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A prospective longitudinal study of the prevalence of post-traumatic stress disorder resulting from childbirth events

  • K. L. Alcorn (a1), A. O'Donovan (a1), J. C. Patrick (a2), D. Creedy (a3) and G. J. Devilly (a1) (a4)...

Childbirth has been linked to postpartum impairment. However, controversy exists regarding the onset and prevalence of post-traumatic stress disorder (PTSD) after childbirth, with seminal studies being limited by methodological issues. This longitudinal prospective study examined the prevalence of PTSD following childbirth in a large sample while controlling for pre-existing PTSD and affective symptomatology.


Pregnant women in their third trimester were recruited over a 12-month period and interviewed to identify PTSD and anxiety and depressive symptoms during the last trimester of pregnancy, 4–6 weeks postpartum, 12 weeks postpartum and 24 weeks postpartum.


Of the 1067 women approached, 933 were recruited into the study. In total, 866 (93%) were retained to 4–6 weeks, 826 (89%) were retained to 12 weeks and 776 (83%) were retained to 24 weeks. Results indicated that, uncontrolled, 3.6% of women met PTSD criteria at 4–6 weeks postpartum, 6.3% at 12 weeks postpartum and 5.8% at 24 weeks postpartum. When controlling for PTSD and partial PTSD due to previous traumatic events as well as clinically significant anxiety and depression during pregnancy, PTSD rates were less at 1.2% at 4–6 weeks, 3.1% at 12 weeks and 3.1% at 24 weeks postpartum.


This is the first study to demonstrate the occurrence of full criteria PTSD resulting from childbirth after controlling for pre-existing PTSD and partial PTSD and clinically significant depression and anxiety in pregnancy. The findings indicate that PTSD can result from a traumatic birth experience, though this is not the normative response.

Corresponding author
*Address for correspondence: Dr G. J. Devilly, School of Psychology and Griffith Institute for Health & Medical Research, Griffith University, Mt Gravatt, Qld 4122, Australia. (Email: (Email:
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Allen S (1998). A qualitative analysis of the process, mediating variables and impact of traumatic childbirth. Journal of Reproductive and Infant Psychology 16, 107131.
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn – text revision. American Psychiatric Association: Washington, DC.
Australian Bureau of Statistics (2004). Births, Australia, No. 3301.0. Australian Bureau of Statistics: Canberra, Australian Capital Territory.
Australian Bureau of Statistics (2007). Household Income and Income Distribution, Australia, 2005–06. Australian Bureau of Statistics: Canberra, ACT.
Ayers S (2001). Assessing psychopathology in pregnancy and postpartum. Journal of Psychosomatic Obstetrics and Gynecology 22, 91–102.
Ayers S, Pickering AD (2001). Do women get posttraumatic stress disorder as a result of childbirth? A prospective study of incidence. Birth: Issues in Perinatal Care 28, 111118.
Bailham D, Joseph S (2003). Post-traumatic stress following childbirth: a review of the emerging literature and directions for research and practice. Psychology, Health and Medicine 8, 159168.
Baldwin S, Williams D, Houts A (2004). The creation, expansion, and embodiment of Posttraumatic Stress Disorder: a case study in historical critical psychopathology. Scientific Review of Mental Health Practice 3, 3352.
Ballard CG, Stanley AK, Brockington IF (1995). Post-traumatic stress disorder (PTSD) after childbirth. British Journal of Psychiatry 166, 525528.
Ballenger JC, Davidson J, Lecrubier Y, Nutt DJ, Foa E, Kessler RC, McFarlane AC, Shalev AY, (2000). Consensus statement on posttraumatic stress disorder from the international consensus group on depression and anxiety. Journal of Clinical Psychiatry 61, 6066.
Beck C (2004 a). Post-traumatic stress disorder due to childbirth: the aftermath. Nursing Research 53, 216224.
Beck C (2004 b). Birth trauma: in the eye of the beholder. Nursing Research 53, 2835.
Brown S, Lumley J (1998). Maternal health after childbirth: results of an Australian population based survey. British Journal of Obstetrics and Gynaecology 105, 156161.
Centres for Disease Control and Prevention (2006). Births: final data for 2004. National Vital Statistics Reports 55, 1102.
Cox JL, Holden J, Sagovsky R (1987). Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry 150, 782786.
Creamer M, Burgess P, McFarlane AC (2001). Post-traumatic stress disorder: findings from the Australian National Survey of Mental Health and Well-being. Psychological Medicine 31, 12371247.
Creamer M, McFarlane AC, Burgess P (2005). Psychopathology following trauma: the role of subjective experience. Journal of Affective Disorders 86, 175782.
Creedy DK, Shochet IM, Horsfall J (2000). Childbirth and the development of acute trauma symptoms: incidence and contributing factors. Birth 27, 104111.
Eberhard-Gran M, Eskild A, Tambs K, Opjordsmoen S, Samuelsen SO (2001). Review of validation studies of the Edinburgh Postnatal Depression Scale. Acta Psychiatrica Scandinavica 104, 243249.
Engelhard IM, van den Hout MA, Kindt M (2003). The relationship between neuroticism, pre-traumatic stress, and post-traumatic stress: a prospective study. Personality and Individual Differences 35, 381388.
Foa E, Cashman L, Jaycox L, Perry K (1997). The validation of a self-report measure of posttraumatic stress disorder: the Posttraumatic Diagnostic Scale. Psychological Assessment 9, 445451.
Foa E, Meadows E (1997). Psychosocial treatments for posttraumatic stress disorder: a critical review. Annual Review of Psychology 48, 449480.
Fones C (1996). Posttraumatic stress disorder occurring after painful childbirth. Journal of Nervous and Mental Disease 184, 195196.
Freedman SA, Gluck N, Tuval-Mashiach R, Brandes D, Peri T, Shalev A (2002). Gender differences in responses to traumatic events: a prospective study. Journal of Traumatic Stress 15, 407413.
Greening L, Stoppelbein L, Docter R (2002). The mediating effects of attributional style and event-specific attributions on post-disaster adjustment. Cognitive Therapy and Research 26, 261274.
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. Journal of Traumatic Stress 17, 497503.
Johnston-Robledo I, Barnack J (2004). Psychological issues in childbirth: potential roles for psychotherapists. Women and Therapy 27, 133150.
Keogh E, Ayers S, Francis H (2002). Does anxiety sensitivity predict post-traumatic stress symptoms following childbirth? A preliminary report. Cognitive Behaviour Therapy 31, 145155.
Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry 52, 10481060.
Laws P, Hilder L (2008). Australia's Mothers and Babies 2006. Australian Institute of Health and Welfare: Sydney, NSW.
Long ME, Elhai JD, Schweinle A, Gray MJ, Grubaugh AL, Frueh C (2008). Differences in posttraumatic stress disorder diagnostic rates and symptom severity between criterion A1 and non-criterion A1 stressors. Journal of Anxiety Disorders 22, 12551263.
McNally RJ (2003). Progress and controversy in the study of posttraumatic stress disorder. Annual Review of Psychology 54, 229252.
Matthey S (2004). Calculating clinically significant change in postnatal depression studies using the Edinburgh Postnatal Depression Scale. Journal of Affective Disorders 78, 269272.
Matthey S, Barnett B, Howie P, Kavanagh DJ (2003). Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety? Journal of Affective Disorders 74, 139147.
Murray D, Cox J (1990). Screening for depression during pregnancy with the Edinburgh Depression Scale (EPDS). Journal of Reproductive and Infant Psychology 8, 99–107.
National Statistics Online (2007). UK Office of National Statistics: people and migration – births and deaths ( Accessed 27 November 2007.
Olde E, van der Hart O, Kleber RJ, van Son MJ, Wijnen HA, Pop VJ (2005). Peritraumatic dissociation and emotions as predictors of PTSD symptoms following childbirth. Journal of Trauma and Dissociation 6, 125142.
Righetti-Veltema M, Conne-Perreard E, Bousquet A, Manzano J (2002). Postpartum depression and mother-infant relationship at 3 months old. Journal of Affective Disorders 70, 291306.
Ryding E, Persson A, Onell C, Kvist L (2003). An evaluation of midwives' counselling of pregnant women in fear of childbirth. Acta Obstetricia et Gynecologica Scandinavica 82, 1017.
Saisto T, Salmela-Aro K, Nurmi JE, Kononen T, Halmesmaki E (2001). A randomized controlled trial of intervention in fear of childbirth. Obstetrics and Gynecology 98, 820826.
Sjostrom K, Valentin L, Thelin T, Marsal K (2002). Maternal anxiety in late pregnancy: effect on fetal movements and fetal heart rate. Early Human Development 67, 87–100.
Social Policy Research Centre (2006). Baseline Demographic Profile 2001. Social Policy Research Centre: Sydney, NSW.
Söderquist J, Wijma B, Wijma K (2006). The longitudinal course of post-traumatic stress after childbirth. Journal of Psychosomatic Obstetrics and Gynaecology 27, 113119.
Soet JE, Brack GA, Dilorio C (2003). Prevalence and predictors of women's experience of psychological trauma during childbirth. Birth 30, 3646.
Sommer I, Ehlert U (2004). Adjustment to trauma exposure: prevalence and predictors of posttraumatic stress disorder symptoms in mountain guides. Journal of Psychosomatic Research 57, 329335.
Spielberger C, Gorsuch R, Lushene R, Vagg P, Jacobs G (1983). Manual for the State-Trait Anxiety Inventory (Form Y). Consulting Pscychologists Press, Inc: Palo Alto, CA.
Stein MB, Walker JR, Forde DR (2000). Gender differences in susceptibility to posttraumatic stress disorder. Behaviour Research and Therapy 38, 619628.
Stein MB, Walker JR, Hazen AL, Forde DR (1997). Full and partial posttraumatic stress disorder: findings from a community survey. American Journal of Psychiatry 154, 11141119.
Switzer GE, Dew MA, Thompson K, Goycoolea JM, Derricott T, Mullins SD (1999). Posttraumatic stress disorder and service utilization among urban mental health center clients. Journal of Traumatic Stress 12, 2539.
van Hooff M, McFarlane AC, Baur J, Abraham M, Barnes DJ (2009). The stressor Criterion-A1 and PTSD: a matter of opinion? Journal of Anxiety Disorders 23, 7786.
Wijma K, Soderquist J, Wijma B (1997). Posttraumatic stress disorder after childbirth: a cross sectional study. Journal of Anxiety Disorders 11, 587597.
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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
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