Interrelationships of postpartum depression and childbirth-related post-traumatic stress disorder with birth memory characteristics among postpartum women: A network perspective

BACKGROUND: Despite prior research linking birth memory characteristics to postpartum depression (PPD) and childbirth-related post-traumatic stress disorder (CB-PTSD), the intricate pathways are not fully understood. Using network analysis, this study shifts the focus from overall diagnoses to specific symptoms, aiming to uncover the network structure connecting PPD and CB-PTSD symptoms with birth memory characteristics. METHODS: Primiparous women aged 18 to 49 years who had a vaginal delivery and had a child aged 0 to 12 months were recruited from three tertiary level public hospitals in China. PPD, CB-PTSD, and birth memory characteristics were assessed using the 10-item Edinburgh Postnatal Depression Scale, the 14-item Perinatal Posttraumatic Stress Disorder Questionnaire, and the 21-item Birth Memory and Recall Questionnaire, respectively. Network analysis was used to explore the interrelations among PPD, CB-PTSD, and birth memory characteristics and to identify central and bridging symptoms within the network structure. Network stability was evaluated using a case-dropping bootstrap procedure. RESULTS: Data from 494 participants were analyzed. "Arousal" emerged with the highest values on centrality and bridge centrality indices. Structurally, it was strongly connected to all PPD symptoms, especially anhedonia, as well as to emotional memory and centrality of memory. Coherence of memory also served as a key bridge, showing a strong negative association with PPD-related anxiety. The network models demonstrated high stability, with a correlation stability coefficient of 0.60 for both node strength and bridge expected influence. CONCLUSION: Arousal, anhedonia, emotional memory, centrality of memory, and coherence of memory play pivotal roles in the network structure of PPD, CB-PTSD, and birth memory characteristics. These variables may serve as important targets for the prevention and intervention of PPD and CB-PTSD.