Document Type : Original Article


1 Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran,

2 Department of Islamic Studies

3 Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

4 Epidemiology and Biostatistics, Mashhad University of Medical Sciences, Mashhad, Iran

5 Psychiatry and Behavioral Sciences, Department of Research Center, Mashhad University of Medical Sciences, Mashhad, Iran,

6 Department of Midwifery, School of Nursing and Midwifery, Esfahan University of Medical Sciences, Esfahan, Iran


INTRODUCTION: Posttraumatic stress disorder is an anxiety disorder that occurs after exposure
to an event that causes injury or threat. The prevalence of preeclampsia was reported to be 28%.
Considering the significant role of spiritual care in physical and psychological outcomes of patients,
this study was conducted to determine “the effect of spiritual care education on postpartum stress
disorder in women with preeclampsia”.
MATERIALS AND METHODS: In this randomized clinical trial, 72 pregnant women (36 in each group)
were selected in a convenient way between the ages of 34 and 38 weeks who had preeclampsia and
admitted to two public hospitals in Mashhad. The questionnaires such as Duke University Religion
Index, DASS 21, the Posttraumatic Stress Disorder Checklist (PCL), and  Prenatal Posttraumatic
Stress Questionnaire (PPQ) were used at the beginning in two groups. In the intervention group, first,
women were educated each day based on Richards and Bergin’s pattern, in three sessions, which
lasted 45–60 min. The control group also received routine cares. All units completed questionnaires
such as Prenatal Posttraumatic Stress Questionnaire (PPQ) at the 4th–6th postpartum period. Results
were analyzed by independent t‑test, Mann–Whitney test, Chi‑square test, and SPSS version 16.
RESULTS: The mean change score of postpartum stress disorder in the intervention and control
groups was different after intervention (P = 0.001).
CONCLUSION: Providing spiritual care to pregnant mothers with preeclampsia reduces their risk
of postpartum stress disorder. Therefore, this kind of care as an effective intervention is included in
the routine care of this group with high‑risk pregnancies.


1. Forouhari S, Zahra Y, Parsanezhad M, Raigan‑Shirazi M. The
effects of regular exercise on pregnancy outcome. Iran Red
Crescent Med J 2009;2009:57‑60.
2. Lyall F, Belfort M. Pre‑Eclampsia: Etiology and Clinical Practice.
Cambridge University Press Publisher; 2007. ISBN: 1139463675,
3. Gabbe SG, Niebyl JR, Simpson JL, Landon MB, Galan HL,
Jauniaux ER, et al. Obstetrics: Normal and Problem Pregnancies
E‑Book. Elsevier Health Sciences Publisher; 2016. ISBN:
4. Soltani N, Abedin Z, Mokhber N, Esmaily H. Study of the
prevalence of post‑traumatic stress disorder delivery following
pre‑eclampsia and its related factors. IJOGI 2013;16(78):16‑24.
5. Adewuya AO, Ologun YA, Ibigbami OS. Post‑traumatic stress
disorder after childbirth in Nigerian women: Prevalence and risk
factors. BJOG 2006;113:284‑8.
6. Lotfi Kashani F, Mahmodian T. Psychological symptoms in
patients PTSD with and without comorbidity with substance
abuse. Andisheh Rafter 2008;2:7.
7. Mohaghegh‑Motlagh SJ, Momtazi S, Musavi‑Nasab SN, Arab A,
Saburi E, Saburi A. Post‑traumatic stress disorder in male chemical
injured war veterans compared to non‑chemical war veterans.
Med J Mashhad Univ Med Sci 2014;56:361‑8.
8. Bahrami N, Bahrami S. Correlation between prenatal depression
with delivery type and neonatal anthropometric indicators.
Koomesh 2013;15(1):39‑45.
9. Partovi S, Kianifar H, Gholami Robatsangi M, Ghorbani Z,
Saeidi R. Evaluation of massage with oil containing medium
chain triglyceride on weight gaining in preterm. Koomesh
10. Saeidi R, Banihashem A, Hammoud M, Gholami M. Comparison
of oral recombinant erythropoietin and subcutaneous recombinant
erythropoietin in prevention of anemia of prematurity. Iran Red
Crescent Med J 2012;14(3):178.
11. Engelhard IM, Van RijM, BoullartI, Ekhart TH, SpaandermanME,
van den Hout MA, et al. Posttraumatic stress disorder after
pre‑eclampsia: An exploratory study. Gen Hosp Psychiatry
12. Kalhornia‑Golkar M, Banijamali S, Bahrami H, Hatami HR,
Ahadi H. Effectiveness of mixed therapy of stress management
training and spiritual therapy on level of blood pressure, anxiety
and quality of life of high blood pressure patients. J Clin Psychol
13. Karimollah M, Abedi HS, Yousefi R. Spiritual care in nursing. Res
J Biol Sci 2009;3:491‑9.
14. Ramezani M, Ahmadi F, Mohammadi E, Kazemnejad A.
Spiritual care in nursing: A concept analysis. Int Nurs Rev
15. Ramezani M, Ahmadi F, Mohammadi E, Kazemnejad A. Catalysts
to spiritual care delivery: A Content analysis. Iran Red Crescent
Med J 2016;18:e22420.
16. Richards PS, Hardman RK, Berrett M. Spiritual Approaches in
the Treatment of Women with Eating Disorders. Washington:
American Psychological Association; 2007.
17. Richards P, Bergin AE. Handbook of Psychotherapy and
Religious Diversity. Washington, DC, US: American Psychological
Association; 2014.
18. Akhbardeh M. Role of spiritual beliefs and prayer in health
promotion of chronic patients: A qualitative study. Quran Med
19. SimoniJM, MartoneMG, Kerwin JF. Spirituality and psychological adaptation among women with HIV/AIDS: Implications for
counseling. J Couns Psychol 2002;49:139.
20. Hayley Harriet R. Hope and Ways of Coping after Breast Cancer:
PhD dissertation of Arts in Clinical Psychology. Johannesburg
University; 2008.
21. Bryant‑Davis T, Wong EC. Faith to move mountains: Religious
coping, spirituality, and interpersonal trauma recovery. Am
Psychol 2013;68:675‑84.
22. HawthorneDM, YoungblutJM, BrootenD. Parent spirituality, grief,
and mental health at 1 and 3 months after their infant’s/Child’s
death in an Intensive Care Unit. J Pediatr Nurs 2016;31:73‑80.
23. Hourani LL, Williams J, Forman‑Hoffman V, Lane ME,
Weimer B, Bray RM, et al. Influence of spirituality on depression,
posttraumatic stress disorder, and suicidality in active duty
military personnel. Depress Res Treat 2012;2012:425463.
24. Berg G. The relationship between spiritual distress, PTSD and
depression in Vietnam combat veterans. J Pastoral Care Counsel
25. Tuck I. A critical review of a spirituality intervention. West J Nurs
Res 2012;34:712‑35.
26. Hart SL, Hoyt MA, Diefenbach M, Anderson DR, Kilbourn KM,
Craft LL, et al. Meta‑analysis of efficacy of interventions for
elevated depressive symptoms in adults diagnosed with cancer.
J Natl Cancer Inst 2012;104:990‑1004.
27. Ghahari S, Fallah R, Bolhari J, Moosavi SM, Razaghi Z, Akbari ME.
Effectiveness of cognitive‑behavioral and spiritual‑religious
interventions on reducing anxiety and depression of women with
breast cancer. Knowl Res Appl Psychol 2012;13:33‑40.
28. Salari P, Firoozi M, Sahebi A. Study of the stressors associated
with pregnancy. J Sabzevar Univ Med Sci 2005;3(37):34‑40.
29. Mohr S, Brandt PY, Borras L, Gilliéron C, Huguelet P. Toward an
integration of spirituality and religiousness into the psychosocial
dimension of schizophrenia. Am J Psychiatry 2006;163:1952‑9.
30. van Olphen J, Schulz A, Israel B, Chatters L, Klem L, Parker E,
et al. Religious involvement, social support, and health among
African‑American women on the East side of Detroit. J Gen Intern
Med 2003;18:549‑57.
31. Chung LY, Wong FK, Chan MF. Relationship of nurses’
spirituality to their understanding and practice of spiritual care.
J Adv Nurs 2007;58:158‑70.
32. Damari B. Spiritual Health. Tehran: Teb and Jamae Publisher;
33. Hafizi S, Memari AH, Pakrah M, Mohebi F, Saghazadeh A,
Koenig HG, et al. The duke university religion index (DUREL):
Validation and reliability of the Farsi version. Psychol Rep
34. Baljani E, Kazemi M, Amanpour E, Tizfahm T. A survey
on relationship between religion, spiritual wellbeing, hope
and quality of life in patients with cancer. Evid Based Care
35. Koenig HG. Spirituality, wellness, and quality of life. Sex Reprod
Menopause 2004;2:76‑82.
36. Feeley N, Zelkowitz P, Cormier C, Charbonneau L, Lacroix A,
Papageorgiou A. Posttraumatic stress among mothers of very
low birthweight infants at 6 months after discharge from
the neonatal intensive care unit. Applied Nursing Research.
37. Goodarzi A. Validity and reliability of post crash impact
scale (ESSL). J Psychol 2003;7(20):153‑178.
38. Weathers FW, Litz BT, Herman DS, Huska JA, Keane TM. The
PTSD Checklist (PCL): Reliability, validity, and diagnostic utility.
Inannual convention of the international society for traumatic
stress studies, San Antonio, Tx 1993 Oct 24 (Vol. 462).
39. Henry JD, Crawford JR. The short-form version of the Depression
Anxiety Stress Scales (DASS-21): Construct validity and
normative data in a large non-clinical sample. Br J Clin Psychol
40. Richards PS, Bergin AE. A Spiritual Strategy for Counseling
and Psychotherapy.Washington, DC: American Psychological
Association; 2005. 422 pp. ISBN 1‑59147‑254‑7.
41. Vaghee S, Sepehrikia M, Saghebi SA, Behnam Voshani H,
Salarhaji A, Nakhaee Moghaddam Z. Comparison of the effect
of face-to-face and multimedia education on the anxiety caused
by electroconvulsive therapy in patients with mood disorders.
Evid Based Care 2017;7:25-34.
42. Siedlecki V, Watlington CG . Trauma and Spirituality: Healing
the Wounded Soul. Liberty University 2013.
43. Watlington CG, Murphy CM. The roles of religion and spirituality
among African American survivors of domestic violence. J Clin
Psychol 2006;62:837‑57.
44. Sanaei B, Nasiri H. The effect of cognitive‑spiritual group
therapy in reducing depression and anxiety in patients with
mood disorders in Isfahan Noor Medical Center. Couns Res Dev
45. Simoni JM, Kerwin J. Spirituality and psychological adaptation
among women with HIV/AIDS: Implications for counseling.
J Couns Psychol 2002;49:139‑47.
46. Rubin HH. Hope and Ways of Coping after Breast Cancer. Rand
Afrikaans University; 2008.
47. Kalhornia‑Golkar M, Banijamali S, Bahrami H, Hatami H,
Ahadi H. Effectiveness of mixed therapy of stress management
training and spiritual therapy on level of blood pressure, anxiety
and quality of life of high blood pressure patients. J Clin Psychol
48. Amram JY. The Contribution of Emotional and Spiritual
Intelligences to Effective Business Leadership. publisher: Institute
of Transpersonal Psychology; 2009.
49. Zohar D, Marshall I, Marshall IN. SQ: Connecting with our
Spiritual Intelligence. publisher: Bloomsbury Publishing USA;
50. King DB. Rethinking claims of spiritual intelligence: A definition,
model, and measure. ProQuest 2008;5(47):23.
51. Vollman MW, LaMontagne LL, Wallston KA. Existential
well‑being predicts perceived control in adults with heart failure.
Appl Nurs Res 2009;22:198‑203.
52. Song Y, Lindquist R, Windenburg D, Cairns B, Thakur A. Review
of outcomes of cardiac support groups after cardiac events. West
J Nurs Res 2011;33:224‑46.
53. Hayase M, Shimada M, Seki H. Sleep quality and stress in women
with pregnancy‑induced hypertension and gestational diabetes
mellitus. Women Birth 2014;27:190‑5