Coping Styles Associated with Post-Traumatic Stress and Depression Symptoms Following Childbirth in Croatian Women

Abstract

Childbirth is a normative event in a woman's life and is considered as a positive event. However, one in three women perceive childbirth as a physical threat to themselves or their new-born and 3% of women develop posttraumatic stress disorder (PTSD) following childbirth. Poor coping strategies have been associated with PTSD following childbirth. However, previous studies mainly utilised unidimensional measures of coping strategies, therefore, it remains to be investigated which specific dimensions of coping are more predictive of PTSD after childbirth. The aims of this study were to explore whether women in Croatia report PTSD symptoms following childbirth, and how different coping styles were related to PTSD and depression symptoms. Women (N = 160) who gave birth in the last two years, completed an online questionnaire measuring PTSD symptoms (Impact of Event Scale – IES), postnatal depression symptoms (Edinburgh Postnatal Depression Scale – EPDS) and coping styles (Brief Cope). In this sample, 1.9% reported severe PTSD symptoms following childbirth and 21.9% reported depression symptoms. Many women (66.7%) with PTSD symptoms reported depression symptoms. On the other hand, 28.6% of women with depression symptoms also reported PTSD symptoms, showing that there is a higher co-morbidity of PTSD and depression than vice versa. Avoidant coping styles, specifically, denial and self-blame were positively correlated with both PTSD and depression symptoms. Moreover, of avoidant coping styles, behavioural disengagement was positively correlated with PTSD symptoms only, while self-distraction was positively correlated with depression symptoms only. Also, lower levels of planning and higher levels of emotional support were related to higher levels of depression. However, after controlling for postnatal psychopathology symptoms, coping styles were not significant predictors of PTSD symptoms, but self-blame was a significant predictor of depression symptoms. Psychopathological symptoms following childbirth are reported by Croatian women and are related to coping styles. The avoidant coping style, self-blame, is particularly associated with depression symptoms. Future studies should explore predictors of postpartum PTSD in Croatian women in more representative samples during pregnancy and with the follow-up after childbirth. Also, screening for postnatal psychopathological symptoms should be performed both for depression and PTSD symptoms.