How do different childbirth experience scales predict childbirth-related posttraumatic stress symptoms and disorder?

Abstract

Purpose

Post-traumatic stress disorder (PTSD) after childbirth causes severe and lasting effects. Screening of childbirth experience may expedite early PTSD recognition. Systematic reviews have not provided consensus on how and when to measure childbirth experience and the clinical implications of such measurements. We aimed to identify a reliable and simple scale for screening the childbirth experience with minimum risk of missing PTSD.

Materials and methods

This cohort study evaluated the childbirth experience of 1527 unselected women with Wijma Delivery Experience Questionnaire (W-DEQ-B), Delivery Satisfaction Scale (DSS), and Visual Analogue Scale (VAS). VAS was measured first <1 week (VAS1) and then, together with the other scales, a few months after childbirth (VAS2). The scales’ ability to identify PTSD (measured with Traumatic Event Scale) was evaluated and compared with receiver operating characteristic (ROC) analysis. Diagnostic accuracy and clinical usefulness were used to suggest cutoff values for scales.

Results

W-DEQ-B showed highest recognition of partial or full PTSD (area under the ROC curve 0.96 in W-DEQ-B, 0.92 in VAS2, 0.91 in DSS and 0.82 in VAS1).

Conclusions

All included scales recognized partial or full PTSD well. Although W-DEQ-B performed best, VAS (measured twice) with cutoff value of 50 mm is most suitable for screening in clinical circumstances.

Keywords:

• Childbirth
• childbirth experience
• post-traumatic stress disorder
• trauma
• scales
• postpartum

Acknowledgements

The authors are grateful for comments from Jenny Miettinen, Lauri Hietajärvi, and Katja Upadyaya.

Disclosure statement

The authors report there are no competing interests to declare.

Data availability statement

The datasets generated and/or analyzed during the current study are not publicly available due to limitations of ethical approval involving the patient data and anonymity but are available from the corresponding author on reasonable request.

Additional information

Funding

This work was supported by Kymenlaakso Central Hospital State Research Funding under Grant [ERV220 and ERV221] to TM; Signe and Gyllenberg Foundation Funding under Grant [001 Forskning] to TM; Academy of Finland under Grant [336138 and 345117] to KSA; and Academy of Finland Strategic Funding Council to FLUX project under Grant [345132] to KSA. Open access funded by Helsinki University Library.