Jeff Patrick

A prospective longitudinal study of the prevalence of post-traumatic stress disorder resulting from childbirth events

BACKGROUND Childbirth has been linked to postpartum impairment. However, controversy exists regarding the onset and prevalence of post-traumatic stress disorder (PTSD) after childbirth, with seminal studies being limited by methodological issues. This longitudinal prospective study examined the prevalence of PTSD following childbirth in a large sample while controlling for pre-existing PTSD and affective symptomatology. METHOD Pregnant women in their third trimester were recruited over a 12-month period and interviewed to identify PTSD and anxiety and depressive symptoms during the last trimester of pregnancy, 4-6 weeks postpartum, 12 weeks postpartum and 24 weeks postpartum. RESULTS Of the 1067 women approached, 933 were recruited into the study. In total, 866 (93%) were retained to 4-6 weeks, 826 (89%) were retained to 12 weeks and 776 (83%) were retained to 24 weeks. Results indicated that, uncontrolled, 3.6% of women met PTSD criteria at 4-6 weeks postpartum, 6.3% at 12 weeks postpartum and 5.8% at 24 weeks postpartum. When controlling for PTSD and partial PTSD due to previous traumatic events as well as clinically significant anxiety and depression during pregnancy, PTSD rates were less at 1.2% at 4-6 weeks, 3.1% at 12 weeks and 3.1% at 24 weeks postpartum. CONCLUSIONS This is the first study to demonstrate the occurrence of full criteria PTSD resulting from childbirth after controlling for pre-existing PTSD and partial PTSD and clinically significant depression and anxiety in pregnancy. The findings indicate that PTSD can result from a traumatic birth experience, though this is not the normative response.

Depression Anxiety Stress Scale: Is It Valid for Children and Adolescents?

The Depression Anxiety Stress Scale (Lovibond & Lovibond, 1995) is used to assess the severity of symptoms in child and adolescent samples although its validity in these populations has not been demonstrated. The authors assessed the latent structure of the 21-item version of the scale in samples of 425 and 285 children and adolescents on two occasions, one year apart. On each occasion, parallel analyses suggested that only one component should be extracted, indicating that the test does not differentiate depression, anxiety, and stress in children and adolescents. The results provide additional evidence that adult models of depression do not describe the experience of depression in children and adolescents.

The Relevance of Community Sentiments to Australian Rural Youths’ Intention to Stay in Their Home Communities

This study explores whether community sentiment factors can mediate structural disadvantage factors in rural youths’ intentions to stay in their home communities. In total, 3,023 Australians ages 13 to 18 years responded to items assessing community sentiment (belonging, sense of community, and social support) and subjective quality of life. Structural disadvantage was represented by population size. Participants responded to “If I could get a job here or go to University/College here, I would choose to stay in this town for the foreseeable future.” Findings indicate all factors had a positive relationship with intention to stay; however, only belonging partially mediates the effect of size of community. The combined effects for all factors account for 19% more of the variability in intention to stay than the size of community alone. Discussion considers how focus on structural factors alone restricts the understanding of push-pull dynamics facing rural youth.

The validity of psychiatric diagnoses: The case of ‘specific’ developmental disorders

We tested whether developmental coordination disorder (DCD) and mixed receptive expressive language disorder (RELD) are valid diagnoses by assessing whether they are separated from each other, from other childhood disorders, and from normality by natural boundaries termed zones of rarity. Standardized measures of intelligence, language, motor skills, social cognition, and executive functioning were administered to children with DCD (n = 22), RELD (n = 30), autistic disorder (n = 30), mental retardation (n = 24), attention deficit/hyperactivity disorder (n = 53) and to a representative sample of children (n = 449). Discriminant function scores were used to test whether there were zones of rarity between the DCD, RELD, and other groups. DCD and RELD were reliably distinguishable only from the mental retardation group. Cluster and latent class analyses both resulted in only two clusters or classes being identified, one consisting mainly of typical children and the other of children with a disorder. Fifty percent of children in the DCD group and 20% in the RELD group were clustered with typical children. There was no evidence of zones of rarity between disorders. Rather, with the exception of mental retardation, the results imply there are no natural boundaries between disorders or between disorders and normality.

How uniform is the structure of ability across childhood

The DSM-IV implicitly assumes that development is uniform across ability domains, which implies that relationships between ability measures do not differ across development. We assessed whether correlations between measures of nine ability constructs differed across samples of children aged 3 – 5 (n = 117), 6 – 8 (n = 116), 9 – 11 (n = 124) and 12 – 14 years (n = 92). LISREL analyses show that correlations in each age group differ from those of each other age group. Parallel analyses indicate that the latent structure of ability differs across age groups. We conclude that shared maturational processes, including changes in the connectivity of neural systems, are responsible for decreasingly and increasingly strong relationships between some ability measures.

The economic value of psychology in Australia: 2001

The purpose of this paper was to update the Guldberg & Sivaciyan (1995) estimates of the value of psychology based on 1991 figures. In addition, this paper expands the scope of their work by including comparisons of other related professional groups (those with tertiary training in psychiatry, mental health nursing, social work, counselling, occupational therapy and human resources). Economic modelling indicated that psychology contributes

PTSD due to childbirth stands at between 3.1% (adjusted) and 5.8% (unadjusted)

8.6 billion to the National economy – some 500% more than in 1991, and more than all other related professional groups combined. However, psychology incomes in most sectors have marginally decreased in real terms, and still lag 9.2% behind related professionals. The number of individuals trained in psychology has also risen dramatically to at least 37 978. Many of these individuals (17 364) have only a bachelor degree, and experience a higher rate of unemployment than both their higher qualified peers in psychology, and the national average for individuals with the same level of qualification. The ongoing lack of Federal funding for professional higher degrees, and the training guidelines of the Australian Psychological Society are likely to lead to rises in the cost of postgraduate education in the coming years. There is nonetheless a substantial economic advantage to students undertaking professional higher degrees in psychology. The implications for the profession of psychology are discussed.

Improving mental health outcomes assessment with the Mental Health Inventory-21

Alcorn et al. (2010) was a prospective longitudinal study of the prevalence of post-traumatic Stress Disorder (PTSD) resulting from childbirth events. One of the features of this work was not only to estimate the absolute prevalence of PTSD, but to adjust these estimates for pre-existing PTSD symptomatology and other more common postnatal symptomatology, such as depression and anxiety. It is of course possible if not probable, that these affective expressions are comorbid or predominantly represent the same underlying post-traumatic sequelae.

Predicting posttraumatic stress disorder after childbirth

Objective There is a growing consensus that mental health should be conceptualised as a complete state that considers both illness and well‐being components. In Australian mental health services, the Mental Health Inventory (MHI) is the only one of the three currently used consumer outcome measures that includes this broader perspective. However, the MHI has been criticised for its length, and variable factor structure. In order to improve the clinical utility of the MHI, a reliability and validity study of the MHI was undertaken. Method The original 38‐item version of the MHI was administered to an Australian adult community sample (n = 616), along with two other consumer outcome measures (BASIS‐32 and Kessler‐10), a measure of psychological distress (DASS‐21) and a measure of well‐being (Satisfaction with Life Scale). Results Parallel analysis did not support the original factor structure of the MHI. The data indicated a correlated three‐factor structure, measuring psychological distress, emotional well‐being, and hopelessness. Seventeen items were deleted due to split loadings > .3, producing a shorter 21‐item scale. New simplified additive scoring rules were also developed to support the practical utility of the scale. Conclusion Research, clinical practice and consumer feedback consistently highlight the need for a balanced assessment approach to mental health, which considers not only illness symptomatology, but also the characteristics of well‐being that support recovery. Use of the three subscales of the MHI‐21 would support a complete state assessment of mental health outcomes.