Primary and secondary clinical outcomes at 1 and 6 months–rates and results of multivariate logistic regression.

The data were not adequately powered to performed binomial logistic regression for the individual components of the composite primary and secondary endpoints.</p

Diagnostic characteristics for 2012 to 2013 and 2015 to 2016.

<p>Diagnostic characteristics for 2012 to 2013 and 2015 to 2016.</p

Treatment characteristics for 2012 to 2013 and 2015 to 2016.

Treatment characteristics for 2012 to 2013 and 2015 to 2016.</p

Timing information for 2012 to 2013 and 2015 to 2016.

<p>Timing information for 2012 to 2013 and 2015 to 2016.</p

Patient characteristics for 2012 to 2013 and 2015 to 2016.

<p>Patient characteristics for 2012 to 2013 and 2015 to 2016.</p

Box plots comparing median summated patient satisfaction scores between 2012–2013 and 2015–2016.

<p>Box plots comparing median summated patient satisfaction scores between 2012–2013 and 2015–2016.</p

Estimated cost savings generated from providing intervention for 207 patients in MBH from February 2015 to January 2016.

<p>Estimated cost savings generated from providing intervention for 207 patients in MBH from February 2015 to January 2016.</p

Procedural characteristics for 2012 to 2013 and 2015 to 2016.

<p>Procedural characteristics for 2012 to 2013 and 2015 to 2016.</p

Summary of selection process for patients from February 2015 to January 2016.

<p>Summary of selection process for patients from February 2015 to January 2016.</p

Interplay of demographic variables, birth experience, and initial reactions in the prediction of symptoms of posttraumatic stress one year after giving birth

There has been increasing research on posttraumatic stress disorder (PTSD) following childbirth in the last two decades. The literature on predictors of who develops posttraumatic stress symptoms (PSS) suggests that both vulnerability and birth factors have an influence, but many studies measure predictors and outcomes simultaneously. In this context, we aimed to examine indirect and direct effects of predictors of PSS, which were measured longitudinally. We assessed women within the first days (n=353), 6 weeks, and 12 months (n=183) after having given birth to a healthy infant. The first assessment included questions on demographics, pregnancy, and birth experience. The second and third assessments contained screenings for postpartum depression, PTSD, and general mental health problems, as well as assessing social support and physical well-being. We analysed our data using structural equation modelling techniques (n=277). Our final model showed good fit and was consistent with a diathesis-stress model of PSS. Women who had used antidepressant medication in the 10 years before childbirth had higher PSS at 6 weeks, independent of birth experiences. Subjective birth experience was the early predictor with the highest total effect on later PSS. Interestingly, a probable migration background also had a small but significant effect on PSS via more episiotomies. The null results for social support may have been caused by a ceiling effect. Given that we measured predictors at different time points, our results lend important support to the etiological model, namely, that there is a vulnerability pathway and a stress pathway leading to PSS. PSS and other psychological measures stayed very stable between 6 weeks and 1 year postpartum, indicating that it is possible to identify women developing problems early. Our results are consistent with a diathesis-stress model: vulnerability (antidepressant use in the previous 10 years) influenced posttraumatic stress symptoms at 6 weeks and 1 year, independently of stress (birth-related variables). The strongest predictor of posttraumatic stress symptoms 1 year postpartum was posttraumatic stress symptoms 6 weeks postpartum. This means that women who develop problems could be identified during routinely offered postpartum care. Women with a probable migration background experienced more PSS 1 year after the birth, which was an indirect effect through more episiotomies and more PSS after 6 weeks.</p