Perinatal Post Traumatic Stress Disorder Questionnaire-II (PPQ-II): adaptation, validity, and reliability study

Objective: The aim of this study is to adapt the Perinatal Post Traumatic Stress Disorder Questionnaire- II (PPQ-II) and determine the psychometric properties of this scale. Method: The study was conducted with two different samples consisting of mothers who give full-term and preterm birth. To investigate the factor structure and conduct confirmatory factor analysis, the first sample was composed of 194 women between the ages of 18-43 (Mean=30.12, standard deviation [SD]=4.96). The second sample in which confirmatory factor analysis was conducted consisted of 238 women between the ages of 19-43 (Mean=30.33, SD=4.00). Depression Anxiety Stress Scale and Connor-Davidson Resilience Scale were used in this study as well as PPQ-II. Results: The exploratory and confirmatory factor analysis revealed a two-factor structure named “Intrusive Thoughts and Avoidance” and “Hyperarousal and Numbness Responses”. The model obtained by confirmatory factor analysis demonstrated acceptable goodness of fit values and the questionnaire was found to have satisfactory reliability and validity values. Conclusion: PPQ-II could be considered as a valid and reliable scale which could be used in maternal mental health studies conducted in Turkey.

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1. Dekel S, Stuebe C, Dishy G. Childbirth induced posttraumatic stress syndrome: a systematic review of prevalence and risk factors. Front Psychol 2017; 8:560.

2. Bydlowski, M, Raoul-Duval A. A psychological manifestation unknown within paediatrics: The posttraumatic obstetric neurosis. Perspect Psychiatry 1978; 4:321-328.

3. Beech BA, Robinson J. Nightmares following childbirth. Br J Psychiatry 1985; 147:586.

4. Arizmendi TG, Affonso DD. Stressful events related to pregnancy and postpartum. J Psychosom Res 1987; 31:743-756.

5. Stolte K. Postpartum ‘missing pieces’: sequela of a passing obstetrical era? Birth 1986; 13:100-103.

6. Söderquist J, Wijma K, Wijma B. Traumatic stress after childbirth: the role of obstetric variables. J Psychosom Obstet Gynaecol 2002; 23:31-39.

7. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fifth edition. Washington DC: American Psychological Association; 2013.

8. Yehuda R. Post-traumatic stress disorder. N Engl J Med 2002; 346:108-114.

9. Ayers S, Jessop D, Pike A, Parfitt Y, Ford E. The role of adult attachment style, birth intervention and support in posttraumatic stress after childbirth: a prospective study. J Affect Disord 2014; 155:295-298.

10. Alcorn KL, O’Donovan A, Patrick JC, Creedy D, Devilly GJ. A prospective longitudinal study of the prevalence of posttraumatic stress disorder resulting from childbirth events. Psychol Med 2010; 40:1849-1859.

11. Ayers S, Pickering AD. Do women get posttraumatic stress disorder as a result of childbirth? A prospective study of incidence. Birth 2001; 28:111-118.

12. Beck CT, Gable RK, Sakala C, Declercq ER. Posttraumatic stress disorder in new mothers: results from a two-stage U.S. national survey. Birth 2011; 38:216-227.

13. Grekin R, O’Hara MW. Prevalence and risk factors of postpartum posttraumatic stress disorder: a meta-analysis. Clin Psychol Rev 2014; 34:389-401.

14. Schwab W, Marth C, Bergant AM. Post-traumatic stress disorder post partum: the impact of birth on the prevalence of posttraumatic stress disorder (PTSD) in multiparous women. Geburtshilfe Frauenheilkd 2012; 72:56-63.

15. Beck CT, Woynar J. Posttraumatic Stress in Mothers While Their Preterm Infants Are in the Newborn Intensive Care Unit: A Mixed Research Synthesis. ANS Adv Nurs Sci 2017; 40:337-355.

16. Helle N, Barkmann C, Ehrhardt S, Bindt C. Postpartum posttraumatic and acute stress in mothers and fathers of infants with very low birth weight: Cross-sectional results from a controlled multicenter cohort study. J Affect Disord 2018;235:467-473.

17. Shaw JG, Asch SM, Kimerling R, Frayne SM, Shaw KA, Phibbs CS. Posttraumatic stress disorder and risk of spontaneous preterm birth. Obstet Gynecol 2014; 124:1111-1119.

18. Wenzel A, Haugen EN, Jackson LC, Brendle JR. Anxiety symptoms and disorders at eight weeks postpartum. J Anxiety Disord 2005; 19:295-311.

19. Yildiz PD, Ayers S, Phillips L. The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis. J Affect Disord 2017; 208:634-645.

20. Ahlund S, Clarke P, Hill J, Thalange NK. Post-traumatic stress symptoms in mothers of very low birth weight infants 2-3 years post-partum. Arch Womens Ment Health 2009; 12:261-264.

21. Brandon DH, Tully KP, Silva SG, Malcolm WF, Murtha AP, Turner BS, et al. Emotional responses of mothers of late-preterm and term infants. J Obstet Gynecol Neonatal Nurs 2011; 40:719-731.

22. Feeley N, Zelkowitz P, Cormier C, Charbonneau L, Lacroix A, Papageorgiou A. Posttraumatic stress among mothers of very low birthweight infants at 6 months after discharge from the neonatal intensive care unit. Appl Nurs Res 2011; 24:114-117.

23. Ghorbani M, Dolatian M, Shams J, Alavi-Majd H, Tavakolian S. Factors associated with posttraumatic stress disorder and its coping styles in parents of preterm and full-term infants. Glob J Health Sci 2014; 6:65-73.

24. Habersaat S, Borghini A, Nessi J, Pierrehumbert B, Forcada-Guex M, Ansermet F, et al. Posttraumatic stress symptoms and cortisol regulation in mothers of very preterm infants. Stress Health 2014; 30:134-141.

25. Ayers S, Eagle A, Waring H. The effects of childbirth-related post-traumatic stress disorder on women and their relationships: a qualitative study. Psychol Health Med 2006; 11:389-398.

26. Dekel S, Thiel F, Dishy G, Ashenfarb AL. Is childbirth-induced PTSD associated with low maternal attachment? Arch Womens Ment Health 2019; 22:119-122.

27. Hairston IS, Handelzalts JE, Assis C, Kovo M. Postpartum bonding diffıculties and adult attachment styles: the mediatıng role of postpartum depression and childbirth-related PTSD. Infant Ment Health J 2018; 39:198-208.

28. Petit AC, Eutrope J, Thierry A, Bednarek N, Aupetit L, Saad S, et al. Mother’s Emotional and Posttraumatic Reactions after a Preterm Birth: the Mother-Infant Interaction Is at Stake 12 Months after Birth. PLoS One 2016; 11:e0151091.

29. Garthus-Niegel S, Ayers S, Martini J, von Soest T, Eberhard-Gran M. The impact of postpartum post-traumatic stress disorder symptoms on child development: a population-based, 2-year follow-up study. Psychol Med 2017; 47:161-170.

30. Ayers S, Wright DB, Thornton A. Development of a measure of postpartum PTSD: the city birth trauma scale. Front Psychiatry 2018; 9:409.

31. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fourth edition. text revision (DSMIV-TR) Washington DC: American Psychological Association; 2000.

32. Weathers FW. Redefining posttraumatic stress disorder for DSM5. Curr Opin Psychol 2017; 14:122-126.

33. Armour C, Műllerová J, Elhai JD. A systematic literature review of PTSD’s latent structure in the Diagnostic and Statistical Manual of Mental Disorders: DSM-IV to DSM-5. Clin Psychol Rev 2016; 44:60-74.

34. Boorman RJ, Devilly GJ, Gamble J, Creedy DK, Fenwick J. Childbirth and criteria for traumatic events. Midwifery 2014; 30:255-261.

35. Zerach G, Elsayag A, Shefer S, Gabis L. Long-term maternal stress and post-traumatic stress symptoms related to developmental outcome of extremely premature infants. Stress Health 2015; 31:204-213.

36. Callahan JL, Borja SE, Hynan MT. Modification of the Perinatal PTSD Questionnaire to enhance clinical utility. J Perinatol 2006; 26:533-539.

37. DeMier RL, Hynan MT, Hatfield RF, Varner MW, Harris HB, Manniello RL. A measurement model of perinatal stressors: identifying risk for postnatal emotional distress in mothers of high-risk infants. J Clin Psychol 2000; 56:89-100.

38. Quinnell FA, Hynan MT. Convergent and discriminant validity of the perinatal PTSD questionnaire (PPQ): a preliminary study. J Trauma Stress 1999; 12:193-199.

39. Dikmen-Yildiz P, Ayers S, Phillips L. Screening for birth-related PTSD: psychometric properties of the Turkish version of the Posttraumatic Diagnostic Scale in postpartum women in Turkey. Eur J Psychotraumatol 2017; 8:1306414.

40. Dikmen-Yildiz P, Ayers S, Phillips L. Depression, anxiety, PTSD and comorbidity in perinatal women in Turkey: A longitudinal population-based study. Midwifery 2017; 55:29-37.

41. -Yildiz P, Ayers S, Phillips L. Factors associated with posttraumatic stress symptoms (PTSS) 4-6 weeks and 6 months after birth: A longitudinal population-based study. J Affect Disord 2017; 221:238-245.

42. Dikmen-Yildiz P, Ayers S, Phillips L. Longitudinal trajectories of post-traumatic stress disorder (PTSD) after birth and associated risk factors. J Affect Disord 2018; 229:377-385.

43. Isbir GG, Inci F, Bektas M, Dikmen Yildiz P, Ayers S. Risk factors associated with post-traumatic stress symptoms following childbirth in Turkey. Midwifery 2016; 41:96-103.

44. Gokce Isbir G, Inci F, Onal H, Yildiz PD. The effects of antenatal education on fear of childbirth, maternal self-efficacy and post-traumatic stress disorder (PTSD) symptoms following childbirth: an experimental study. Appl Nurs Res 2016; 32:227- 232.

45. De Schepper S, Vercauteren T, Tersago J, Jacquemyn Y, Raes F, Franck E. Post-Traumatic Stress Disorder after childbirth and the influence of maternity team care during labour and birth: A cohort study. Midwifery 2016; 32:87-92.

46. Kersting A, Dorsch M, Wesselmann U, Lüdorff K, Witthaut J, Ohrmann P, et al. Maternal posttraumatic stress response after the birth of a very low-birth-weight infant. J Psychosom Res 2004; 57:473-476.

47. Ionio C, Di Blasio P. Post-traumatic stress symptoms after childbirth and early mother-child interactions: an exploratory study. J Reprod Infant Psychol 2014; 32:163-181.

48. Forcada-Guex M, Borghini A, Pierrehumbert B, Ansermet F, Muller-Nix C. Prematurity, maternal posttraumatic stress and consequences on the mother-infant relationship. Early Hum Dev 2011; 87:21-26.

49. Muller-Nix C, Forcada-Guex M, Pierrehumbert B, Jaunin L, Borghini A, Ansermet F. Prematurity, maternal stress and mother-child interactions. Early Hum Dev 2004; 79:145-158.

50. Pierrehumbert B, Nicole A, Muller-Nix C, Forcada-Guex M, Ansermet F. Parental post-traumatic reactions after premature birth: implications for sleeping and eating problems in the infant. Arch Dis Child Fetal Neonatal Ed 2003; 88:F400-404.

51. DeMier RL, Hynan MT, Harris HB, Manniello RL. Perinatal stressors as predictors of symptoms of posttraumatic stress in mothers of infants at high risk. J Perinatol 1996; 16:276-280.

52. Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995; 33:335-343.

53. Akin A, Cetin B. The Depression Anxiety and Stress Scale (DASS): The study of validity and reliability. Educational Sciences: Theory and Practice 2007; 7:260-268.

54. Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety 2003; 18:76-82.

55. Karaırmak O. Establishing the psychometric qualities of the Connor-Davidson Resilience Scale (CD-RISC) using exploratory and confirmatory factor analysis in a trauma survivor sample. Psychiatry Res 2010; 179:350-356.

56. Eekhout I, de Vet HC, Twisk JW, Brand JP, de Boer MR, Heymans MW. Missing data in a multi-item instrument were best handled by multiple imputation at the item score level. J Clin Epidemiol 2014; 67:335-342.

57. Field AP. Discovering statistics using IBM SPSS Statistics: And sex and drugs and rock ‘n’roll. Fouth ed., London: Sage, 2013.

58. George D, Mallery P. SPSS for Windows step by step. A Simple study guide and reference Tenth ed., GEN, Boston, MA: Pearson Education, 2010.

59. Kline RB. Principles and practice of structural equation modeling. Fourth ed., NY: Guilford Press, 2015.

60. Byrne BM. Testing for the factorial validity of a theoretical construct. Structural equation modeling with AMOS: Basic concepts, applications, and programming. Second ed., NY: Routledge, 2010.

61. Byrne BM. Structural equation modeling with Mplus: Basic concepts, applications, and programming. NY: Routledge, 2011.

62. Marsh HW, Hau KT, Wen Z. In search of golden rules: Comment on hypothesis-testing approaches to setting cutoff values for fit indexes and dangers in overgeneralizing Hu and Bentler’s (1999) findings. Struct Equ Modeling 2004; 11:320-341.

63. Wikipedia. Bayesian information criterion. https:// en.wikipedia.org/w/index.php?title=Bayesian_information_ criterion&oldid=496433604. Accessed September 21, 2020.

64. Worthington RL, Whittaker TA. Scale development research: A content analysis and recommendations for best practices. Couns Psychol 2006; 34:806-838.

65. Tabachnick BG, Fidell LS. Using multivariate statistics. Sixth ed., Upper Saddle River NJ: Pearson, 2013.

66. Nunnally JC, Bernstein IH. Psychometric theory. Third ed., New York, McGraw-Hill, 1994.

67. Di Blasio P, Ionio C, Confalonieri E. Symptoms of postpartum PTSD and expressive writing: A prospective study. J Prenat Perinat Psychol Health 2009; 24:49-65.

68. Callahan JL, Hynan MT. Identifying mothers at risk for postnatal emotional distress: further evidence for the validity of the perinatal posttraumatic stress disorder questionnaire. J Perinatol 2002; 22:448-454.