Trauma Exposure and Posttraumatic Stress Disorder in a Rural Perinatal Population

There is very limited information on the rates of trauma exposure and posttraumatic stress disorder (PTSD) symptoms for perinatal individuals who live in rural settings. Increasing understanding of traumatic experiences among rural-dwelling pregnant individuals may be an important avenue through which midwives can help address the care disparities and poor outcomes in this population. This study aimed to implement screening and estimate prevalence rates of trauma exposure and perinatal PTSD symptoms among individuals at a Midwestern rural obstetric clinic.

Participants completed a brief screening measure that assessed demographics, trauma exposure, mental health knowledge and experience, and PTSD symptoms.

Of the 421 patients screened, the mean age was 26.8 years, and 69.6% identified as White and 11.9% identified as Latina. Over half endorsed trauma exposure (53.0%). The most common types of traumatic events were death of a close family member or friend (36.1%) and childhood sex abuse (14.3%). About 1 in 4 trauma-exposed patients (25.6%) scored above the clinical threshold for probable PTSD (≥3 on the Primary Care PTSD Screen for DSM-5). The most endorsed PTSD symptom type was internal and external avoidance of trauma-related stimuli (32.4%).

A history of trauma exposure and perinatal PTSD symptoms were more common than expected when compared with both overall perinatal and rural population PTSD prevalence rates. Specific considerations were identified that facilitated successful screening in our rural population. Future clinical research with rural populations should consider: (1) broad implementation of PTSD symptom screening of perinatal patients and creation of a workflow that establishes follow-up steps for patients who screen positive; (2) development of training and psychoeducational materials for health care providers and patients to facilitate connection with brief trauma interventions; and (3) support of trauma-informed, stepped care models with a range of disciplines and provider types to help manage perinatal PTSD symptoms.