PTSD Screening for Pregnant Women

Recruiting at 1 trial location

Overseen By Abigail Powers Lott, PhD, ABPP

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Emory University

Disqualifiers: Active suicidality

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 6

804 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Brief Screening for PTSD, Culturally Responsive SBIRT for OB for PTSD in pregnant women?

A short-term psychotherapy intervention for PTSD during pregnancy significantly reduced PTSD and depression symptoms in pregnant women, with benefits lasting post-treatment and post-partum. This suggests that brief, targeted interventions can be effective in managing PTSD symptoms in pregnant women. ^{1 2 3 4 5}

Is the PTSD screening and intervention safe for pregnant women?

The studies reviewed did not report any specific safety concerns related to the PTSD screening and brief intervention for pregnant women. The intervention was successful in reducing PTSD and depression symptoms, suggesting it is generally safe for use in this population. ^{1 2 3 4 6}

How is the treatment 'Brief Screening for PTSD, Culturally Responsive SBIRT for OB' different from other PTSD treatments for pregnant women?

This treatment is unique because it involves a brief screening tool specifically designed for prenatal care, which is culturally responsive and tailored to diverse, low-income populations. Unlike other treatments, it focuses on early identification of PTSD symptoms during pregnancy, which is often overlooked in standard obstetric care. ^{3 7 8 9 10}

What is the purpose of this trial?

This study will compare the effectiveness of two active screening interventions in improving post-traumatic stress disorder (PTSD) symptoms, maternal perinatal care utilization, satisfaction utilization of mental healthcare services, and maternal health and birth-related outcomes for Black pregnant women.

Research Team

Abigail Lott, PhD, ABPP

Principal Investigator

Emory University

Briana Woods-Jaeger, PhD

Principal Investigator

Emory University

Eligibility Criteria

This trial is for Black pregnant women who may have PTSD. It's designed to see if certain screening methods can help improve their mental health, satisfaction with care, and birth outcomes.

Inclusion Criteria

Ability to provide informed consent

I am willing to participate in the study.

Self-identification as Black or African American

Exclusion Criteria

Active suicidality

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

1 visit (in-person)

Intervention

Participants receive either Culturally Responsive SBIRT for OB or Brief Screening for PTSD during their prenatal care visit

Initial OB visit (weeks 1-13)

1 visit (in-person)

Follow-up

Participants are monitored for PTSD symptoms and prenatal care utilization

12 months

4 visits (in-person)

Postpartum Follow-up

Participants are assessed for PTSD symptoms and adequacy of prenatal care utilization 6 weeks postpartum

6 weeks postpartum

Treatment Details

Interventions

• Brief Screening for PTSD
• Culturally Responsive SBIRT for OB

Trial Overview The study compares two approaches: a brief screening for PTSD and a culturally responsive SBIRT (Screening, Brief Intervention, and Referral to Treatment) specifically tailored for obstetrics.

Participant Groups

Group I: Culturally Responsive SBIRT for OB Experimental Treatment 1 Intervention

Participants randomized to Culturally Responsive SBIRT for OB will participate in the intervention visit (20-30 minutes) while waiting for their OB visit (or after the visit if time does not allow) and then engage in their prenatal care visit as usual. If any safety concerns emerge during the visit, the lay provider will contact the clinical staff on the study

Group II: Brief Screening for PTSD Experimental Treatment 1 Intervention

Participants randomized to Brief Screening For PTSD, screening will be conducted as part of regular clinic activities during the initial prenatal care visit. Specifically, clinic staff (nurse, PA) or study staff will ask the questions in the PC-PTSD-5 along with the standard procedure to administer the Edinburgh Postnatal Depression Scale (EPDS), and the provider will review the results with the patient during the prenatal care visit and provide referral resources regardless of screen outcome. Positive PTSD screens (PC-PTSD-5 ≥ 3) will be referred to the hospital's integrated care team following the same model as positive EPDS screens.

Who Is Running the Clinical Trial?

Emory University

Lead Sponsor

Trials

1,735

Recruited

2,605,000+

University of Missouri, Kansas City

Collaborator

Trials

73

Recruited

34,600+

Patient-Centered Outcomes Research Institute

Collaborator

Trials

592

Recruited

27,110,000+

Findings from Research

In a study of 745 pregnant women at urban health centers, 6.6% were diagnosed with current PTSD, and over half reported experiencing trauma that met PTSD criteria, highlighting the prevalence of trauma in this population.

Women with PTSD were significantly more likely to face additional psychosocial risks, such as housing instability and depression, indicating that PTSD is associated with broader social challenges during pregnancy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Posttraumatic stress disorder among women receiving prenatal care at three federally qualified health care centers. Kim, HG., Harrison, PA., Godecker, AL., et al.[2021]

The TO-CARE intervention, which combines cognitive-behavioral therapy (CBT) and trauma-sensitive obstetric care, was found to be acceptable to pregnant abuse survivors, with 95% of participants reporting benefits from the program.

While most participants showed some improvement in posttraumatic stress symptoms (PTS), only a small number achieved reliable improvement, highlighting challenges in retention and effectiveness for low-income, ethno-racial minority pregnant women.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A feasibility study of trauma-sensitive obstetric care for low-income, ethno-racial minority pregnant abuse survivors. Stevens, NR., Lillis, TA., Wagner, L., et al.[2022]

The PTSD-PC screening tool was successfully implemented in prenatal care for 1259 women, revealing that 17% screened positive for PTSD, indicating a significant prevalence of PTSD symptoms in this population.

Women with clinical-level PTSD symptoms exhibited more severe trauma histories and mental health issues compared to those with sub-threshold symptoms, highlighting the need for mental health support, as only 25% had previously received treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Screening for Post-traumatic Stress Disorder in Prenatal Care: Prevalence and Characteristics in a Low-Income Population. Wenz-Gross, M., Weinreb, L., Upshur, C.[2021]

A brief psychotherapeutic intervention consisting of four sessions significantly reduced PTSD symptoms and depression in 32 pregnant women, with improvements sustained at post-treatment and postpartum follow-ups.

The study highlights the need for targeted mental health interventions for low-income, minoritized pregnant women, who are at higher risk for trauma-related symptoms and may lack access to traditional mental health care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Engagement in and Benefits of a Short-Term, Brief Psychotherapy Intervention for PTSD During Pregnancy. Kornfield, SL., Johnson, RL., Hantsoo, LV., et al.[2022]

Perinatal PTSD is a significant issue among pregnant women, particularly those with a history of adult abuse, multiple traumas, severe trauma experiences, insomnia, and low social support, highlighting the need for targeted interventions.

Healthcare providers must implement culturally sensitive screening and treatment strategies for perinatal PTSD to prevent serious health complications for both mothers and their developing fetuses.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Correlates of Perinatal Post-Traumatic Stress among Culturally Diverse Women with Depressive Symptomatology. Vignato, J., Connelly, CD., Bush, RA., et al.[2023]

In a study of 46 adult patients with gunshot wounds, the SBIRT Intervention for Trauma Patients (SITP) significantly reduced PTSD symptoms compared to treatment as usual after three months, highlighting its efficacy in trauma care.

Both groups showed similar physical healing, indicating that the SITP intervention effectively addresses psychological outcomes without negatively impacting physical recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Screening, Brief Intervention, and Referral to Treatment to Prevent Post-Traumatic Stress Disorder After Gunshot Wounds. Castater, C., Raney, E., Nguyen, J., et al.[2022]

In a study involving 376 postpartum patients, 8.4% screened positive for PTSD, highlighting the importance of routine screening in identifying this underdiagnosed condition during the peripartum period.

The majority of those who screened positive for PTSD (66.7%) received follow-up care, suggesting that integrating PTSD screening into routine obstetric care can effectively connect at-risk patients with necessary behavioral health support.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility and Utility of Posttraumatic Stress Disorder Screening Among Postpartum Patients at an Urban Safety-Net Institution. Drake, E., Larrea, N., Wolverton, E., et al.[2023]

In a study of 3,372 pregnant Peruvian women, 41.8% reported symptoms consistent with post-traumatic stress disorder (PTSD), highlighting a significant prevalence of PTSD during pregnancy.

The study found that experiencing interpersonal trauma was the strongest predictor of PTSD, with women who had four or more traumatic events having a 60.5% rate of PTSD, emphasizing the need for effective screening and support for pregnant women facing trauma.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Trauma exposure and post-traumatic stress disorder in a cohort of pregnant Peruvian women. Levey, EJ., Gelaye, B., Koenen, K., et al.[2018]

In a study of 1,402 pregnant patients, 11.1% screened positive for PTSD without depression, indicating a significant gap in mental health care during prenatal visits, as PTSD screening is rarely conducted.

Demographic factors showed that Black and Latinx patients were more likely to screen positive for PTSD, suggesting the need for targeted mental health interventions and routine PTSD screenings in obstetric care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Screening for PTSD during pregnancy: a missed opportunity. Padin, AC., Stevens, NR., Che, ML., et al.[2022]

In a study of 104 African American women in residential treatment for substance use disorders, 94.2% reported experiencing at least one trauma, and over half (51.0%) met the criteria for PTSD, indicating a high prevalence of trauma-related issues in this population.

A subset of screening items was identified that could effectively indicate probable PTSD, achieving a sensitivity of 88.7% and an accuracy of 77.9%, suggesting that brief screenings could help in the timely identification and treatment of PTSD alongside substance use disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Posttraumatic Stress Disorder, Health Problems, and Depression Among African American Women in Residential Substance Use Treatment. Meshberg-Cohen, S., Presseau, C., Thacker, LR., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Posttraumatic stress disorder among women receiving prenatal care at three federally qualified health care centers. [2021]

2. England pubmed.ncbi.nlm.nih.gov

A feasibility study of trauma-sensitive obstetric care for low-income, ethno-racial minority pregnant abuse survivors. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Screening for Post-traumatic Stress Disorder in Prenatal Care: Prevalence and Characteristics in a Low-Income Population. [2021]

4. Switzerland pubmed.ncbi.nlm.nih.gov

Engagement in and Benefits of a Short-Term, Brief Psychotherapy Intervention for PTSD During Pregnancy. [2022]

5. England pubmed.ncbi.nlm.nih.gov

Correlates of Perinatal Post-Traumatic Stress among Culturally Diverse Women with Depressive Symptomatology. [2023]

6. United States pubmed.ncbi.nlm.nih.gov

Screening, Brief Intervention, and Referral to Treatment to Prevent Post-Traumatic Stress Disorder After Gunshot Wounds. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Feasibility and Utility of Posttraumatic Stress Disorder Screening Among Postpartum Patients at an Urban Safety-Net Institution. [2023]

8. Austria pubmed.ncbi.nlm.nih.gov

Trauma exposure and post-traumatic stress disorder in a cohort of pregnant Peruvian women. [2018]

9. England pubmed.ncbi.nlm.nih.gov

Screening for PTSD during pregnancy: a missed opportunity. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

Posttraumatic Stress Disorder, Health Problems, and Depression Among African American Women in Residential Substance Use Treatment. [2022]