Delivery as a traumatic event: prevalence, risk factors, screening & treatment

This review looks at the evidence for postnatal posttraumatic stress disorder (PTSD). Postnatal traumatic stress responses are divided into: appraisal of birth as traumatic, traumatic stress responses (severe symptoms of intrusions and avoidance that do not fulfil criteria for PTSD), and PTSD. Evidence is examined for the prevalence of these types of responses after birth, and for prenatal, perinatal, and postnatal vulnerability and risk factors. Screening tools that could be used are outlined and possible intervention and treatment approaches considered. Various conceptual and methodological issues are also raised. It is concluded that up to 10% of women have severe traumatic stress responses to birth although only 1-2% of women actually develop chronic postnatal PTSD. The limited research available suggests that a history of psychiatric problems, mode of delivery, and low support during labour put women at increased risk of postnatal PTSD, although there is unlikely to be a simple relationship between mode of delivery and traumatic stress responses. A model of the possible pathways between vulnerability/risk factors and postnatal PTSD is proposed. Current evidence suggests that brief cognitive-behavioural therapy (CBT) interventions should be used with women who have a severe traumatic stress response, and longer CBT interventions with women with postnatal PTSD. More research is needed to further explore and confirm prenatal, birth, and postnatal risk factors

The association between parent's and healthcare professional's behavior and children's coping and distress during venepuncture

Objectives: Examine the association between children’s distress and coping during venepuncture with parent’s and healthcare professional’s behavior in a sample from the UK. Methods: Fifty children aged 7–16 years accompanied by a carer were videotaped while having venepuncture. Verbalizations of children, parents, and healthcare professionals were coded using the Child–Adult Medical Procedure Interaction Scale-Revised. Results: Children’s distress was associated with child’s age, anxiety, and distress promoting behavior of adults (R2 = .91). Children’s coping was associated with age, anxiety, and coping promoting behaviors of adults (R2 = .57). Associations were stronger between healthcare professional’s behavior and child coping; and between parent’s behaviors and child distress. Empathizing, apologizing, and criticism were not frequently used by adults in this sample (<12%). Conclusion: This study supports and extends previous research showing adult’s behavior is important in children’s distress and coping during needle procedures. Clinical implications and methodological issues are discussed

Recognising anxiety and post-traumatic stress disorder in cardiac patients

Research has established that anxiety and post-traumatic stress disorder (PTSD) are risk factors for the development of heart disease in healthy populations. In addition, anxiety and PTSD are associated with further morbidity in people with existing heart disease. This article considers whether anxiety and PTSD influence onset and recovery from heart disease. Clinical implications for cardiac nursing are considered, including screening, treatment, and referral on to specialist services

Noncariogenic Sweeteners: Sugar Substitutes for Caries Control

The evidence is clear that the incidence of dental caries is related to the frequency of eating sugar. The use of sugar substitutes is a suggested way of reducing sugar intake. A variety of noncariogenic sweeteners exists, but most have no practical value for caries control because of their technical or safety problems, taste, or cost. Urinary bladder tumorigenic effects have been reported in experimental animals treated with saccharin and cyclamates. Because of concerns for human safety, cyclamates were banned in the U.S., and saccharin use was permitted only by special legislation. The polyalcohols sorbitol and xylitol are important sugar substitutes since they are not efficient substrates for plaque bacteria and therefore produce only minimal plaque pH drop. Aspartame, with its sugar-like taste, is an excellent low-calorie sweetener now used in over 100 products under the name NutraSweet. Consumption of aspartame by normal humans is safe and does not promote tooth decay. Individuals with a need to control their phenylalanine intake should handle aspartame like any other source of phenylalanine

Coping styles associated with post-traumatic stress and depression symptoms following childbirth in croatian women

Childbirth is a normative event in a woman's life and is considered as a positive event. However, one in three women perceive childbirth as a physical threat to themselves or their new-born and 3% of women develop posttraumatic stress disorder (PTSD) following childbirth. Poor coping strategies have been associated with PTSD following childbirth. However, previous studies mainly utilised unidimensional measures of coping strategies, therefore, it remains to be investigated which specific dimensions of coping are more predictive of PTSD after childbirth. The aims of this study were to explore whether women in Croatia report PTSD symptoms following childbirth, and how different coping styles were related to PTSD and depression symptoms. Women (N = 160) who gave birth in the last two years, completed an online questionnaire measuring PTSD symptoms (Impact of Event Scale – IES), postnatal depression symptoms (Edinburgh Postnatal Depression Scale – EPDS) and coping styles (Brief Cope). In this sample, 1.9% reported severe PTSD symptoms following childbirth and 21.9% reported depression symptoms. Many women (66.7%) with PTSD symptoms reported depression symptoms. On the other hand, 28.6% of women with depression symptoms also reported PTSD symptoms, showing that there is a higher co-morbidity of PTSD and depression than vice versa. Avoidant coping styles, specifically, denial and self-blame were positively correlated with both PTSD and depression symptoms. Moreover, of avoidant coping styles, behavioural disengagement was positively correlated with PTSD symptoms only, while self-distraction was positively correlated with depression symptoms only. Also, lower levels of planning and higher levels of emotional support were related to higher levels of depression. However, after controlling for postnatal psychopathology symptoms, coping styles were not significant predictors of PTSD symptoms, but self-blame was a significant predictor of depression symptoms. Psychopathological symptoms following childbirth are reported by Croatian women and are related to coping styles. The avoidant coping style, self-blame, is particularly associated with depression symptoms. Future studies should explore predictors of postpartum PTSD in Croatian women in more representative samples during pregnancy and with the follow-up after childbirth. Also, screening for postnatal psychopathological symptoms should be performed both for depression and PTSD symptoms

Understanding needle-related distress in children with cystic fibrosis

Objective. To explore the nature and management of needle-related distress in children and adolescents with cystic fibrosis (CF). Design. Qualitative study using semi-structured interviews. Methods. Fourteen child–parent dyads took part. Children (5 male; 9 female) had a mean age of 12.4 years (range 7–17) and were mostly diagnosed with CF at birth (N= 11). Frequency of needle procedures ranged from once to six times a year. Parents (3 male; 11 female) had a mean age of 41.5 years and were from a variety of socio-economic backgrounds. Interviews were transcribed and analysed using thematic analysis. Results. Most participants identified previous needle experiences and pain as related to their needle anxiety. Over half of parents and children considered ‘taking control’ to be the optimum coping strategy. The majority of parents and children thought inhaled nitrous oxide gas during needle procedures was helpful in managing needle-related distress. Parent and staff influences on needle-related distress are also examined. Conclusions. Needle-related distress in children with CF has a substantial impact on children and their parents, and may lead to management problems and treatment refusal. Psychological and pharmacological interventions could reduce distress and aid management

The role of posttraumatic stress and depression symptoms in mother-infant bonding

Background: There is some evidence posttraumatic stress disorder (PTSD) following childbirth may impact on the mother-infant bond. However, the evidence is inconsistent over whether PTSD or co-morbid depressive symptoms are primarily related to impaired bonding. This study therefore aimed to examine the relationship between PTSD symptoms, depressive symptoms and mother-infant bonding. Methods: A cross-sectional online study included 603 mothers of infants aged 1–12 months. Measures were taken of PTSD (City Birth Trauma Scale, Ayers et al., 2018) which has two subscales of birth-related PTSD symptoms and general PTSD symptoms; depression (Edinburgh Postnatal Depression Scale, Cox et al., 1987) and mother-infant bonding (Postpartum Bonding Questionnaire, Brockington et al., 2001). Results: Impaired bonding was related to both dimensions of PTSD symptoms and depressive symptoms in bivariate analysis. Path analysis testing the model of whether depressive symptoms mediated the effect of PTSD symptoms on mother-infant bonding found a differential role of birth-related and general PTSD symptoms. Birth-related PTSD symptoms did not have any effect on bonding or depressive symptoms. In contrast, general PTSD symptoms had a direct effect on bonding and an indirect effect on bonding via depressive symptoms. Limitations: Self-report measures of PTSD and depression symptoms were used. Conclusions: Further research regarding different aspects of postpartum PTSD, depression and other disorders in the context of mother-infant bonding are needed. Future preventive programs should focus on diminishing symptoms of postpartum PTSD and depression so that the mother-infant bonding remains optimal

The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework

There is evidence that 3.17% of women report posttraumatic stress disorder (PTSD) after childbirth. This meta-analysis synthesizes research on vulnerability and risk factors for birth-related PTSD and refines a diathesis-stress model of its etiology. Systematic searches were carried out on PsychInfo, PubMed, Scopus and Web of Science using PTSD terms crossed with childbirth terms. Studies were included if they reported primary research that examined factors associated with birth-related PTSD measured at least one month after birth. 50 studies (N=21,429) from 15 countries fulfilled inclusion criteria. Pre-birth vulnerability factors most strongly associated with PTSD were depression in pregnancy (.51), fear of childbirth (.41), poor health or complications in pregnancy (r = .38), and a history of PTSD (.39) and counselling (.32). Risk factors in birth most strongly associated with PTSD were negative subjective birth experiences (.59), having an operative birth (assisted vaginal or caesarean, .48), lack of support (-.38), and dissociation (.32). After birth, PTSD was associated with poor coping and stress (.30), and was highly comorbid with depression (.60). Moderator analyses showed that the effect of poor health or complications in pregnancy was more apparent in high-risk samples. The results of this meta-analysis are used to update a diathesis-stress model of the etiology of postpartum PTSD and can be used to inform screening, prevention and intervention in maternity care