Prevalence and predictors of women's experience of psychological trauma during childbirth
Prevalence and predictors of women's experience of psychological trauma during childbirth
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DOI：
10.1046/j.1523-536x.2003.00215.x
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发表时间：
2003-03-01
影响因子：
2.5
通讯作者：
Dilorio, C
中科院分区：
文献类型：
--
作者：
Soet, JE;Brack, GA;Dilorio, C
背景：人们越来越多地接受人类经历中普遍存在的创伤及其心理后果，导致该疾病诊断标准的修订。这项研究的三个目的是检查妇女在分娩时经历心理创伤的比率，探索可能的因果因素，并检查该疾病发展的可能因素。方法：亚特兰大都市区的 103 名参加分娩教育课程的妇女完成了妊娠晚期调查，并在分娩后约 4 周进行了后续访谈。结果：34% 的参与者表示分娩经历是痛苦的。两名女性 (1.9%) 出现了诊断创伤后应激障碍所需的所有症状，31 名女性 (30.1%) 出现部分症状。回归分析显示，先行因素（例如性创伤史和社会支持）和事件特征（例如第一产程疼痛、无力感、期望、医疗干预以及与医务人员的互动）是分娩创伤认知的重要预测因素。分娩过程中经历的疼痛、社会支持水平、自我效能、内部控制点、特质焦虑和应对方式是出生后创伤后应激障碍症状发展的重要预测因素。结论：这些研究结果为医疗保健从业者提出了几个干预点，包括对既往创伤史、社会支持和对出生的期望进行仔细的产前筛查；改善分娩期间的沟通和疼痛管理；以及讨论产后分娩的机会。
Background: The increased acceptance of the prevalence of trauma in human experience as well as its psychological consequences has led to revisions of diagnostic criteria for the disorder. The three purposes of this study were to examine the rates at which women experienced psychological trauma in childbirth, to explore possible causal factors, and to examine possible factors in the development of the disorder. Methods: One hundred and three women from childbirth education classes in the Atlanta metropolitan area completed a survey in late pregnancy and a follow-up interview approximately 4 weeks after the birth. Results: The childbirth experience was reported as traumatic by 34 percent of participants. Two women (1.9%) developed all the symptoms needed to diagnose posttraumatic stress disorder, and 31 women (30.1%) were partially symptomatic. Regression analysis showed that antecedent factors (e.g., history of sexual trauma and social support) and event characteristics (e.g., pain in first stage of labor, feelings of powerlessness, expectations, medical intervention, and interaction with medical personnel) were significant predictors of perceptions of the childbirth as traumatic. The pain experienced during the birth, levels of social support, self-efficacy, internal locus Of control, trait anxiety, and coping were significant predictors of the development of posttraumatic stress disorder symptoms after the birth. Conclusions: These findings suggest several intervention points for health care practitioners, including careful prenatal screening of past trauma history, social support, and expectations about the birth; improved communication and pain management during the birth; and opportunities to discuss the birth postpartum.