Status And Influencing Factors Of Postpartum Post-traumatic Stress Disorder Based On Potential Profile Analysis

Background: It was generally believed that childbirth was a natural biological instinct of women,and it was a happy thing for them,which usually caused positive psychological reaction.However,it neglected that childbirth as a special trauma,which may lead to postpartum depression,postpartum mental disorders and other psychological problems if handled improperly.In recent years,paying attention to the psychosocial needs of parturient from the perspective of childbirth trauma has become a hot topic of research in China and abroad,and postpartum post-traumatic stress disorder（PP-PTSD）has received more and more clinical attention.As a typical representative of maternal psychological disorders in traumatic childbirth,PP-PTSD could damage the physical and mental health and family social functions of parturient and infants,and helping parturient cope with PP-PTSD and improve their mental health level has become the focus of research.China has a large parturient base,the introduction of the "three-child policy" and the increase of the number of high-risk parturient make the number of parturient at risk of PP-PTSD continue increasing,it’s of great significance to pay attention to the PP-PTSD of Chinese parturient.Objective: The purpose of this study was to analyze the current situation and influencing factors of maternal PP-PTSD in China,and to study the potential classification characteristics of maternal PP-PTSD.On this basis,the relationship between maternal PP-PTSD,psychological resilience and intimacy satisfaction（IRS）was explored.The role of IRS on the relationship between maternal resilience and PPPTSD was analyzed through the mediation effect,in order to reveal the impact of resilience on PP-PTSD and to provide ideas and basis for constructing maternal PPPTSD intervention programs based on resilience.Methods: In this study,convenience sampling method was used to conduct a cross-sectional survey of parturient in 3 grade III class A hospitals,1 grade II Class A hospital,1 community health service center and 1 postpartum care center in Shiyan city,Hubei Province from March 2021 to June 2021.A total of 530 valid questionnaires were collected using the self-designed General demographic data questionnaire,Intimacy Index Quality Scale（QRI）,Connor-Davidson Resilience Scale（CD-RISC-10）and The City Birth Trauma Scale（Bi TS）.Harman single-factor test was used to test the common method deviation of the study data,Mplus 8.7 was used to fit the potential categories of maternal PP-PTSD,SPSS25.0 was used to analyze the presentation characteristics of different potential categories,and a three-step regression method was used to establish the mediation model.Finally,Bootstrap method in PROCESS plug-in was used to test the mediating effect of IRS in maternal couples on psychological resilience and PP-PTSD.Specific analysis methods include: descriptive analysis,T test,one-way analysis of variance,Chi-square test,correlation analysis,potential profile analysis,multiple linear regression analysis and Bootstrap test.Results: 1.The relationship between variables in this study is less affected by common method bias.2.Analysis of the status and influencing factors of maternal PP-PTSD: the maternal Bi TS score was 0-57（14.97±12.34）,and the total score of childbirth-related symptoms dimension was（6.13±6.3）（including intrusive recall（3.59±3.51）and avoidance symptoms（2.54±3.32））,the general symptom dimension total score was（8.84±7.4）（including negative cognition and emotion（4.04±3.98）and hyperarousal（4.80±3.93））.The score of avoidance symptom was the lowest and hypervigilance symptom was the highest in specific symptom classification.The score of psychological resilience was 7~40（25.71 ± 6.76）and the score of IRS was 20~42（32.29 ± 4.98）.Multiple regression showed that different marital status,marriage and childbearing interval,relationship with the second main caregiver of the child,single / multiple pregnancy,pregnancy mode,delivery times,whether the newborn was sent to ICU for treatment,psychological resilience and IRS are the influencing factors of parturient PP-PTSD,which can jointly explain parturient PP-PTSD 57.5% variation.3.Analysis of the influencing factors of PP-PTSD in different potential types of parturient: the maternal PP-PTSD in this study was divided into three potential categories: "low PP-PTSD level type"（59.3%）,"medium PP-PTSD level type"（31.1%） and "high PP-PTSD level type"（9.7%）.In "low-level" parturient,psychological resilience,IRS and whether they experienced major traumatic events could explain 19.9% of the variation of maternal PP-PTSD;in "medium PP-PTSD level" parturient,psychological resilience,newborns sent ICU and IRS could explain 21.8% of the variation of maternal PP-PTSD;in "high-level" mothers,IRS,whether to have an only child,marital status and psychological resilience could explain the 59.0% variation of maternal PP-PTSD.4.Analysis of the relationship between maternal PP-PTSD and psychological resilience,and couple IRS: Comparing the overall and three potential categories of maternal PP-PTSD,psychological resilience,and IRS scores found that there were differences in the scores between different potential categories.And maternal PP-PTSD,psychological resilience and IRS all have pairwise correlations,but the specific correlations are different.The mediation effect model and Bootstrap test showed that,in general and among the three categories of "low","medium",and "high",psychological resilience and IRS could negatively predict maternal PP-PTSD level,and psychological resilience can further reduce maternal PP-PTSD levels through IRS.And IRS played a partial mediating role between psychological resilience and PP-PTSD,with the mediating effect accounting for 16%,9.15%,9.98% and 29.73% of the total effect,respectively.Conclusion: 1.The Chinese version of Bi TS has shown good applicability in the investigation and study of Chinese parturient,and this measurement tool has laid a foundation for the extensive research on PP-PTSD in China.2.The average level of maternal PP-PTSD in China was higher than that of similar populations abroad,and the level of general symptoms was significantly higher than that of childbirth-related symptoms.In other words,the predictive effect of general symptoms on the level of maternal PP-PTSD in China parturient was more significant,suggesting that paying attention to and treating general maternal symptoms can effectively reduce maternal PP-PTSD levels.3.The classification characteristics of maternal PP-PTSD were obvious,and can be divided into three potential categories: "low-level type","medium-level type" and "high-level type".The "low-level type" accounted for the largest proportion of parturient in China,while "high-level type" accounted for the smallest.4.Maternal IRS partially mediates the relationship between psychological resilienceand PP-PTSD,and the mediating role of IRS in maternal psychological resilience and PP-PTSD gradually increased with the increase of PP-PTSD level.It was suggested that parturient with higher levels of PP-PTSD should pay more attention to IRS interventions.