Patterns and Predictors of Perinatal Posttraumatic Stress Symptoms: A Latent Transition Analysis

Intimate partner violence (IPV) represents a global human rights and public health concern associated with a wide range of adverse outcomes, including posttraumatic stress symptoms (PTSS). Pregnancy is a time of increased risk for IPV exposure for some women, and yet there is a dearth of prospective research examining the relationship between recent IPV exposure and PTSS in the perinatal period. Further, relationships among different types of IPV exposure and perinatal PTSS remain understudied. Lastly, research on IPV and PTSS tends to lack a guiding theoretical perspective in which to understand their relationship, underscoring the need for research that might inform new theoretical models. Latent class and transition analysis were used to examine classes of PTSS in pregnancy and postpartum, the longitudinal patterns of transitions across these classes, and the role of IPV types, childhood adversity, and depression in PTSS presentation. Participants (N=238) were drawn from two longitudinal studies of high-risk perinatal women, interviewed in pregnancy and at 3-4 months postpartum. Four latent classes of PTSS emerged: High PTSS class, Flight response class, Fight response class, and Low PTSS class. Childhood adversity, prenatal depression, and psychological IPV were associated with membership in higher severity PTSS classes. Women with low levels of PTSS at baseline continued to have low levels at postpartum, and women in higher severity classes at baseline tended to transition into statuses with adjacent, and often lower, levels of symptom severity. Among women with high levels of PTSS at baseline, prenatal depression negatively predicted transitions into the low severity PTSS class. Findings highlight the importance of individualized approaches to assessing, monitoring, and treating PTSS in the perinatal period.