Testing a Model of the Development of PTSD Following Childbirth Resulting in Admission to the Neonatal Intensive Care Unit (NICU)

Abstract

Posttraumatic stress disorder (PTSD) can include symptoms of anxiety, mood disturbance, and behavioral difficulties following exposure to a traumatic stressor such as childbirth (American Psychiatric Association, 2013). Mothers of infants requiring specialty care in the Neonatal Intensive Care Unit (NICU) immediately after birth, are at increased risk to experience PTSD in the time following childbirth (Brandon et al., 2011). NICU mothers face unique challenges including decreased ability to participate in traditional parenting roles and worry for the health of their child, and this unique stress may interfere for adjustment following childbirth (Miles, Holditch-Davis, Schwartz, & Scher, 2007). However, recent changes to the diagnostic criteria with the American Psychiatric Association's (APA) update from the DSM-IV (APA, 2000) to the DSM-5 mean previous research has utilized diagnostic criteria that are out-of-date. Furthermore, no research exists that assesses childbirth as a traumatic stressor (PTSD Criterion A) for NICU mothers. The purpose of the current study was to test a new model of the development of PTSD symptoms specific to childbirth in a sample of NICU mothers. This model identified childbirth as a traumatic stressor in accordance with DSM-5 diagnostic criteria and examined the influence of the unique stressors associated with NICU hospitalization on the development of PTSD following childbirth. Participants included 54 women recruited through social media who had given birth in the past one to four months whose infant was hospitalized in the NICU for at least two days. They completed an online survey assessing pregnancy and childbirth history, childbirth-specific PTSD symptoms, and stress associated with experiences in the NICU (NICU stress). Childbirth was also assessed as a potential traumatic stressor. Prior traumatic experiences and symptoms of anxiety and depression were assessed as control variables. Exploratory analyses were utilized to identify the prevalence of traumatic childbirth appraisal and PTSD. Differences in prior trauma experiences and current emotional distress were examined between mothers who appraised their childbirth as traumatic and those who did not. Moderation analyses explored the influence of NICU stress on the relationship between traumatic childbirth and PTSD symptoms while accounting for prior trauma, anxiety, and depression. The proportion of NICU mothers reporting traumatic childbirth was 69% and the proportion scoring above the clinical cutoff for PTSD was 13%. The proportion meeting the full criteria for PTSD (reporting a traumatic childbirth and scoring above the clinical cutoff) was 20%. The moderation analysis revealed that a significant relationship between traumatic childbirth and PTSD existed for mothers who reported both traumatic childbirth experience and high NICU stress. These results provide the first estimates of the prevalence of PTSD in NICU mothers including the assessment of traumatic childbirth. Furthermore, these results identify NICU stress as a potential treatment target to decrease PTSD symptoms following NICU hospitalization.