Exploring posttraumatic stress disorder symptom profile among pregnant women.

Posttraumatic stress disorder (PTSD) is more prevalent in perinatal than general samples of women (6-8% vs. 4-5%). To explore potential causes, we examined the symptom profiles of women belonging to two separate samples: a perinatal clinic sample (n = 1581) and a subsample of women in a similar age range from the U. S. National Women's Study (NWS) (n = 2000). Within the perinatal sample, risk ratios were higher for all 17 PTSD symptoms among women with current PTSD compared with unaffected women, suggesting that higher rates are not likely due to measurement error. The younger age and greater social disadvantage in the perinatal clinic sample contributed only a small proportion of variance in symptom levels compared with extent of trauma exposure and pre-existing PTSD. Compared with the national study sample's symptom profile, the perinatal sample had higher rates of occurrence of five symptoms: detachment, loss of interest, anger and irritability, trouble sleeping, and nightmares. This analysis confirms that PTSD rates are higher in perinatal samples, which is likely due to exacerbation of pre-existing PTSD among women of a younger age and greater social disadvantage. Further elucidation is warranted, including identifying triggers and determining if there are needs for pregnancy-specific interventions.

Ecological salivary cortisol specimen collection--part 1: methodological consideration of yield, error, and effects of sampling decisions in a perinatal mental health study.

BACKGROUND: Current health research strives to integrate biological, psychological, and social factors consistent with ecological models. Home-based biomarker specimens are consistent with an ecological approach, but deviations from laboratory norms could affect validity of results. OBJECTIVE: This article uses salivary cortisol specimens collected early in a perinatal mental health study to describe (a) return rate and returner characteristics, (b) adherence to procedures, (c) sources of laboratory error, (d) effects of deleting specimens with "nuisance" factors, and (e) effects that selection bias could have on cortisol concentration distribution. STUDY DESIGN: This includes methodological analysis of collection, assay, and preanalysis decision components. RESULTS: Rates of return do not differ by participants' sociodemographic, perinatal, or psychiatric characteristics. Excluding smokers affects representativeness. Selection bias in favor of more or less disadvantaged participants affects cortisol distribution. CONCLUSIONS: The large yield of useable specimens permits multivariate modeling of cortisol level in association with health outcomes, potentially enhancing ecological validity. J Am Psychiatr Nurses Assoc, 2008; 14(4), 273-284. DOI: 10.1177/1078390308322944.