Research paperFactors associated with post-traumatic stress symptoms (PTSS) 4-6 weeks and 6 months after birth: A longitudinal population-based study

•The strongest predictor of PTSS at 6-months postpartum is PTSS at 4-6 weeks postpartum.•Antenatal anxiety and PTSS predict PTSS after birth.•PTSS are highly comorbid with symptoms of depression and anxiety after birth.•Postpartum fear of birth and social support are risk factors for birth-related PTSS.•Satisfaction with health professionals during birth was predictive of postpartum PTSS.

BackgroundIdentifying factors that precipitate and maintain post-traumatic stress symptoms (PTSS) after birth is important to inform clinical and research practice; yet, prospective longitudinal studies on the predictors of PTSS are limited. This study aimed to determine the pregnancy and postpartum factors associated with PTSS at 4-6 weeks and 6-months postpartum.MethodA systematic sample of 950 pregnant women were recruited from three maternity hospitals in Turkey. Participants completed assessments of depression, anxiety, PTSS and social support in pregnancy, 4-6 weeks and 6-months postpartum. Fear of childbirth was assessed in pregnancy and 4-6 weeks after birth.ResultsRegression models showed that PTSS six months after birth were associated with anxiety and PTSS in pregnancy, complications during birth, satisfaction with health professionals, fear of childbirth 4-6 weeks after birth, PTSS and depression 4-6 weeks after birth, social support 4-6 weeks after birth, traumatic events after birth, need for psychological help, and social support 6-months after birth. PTSS was highly comorbid with depression and anxiety at all-time points. The most robust predictor of PTSS at 6-months postpartum was PTSS at 4-6 weeks postpartum. Intra-partum complications were not associated with PTSS 4-6 weeks after birth. No socio-demographic variables were correlated with PTSS postpartum.LimitationsSelf-report questionnaires were used to measure outcomes. This study is based on sampling from public hospitals so may not represent women treated in private hospitals.ConclusionsAssociated risk factors may help to identify women at risk of PTSS after birth and to inform targeted early intervention.