Trauma & PTSD
Does attachment style shape trauma symptoms after childbirth?
Open access · cc by · source: Europe PMC
How a mother's attachment style related to post-traumatic stress after childbirth depended on whether she had a history of interpersonal trauma.
Study at a glance
- Design
- Cohort — Prospective postpartum cohort (secondary analysis) with PTSD symptoms measured at 5 weeks, 2 months and 6 months; latent growth curve models with multi-group comparison of women with vs without interpersonal trauma history.
- N
- N=251 · 298 women recruited; 251 with complete data entered the growth models (40 with and 211 without a history of interpersonal trauma).
- Population
- Women who had just given birth at hospitals in Montreal, Canada, across four birth groups (vaginal, vaginal with NICU admission, planned caesarean, emergency caesarean).
- Outcome
- Childbirth-related post-traumatic stress symptoms (Perinatal PTSD Questionnaire): initial level at 5 weeks and rate of change to 6 months, predicted by attachment ratings and trauma history.
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Key findings
Symptoms declined on average over time, and those above the clinical cut-off fell from 11.1% at 5 weeks to 6.2% at 6 months. Across the sample, psychosocial risk, more labour pain, a negative birth experience, lower secure attachment and trauma history predicted higher symptoms at 5 weeks, while mode of delivery did not. Among women without trauma history, higher secure attachment predicted fewer initial symptoms and faster decline, and fearful attachment predicted more initial symptoms. Among women with trauma history, secure attachment was not protective; instead preoccupied and dismissing attachment were linked to lower or faster-declining symptoms, contrary to the authors' predictions.
Methodology
298 women were recruited shortly after giving birth in Montreal and followed to 6 months postpartum. Childbirth-related PTSD symptoms were measured at 5 weeks, 2 months and 6 months; interpersonal trauma history (childhood emotional abuse, unsupportive mother, or lifetime physical or sexual abuse) and psychosocial risk were measured at 2 months, and attachment style ratings (secure, fearful, preoccupied, dismissing) at 6 months. Latent growth curve models estimated each woman's starting symptom level and rate of decline, controlling for labour pain, birth experience and other risk factors, and compared women with and without trauma history.
Limitations
Attachment was measured at 6 months, after the symptoms it was used to predict, so the direction of influence cannot be established even though the authors cite evidence that attachment is fairly stable. The trauma-history group was small (40 women) and trauma was defined from a few questionnaire items, and all measures were self-report with only modest reliability for the attachment ratings (alpha = 0.60). Psychosocial risk was assessed only once, so later stressors were not controlled, and no prenatal measures were taken to separate pre-existing symptoms from childbirth-related ones. Some findings (e.g. dismissing attachment being protective) were unexpected and need replication.
How this study connects
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