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Published (Version of record)CC BY V4.0, Open Access
Published (Version of record)CC BY V4.0, Open
Journal article
Cross-national risk factors for childbirth-related PTSD: Findings from the INTERSECT study
Psychological medicine, Vol.55, pp.1-9
17/11/2025
PMID: 41243440
Appears in Recent Faculty of Health Publications
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Source: InCites
Abstract
Background: Childbirth-related post-traumatic stress disorder (CB-PTSD) is an underrecognized condition with consequences for mothers and infants. This study aimed to determine risk factors for CB-PTSD symptoms across countries within a stress-diathesis framework, focusing on antenatal, birth-related, and postpartum predictors.
Methods: The INTERSECT cross-sectional survey (April 2021-January 2024) included 11,302 women at 6-12 weeks postpartum. The study was carried out across maternity services in 31 countries. Outcomes were CB-PTSD diagnosis, symptom severity, and perceived traumatic birth, assessed with the City Birth Trauma Scale. Multiple risk factors were assessed, including preexisting vulnerability, pregnancy, birth, and infant-related factors. All models were adjusted for country-level variation as a random effect.
Results: Models explained substantial variance across all outcomes (conditional R2 = 0.53-0.58). Negative birth experience was the strongest predictor (e.g. odds ratio [OR] = 0.82, 95% confidence interval [CI] = 0.80-0.84 for diagnosis). Ongoing maternal complications predicted both CB-PTSD diagnosis and symptoms (e.g. OR = 1.61, 95% CI = 1.41-1.84), and major infant complications were associated with CB-PTSD diagnosis (OR = 1.63, 95% CI = 1.29-2.07). Reports of perceived danger to self or infant (criterion A) were linked to higher CB-PTSD symptoms and traumatic birth ratings (e.g., β =0.25, 95% CI = 0.21-0.29). Other predictors reached significance but showed small effects.
Conclusions: Findings support a stress-diathesis framework, showing that while pre-existing vulnerabilities contribute, birth-related stressors exert the strongest influence. Trauma-informed maternity care should prioritize these factors, with attention to women's appraisals of birth.
Details
- Title
- Cross-national risk factors for childbirth-related PTSD: Findings from the INTERSECT study
- Creators
- Jonathan E Handelzalts - Academic College of Tel, Aviv-Yafo (Israel)Susan Ayers - University of LondonRebecca Webb - University of LondonGeorgina Constantinou - University of LondonGrace Lucas - University of LondonChristopher Grollman - University of LondonShay Ohayon - Bar-Ilan UniversityNatalia Awad Sirhan - Universidad del DesarrolloKathleen Baird - University of Technology SydneyMárcia Baldisserotto - Universidade Federal do Rio de JaneiroRamish Batool - Beaconhouse School System (Pakistan)Shahida Batool - Government College University, LahoreRafael A Caparros-Gonzalez - Instituto de Investigación Biosanitaria de GranadaGenesis Chorwe-Sungani - Kamuzu University of Health SciencesAndri Christoforou - European University CyprusSoledad Coo - Universidad del Desarrollo del Estado de PueblaRaquel Costa - Universidade LusófonaPelin Dikmen-Yildiz - Kırklareli UniversityBarbora Ďuríčeková - Comenius University BratislavaBohdana Dušová - University of OstravaVioleta Enea - Alexandru Ioan Cuza UniversitySusan Garthus-Niegel - Norwegian Institute of Public HealthHanna Grundström - Linköping UniversityOye Gureje - University of IbadanEleni Hadjigeorgiou - Cyprus University of TechnologySilje Marie Haga - Regional Centre for Child and Adolescent Mental Health (Norway)Antje Horsch - University of LausanneChiara Ionio - University of MilanGabija Jarašiūnaitė-Fedosejeva - Vytautas Magnus UniversityJulie Jomeen - Southern Cross UniversityMaria Kazmierczak - University of Gdansk (Poland)Joan Lalor - Trinity College DublinMaja Milosavljevic - University of BelgradeUrsula Nagle - Trinity College DublinSandra Nakić Radoš - Catholic University of CroatiaKatri Nieminen - Linköping UniversityBibilola Damilola Oladeji - University of IbadanFlavia Osório - University of Sao PauloPaulina Pawlicka - University of GdańskYoav Peled - Tel-Aviv University (Israel, Tel-Aviv)Tiago Miguel Pinto - Universidade LusófonaValentine Rattaz - University of LausanneOlga Riklikienė - Lithuanian University of Health SciencesJulia Schellong - Technische Universität DresdenValgerður Lísa Sigurðardóttir - University of IcelandNarenda Singh Thagunna - Psychdesk Foundation (Nepal, Kathmandu)Mariza Theme Filha - Oswaldo Cruz Foundation (Brazil, Rio de Janeiro)Zuzana Škodová - Comenius University BratislavaPetra Stebelová - University of OstravaTjasa Stepisnik Perdih - Nova Southeastern UniversityRobert Stewart - University of EdinburghEmma Marie Swift - University of IcelandKristiina Uriko - Tallinn UniversityZahir Vally - United Arab Emirates UniversityMilica Vezmar - University of BelgradeHaya H Zedan - Saudi Electronic UniversityMaja Žutić - Catholic University of CroatiaINTERSECT Consortium
- Publication Details
- Psychological medicine, Vol.55, pp.1-9
- Publisher
- Cambridge University Press
- Grant note
- The International Survey of Childbirth-Related Trauma (INTERSECT, www.intersectstudy.org) was conducted by the INTERSECT Consortium, funded by the Myriam de Senarclens Foundation and City, University of London.
- Identifiers
- 991013330007102368
- Copyright
- © The Author(s), 2025.
- Academic Unit
- Nursing; Faculty of Health
- Language
- English
- Resource Type
- Journal article