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Measuring posttraumatic stress following childbirth: a critical evaluation of instruments
Claire A I Stramrood1, Elisabeth M J Huis In 't Veld, Maria G Van Pampus
1Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands. c.a.i.stramrood@og.umcg.nl
Objectives:
To evaluate instruments used to assess posttraumatic stress disorder (PTSD) following childbirth with both quantitative (reliability analysis and factor analysis) and qualitative (comparison of operationalization) techniques.
Methods:
An unselected population of 428 women completed the Traumatic Event Scale-B (TES-B) and the PTSD Symptom Scale-Self Report (PSS-SR) 2-6 months after delivery.
Results:
Assessment of internal consistency yielded similar results for the TES-B and PSS-SR (Cronbach's alpha = 0.87 and 0.82, respectively). Factor analysis revealed two rather than three DSM-IV symptom categories for both instruments: childbirth-related factors (re-experiencing/ avoidance) and symptoms of depression and anxiety (numbing/hyperarousal). Although the TES-B and the PSS-SR sum-scores show a strong relationship (Spearmans rho = 0.78), agreement between the instruments on the identification of PTSD cases is low (kappa = 0.24); discrepancy between TES-B and PSS-SR is largely due to differences in instruction to respondents, formulation of items, answer categories, and cut-off values.
Conclusions:
Large operationalization differences between TES-B and PSS-SR have been identified, i.e., in the formulation of questions, answer categories, cut-off values and instructions to respondents. Comparison between studies using different instruments for measuring PTSD following childbirth should be done with utmost caution.
