Postpartum post-traumatic stress disorder and health service use: A longitudinal cohort study

Background
Postpartum post-traumatic stress disorder (PTSD) can lead to significant distress, yet little is known about health service use by those affected. This longitudinal cohort study examined health service use among postpartum women experiencing PTSD symptoms.
Methods
Participants were recruited during pregnancy and completed questionnaires assessing mental health and service use at 6-, 12-, and 24-months postpartum. Analysis compared women reporting at least one PTSD symptom (n = 172–182) to a no symptoms group (n = 322–344) 6–12 months and 12–24 months postpartum..
Results
Women with PTSD symptoms reported greater use of general health services for self and infant. At 6–12 months postpartum they more frequently accessed GP (IRR 1.88, 95% CI: 1.46–2.42), health visitor (IRR 1.47, 95% CI: 1.20–1.80) and hospital outpatient services (IRR 3.70, 95% CI: 2.21–6.20) for themselves; and GP (IRR 1.27, 95% CI: 1.04–1.55) and hospital outpatient services (IRR 1.65, 95% CI: 1.09–2.49) for their baby. Some of the differences for themselves remained 12–24 months postpartum (GP: IRR 1.43, 95% CI: 1.15–1.78; health visitor: IRR 1.32, 95% CI: 1.03–1.72). Women with PTSD symptoms were more likely to be referred to mental health and support services (OR 12.13, 95% CI: 5.65–26.10). However, almost half of women who met criteria for probable PTSD at 6 months did not receive a mental health referral.
Conclusions
Women with PTSD symptoms postpartum are high users of health services but may still experience gaps in care. Improved prevention, screening, referral, and support may reduce the burden of postpartum PTSD for women, their children, and services.