Symptoms of Postpartum PTSD and Expressive Writing: A Prospective Study

By Di Blasio, Paola; Ionio, Chiara et al. | Journal of Prenatal & Perinatal Psychology & Health, Fall 2009 | Go to article overview

Symptoms of Postpartum PTSD and Expressive Writing: A Prospective Study


Di Blasio, Paola, Ionio, Chiara, Confalonieri, Emanuala, Journal of Prenatal & Perinatal Psychology & Health


Abstract: Research studies on post-partum PTSD have highlighted that the experience of childbirth can be traumatic in itself because it often involves fear, pain, impotence and non-expressed negative emotions. This study hypothesized that mental processing post-partum emotions, through Pennekaber's expressive writing (EW) method, can reduce short- and long-term posttraumatic symptoms. The sample was of 242 women (mean age=31.5; SD=4) of whom 120 performed the EW-task and 122 were not asked to write. The Perinatal PTSD Questionnaire (PPQ) was administered 48 hours and two months after childbirth (the total sample) and 12 months after childbirth (65 women). The data show a positive effect of expressive writing, which allows them to process and mentalize negative emotions, worries and fears, deactivating both avoidance mechanisms and physiological symptoms linked to hyperarousal.

Key Words: childbirth, expressive writing, negative emotion elaboration, PTSD, post partum symptoms

Post-partum stress symptoms have long been underestimated. However, the massive presence of post-partum anxiety symptoms (Abramowitz, Schwartz, Moore, & Luenzmann, 2003; Matthey, Barnett, Howie, & Kavanagh, 2003; McMahon, Barnett, Kowalenko, & Tennant, 2001; Shear & Mammen, 1995; Wenzel, Haugen, Jackson, & Brendle, 2005) has persuaded researchers to introduce systematically the diagnostic category of post-traumatic stress disorder (PTSD) (Ballard, Stanley, & Brockington, 1995; Fones, 1996) to consider the significance of this disorder and to reveal its prevalence by studying also explicative factors (Ayers, 2004; Ayers & Pickering, 2001; Greedy, Shochet, & Horsfall, 2000; Czarnocka & Slade, 2000; Soet, Brack, & Dilorio, 2003; van Son, Verkerk, van der Hart, Komproe, & Pop, 2005; Wijma, Wijma, & Soderquist, 1997).

Various studies have produced data that are reliable, differences of methods used, and in the time period considered for the persistence of the symptoms. Researchers speak of a percentage of women, varying between 2% and 7%, who present with this disorder 6 weeks after childbirth. In particular, Wijma et al. (1997) find percentages of 1.7%, Czarnocka and Slade (2000) of 3% and Soet et al. (2003) of 1.9%, while Greedy et al. (2000) and Ayers and Pickering (2001) report higher values, of 5.6% and 6.9% respectively. However, the number of women affected by post-partum stress increases by about 10.5% when the symptoms are considered in a partial form and not according to the criteria indicated by the Diagnostic and Statistical Manual (DSM-IV; 2000) for the diagnosis of PTSD (Greedy et al., 2000; Czarnocka & Slade, 2000). Negative experiences connected to childbirth are common to a higher number of women when the limits of the diagnostic categories are widened.

As far as stability across time of these symptoms is concerned, some studies show that a percentage of 6.9% of women with PTSD 6 weeks after childbirth moves to 3.5% 6 months after childbirth (Ayers & Pickering, 2001); others indicate a substantial stability (White, Matthey, Boyd, & Barnett, 2006) with percentages of 2.6% of women with PTSD 6 months after childbirth and 2.4% 12 months after childbirth, or an increase in symptoms.

The few studies on the co-morbidity between post-partum PTSD and depression (Czarnocka & Slade, 2000; Wenzel et al., 2005; White et al., 2006) indicate both the co-presence of stress symptoms and depressive disorders, and the wider recurrence and extension of PTSD than of depression.

The overlap between neonatal depressive disturbance and PTSD leads to an underestimation of stress symptoms, due both to the fact that attention has only recently been dedicated to this diagnostic category and to the fact that knowledge and diagnostic instruments facilitating the identification of postnatal depression are more diffused among professionals.

Post-traumatic stress disorder is, in fact, typically an anxiety condition, which implies a perception of self as vulnerable, a perception of the world as unreliable and a fear of the future as unpredictable. …

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