Journal article
Cross-national risk factors for childbirth-related PTSD: Findings from the INTERSECT study
Psychological Medicine, Vol.55, pp.1-9
2025
PMID: 41243440
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
- Authors
- Jonathan E Handelzalts - Tel Hai Academic CollegeSusan Ayers (Corresponding Author) - Universidad de LondresRebecca Webb - Universidad de LondresGeorgina Constantinou - Universidad de LondresGrace Lucas - Universidad de LondresChristopher Grollman - Universidad de LondresShay Ohayon - Bar-Ilan UniversityNatalia Awad Sirhan - Universidad del DesarrolloKathleen Baird - University of Technology SydneyMárcia Baldisserotto - Universidade Federal do Rio de JaneiroRamish Batool - Beaconhouse National UniversityShahida Batool - Government College University, LahoreRafael A Caparros-Gonzalez - Instituto de Investigación Biosanitaria de GranadaGenesis Chorwe-Sungani - Kamuzu Central HospitalAndri 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 - Technische Universität DresdenHanna Grundström - Linköping UniversityOye Gureje - University of IbadanEleni Hadjigeorgiou - Cyprus University of TechnologySilje Marie Haga - Center for Child and Adolescent Mental Health, Eastern and Southern NorwayAntje Horsch - University of LausanneChiara Ionio - University of MilanGabija Jarašiūnaitė-Fedosejeva - Vytautas Magnus UniversityJulie Jomeen - Southern Cross UniversityMaria Kazmierczak - University of GdańskJoan Lalor - Iranshahr UniversityMaja Milosavljevic - University of BelgradeUrsula Nagle - Iranshahr UniversitySandra Nakić Radoš - Catholic University of CroatiaKatri Nieminen - Linköping UniversityBibilola Damilola Oladeji - University of IbadanFlavia Osório - Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, https://ror.org/036rp1748University of Sao Paulo, BrazilPaulina Pawlicka - University of GdańskYoav Peled - Tel Aviv UniversityTiago Miguel Pinto - Universidade LusófonaValentine Rattaz - University of LausanneOlga Riklikienė - Lithuanian University of Health SciencesJulia Schellong - Technische Universität DresdenValgerður Lísa Sigurðardóttir - National University HospitalNarenda Singh Thagunna - ACT FoundationMariza Theme Filha - Fundação Oswaldo CruzZuzana Škodová - Comenius University BratislavaPetra Stebelová - University of OstravaTjasa Stepisnik Perdih - School of Advanced Social Studies[CMT5], Nova Gorica, SloveniaRobert Stewart - Division of Psychiatry, https://ror.org/01nrxwf90University of Edinburgh, Edinburgh, UKEmma Marie Swift - National University HospitalKristiina Uriko - Tallinn UniversityZahir Vally - United Arab Emirates UniversityMilica Vezmar - University of BelgradeHaya H Zedan - Saudi Electronic UniversityMaja Žutić - Catholic University of CroatiaINTERSECT Consortium (Research Group)Elaine Jefford (Consortium Member) - University of the Sunshine Coast, Queensland, School of Health - Midwifery
- Publication details
- Psychological Medicine, Vol.55, pp.1-9
- Publisher
- Cambridge University Press
- Date published
- 2025
- DOI
- 10.1017/S0033291725102298
- ISSN
- 1469-8978
- PMID
- 41243440
- Copyright note
- © The Author(s), 2025. Published by Cambridge University Press. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
- 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. GA 2287/7-1 and SCHE 1986/6-1 / Deutsche Forschungsgemeinschaft; 2020-0056 / Fredrik och Ingrid Thurings Stiftelse; 11170338 / Secretaria de Estado de Ciência, Tecnologia e Ensino Superior de Minas Gerais; European Social Fund; UIDB/05380/2023 / Fundação para a Ciência e a Tecnologia
- Organisation Unit
- School of Health - Midwifery
- Language
- English
- Record Identifier
- 991191645802621
- Output Type
- Journal article
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web Of Science research areas
- Psychiatry
- Psychology
- Psychology, Clinical