Academic journal article European Journal of Psychotraumatology

Psychological Trauma and Posttraumatic Stress Disorder: Risk Factors and Associations with Birth Outcomes in the Drakenstein Child Health Study

Academic journal article European Journal of Psychotraumatology

Psychological Trauma and Posttraumatic Stress Disorder: Risk Factors and Associations with Birth Outcomes in the Drakenstein Child Health Study

Article excerpt

Exposure to psychological trauma is highly prevalent in South Africa. According to nationally representative data from the South African Stress and Health Study (SASH) (Williams et al., 2004), most individuals experience at least one traumatic event in their lifetimes, including criminal victimization, witnessing atrocities, and intimate partner violence (IPV) (Williams et al., 2007). Posttraumatic stress disorder (PTSD) is a debilitating stress-related psychiatric disorder affecting vulnerable individuals after trauma exposure and has a reported lifetime population prevalence of 2.3% among South Africans (Herman et al., 2009). A focus on PTSD is highly relevant in low-middle income (LMIC) settings, such as South Africa, given the high trauma burden and additive risk factor profile in this context.

Findings from the National Comorbidity Survey (Kessler, Chiu, Demler, & Walters, 2005; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995), a nationally representative study of 5,877 adults in the United States, indicated that women were overall more than twice as likely as men to develop lifetime PTSD (10.4% vs. 5.0%, respectively). Pregnant women and new mothers, in particular, comprise a highly vulnerable subgroup (e.g., Beck, Gable, Sakala, & Declercq, 2011; Soderquist, Wijma, Thorbert, & Wijma, 2009; Zaers, Waschke, & Ehlert, 2008). Prenatal trauma may place mothers at a high risk of developing PTSD and may result in a number of adverse maternal and fetal sequelae. For example, there is a strong body of evidence documenting the association between maternal trauma and related disorders, and delivery of an infant with low birthweight (LBW). Murphy, Schei, Myhr, and Du Mont (2001) provided meta-analytical evidence that physical, sexual, or emotional abuse during pregnancy may be part of a complex causative pathway contributing to low infant birthweight. In their prospective study of a cohort of 301 pregnant women from New Orleans and Baton Rouge who had been exposed to Hurricane Katrina, Xiong et al. (2008) reported that the frequency of LBW was notably higher among woman with high hurricane exposure versus those without high hurricane exposure (aOR 3.3; 95% CI: 1.13-9.89). The frequency of preterm birth was also found to be higher in the exposed group (aOR 2.3; 95% CI: 0.826.38). Similarly, in their prospective cohort study of 839 nulliparas in Michigan, USA, Seng, Low, Sperlich, Ronis, and Liberzon (2011) reported that infants born to women who had experienced PTSD during pregnancy had a mean birthweight which was 283 g less than those who had not developed PTSD following trauma exposure. Even the resilient (trauma-exposed) women were found to deliver infants with a mean birthweight which was 221 g less than that of the non-traumatized group. PTSD was also found to be associated with shorter gestation in this cohort. Adverse birth outcomes such as these are important risk factors for poor growth and neurodevelopment in infancy and childhood.

South Africa provides a unique context for further work in the field of psychological trauma exposure and consequent PTSD. First, most individuals experience multiple traumatic events across their lifespan. Second, genderand pregnancy-specific trauma is rife, and likely to exert a range of adverse intergenerational effects. Third, ours is a population in transition. Despite a decline in recent years, the rate of urbanization and urban population growth in sub-Saharan Africa remains among the highest worldwide (Tacoli, McGranahan, & Satterthwaite, 2015). Furthermore, the number of lifetime immigrants in South Africa increased from approximately 800,000 pre-2001 to almost 1.5 million between 2001 and 2011 (Statistics SA, 2014). The Western Cape was found to have the second highest provincial net migration rate during this period. Female migrants in particular may be at increased risk of gender-specific trauma such as violence; inadequate access to basic infrastructure; and the burden of unpaid, unsupported, care work. …

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