Measuring posttraumatic stress following childbirth: a critical evaluation of instruments

• Published in: Journal of psychosomatic obstetrics and gynaecology 2010-03, Vol.31 (1), p.40-49
• Main Authors: Stramrood, Claire A. I., Huis in 'T Veld, Elisabeth M. J., Van Pampus, Maria G., Berger, Leonard W. A. R., Vingerhoets, Ad J. J. M., Schultz, Willibrord C. M. Weijmar, Van Den Berg, Paul P., Van Sonderen, Eric L. P., Paarlberg, K. Marieke
• Format: Article
• Language: English
• Subjects: Adult; Adult and adolescent clinical studies; Anxiety disorders. Neuroses; Biological and medical sciences; childbirth; Female; Fundamental and applied biological sciences. Psychology; Gynecology and obstetrics; Humans; instruments; Life Change Events; Medical sciences; Mothers - psychology; operationalization; Parturition - psychology; Post-traumatic stress disorder; postpartum; Postpartum Period - psychology; Posttraumatic stress disorder; Pregnancy; Pregnancy Outcome - psychology; Psychology and medicine; Psychology. Psychoanalysis. Psychiatry; Psychology. Psychophysiology; Psychometrics; Psychometrics. Diagnostic aid systems; Psychopathology. Psychiatry; Reproducibility of Results; Sensitivity and Specificity; Stress Disorders, Post-Traumatic - diagnosis; Surveys and Questionnaires; Techniques and methods; Young Adult
• ISSN: 0167-482X; 1743-8942
• DOI: 10.3109/01674820903573946

Objectives. To evaluate instruments used to assess posttraumatic stress disorder (PTSD) following childbirth with both quantitative (reliability analysis and factor analysis) and qualitative (comparison of operationalization) techniques. Methods. An unselected population of 428 women completed the Traumatic Event Scale-B (TES-B) and the PTSD Symptom Scale-Self Report (PSS-SR) 2-6 months after delivery. Results. Assessment of internal consistency yielded similar results for the TES-B and PSS-SR (Cronbach's α = 0.87 and 0.82, respectively). Factor analysis revealed two rather than three DSM-IV symptom categories for both instruments: childbirth-related factors (re-experiencing/ avoidance) and symptoms of depression and anxiety (numbing/ hyperarousal). Although the TES-B and the PSS-SR sum-scores show a strong relationship (Spearmans ρ = 0.78), agreement between the instruments on the identification of PTSD cases is low (κ = 0.24); discrepancy between TES-B and PSS-SR is largely due to differences in instruction to respondents, formulation of items, answer categories, and cut-off values. Conclusions. Large operationalization differences between TES-B and PSS-SR have been identified, i.e., in the formulation of questions, answer categories, cut-off values and instructions to respondents. Comparison between studies using different instruments for measuring PTSD following childbirth should be done with utmost caution.