Screening for Post-Traumatic Stress Disorder in Pregnancy and after Childbirth

Any traumatic, stressful or distressing experience in a person’s life can lead to post traumatic stress disorder or PTSD. This is an anxiety disorder that refers to a range of symptoms or reactions that an individual can develop when he/she or others around him/her, feel threatened or unsafe as a result of the situation. Pregnant mothers, or women who have given birth, may also experience PTSD, known as perinatal PTSD. This can happen in relation to both difficult pregnancy-related events or complications such as miscarriage, traumatic birth, etc., but also as a result of other lifetime traumatic experiences, such as rape or sexual assault, serious health problems, intimate partner violence and other traumas.

Some of the symptoms may include re-living the traumatic event through – for example – nightmares and flashbacks, being overly alert or wound up, avoiding reminders of the negative experience or feeling emotionally numb. There may be feelings of isolation, irritability and guilt, and the person may also have problems sleeping, and find it difficult to concentrate. These symptoms may be sufficiently severe and persistent to have a negative impact on the person’s day-to-day life and functioning. Effective treatment is available to help the person recover from PTSD and to move on from the traumatic experience, so early recognition is fundamental. To date, however, there is a lack of validated – and readily available – measures to detect this disorder in pregnancy and after childbirth. In the context of this existing gap, Dr Buhagiar has validated a brief PTSD questionnaire, the Post-Traumatic Stress Disorder Checklist for DSM-V (PCL-5), to screen women for perinatal PTSD. This questionnaire, which takes just a few minutes to complete, has now been translated into the Maltese language and culturally adapted for use within the Maltese population.

The implementation of this selfreport tool in healthcare services in Malta will help identify those mothers (both pregnant and postnatal) who might have a possible diagnosis of PTSD. Whilst a more comprehensive assessment would still be needed to confirm or refute a diagnosis of PTSD, the use of this questionnaire can be the first step in the early detection and treatment of these women. This is important, because unrecognised and/or untreated perinatal PTSD can have adverse effects for the mother, her baby and the rest of the family unit.

Based on study results, the prevalence of PPTSD in Malta ranges between 0 and 3.63 per cent. Additionally, a significantly high trauma rate was identified in our study population.

This further reinforces the need to consider the possibility of unresolved trauma and/or PTSD in all healthcare settings in Malta and to ensure the provision of trauma-informed care to our patients and their families.

Dr Rachel Buhagiar is a Perinatal Psychiatrist who has completed a study on posttraumatic stress disorder in pregnancy and post-partum as part of her Master’s Degree in Perinatal and Infant Mental Health. This project was partly sponsored by the Endeavour Scholarship Scheme from the Ministry of Education and Employment in Malta. Dr Buhagiar works in the Perinatal Mental Health Clinic at Mater Dei Hospital and with TAASC in the private sector.