Understanding how adverse childhood experiences influence the development of postpartum post-traumatic stress...

Background: Adverse childhood experiences (ACEs) disproportionately affect women and significantly increase the risk of postpartum post-traumatic stress disorder (PTSD). However, the psychological mechanisms underlying this relationship remain inadequately investigated.Aim: To develop a constructivist grounded theory explaining how ACEs influence the development of postpartum PTSD.Methods: Employing a constructivist grounded theory approach, this qualitative study was conducted at a tertiary hospital in South China between November 2023 and October 2024. Data were collected through in-depth interviews conducted with 10 women who experienced ACEs and subsequently developed postpartum PTSD. Early maladaptive schemas (EMS) were identified as the central construct in the resulting theory.Results: The developed theory contains five components: (1) the origin of EMS; (2) the formation of EMS; (3) the trigger of EMS; (4) the operation of EMS; and (5) the outcome of EMS. Findings suggest that ACEs were perceived as providing the foundation for EMS, which gradually solidified during an individual's developmental trajectory to become an ingrained subconscious framework for responding to external stressors. During the stress-inducing event of childbirth, EMS appeared to be activated, influencing cognitive appraisals of the stressor, coping strategies, and perceived social support, ultimately contributing to the experience of postpartum PTSD symptoms.Conclusion: This study advances a constructivist grounded theory that elucidates how ACEs relate to the development of postpartum PTSD within the context of the formation, activation, and operationalisation of EMS. Given the modifiable nature of EMS, these findings highlight the potential of targeted interventions like schema therapy and trauma-informed care. Effective maternal support should address both the immediate stress of childbirth and the persisting influence of ACEs.