Background Post-traumatic stress disorder (PTSD) can occur after the experience of real or perceived trauma during childbirth or the postpartum period. Estimates of the prevalence and correlates of PTSD following childbirth vary widely in the literature. The aim of this study was to explore: prevalence of PTSD; comorbidity between PTSD, anxiety and depression; and association between PTSD and sociodemographic characteristics in a large sample of women six months after childbirth.

Methods The study was a cross-sectional population-based questionnaire survey of 16,000 women selected at random from birth registrations. The women had given birth in England during October 2017 and were six months postpartum at the time of the survey. The women received a postal questionnaire, which they could complete on paper, by telephone or online. The questionnaire included validated measures of PTSD (Primary Care PTSD Screen (PC-PTSD)), anxiety (Generalised Anxiety Disorder Scale-2) and depression (Edinburgh Postnatal Depression Scale) in addition to general questions covering health and care during pregnancy, labour and birth, and the postnatal period. Prevalence of PTSD, anxiety and depression was estimated with 95% confidence intervals; association between PTSD and sociodemographic characteristics was explored using logistic regression. Survey weights based on characteristics associated with response were applied to the data.

Results Questionnaires were returned by 4,509 women. The mean age of the women was 32 years (sd=5 years) and the majority were married (64%), born in the UK (77%), and from White British backgrounds (76%). One in ten women (9.4%,95%CI:8.6–10.3) scored above the cut-off on the PC-PTSD, reporting at least three of the four symptoms of PTSD (re-experiencing, emotional numbing, avoidance, hyperarousal); 2.5% of women indicated that their symptoms were specifically related to their childbirth experience (95%CI:2.1–3.0). The prevalence of anxiety was significantly higher in women with PTSD (score>3) (45.0,95%CI:40.1–50.0) compared to women without PTSD (score<3) (9.9%,95%CI:9.0–10.9). Similarly, the prevalence of depression was significantly higher in women with PTSD (59.3%,95%CI:54.3–64.1) compared to women without PTSD (10.7%,95%CI:9.8–11.8). Regression analyses indicated that women who were younger, unmarried and born in the UK were more likely to report PTSD.

Conclusion The survey findings indicate a significant proportion of women were experiencing PTSD six months after childbirth. There was high comorbidity between PTSD, anxiety and depression with younger, unmarried, UK-born women being most at risk. Current guidelines recommend screening for anxiety and depression during the postnatal period; a brief screen for PTSD should be included to ensure women with symptoms are identified and offered focused interventions.