Access Type

Open Access Dissertation

Date of Award

January 2014

Degree Type


Degree Name



Social Work

First Advisor

Arlene N. Weisz


The adverse effects of posttraumatic stress and depression have separately been well-documented in the perinatal mental health literature. However, few studies have considered the comorbidity between trauma, posttraumatic stress and depression. This dissertation study brings attention to this comorbidity and explores implications of recent changes to diagnostic criteria for posttraumatic stress disorder related to the ability to predict postpartum depression and impairments in mother/infant bonding. Following a conceptual framework which outlines the effects of violence and trauma on adverse childbearing outcomes, hypotheses were that many women with depression in pregnancy would endorse trauma and would be at risk for subthreshold posttraumatic stress, that the type of traumas would differ based on diagnosis, and that posttraumatic stress in pregnancy would emerge as an important predictor of postpartum depression. Additional hypotheses were that recent changes in diagnostic criteria would reduce the apparent rate of posttraumatic stress disorder diagnosis in these data and would have the effect of limiting the ability to predict postpartum depression and impairments in mother/baby bonding. A secondary analysis of a prospective study of a diverse community sample of 1581 first-time mothers was undertaken. Multinomial logistic regression and receiver-operator growth curve modeling were used to test the study hypotheses. Results from the analyses broadly supported the hypotheses, finding differences in the kinds of traumatic exposures among diagnostic categories, risk for subthreshold posttraumatic stress regardless of trauma endorsement, and risk for postpartum depression among women with posttraumatic stress in pregnancy. Analyses also showed that diagnostic changes which constrain the trauma criterion for posttraumatic stress disorder limits the ability to predict women at risk for postpartum depression and bonding impairment. As a whole these analyses show that integrating mental health care to combine attention to depression, trauma, and posttraumatic stress is warranted and that changes to posttraumatic stress disorder diagnostic criteria must be further examined for implications for perinatal mental health. These analyses show that trauma-informed interventions are needed to help to improve the lives of mothers, babies, and families by addressing symptoms of posttraumatic stress that contribute to the development of postpartum depression.

Included in

Social Work Commons