Journal article
A brief international screening tool for traumatic birth and childbirth-related PTSD: the city BiTS-short form
BMJ Global Health, Vol.10, pp.1-12
2025
PMID: 40846343
Abstract
Introduction: Screening to identify traumatic births and childbirth-related post-traumatic stress disorder (CB-PTSD) is critical for reducing the global burden of maternal mental health challenges. Despite this, no brief, validated tools exist for international use. This study therefore developed and validated a short version of the City Birth Trauma Scale (City BiTS) to provide a brief, globally relevant screening tool.
Methods: The City BiTS-Short was developed in three stages. In stage 1, exclusive lasso statistical analyses were conducted on survey data of 11 302 postpartum women in 31 countries to identify the most effective items for the City BiTS-Short, ensuring all four CB-PTSD symptom domains were represented. In stage 2, stakeholder reviews were conducted with researchers, health professionals (midwives, health visitors, psychiatrist, psychologist) and representatives of women who experienced traumatic birth. In stage 3, the City BiTS-Short was finalised and psychometric properties examined across diverse geographical settings.
Results: The City BiTS-Short comprises one item assessing traumatic birth and four items assessing CB-PTSD symptoms: re-experiencing, avoidance, negative cognitions and mood and hyperarousal. The scale had strong psychometric properties, including good internal consistency (α=0.78) and high correlations with the original City BiTS (r=0.90), birth trauma ratings (r=0.50), distress (r=0.56), impairment (r=0.47) and CB-PTSD diagnoses (r=0.54). It identified 90% of participants with a CB-PTSD diagnosis. Women who had operative births (F(3,2174)=127.38, p<0.001), maternal complications (F(2,2163)=212.84, p<0.001), infant complications (F(2,1100)=138.93, p<0.001) or depression (t(3209.5)=−30.96, p<0.001) had higher scores. Psychometric properties were consistent across most international contexts, with stakeholders affirming its utility.
Conclusion: The City BiTS-Short offers a brief, validated screening tool for identifying birth trauma and CB-PTSD symptoms. Its widespread adoption can enhance early detection and support for women, potentially reducing the global burden of birth trauma and improving maternal mental health outcomes worldwide. Further research is needed to explore its use in specific contexts.
Details
- Title
- A brief international screening tool for traumatic birth and childbirth-related PTSD: the city BiTS-short form
- Authors
- Susan Ayers - St George's, University of LondonDan Brooks Wright - University of Nevada, RenoRafael A. Caparros-Gonzalez - Instituto de Investigación Biosanitaria de GranadaGiulia Ciuffo - University of MilanGeorgina Constantinou - St George's, University of LondonPelin Dikmen-Yildiz - Kırklareli UniversitySusan Garthus-Niegel - Technische Universität DresdenHanna Grundstrom (Corresponding Author) - Linköping UniversityJonathan Handelzalts - Tel Hai Academic CollegeAntje Horsch - University of LausanneChiara Ionio - University of IcelandSandra Nakic Rados - Catholic University of CroatiaFlavia L. Osorio - Univ Sao Paulo, Fac Med Ribeirao Preto, Dept Neurosci & Behav Sci, Sao Paulo, BrazilValentine Rattaz - University of LausanneOlga Riklikiene - Lithuanian University of Health SciencesLara Seefeld - Technische Universität DresdenValgerour Lisa Siguroardottir - University of IcelandRebecca Webb - St George's, University of LondonINTERSECT ConsortiumElaine Jefford (Consortium Member) - University of the Sunshine Coast
- Publication details
- BMJ Global Health, Vol.10, pp.1-12
- Publisher
- BMJ Group
- Date published
- 2025
- DOI
- 10.1136/bmjgh-2025-019216
- ISSN
- 2059-7908
- PMID
- 40846343
- Copyright note
- © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.
- Organisation Unit
- School of Health - Midwifery
- Language
- English
- Record Identifier
- 991244299302621
- Output Type
- Journal article
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