# Screening for Postpartum Post-traumatic Stress Disorder (PTSD) Using the Kurdish Version of the PTSD Checklist for DSM-5 (PCL-5)

## TL;DR

This study estimates the prevalence of postpartum PTSD in Kurdish women and identifies risk factors like stillbirth and mental health history.

## Contribution

The study introduces the use of the Kurdish version of the PCL-5 to screen for postpartum PTSD in this specific population.

## Key findings

- The prevalence of postpartum PTSD was 2.9% among Kurdish women.
- Stillbirth was the strongest predictor of PTSD, increasing odds by over 120 times.
- Older age, mental health history, and obstetric complications were significant risk factors.

## Abstract

Introduction and aim: Postpartum post-traumatic stress disorder (PPTSD) is a psychiatric anxiety disorder with a set of reactions and symptoms that may develop in a woman after childbirth, and it may cause significant functional impairment. This study was conducted to estimate the prevalence of PPTSD in a sample of Kurdish women, to explore possible risk factors for the development of the disorder, and to identify the severity of post-traumatic symptoms.

Methods: A cross-sectional study was conducted at Brayati Primary Health Center in Erbil, Kurdistan, Iraq, from January 2020 to January 2021. Using systematic random sampling, researchers enrolled every third woman who visited the clinic for her infant's vaccinations 50-60 days postpartum. A total of 1,301 postpartum women who met the inclusion criteria participated in the study. The prevalence of PPTSD was estimated using the Kurdish version of the Post-traumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (PCL-5). Demographic, obstetric, and symptom severity factors were then compared between women with and without a PPTSD.

Results: The overall prevalence of PPTSD was 2.9% (95% confidence interval: 2.0-3.8%). Binary logistic regression analysis revealed several predictors of PPTSD. The strongest independent predictor was a stillbirth, which increased the odds of developing PTSD by over 120 times compared to having a live baby (OR=120.546, 95% CI: 9.606, 1512.675, p<0.001). A positive history of mental health issues was also a strong predictor, increasing the odds of postpartum PTSD by more than 15 times (OR=15.313, 95% CI: 2.933, 79.955, p=0.001). Furthermore, both complications of pregnancy and labor (OR=5.852, 95% CI: 2.208, 15.514, p<0.001) and postpartum complications (OR=7.487, 95% CI: 1.808, 30.997, p=0.005) were significant risk factors. Women aged 25 years and older were also significantly more likely to develop PTSD compared to those aged 20-24 years (OR=5.855, 95% CI: 1.678, 20.432, p=0.006). Educational level, employment, conceiving type, and mode of delivery were not associated with the prevalence of PPTSD.

Conclusions: This study found a 2.9% prevalence of PPTSD, significantly associated with a history of stillbirth, specific age groups, obstetric complications, and mental health history. Women with PPTSD reported more severe symptoms across all symptom clusters.