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Screening for Post-traumatic Stress Disorder in Prenatal Care: Prevalence and Characteristics in a Low-Income Population

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Abstract

Objectives Investigate the feasibility of using a brief, 4-item PTSD screening tool (PTSD-PC) as part of routine prenatal care in two community health care settings serving ethnically and linguistically diverse low-income populations. Report prevalence and differences by sub-threshold and clinical levels, in demographic, health, mental health, risk behaviors, and service use. Methods Women were screened as part of their prenatal intake visit over a 2-year period. Those screening positive at clinical or sub-threshold levels were recruited if they spoke English, Spanish, Portuguese, Vietnamese or Arabic. Enrolled women were interviewed about psychosocial risk factors, prior traumas, PTSD symptoms, depression, anxiety, substance use, health and services, using validated survey instruments. Results Of 1362 women seen for prenatal intakes, 1259 (92 %) were screened, 208 (17 %) screened positive for PTSD at clinical (11 %) or sub-threshold levels (6 %), and 149 (72 % of all eligible women) enrolled in the study. Those screening positive were significantly younger, had more prior pregnancies, were less likely to be Asian or black, and were more likely to be non-English speakers. Enrolled women at clinical as compared to sub-threshold levels showed few differences in psychosocial risk, but had significantly more types of trauma, more trauma before age 18, more interpersonal trauma, and had greater depression, anxiety, and PTSD symptoms. Only about 25 % had received mental health treatment. Conclusions The PTSD-PC was a feasible screening tool for use in prenatal care. While those screening in at clinical levels were more symptomatic, those at subthreshold levels still showed substantial symptomology and psychosocial risk.

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Acknowledgments

This study was supported by Grant R40MC23633 from the Maternal and Child Health Research Program, Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services. The funding source had no role in design, data collection, analysis, interpretation or writing of this manuscript. We would like to thank the prenatal care staff at both of the participating community health centers, and the women who participated in this study. A special thanks to Jennifer Moffitt, MSN, CNM, Perinatal Services Manager and Mary Fierro, Ph.D., Director of Social and Behavioral Health Services, for their leadership and assistance with the project, and to Elizabeth Delarosa Lawson, BA, Research Coordinator for her persistence and sensitivity in collecting the data.

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Authors and Affiliations

  1. Department of Family Medicine and Community Health, University of Massachusetts Medical School, Benedict Building A3-203, 55 Lake Avenue North, Worcester, MA, 01655, USA

    Melodie Wenz-Gross, Linda Weinreb & Carole Upshur

  2. Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA

    Melodie Wenz-Gross

  3. Department Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA

    Carole Upshur

  4. Center for Health Equity Interventions Research, University of Massachusetts Medical School, Worcester, MA, USA

    Carole Upshur

Authors
  1. Melodie Wenz-Gross
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  2. Linda Weinreb
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Correspondence to Melodie Wenz-Gross.

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Wenz-Gross, M., Weinreb, L. & Upshur, C. Screening for Post-traumatic Stress Disorder in Prenatal Care: Prevalence and Characteristics in a Low-Income Population. Matern Child Health J 20, 1995–2002 (2016). https://doi.org/10.1007/s10995-016-2073-2

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  • DOI: https://doi.org/10.1007/s10995-016-2073-2

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