Postpartum outcomes of a pilot prenatal care-based psychosocial intervention for PTSD during pregnancy
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.
KeywordsPrenatal care PTSD Pregnancy Birth outcomes Postpartum Health services Psychosocial intervention
The authors wish to thank the prenatal care teams, prenatal advocates, and administrators of the Edward M Kennedy Community Health Center and the Family Health Center of Worcester MA for their dedication to carrying out this study, and all the women who participated in screening and study activities. We also wish to thank our consultant, Lisa Najavits, PhD, for her guidance and review of an earlier version of this paper, Robin Clark, PhD for his guidance on the revised manuscript, and our Advisory Committee: Denise Hien, PhD, City University of New York; Wayne Katon, MD, University of Washington (deceased); Esteban Cardemil, PhD, Clark University; and Stacey Cunningham, MSW, MPH, National Healthy Start Association for assistance with study planning and problem solving.
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
- 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 CrossRefGoogle Scholar
- 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 CrossRefPubMedPubMedCentralGoogle Scholar
- 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 CrossRefPubMedGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefPubMedGoogle Scholar
- McLellan AT, Alterman AI, Woody GE, Metzger D (1992) Treatment services review. University of Pennsylvania, PhiladelphiaGoogle Scholar
- Najavits LM (2002) Seeking Safety: a treatment manual for PTSD and substance abuse. Guilford Press, New YorkGoogle Scholar
- National Health Interview Survey (1990) http://www.cdc.gov/nchs/data/series/sr_10/sr10_194.pdf
- 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 CrossRefGoogle Scholar
- 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 CrossRefPubMedGoogle Scholar
- 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., LincolnGoogle Scholar
- 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 CrossRefPubMedGoogle Scholar