Background: Childbirth-related PTSD (CB-PTSD) is a prominent mental heath concern women may experience after childbirth. The prevalence of CB-PTSD varies internationally, understanding the expression of CB-PTSD symptoms in different countries may explain some of this variation. The aim of this study was to examine patterns of CB-PTSD symptoms across countries to understand its presentation and inform culturally sensitive screening and intervention strategies.
Methods: An international cross-sectional survey study with 11,302 women who were 6-12 weeks postpartum was carried out. The data were collected in 31 countries as part of the International Survey of Childbirth-Related Trauma (INTERSECT). The survey used the City Birth Trauma Scale to assess CB-PTSD symptoms which identifies DSM-5 symptom clusters (re-experiencing, avoidance, negative cognitions and mood, hyperarousal) and symptom clusters identified by factor-analytic studies (birth-related symptoms, general symptoms).
Results: Although differences were shown in symptom severity, the majority of countries followed a similar pattern of symptoms with mean hyperarousal symptoms highest and mean avoidance symptoms lowest. However, some exceptions were found in those countries where there were high levels of CB-PTSD and in participants with diagnostic CB-PTSD, where re-experiencing and avoidance symptoms were higher than hyperarousal and negative cognitions and mood. Correlations between symptom clusters ranged from .31 to .69, with the strongest associations between re-experiencing and avoidance symptoms (.69, IQR .63-.72) and between hyperarousal and negative cognitions and mood (.71, IQR .67-.75).
Interpretation: Our findings suggest that while CB-PTSD severity varies across countries, the symptom patterns are fundamentally consistent, suggesting CB-PTSD is a meaningful construct worldwide. The variation shown for those countries with high levels of symptoms and with women with diagnostic CB-PTSD, warrants the need for further research to understand these differences in more detail to ensure perinatal mental health strategies are culturally sensitive and ensure approaches to screening and assessment are effective worldwide.