Post-traumatic stress disorder and postpartum depression and their reported association with recent labor and delivery: a questionnaire survey cohort.

BACKGROUND: We aimed to investigate the index traumatic event associated with post-traumatic stress disorder (PTSD) and evaluate the timing of the onset of symptoms in relation to the recent delivery. METHODS: Questionnaire study regarding prior exposure to traumatic events, PTSD, postpartum depression (PPD) and fear of childbirth among women two to 12 months postpartum, recruited via targeted internet sites. RESULTS: Questionnaires were completed by 143 women, with PPD reported by 22 (15.4%), probable PTSD by 11 (7.7%), and fear of childbirth by 14 (9.8%). Overall, 97 (67.8%) women reported a prior traumatic event: 16 (16.5%) reported the recent delivery to be the worst traumatic event and that symptoms began subsequent to this delivery; 17 (17.5%) reported the worst traumatic event was not the recent delivery but symptoms had started postpartum. Significantly higher symptom levels suggestive of PTSD and PPD were found in women whose trauma event was not delivery, yet symptoms started postpartum. Women whose traumatic event pre-dated the delivery also showed significantly higher symptom levels of PTSD. More than half of those describing PTSD related to the recent delivery presented with clinically relevant levels of fear of childbirth, compared with less than a third of women whose PTSD was related to a different event. CONCLUSION: PTSD identified postpartum may not be linked to the recent delivery and often pre-dates it. Future studies should identify the trigger traumatic event responsible for PTSD symptoms, to enable a more accurate picture of the reasons for PTSD and fear of childbirth.

Predictors of chronic post-traumatic stress disorder. A prospective study.

BACKGROUND: Most individuals who, shortly after trauma, express symptoms of post-traumatic stress disorder (PTSD) recover within one year of their traumatic experiences. In contrast, those who remain ill for one year rarely recover completely. The early identification of the latter is, therefore, very important. AIMS: To prospectively evaluate predictors of PTSD at four months and one year. METHOD: We followed 236 trauma survivors recruited from admissions to a general hospital's emergency room for four months, at which point 41 (17.4%) met diagnostic criteria for PTSD. Twenty-three of these individuals, and 39 individuals without PTSD at four months, were assessed again at one year. RESULTS: Depressive symptoms were the best predictors of PTSD at both time points. Intrusive symptoms and peri-traumatic dissociation were better at predicting four-month PTSD than one-year PTSD. CONCLUSIONS: The occurrence of depression during the months that follow a traumatic event is an important mediator of chronicity in PTSD.

No new state tax: universal health care coverage for children in Florida.

Florida, which this year passed a sweeping health reform measure, is considering use of a Medicaid expansion option to revamp health care delivery for its children.

Model program. REACH: a family-centered community-based case management model for children with special health care needs.

The Rural Efforts to Assist Children at Home (REACH) model of decentralized case management has been found to be an efficient and effective method for (a) coordinating and structuring the health, social service, and educational needs of complex chronically ill children and their families and (b) providing to families the training and support they need to effectively assume the role of primary case manager. The REACH administrative, training, care planning, and staff monitoring systems are presented as a model for family-centered community-based case management.

The REACH Project: an innovative health delivery model for medically dependent children.

Rural Efforts to Assist Children at Home (REACH) is a service/demonstration and training project designed to provide specialized health care and case management services to medically dependent children in a 16-county area in central FLorida. REACH nurses, acting as Health Care Coordinators, provide instruction, consultation, coordination, and supervision of health care services in collaboration with tertiary care physicians and services at the University of Florida Health Center. Patients include infants, children, and adolescents with a wide variety of chronic illnesses including leukemia, muscular dystrophy, pulmonary disorders, failure to thrive, and seizure disorders. In addition to extensive work with families in the home, the REACH program incorporates a feedback system for its nurses, a progress-oriented record system, carefully designed agreements between tertiary care centers and community agencies, and an innovative training program for its nurses. REACH intends to serve about 1000 children during its 3-year demonstration phase. Success will be based on careful monitoring of costs, family functioning, and school attendance. If successful, the project will provide a model for the structured utilization of health and social services for families with medically dependent children.