Document Type : Original Article
Authors
1 Department of Midwifery, Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
2 Department of Midwifery, Maternal‑Fetal Medicine Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract
BACKGROUND: Women who experience stillbirth and preterm delivery are likely to be associated
with an increased risk of posttraumatic stress disorder (PTSD) compared to women with live births
and dose religious attitude related to posttraumatic stress? The aim of the study was promotion PTSD
following traumatic birth experiences and the influence of maternity religious Attitude.
MATERIALS AND METHODS: A cross‑sectional analytical study was conducted at selected hospitals
of Shiraz University of Medical Sciences on 82 subjects in 2018. The instruments were demographic
questionnaire, Religious Attitude questionnaire, and Mississippi PTSD Scale which were completed
after delivery. Data were analyzed using SPSS software, version 22, using the Pearson correlation test.
RESULTS: About 75% stillbirth group and 65% of the preterm delivery group had a high level of
religious attitude. In the stillbirth group, 90% had high levels of PTSD and in the preterm delivery
group, 90% had moderate stress, and 10% had high PTSD levels. The correlation between religious
attitude and PTSD after stillbirth was 0.373 with a significance level of 0.018. Therefore, there was
a significant positive relationship between religious attitude and PTSD. However, the relationship
between religious attitude and PTSD after preterm delivery was not statistically significant (P = 0.158).
CONCLUSION: PTSD was significantly higher in mothers with stillbirth and had a significant
relationship with religious attitude. However, in mothers of preterm infants, the level of stress was
moderate and did not have a significant relationship with religious attitude. The findings indicate the
need of mothers for interventions to cope better with the physical and psychological problems of
stillbirth and preterm delivery.
Keywords
- Correia LL, Linhares MB. Maternal anxiety in the pre‑and
postnatal period: A literature review. Rev Lat Am Enfermagem
2007;15:677‑83.
2. Grippo A, Zhang J, Chu L, Guo Y, Qiao L, Zhang J, et al. Air
pollution exposure during pregnancy and spontaneous abortion
and stillbirth. Rev Environ Health 2018;33:247‑64.
3. Erfani A. Induced abortion in Tehran, Iran: Estimated rates and
correlates. Int Perspect Sex Reprod Health 2011;37:134‑42.
4. Yao R, Ananth CV, Park BY, Pereira L, Plante LA; Perinatal
Research Consortium. Obesity and the risk of stillbirth: A
population‑based cohort study. Am J Obstet Gynecol 2014;210:457.
e1‑9.
5. Lamont K, Scott NW, Jones GT, Bhattacharya S. Risk of
recurrent stillbirth: Systematic review and meta‑analysis. BMJ
2015;350:h3080.
6. Lawn JE, Gravett MG, Nunes TM, Rubens CE, Stanton C; GAPPS
Review Group. Global report on preterm birth and stillbirth (1 of 7):
Definitions, description of the burden and opportunities to improve
data. BMC Pregnancy Childbirth 2010;10 Suppl 1:S1.
7. Ellis A, Chebsey C, Storey C, Bradley S, Jackson S, Flenady V, et al.
Systematic review to understand and improve care after stillbirth:
A review of parents’ and healthcare professionals’ experiences.
BMC Pregnancy Childbirth 2016;16:16.
8. Robinson GE. Pregnancy loss. Best Pract Res Clin Obstet Gynaecol
2014;28:169‑78.
9. Chung MC, Reed J. Posttraumatic Stress disorder following
stillbirth: Trauma characteristics, locus of control, posttraumatic
cognitions. Psychiatr Q 2017;88:307‑21.
10. Scheidt CE, Hasenburg A, Kunze M, Waller E, Pfeifer R,
Zimmermann P, et al. Are individual differences of attachment
predicting bereavement outcome after perinatal loss? A
prospective cohort study. J Psychosom Res 2012;73:375‑82.
11. Kersting A, Wagner B. Complicated grief after perinatal loss.
Dialogues Clin Neurosci 2012;14:187‑94.
12. Flenady V, Boyle F, Koopmans L, Wilson T, Stones W, Cacciatore
J. Meeting the needs of parents after a stillbirth or neonatal death.
BJOG 2014;121 Suppl 4:137‑40.
13. Nuzum D, Meaney S, O’Donoghue K. The spiritual and
theological challenges of stillbirth for bereaved parents. J Relig
Health 2017;56:1081‑95.
14. Liu LC, Wang YC, Yu MH, Su HY. Major risk factors for stillbirth
in different trimesters of pregnancy – A systematic review. Taiwan
J Obstet Gynecol 2014;53:141‑5.
15. Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan
D, et al. Stillbirths: Rates, risk factors, and acceleration towards
2030. Lancet 2016;387:587‑603.
16. Nyári TA. Risk factors and trends in the rate of stillbirth in
Hungary between 1971 and 2010. J Matern Fetal Neonatal Med
2014;27:1195‑8.
17. Frey HA, Odibo AO, Dicke JM, Shanks AL, Macones GA, Cahill
AG. Stillbirth risk among fetuses with ultrasound‑detected
isolated congenital anomalies. Obstet Gynecol 2014;124:91‑8.
18. Auger N, Vecchiato L, Naimi AI, Costopoulos A, Fraser WD.
Stillbirth rates among Haitians in Canada. Paediatr Perinat
Epidemiol 2014;28:333‑7.
19. Almasi‑Hashiani A, Sepidarkish M, Safiri S, Khedmati Morasae
E, Shadi Y, Omani‑Samani R. Understanding determinants of
unequal distribution of stillbirth in Tehran, Iran: A concentration
index decomposition approach. BMJ Open 2017;7:e013644.
20. Shah PE, Clements M, Poehlmann J. Maternal resolution of grief
after preterm birth: Implications for infant attachment security.
Pediatrics 2011;127:284‑92.
21. Gray PH, Edwards DM, O’Callaghan MJ, Cuskelly M. Parenting
stress in mothers of preterm infants during early infancy. Early
Hum Dev 2012;88:45‑9.
22. Tehranian N, Ranjbar M, Shobeiri F. The prevalence and
risk factors for preterm delivery in Tehran, Iran. J Midwifery
Reproduct Health 2016;4:600‑4.
23. Dolatian M, Mirabzadeh A, Forouzan AS, Sajjadi H, Alavi Majd
H, Moafi F. Preterm delivery and psycho‑social determinants of
health based on World Health Organization model in Iran: A
narrative review. Glob J Health Sci 2012;5:52‑64.
24. Shaw RJ, Lilo EA, Storfer‑Isser A, Ball MB, Proud MS, Vierhaus NS,
et al. Screening for symptoms of postpartum traumatic stress in a
sample of mothers with preterm infants. Issues Ment Health Nurs
2014;35:198‑207.
25. Haghparast E, Faramarzi M, Hassanzadeh R. Psychiatric
symptoms and pregnancy distress in subsequent pregnancy after
spontaneous abortion history. Pak J Med Sci 2016;32:1097.
26. Langkaas TF, Hoffart A, Øktedalen T, Ulvenes PG, Hembree EA,
Smucker M. Exposure and non‑fear emotions: A randomized
controlled study of exposure‑based and rescripting‑based
imagery in PTSD treatment. Behav Res Ther 2017;97:33‑42.
27. Jeffries FW, Davis P. What is the role of eye movements in
eye movement desensitization and reprocessing (EMDR) for
post‑traumatic stress disorder (PTSD)? A review. Behav Cogn
Psychother 2013;41:290‑300.
28. Lacasse JR, Cacciatore J. Prescribing of psychiatric medication
to bereaved parents following perinatal/neonatal death: An
observational study. Death Stud 2014;38:589‑96.
29. Kajbaf MB, Ghasemiannejad Jahromi A, Ahmadi Forushani SH.
The effectiveness of spiritual and existential group therapy on
the rates of depression, death anxiety and afterlife belief among
students: A study based on the reports of people with death
experience. JSR 2016;16:4‑13.
30. Kashfi SM, Yazdankhah M, Heydarabadi AB, Jeihooni AK,
Tabrizi R. The relationship between religious attitude and mental
health in students of Shiraz University of Medical Sciences. J Res
Relig Health 2016;1:34‑41.
31. Janbozorgi M. Religious orientation and mental health. Res Med
2007;31:345‑50.
32. Nelson SK, Kushlev K, English T, Dunn EW, Lyubomirsky S. In
defense of parenthood: Children are associated with more joy
than misery. Psychol Sci 2013;24:3‑10.
33. Cowchock FS, Lasker JN, Toedter LJ, Skumanich SA, Koenig HG.
Religious beliefs affect grieving after pregnancy loss. J Relig
Health 2010;49:485‑97.
34. American Psychiatric Association. Diagnosis and Statistical Manual
of Mental Disorders. IVTR ed. Washington D.C.: Author; 2000.
35. Gamble J, Creedy D, Moyle W, Webster J, McAllister M, Dickson P.
Effectiveness of a counseling intervention after a traumatic childbirth:
A randomized controlled trial. Birth 2005;32:11‑9.
36. Bashpour S. The effectiveness of cognitive processing therapy on
the improvement of posttraumatic symptoms qol, self esteem and
marital satisfaction in the women exposed to infidelity. Journal
of Family Counseling and Psychotherapy (FCPJ) . 2012;2:193‑208
[Persian].
37. Alden LE, Regambal MJ, Laposa JM. The effects of direct
versus witnessed threat on emergency department healthcare
workers: implications for PTSD criterion A. J Anxiety Disord
2008;22:1337‑46. - 38. Goodarzi M. Evaluating validity and reliability of Mississippi
Post Traumatic stress disorder scale. J Psychol 2003;7:153‑78.
39. Ebrahimi A, Neshatdoost H, Kalantari M, Molavi H,
Asadollahi G. Factor structure, reliability and validity of Religious
Attitude Scale. J Fundam Ment Health 2008;10:107‑16.
40. Mokhtaryan T, Yazdanpanahi Z, Akbarzadeh M, Amooee S,
Zare N. The impact of Islamic religious education on anxiety level
in primipara mothers. J Family Med Prim Care 2016;5:331‑7.
41. Akbarzadeh M, Mokhtaryan T, Amooee S, Moshfeghy Z, Zare N.
Investigation of the effect of religious doctrines on religious
knowledge and attitude and postpartum blues in primiparous
women. Iran J Nurs Midwifery Res 2015;20:570.
42. Van P, Meleis AI. Coping with grief after involuntary pregnancy
loss: Perspectives of African American women. J Obstet Gynecol
Neonatal Nurs 2003;32:28‑39.
43. Cowchock FS, Ellestad SE, Meador KG, Koenig HG, Hooten EG,
Swamy GK. Religiosity is an important part of coping with grief
in pregnancy after a traumatic second trimester loss. J Relig Health
2011;50:901‑10.
44. Mann JR, McKeown RE, Bacon J, Vesselinov R, Bush F. Do
antenatal religious and spiritual factors impact the risk of
postpartum depressive symptoms? J Womens Health (Larchmt)
2008;17:745‑55.
45. Nuzum D, Meaney S, O’Donoghue K. The provision of spiritual
and pastoral care following stillbirth in Ireland: A mixed methods
study. BMJ Support Palliat Care 2016;6:194‑200.
46. Horsch A, Jacobs I, McKenzie-McHarg K. Cognitive predictors
and risk factors of PTSD following stillbirth: A short-term
longitudinal study. J Traum Stress 2015;28:110‑7.
47. Kersting A, Dorsch M, Kreulich C, Klockenbusch W. Coping with
termination of pregnancy for fetal abnormality. Prenat Diagn
2004;24:70‑2.
48. Park JI, Hong JP, Park S, Cho MJ. The relationship between
religion and mental disorders in a Korean population. Psychiatry
Investig 2012;9:29‑35.
49. Koenig HG, Larson DB. Religion and mental health: Evidence for
an association. Int Rev Psychiatry 2001;13:67‑78.
50. Weaver AJ, Flannelly KJ, Larson DB, Stapleton CL,
Koenig HG. Mental health issues among clergy and other religious
professionals: A review of research. J Pastoral Care Counsel
2002;56:393‑403.
51. Reihani T, Sekhavat Poor Z, Heidarzadeh M, Mosavi SM,
Mazlom SR. The effect of spiritual self‑care training on feeling of
comfort in mothers of hospitalized preterm infants. J Midwifery
Reproduct Health 2014;2:112‑9.
52. Bener A, Gerber LM, Sheikh J. Prevalence of psychiatric disorders
and associated risk factors in women during their postpartum
period: A major public health problem and global comparison.
Int J Womens Health 2012;4:191‑200.
53. Beck CT, Gable RK, Sakala C, Declercq ER. Posttraumatic stress
disorder in new mothers: Results from a two-stage US national
survey. Birth 2011;38:216‑27.
54. 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. Appl Nurs Res 2011;24:114‑7.
55. Mirbagher N, Ranjbar N. Effects of Holy Quran on mother’s
anxiety before Caesarean section. J Qom Univ Med Sci
2010;4:15‑9.
56. Kamali Z, Tafazoli M, Ebrahimi M, Hosseini M, Saki A,
Fayyazi‑Bordbar MR, et al. Effect of spiritual care education on
postpartum stress disorder in women with preeclampsia. J Educ
Health Promot 2018;7:73.
57. Lucero SM, Pargament KI, Mahoney A, DeMaris A. Links between
religious and spiritual coping and adjustment among fathers
and mothers during first pregnancy. J Reproduct Infant Psychol
2013;31:309‑22.
58. Staneva A, Bogossian F, Pritchard M, Wittkowski A. The effects
of maternal depression, anxiety, and perceived stress during
pregnancy on preterm birth: A systematic review. Women Birth
2015;28:179‑93.
59. Kartal YA, Oskay UY. Anxiety, depression and coping with stress
styles of pregnant women with preterm labor risk. Int J Caring
Sci 2017;10:716.
60. Bagheri M, Chegeni ME, Negar FM. Reviews of the effectiveness
of religious, spiritual and mental therapy on stress reduction,
anxiety and depression in women with addicted spouse in Ilam
city. J Res Relig Health 2016;1:19‑25.
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