Person: Awad Sirhan, Natalia
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Awad Sirhan
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Natalia
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Publication Cross-national risk factors for childbirth-related PTSD: Findings from the INTERSECT study(2025) Handelzalts, Jonathan E.; Ayers, Susan; Webb, Rebecca; Constantinou, Georgina; Lucas, Grace; Grollman, Christopher; Ohayon, Shay; Awad Sirhan, Natalia; Baird, Kathleen; Baldisserotto, Márcia; Batool, Ramish; Batool, Shahida; Caparros-Gonzalez, Rafael A.; Chorwe-Sungani, Genesis; Christoforou, Andri; Coo, Soledad; Costa, Raquel; Dikmen-Yildiz, Pelin; Ďuríčeková, Barbora; Dušová, Bohdana; Enea, Violeta; Garthus-Niegel, Susan; Grundström, Hanna; Gureje, Oye; Hadjigeorgiou, Eleni; Marie Haga, Silje; Horsch, Antje; Ionio, Chiara; Jarašiūnaitė-Fedosejeva, Gabija; Jomeen, Julie; Kazmierczak, Maria; Lalor, Joan; Milosavljevic, Maja; Nagle, Ursula; Nakić Radoš, Sandra; Nieminen, Katri; Damilola Oladeji, Bibilola; Osório, Flavia; Pawlicka, Paulina; Peled, YoavBackground: Childbirth-related post-traumatic stress disorder (CB-PTSD) is an underrecognized condition with consequences for mothers and infants. This study aimed to determine risk factors for CB-PTSD symptoms across countries within a stress-diathesis framework, focusing on antenatal, birth-related, and postpartum predictors. Methods: The INTERSECT cross-sectional survey (April 2021-January 2024) included 11,302 women at 6-12 weeks postpartum. The study was carried out across maternity services in 31 countries. Outcomes were CB-PTSD diagnosis, symptom severity, and perceived traumatic birth, assessed with the City Birth Trauma Scale. Multiple risk factors were assessed, including preexisting vulnerability, pregnancy, birth, and infant related factors. All models were adjusted for country-level variation as a random effect. Results: Models explained substantial variance across all outcomes (conditional R2 = 0.53-0.58). Negative birth experience was the strongest predictor (e.g. odds ratio [OR] = 0.82, 95% confidence interval [CI] = 0.80-0.84 for diagnosis). Ongoing maternal complications predicted both CB-PTSD diagnosis and symptoms (e.g. OR = 1.61, 95% CI = 1.41-1.84), and major infant complications were associated with CB-PTSD diagnosis (OR = 1.63, 95% CI = 1.29-2.07). Reports of perceived danger to self or infant (criterion A) were linked to higher CB-PTSD symptoms and traumatic birth ratings (e.g., β =0.25, 95% CI = 0.21-0.29). Other predictors reached significance but showed small effects. Conclusions: Findings support a stress-diathesis framework, showing that while pre-existing vulnerabilities contribute, birth-related stressors exert the strongest influence. Trauma-informed maternity care should prioritize these factors, with attention to women's appraisals of birth.