Posttraumatic stress disorder (PTSD) has been described as the stress disorder and intimate relationship problems: a meta-analysis. Psychological Distress of Intimate Partners: A Meta-Analytic Review Keywords: posttraumatic stress disorder, relationship quality, secondary traumatic stress ceiving more problems in the relationship (Nelson Goff & Smith. Posttraumatic stress disorder and intimate relationship problems: A meta- analysis. Journal of Consulting and Clinical Psychology, 79(1), doi: /.
Also, some women felt they were no longer worthy of the relationship Fenech and Thomson, To date, quantitative studies examining the influence of postpartum PTSD on satisfaction with the couple relationship are sparse. One study with 64 couples who completed questionnaires 9 weeks after childbirth found no cross-sectional association between PTSD symptoms and couple relationship satisfaction Ayers et al.
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However, this study was limited by a low response rate, a small sized sample, and a short follow-up period 9 weeks postpartum. Therefore, well-designed large-scale longitudinal studies examining the association between postpartum PTSD symptoms and subsequent couple relationship satisfaction are needed. Moreover, given such associations are found, studies examining potential mechanisms through which PTSD symptoms may influence couple relationship satisfaction are warranted.
Postpartum depression may play a role in such potential mechanisms, as postpartum PTSD may lead to increased depressive symptoms in the woman. Such symptoms, including lack of energy, disinterest in social life, and irritability may in turn reduce couple relationship satisfaction Zelkowitz and Milet, ; Wenzel et al.
Similarly, anxiety in the postpartum period may arise as a result of symptoms of postpartum PTSD such as intrusion and hyperarousal, thereby leading to reduced couple relationship quality McKenzie-McHarg et al. So far, research has only provided preliminary support for such potential mechanisms where maternal mental health problems mediate the association between postpartum PTSD symptoms and couple relationship satisfaction. More specifically, by examining the effect of postpartum PTSD symptoms and depression on the couple relationship and the parent-baby bond with a convenience sample, one study found that postpartum PTSD had no direct effect on the couple relationship, but the effect of PTSD on the couple relationship was fully mediated by symptoms of postpartum depression Parfitt and Ayers, Research is needed to provide a more detailed account of how factors such as depressive symptomatology may mediate the association between PTSD symptoms and couple relationship satisfaction.
When examining the association between postpartum PTSD and couple satisfaction, potential third variables that may be related to both postpartum PTSD and couple satisfaction have to be taken into account.
For example, couple relationship satisfaction is associated with maternal sociodemographic factors, such as age Hershkowitz et al. Regarding infant factors, temperament is related to maternal sensitivity and parenting, both of which are related to the couple relationship Lee, A difficult infant temperament has also been shown to be related to maternal PTSD symptoms after birth Garthus-Niegel et al. Thus, the present study includes maternal age, educational background, negative life events, and infant temperament as covariates in the analyses to control for the potential confounding effects of these variables.
An international group of researchers and clinicians from the UK and other European countries stated the need for quantitative research using prospective studies with large, representative samples to investigate the possible negative impact of postpartum PTSD on relationships McKenzie-McHarg et al. Therefore, this study that draws on data examining various risk factors and consequences of postpartum PTSD Garthus-Niegel et al. In particular, we aimed to test the following hypotheses: We hypothesized that postpartum PTSD will be prospectively associated with low couple relationship satisfaction, even when taking into account a variety of potential confounding variables.
We hypothesized that the effect of postpartum PTSD symptoms on couple relationship satisfaction will be mediated by postpartum depression symptoms. Recruitment took place from November to April Women were recruited for the study during their routine fetal ultrasound examination, which is performed at 17 weeks gestation, and were asked to complete questionnaires at 17 weeks gestation, 32 weeks gestation, 8 weeks postpartum, and 2 years postpartum. The number of eligible women dropped somewhat during the study time because some women had moved or were withdrawn from the study due to severe birth complications.
Detailed information regarding participation and drop out in the study has been published elsewhere Garthus-Niegel et al. Data from the birth record were electronically recorded by hospital staff, including socio-demographic and medical information about the woman, the delivery, and the child.
The Akershus Birth Cohort study obtained ethical approval from the Regional Committees for Medical and Health Research Ethics approval number Saand all participants provided written informed consent. The RS10 scale has good psychometric properties, high structural and predictive validity, and correlates 0. The sum score ranges from 10 to 40 and higher scores reflect a larger degree of couple relationship satisfaction.
The instrument is a self-rating scale that measures symptoms of intrusion seven items and avoidance eight items. The scale has four response categories with the following weightings: Sum scores of the overall scale were computed range 0—75where higher scores reflect a higher degree of post-traumatic stress.
Posttraumatic stress disorder and intimate relationship problems: a meta-analysis.
Participants were instructed to complete the scale in relation to their childbirth. The IES has been previously validated in postpartum women Olde et al.
The EPDS is a item self-rating scale designed to identify postnatal depression. However, it is comprized of distinct and correlated depression and anxiety subscales Ross et al. The scale has four response categories ranging from 0 to 3; thus, the total scores can range from 0 to Further, age at delivery and maternal education were obtained from the hospital birth records.
According to Norwegian definitions Haland and Glad,employment was defined as: Regarding PTSD symptoms prior to birth, the women in our study reported at pregnancy week 17 whether at any time in their life they had been involved in or had experienced a dramatic or terrifying event.
If this was the case, they reported whether they had suffered from eight potential symptoms related to that event during the last month.
Posttraumatic stress disorder and intimate relationship problems: a meta-analysis.
The symptoms were based on questions included in the Mini-International Neuropsychiatric Interview, which is designed for epidemiological studies and clinical trials.
We measured symptoms as follows: This resulted in a symptom score ranging from 0 no symptoms to 8 maximum number of symptoms. Adverse life events during the last 12 months were measured at pregnancy week 32 by seven selected items from existing life event scales Coddington, ; Swearingen and Cohen, The following life events were included: This scale assesses infant difficultness as perceived by the primary caregiver.
A robust weighted least squares estimator WLSMV was employed because some of the items included in the analyses i. First, we conducted a confirmatory factor analysis of the RS10 Scale, constructing a latent factor for couple relationship satisfaction. Likewise, a latent factor for postpartum PTSD was modeled by means of confirmatory factor analysis. Further, for the EPDS a second order confirmatory factor analysis was conducted, as the EPDS has been shown to have a bi-dimensional factor structure with a depression and an anxiety component Ross et al.
In addition, an overall EPDS factor was constructed, based on the two lower order latent factors.
As conducting confirmatory factor analyses for all scales would have led to an excessively complex model, we chose to construct latent variables only for the most important psychological variables, i. The remaining background variables were treated as manifest variables.
Correlation analyses were conducted to study the bivariate associations among all included variables. Further, all latent and manifest variables that were significantly related to couple relationship satisfaction were entered into a multivariate mediation model. Finally, in order to differentiate the distinct relationship of the depression and the anxiety component of the EPDS, we also estimated a multivariate mediation model with those two components separately, each being represented by their own latent factor.
We conducted mediation analyses to test whether or not the indirect effects involving the putative mediators were statistically significant Hayes, More specifically, standard errors of the mediation effects were estimated by the product of coefficients approach in a path analytic framework Hayes, As recommended in the literature Hayes,we estimated bias corrected standard errors of the mediation effects by means of bootstrapping based on 5, bootstrap samples.
As a considerable number of participants had dropped out during the course of the study Garthus-Niegel et al. More specifically, we included relevant socio-demographic and mental health variables i.
The results showed that women with higher education OR. Conversely, women with a high symptom load of depression OR 1.
Our final sample consisted of 2, women. Results Table 1 shows descriptive statistics for all variables. Mean maternal age at birth was Means and SDs of all study variables.
At 8 weeks postpartum, 2. The mean IES score was 7. Prevalence of likely depression was 7. Thus, results indicated low symptom burden for both postpartum PTSD and depression symptoms, as expected in a community sample such as the present one. Two years postpartum, the vast majority of women Table 2 shows intercorrelations among all study variables. As expected, most background variables significantly negatively predicted couple relationship satisfaction.
Intercorrelations between all included study variables. Table 3Model 1, displays results from structural equation models where postpartum PTSD symptoms and all background variables except maternal paid employment were included as predictors of couple relationship satisfaction.
Moreover, parity, age, prior PTSD symptoms, negative life events, and difficult infant temperament significantly predicted couple relationship satisfaction in the multiple model.
Results from structural equation models predicting couple relationship satisfaction.
Next, further analyses were conducted by including postpartum depression symptoms as additional predictor in the model see Table 3Model 2. The HPA axis that coordinates the hormonal response to stress,  which activates the LC-noradrenergic system, is implicated in the over-consolidation of memories that occurs in the aftermath of trauma. The amygdala is responsible for threat detection and the conditioned and unconditioned fear responses that are carried out as a response to a threat. Following war trauma, Swedish soldiers serving in Bosnia and Herzegovina with low pre-service salivary cortisol levels had a higher risk of reacting with PTSD symptoms, following war trauma, than soldiers with normal pre-service levels.
It is thought that the locus coeruleus-noradrenergic system mediates the over-consolidation of fear memory. High levels of cortisol reduce noradrenergic activity, and because people with PTSD tend to have reduced levels of cortisol, it has been proposed that individuals with PTSD cannot regulate the increased noradrenergic response to traumatic stress. Neuropeptide Y has been reported to reduce the release of norepinephrine and has been demonstrated to have anxiolytic properties in animal models.
Dopamine levels in a person with PTSD can help contribute to the symptoms associated. Low levels of dopamine can contribute to anhedoniaapathyimpaired attentionand motor deficits. Increased levels of dopamine can cause psychosisagitationand restlessness.
Hyperresponsiveness in the norepinephrine system can also be caused by continued exposure to high stress. Overactivation of norepinephrine receptors in the prefrontal cortex can be connected to the flashbacks and nightmares frequently experienced by those with PTSD. A decrease in other norepinephrine functions awareness of the current environment prevents the memory mechanisms in the brain from processing that the experience, and emotions the person is experiencing during a flashback are not associated with the current environment.
A review showed no clear relationship between cortisol levels and PTSD. The majority of reports indicate people with PTSD have elevated levels of corticotropin-releasing hormonelower basal cortisol levels, and enhanced negative feedback suppression of the HPA axis by dexamethasone. During high stress, the hippocampuswhich is associated with placing memories in the correct context of space and time and memory recall, is suppressed.
According to one theory this suppression may be the cause of the flashbacks that can affect people with PTSD. When someone with PTSD undergoes stimuli similar to the traumatic event, the body perceives the event as occurring again because the memory was never properly recorded in the person's memory. The BLA activates the central nucleus CeA of the amygdala, which elaborates the fear response, including behavioral response to threat and elevated startle response.
Descending inhibitory inputs from the medial prefrontal cortex mPFC regulate the transmission from the BLA to the CeA, which is hypothesized to play a role in the extinction of conditioned fear responses.
Comparing dorsal roughly the CeA and ventral roughly the BLA clusters, hyperactivity is more robust in the ventral cluster, while hypoactivity is evident in the dorsal cluster. The distinction may explain the blunted emotions in PTSD via desensitization in the CeA as well as the fear related component. Any stressor can result in a diagnosis of adjustment disorder and it is an appropriate diagnosis for a stressor and a symptom pattern that does not meet the criteria for PTSD.
The symptom pattern for acute stress disorder must occur and be resolved within four weeks of the trauma. If it lasts longer, and the symptom pattern fits that characteristic of PTSD, the diagnosis may be changed. Traumatic memories Modest benefits have been seen from early access to cognitive behavioral therapy. Critical incident stress management has been suggested as a means of preventing PTSD, but subsequent studies suggest the likelihood of its producing negative outcomes.
Risk-targeted interventions are those that attempt to mitigate specific formative information or events.