Farrell, Derek

Gillen, Patricia

Klaus, Phyllis

Mc Cullough, Julie

Miller, Paul William

Shapiro, Elan

Sinclair, Marlene

Slater, Paul F

Taylor Miller, Paula G

English

Ulster University's Research Portal

ulster.ac.ukHow can we prevent post traumatic stress (PTSD) in the aftermath of birth trauma? P.G.T. Miller, Prof M. Sinclair, Dr P. Gillen, Prof P.W. Miller, Dr J.E.M. McCullough, Dr D Farrell, Dr P Slater, E. Shapiro, P. Klaus.Introduction➢ Prevalence rates for Post-Traumatic Stress Disorder (PTSD) range from 3.1 to 15.7% of post-partum women [1]➢ 1 in 10 women experience PTSD at 4-6 weeks postpartum ➢ Other women report symptoms of PTSD, including ▪ re-experiencing, ▪ avoidance, ▪ emotional numbing, ▪ hyper arousal▪ negative changes in thinking and moodin the immediate period following childbirth, but do not qualify for the disorder itself.  ➢ Symptoms impact upon women’s quality of life, physical health, personal relationships and the infants physical, behavioural, social and emotional development [2,3]Systematic Review & Meta-AnalysisResearch questionWhat are the effects of early psychological interventions delivered during the perinatal period on post-traumatic stress disorder and post-traumatic stress symptoms in post-partum women following a traumatic birth? Objectives▪ Estimate the effect of early interventions on PTSD and post-traumatic stress symptoms in women following a traumatic birth.▪ Estimate the effect of intervention type.MethodsThe review was reported on in accordance with Prisma guidelines and focused on the PICOS frameworkResults ConclusionThere is firm evidence in favour of immediate response early psychological interventions in reducing symptoms of PTSD in women on a case by case basis. Further long-term studies of high methodological quality are required before recommendation can be made to routine clinical practice. References1. Grekin, R., & O'Hara, M. W. (2014). Prevalence and risk factors of postpartum posttraumatic stress disorder: a meta-analysis. Clinical psychology review, 34(5), 389-401.2. Fenech, G. and Thomson, G. (2014) Tormented by ghosts from their past’: a meta-synthesis to explore the psychosocial implications of a traumatic birth on maternal well-being. Midwifery, 30(2), 185-193.3. Yehuda R, Engel SM, Brand SR, Seckl J, Marcus SM, Berkowitz GS. Transgenerational effects of posttraumatic stress disorder in babies of mothers exposed to the World Trade Center attacks during pregnancy. The Journal of Clinical Endocrinology & Metabolism. 2005 Jul 1;90(7):4115-8.4. Miller, PGT., Sinclair, M., Gillen, P., Miller, P.W., McCullough, J., Farrell, D., Slater, P., Shapiro, E., Klaus, P. (2021) Early psychological interventions for prevention and treatment of post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms in post-partum women: a systematic review and meta-analysis. (in press). This study is in part fulfilment of PhD. Scholarship awarded to P.G.T. Miller by the  Department of Economy (DfE) Northern Ireland.PROSPERO registration number CRD42020202576 Key FindingsEleven studies were identified that evaluated the effectiveness of a range of early psychological interventions. Midwifery or clinician led early psychological interventions administered within 72 hours following traumatic childbirth are more effective than usual care in reducing traumatic stress symptoms in women following traumatic birth.:4-6 weeks (SMD -0.58, 95% CI -0.91, -0.26) and 12 weeks (SMD -1.08 95% CI 1.67, -0.49)▪ A formal and robust review of the literature was conducted. ▪ A total of nine electronic databases were searched.▪ Random effects model was used for comparisons in meta-analysis, investigation of heterogeneity  was conducted by type of intervention. ▪ Outcomes were evaluated by Grading of Recommendation, Assessment, Development, and Evaluation’ (GRADE) approach.Population Women in the perinatal periodIntervention and comparisonAny psychological intervention compared with usual careOutcome Post traumatic stress disorder and post-traumatic stress symptomsStudy Design Randomised controlled trial or pilot studyPRISMA flow diagramA total of 11 studies were found to meet the eligibility criteria with a total of  1,875 participant across studies. Risk of bias was assessed in accordance with criteria outlined in Cochrane Handbook for Systematic Reviews of Interventions.Additional records identified through other sources(n = 6)IdentificationScreeningEligibilityIncludedRecords identified through database searching(n = 785)Duplicates removed(n=34)Total number of identified records(n = 791)Records screened by title for inclusion            (n =757)Records excluded not relevant                              (n =674)Full-text articles assessed for eligibility(n = 83) Full-text articles excluded with reasons                       (n = 72)                                      Study design =18 Population = 3 Outcome = 6    Intervention = 30 Conference abstract = 4Book chapter = 2   Study protocol = 6   Trial registry = 2  unpublished = 1Studies included in quantitative synthesis(n = 11)MIRABILISHEALTH

How do we prevent post traumatic stress (PTSD) in the aftermath of birth trauma?

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How do we prevent post traumatic stress (PTSD) in the aftermath of birth trauma?

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