiatry 48(9):902–909. doi:10.1016/S0006-3223(00)00933-1 PubMedCrossRefGoogle Scholar
  15. Breslau N, Lucia VC, Davis GC (2004) Partial PTSD versus full PTSD: an empirical examination of associated impairment. Psychol Med 34(7):1205–1214. doi:10.1017/S0033291704002594 PubMedCrossRefGoogle Scholar
  16. Brooks J, Nathan E, Speelman C, Swalm D, Jacques A, Doherty D (2009) Tailoring screening protocols for perinatal depression: prevalence of high risk across obstetric services in Western Australia. Arch Womens Ment Health 12(2):105–112. doi:10.1007/s00737-009-0048-7 PubMedGoogle Scholar
  17. Bruce SE, Weisberg RB, Dolan RT, Machan JT, Kessler RC, Manchester G, Culpepper L, Keller MB (2001) Trauma and posttraumatic stress disorder in primary care patients. Prim Care Companion J Clin Psychiatry 3(5):211–217PubMedCrossRefGoogle Scholar
  18. Cerulli CC, Talbot NLNL, Tang WW, Chaudron LHLH (2011) Co-occurring intimate partner violence and mental health diagnoses in perinatal women. CORD Conf Proc 20(12):1797–1803Google Scholar
  19. Class QA, Lichtenstein P, Langstrom N, D’Onofrio BM (2011) Timing of prenatal maternal exposure to severe life events and adverse pregnancy outcomes: a population study of 2.6 million pregnancies. Psychosom Med 73(3):234–241. doi:10.1097/PSY.0b013e31820a62ce PubMedCrossRefGoogle Scholar
  20. Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24(4):385–396. doi:10.2307/2136404 PubMedCrossRefGoogle Scholar
  21. Dennis MF, Flood AM, Reynolds V, Araujo G, Clancy CP, Barefoot JC, Beckham JC (2009) Evaluation of lifetime trauma exposure and physical health in women with posttraumatic stress disorder or major depressive disorder. Violence Against Women 15(5):618–627. doi:10.1177/1077801209331410 PubMedCrossRefGoogle Scholar
  22. Dunkel Schetter C, Tanner L (2012) Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice. Curr Opin Psychiatry 25(2):141–148. doi:10.1097/YCO.0b013e3283503680 PubMedCrossRefGoogle Scholar
  23. Evans J, Heron J, Francomb H, Oke S, Golding J (2001) Cohort study of depressed mood during pregnancy and after childbirth. BMJ 323(7307):257–260. doi:10.1136/bmj.323.7307.257 PubMedCrossRefGoogle Scholar
  24. Federenko IS, Wadhwa PD (2004) Women’s mental health during pregnancy influences fetal and infant developmental and health outcomes. CNS Spectr 9(3):198–206PubMedGoogle Scholar
  25. 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(6):522–527. doi:10.1080/14767050902801686 PubMedCrossRefGoogle Scholar
  26. Freedy JR, Steenkamp MM, Magruder KM, Yeager DE, Zoller JS, Hueston WJ, Carek PJ (2010) Post-traumatic stress disorder screening test performance in civilian primary care. Fam Pract 27(6):615–624. doi:10.1093/fampra/cmq049 PubMedCrossRefGoogle Scholar
  27. Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T (2005) Perinatal depression: a systematic review of prevalence and Incidence. Obstet Gynecol 106 (5, Part 1):1071–1083. doi:1010.1097/1001.AOG.0000183597.0000131630.db
  28. Glynn LM, Schetter CD, Hobel CJ, Sandman CA (2008) Pattern of perceived stress and anxiety in pregnancy predicts preterm birth. Health Psychol 27(1):43–51. doi:10.1037/0278-6133.27.1.43 PubMedCrossRefGoogle Scholar
  29. Goebert D, Morland L, Frattarelli L, Onoye J, Matsu C (2007) Mental health during pregnancy: a study comparing Asian, Caucasian and native Hawaiian women. Matern Child Health J 11(3):249–255. doi:10.1007/s10995-006-0165-0 PubMedCrossRefGoogle Scholar
  30. Heron J, O’Connor TG, Evans J, Golding J, Glover V (2004) The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord 80(1):65–73. doi:10.1016/j.jad.2003.08.004 PubMedCrossRefGoogle Scholar
  31. Homish GG, Cornelius JR, Richardson GA, Day NL (2004) Antenatal risk factors associated with postpartum comorbid alcohol use and depressive symptomatology. Alcohol Clin Exp Res 28(8):1242–1248PubMedCrossRefGoogle Scholar
  32. Hosseini SM, Biglan MW, Larkby C, Brooks MM, Gorin MB, Day NL (2009) Trait anxiety in pregnant women predicts offspring birth outcomes. Paediatr Perinat Epidemiol 23(6):557–566. doi:10.1111/j.1365-3016.2009.01065.x PubMedCrossRefGoogle Scholar
  33. Hung T-H, Lo L-M, Chiu T-H, Li M-J, Yeh Y-L, Chen S-F, Hsieh T-T (2010) A longitudinal study of oxidative stress and antioxidant status in women with uncomplicated pregnancies throughout gestation. Reprod Sci 17(4):401–409. doi:10.1177/1933719109359704 PubMedCrossRefGoogle Scholar
  34. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry 62(6):593–602. doi:10.1001/archpsyc.62.6.593 PubMedCrossRefGoogle Scholar
  35. Koubovec D, Geerts L, Odendaal HJ, Stein DJ, Vythilingum B (2005) Effects of psychologic stress on fetal development and pregnancy outcome. Curr Psychiatry Rep 7(4):274–280PubMedCrossRefGoogle Scholar
  36. Kubany ES, Haynes SN, Leisen MB, Owens JA, Kaplan AS, Watson SB, Burns K (2000) Development and preliminary validation of a brief broad-spectrum measure of trauma exposure: the traumatic life events questionnaire. Psychol Assess 12(2):210–224. doi:10.1037/1040-3590.8.4.428 PubMedCrossRefGoogle Scholar
  37. Littleton HL, Breitkopf CR, Berenson AB (2007) Correlates of anxiety symptoms during pregnancy and association with perinatal outcomes: a meta-analysis. Am J Obstet Gynecol 196(5):424–432. doi:10.1016/j.ajog.2007.03.042 PubMedCrossRefGoogle Scholar
  38. 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(4):710–717. doi:10.1097/01.AOG.0000119222.40241.fb PubMedCrossRefGoogle Scholar
  39. Maggioni C, Margola D, Filippi F (2006) PTSD, risk factors, and expectations among women having a baby: a two-wave longitudinal study. J Psychosom Obstet Gynaecol 27(2):81–90. doi:10.1080/01674820600712875 PubMedCrossRefGoogle Scholar
  40. Manne SL, Du Hamel K, Gallelli K, Sorgen K, Redd WH (1998) Posttraumatic stress disorder among mothers of pediatric cancer survivors: diagnosis, comorbidity, and utility of the PTSD checklist as a screening instrument. J Pediatr Psychol 23(6):357–366PubMedCrossRefGoogle Scholar
  41. Marcus SM, Flynn HA, Blow FC, Barry KL (2003) Depressive symptoms among pregnant women screened in obstetrics settings. J Womens Health (Larchmt) 12(4):373–380. doi:10.1089/154099903765448880 CrossRefGoogle Scholar
  42. Mezey G, Bacchus L, Bewley S, White S (2005) Domestic violence, lifetime trauma and psychological health of childbearing women. BJOG 112(2):197–204. doi:10.1111/j.1471-0528.2004.00307.x PubMedCrossRefGoogle Scholar
  43. Monk C (2001) Stress and mood disorders during pregnancy: implications for child development. Psychiatr Q 72(4):347–357. doi:10.1023/A:1010393316106 PubMedCrossRefGoogle Scholar
  44. Morland LA, Goebert DA, Onoye JM, Frattarelli L, Derauf C, Herbst M, Matsu C, Friedman M (2007) Posttraumatic stress disorder and pregnancy health: preliminary update and implications. Psychosomatics 48(4):304–308. doi:10.1176/appi.psy.48.4.304 PubMedCrossRefGoogle Scholar
  45. Mosack V, Shore ER (2006) Screening for depression among pregnant and postpartum women. J Community Health Nurs 23(1):37–47. doi:10.1207/s15327655jchn2301_4 PubMedCrossRefGoogle Scholar
  46. Onoye JM, Goebert D, Morland L, Matsu C, Wright T (2009) PTSD and postpartum mental health in a sample of Caucasian, Asian, and Pacific Islander women. Arch Womens Ment Health 12(6):393–400. doi:10.1007/s00737-009-0087-0 PubMedGoogle Scholar
  47. Radloff L (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1(3):385–401. doi:10.1177/014662167700100306 CrossRefGoogle Scholar
  48. Resnick HS, Kilpatrick DG, Dansky BS, Saunders BE, Best CL (1993) Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. J Consult Clin Psychol 61(6):984–991. doi:10.1037/0022-006X.61.6.984 PubMedCrossRefGoogle Scholar
  49. Rodríguez MA, Valentine J, Ahmed SR, Eisenman DP, Sumner LA, Heilemann MV, Liu H (2010) Intimate partner violence and maternal depression during the perinatal period: a longitudinal investigation of Latinas. Violence Against Women 16(5):543–559. doi:10.1177/1077801210366959 PubMedCrossRefGoogle Scholar
  50. Rogal SS, Poschman K, Belanger K, Howell HB, Smith MV, Medina J, Yonkers KA (2007) Effects of posttraumatic stress disorder on pregnancy outcomes. J Affect Disord 102(1–3):137–143. doi:10.1016/j.jad.2007.01.003 PubMedCrossRefGoogle Scholar
  51. Rondo PH, Vaz AJ, Moraes F, Tomkins A (2004) The relationship between salivary cortisol concentrations and anxiety in adolescent and non-adolescent pregnant women. Braz J Med Biol Res 37(9):1403–1409PubMedCrossRefGoogle Scholar
  52. Rosen D, Seng JS, Tolman RM, Mallinger G (2007) Intimate partner violence, depression, and posttraumatic stress disorder as additional predictors of low birth weight infants among low-income mothers. J Interpers Violence 22(10):1305–1314. doi:10.1177/0886260507304551 PubMedCrossRefGoogle Scholar
  53. Ross LE, McLean LM (2006) Anxiety disorders during pregnancy and the postpartum period: a systematic review. J Clin Psychiatry 67(8):1285–1298PubMedCrossRefGoogle Scholar
  54. Rothenberger SE, Moehler E, Reck C, Resch F (2011) Prenatal stress: course and interrelation of emotional and physiological stress measures. Psychopathology 44(1):60–67. doi:10.1159/000319309 PubMedCrossRefGoogle Scholar
  55. Seng JS (2002) A conceptual framework for research on lifetime violence, posttraumatic stress, and childbearing. J Midwifery Womens Health 47(5):337–346PubMedCrossRefGoogle Scholar
  56. Seng JS, Oakley DJ, Sampselle CM, Killion C, Graham-Bermann S, Liberzon I (2001) Posttraumatic stress disorder and pregnancy complications. Obstet Gynecol 97(1):17–22PubMedCrossRefGoogle Scholar
  57. Seng JS, Low LK, 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(4):839–847. doi:10.1097/AOG.0b013e3181b8f8a2 PubMedCrossRefGoogle Scholar
  58. Seng JS, Rauch SA, Resnick H, Reed CD, King A, Low LK, McPherson M, Muzik M, Abelson J, Liberzon I (2010) Exploring posttraumatic stress disorder symptom profile among pregnant women. J Psychosom Obstet Gynaecol 31(3):176–187. doi:10.3109/0167482x.2010.486453 PubMedCrossRefGoogle Scholar
  59. Seng JS, Kohn-Wood LP, McPherson MD, Sperlich M (2011a) Disparity in posttraumatic stress disorder diagnosis among African American pregnant women. Arch Womens Ment Health 14(4):295–306. doi:10.1007/s00737-011-0218-2 PubMedGoogle Scholar
  60. Seng JS, Low LK, Sperlich M, Ronis DL, Liberzon I (2011b) Post-traumatic stress disorder, child abuse history, birthweight and gestational age: a prospective cohort study. BJOG 118(11):1329–1339. doi:10.1111/j.1471-0528.2011.03071.x PubMedCrossRefGoogle Scholar
  61. Smith MV, Rosenheck RA, Cavaleri MA, Howell HB, Poschman K, Yonkers KA (2004) Screening for and detection of depression, panic disorder, and PTSD in public-sector obstetric clinics. Psychiatr Serv 55(4):407–414. doi:10.1176/appi.ps.55.4.407 PubMedCrossRefGoogle Scholar
  62. 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. doi:10.1176/appi.ajp.163.5.881 PubMedCrossRefGoogle Scholar
  63. Soderquist J, Wijma B, Wijma K (2006) The longitudinal course of post-traumatic stress after childbirth. J Psychosom Obstet Gynaecol 27(2):113–119PubMedCrossRefGoogle Scholar
  64. Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA (1983) Manual for the State-Trait Anxiety Inventory. Consulting Psychologists, Palo AltoGoogle Scholar
  65. Stein MB, Walker JR, Hazen AL, Forde DR (1997) Full and partial posttraumatic stress disorder: findings from a community survey. Am J Psychiatry 154(8):1114–1119PubMedGoogle Scholar
  66. Tollenaar MS, Beijers R, Jansen J, Riksen-Walraven JM, de Weerth C (2010) Maternal prenatal stress and cortisol reactivity to stressors in human infants. Stress 13(6):491–497. doi:10.3109/10253890.2010.499485 Google Scholar
  67. van Bussel J, Spitz B, Demyttenaere K (2009) Depressive symptomatology in pregnant and postpartum women. An exploratory study of the role of maternal antenatal orientations. Arch Womens Ment Health 12(3):155–166. doi:10.1007/s00737-009-0061-x PubMedCrossRefGoogle Scholar
  68. Van den Bergh BR, Mulder EJ, Mennes M, Glover V (2005) Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child: links and possible mechanisms. A review. Neurosci Biobehav Rev 29(2):237–258. doi:10.1016/j.neubiorev.2004.10.007 PubMedCrossRefGoogle Scholar
  69. Vesga-Lopez O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS (2008) Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry 65(7):805–815. doi:10.1001/archpsyc.65.7.805 PubMedCrossRefGoogle Scholar
  70. Wadhwa PD, Sandman CA, Garite TJ (2001) The neurobiology of stress in human pregnancy: implications for prematurity and development of the fetal central nervous system. Prog Brain Res 133:131–142PubMedCrossRefGoogle Scholar
  71. Weathers FW, Litz BT, Huska JA, Keane TM (1994) PTSD Checklist—Civilian version. National Center for PTSD, Behavioral Science Division, BostonGoogle Scholar
  72. Wenzel A, Haugen EN, Jackson LC, Brendle JR (2005) Anxiety symptoms and disorders at eight weeks postpartum. J Anxiety Disord 19(3):295–311. doi:10.1016/j.janxdis.2004.04.001 PubMedCrossRefGoogle Scholar
  73. Yampolsky L, Lev-Wiesel R, Ben-Zion IZ (2010) Child sexual abuse: is it a risk factor for pregnancy? J Adv Nurs 66(9):2025–2037. doi:10.1111/j.1365-2648.2010.05387.x PubMedGoogle Scholar
  74. Yarvis JS, Schiess L (2008) Subthreshold posttraumatic stress disorder (PTSD) as a predictor of depression, alcohol use, and health problems in veterans. J Work Behav Health 23(4):395–424CrossRefGoogle Scholar
  75. Yim IS, Glynn LM, Dunkel Schetter C, Hobel CJ, Chicz-DeMet A, Sandman CA (2009) Risk of postpartum depressive symptoms with elevated corticotropin-releasing hormone in human pregnancy. Arch Gen Psychiatry 66(2):162–169. doi:10.1001/archgenpsychiatry.2008.533 PubMedCrossRefGoogle Scholar
  76. Zaers S, Waschke M, Ehlert U (2008) Depressive symptoms and symptoms of post-traumatic stress disorder in women after childbirth. J Psychosom Obstet Gynaecol 29(1):61–71. doi:10.1080/01674820701804324 PubMedCrossRefGoogle Scholar
  77. Zelkowitz P, Saucier JF, Wang T, Katofsky L, Valenzuela M, Westreich R (2008) Stability and change in depressive symptoms from pregnancy to two months postpartum in childbearing immigrant women. Arch Womens Ment Health 11(1):1–11. doi:10.1007/s00737-008-0219-y PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • Jane M. Onoye
    • 1
    • 3
  • Leigh Anne Shafer
    • 2
  • Deborah A. Goebert
    • 1
    • 3
  • Leslie A. Morland
    • 1
    • 4
  • Courtenay R. Matsu
    • 1
    • 3
  • Fumiaki Hamagami
    • 1
  1. 1.Department of Psychiatry, John A. Burns School of MedicineUniversity of Hawai‘i at MānoaHonoluluUSA
  2. 2.Department of Internal MedicineUniversity of Manitoba, Health Sciences CentreWinnipegCanada
  3. 3.The Queen’s Medical CenterHonoluluUSA
  4. 4.National Center for PTSD—Pacific Islands Division, Department of Veterans Affairs Pacific Islands Healthcare SystemHonoluluUSA

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