Research
A Quasi‐experimental Outcomes Analysis of a Psychoeducation Intervention for Pregnant Women with Abuse‐related Posttraumatic Stress

https://doi.org/10.1111/1552-6909.12312Get rights and content

ABSTRACT

Objective

To test the effectiveness of a trauma‐specific, psychoeducational intervention for pregnant women with a history of childhood maltreatment on six intrapartum and postpartum psychological outcomes.

Design

Quasi‐experimental study comparing women from a single‐group, pretest–posttest pilot intervention study with women matched from a prospective observational study.

Setting

Rural and university‐based prenatal clinics.

Participants

Pregnant women entered the study by responding to an advertisement or by referral from a maternity care provider. Women could take part whether or not they met posttraumatic stress disorder diagnostic criteria. Outcomes data exist for 17 pilot intervention study participants and 43 matched observational study participants.

Interventions

Participants in the observational study received usual care. Participants in the pilot intervention study received usual care plus the intervention, a fully manualized, self‐study program supported by weekly phone tutoring sessions with a health professional.

Main Outcome Measures

The National Women's Study PTSD Module, the Peritraumatic Dissociation Experience Questionnaire, the Perception of Care Questionnaire, the Postpartum Depression Screening Scale, the Postpartum Bonding Questionnaire, and a semantic differential appraisal of the labor experience.

Results

Participants in the intervention study had better scores on all measures. Differences in means between participants in the intervention study and participants in the observational study equated to medium effect sized for dissociation during labor, rating of labor experience, and perception of care in labor and small effect sizes for postpartum posttraumatic stress disorder (PTSD) symptoms, postpartum depression symptoms, and motherinfant bonding.

Conclusion

This trauma‐specific intervention reaches and benefits pregnant women with a history of childhood maltreatment.

Section snippets

Methods

We compared women from a single‐arm open pilot study who participated in the SMC psychoeducational intervention with women who did not receive the program, matched from a prospective observational study, known as the STACY Project, conducted by the same team. Eligible women in both studies were age 18 or older, initiating prenatal care at fewer than 28 completed weeks gestation, and able to speak English without an interpreter. Institutional Ethics Review Boards approved both studies, and

Results

Descriptive analysis of the outcome variable scales indicated that all distributions approximated normal except for the PDEQ score, which was strongly skewed with a mode of reporting no symptoms. Assumptions for parametric testing of the PDEQ were verified by a normal distribution in the error variance, using standardized residuals in a linear regression with PTSD symptoms as a predictor.

Discussion

This study was a preliminary assessment of the novel, psychoeducational SMC program, which focuses on management of PTSD symptoms in pregnant women. We specifically examined the SMC program's effect on the labor, birth, and postpartum experiences of participants. The quasi‐experimental method employed a systematically collected data set to provide a matched comparison sample to assess effect sizes on standardized assessments of six outcomes of interest. The study has a number of strengths,

Acknowledgement

Supported by Blue Cross and Blue Shield Foundation of Michigan and National Institutes of Health, National Institute for Nursing Research grant NR008767. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institutes of Health.

Heather Rowe, BSc (Hons), PhD, is a senior research fellow, Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

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    Heather Rowe, BSc (Hons), PhD, is a senior research fellow, Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

    Mickey Sperlich, MA, MSW, CPM, is a doctoral student, School of Social Work, Wayne State University, Detroit, MI.

    Heather Cameron, MPH, is a research assistant, Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI.

    Julia S. Seng, PhD, CNM, FAAN, is an associate professor in the School of Nursing, Institute for Research on Women and Gender, Department of Obstetrics & Gynecology and Department of Women's Studies, University of Michigan, Ann Arbor, MI.

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