{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T19:25:55Z","timestamp":1792092355143,"version":"4.4.0"},"reference-count":49,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2020,3,1]],"date-time":"2020-03-01T00:00:00Z","timestamp":1583020800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>A birth experience with cesarean section (CS) can be a cause of the development of post-traumatic stress disorder after a cesarean (PTSD-AC) or profile PTSD, for a percentage of women. So far, there is no data on the frequency of PTSD-AC in Greece and this syndrome is often associated with other mental disorders of the postpartum period. The purpose of this research is to associate the kind of CS with PTSD-AC for Greek mothers and the combination of factors that make them less resistant to trauma. A sample of ahundred and sixty-six mothers who gave birth with emergency cesarean section (EMCS) and elective cesarean section (ELCS) at a Greek University hospital have consented to participate in the two phases of the survey, in the 2nd day postpartum and a follow-up in the 6th week postpartum. Medical\/demographic data and a life events checklist (LEC-5) with Criterion A and post-traumatic stress checklist (PCL-5) were used to diagnose PTSD and PTSD Profile. Out of166 mothers enrolled, 160 replied to the follow-up (96.4%), ELCS 97 (97%) and EMCS 63 (95%). Twenty (31.7%) EMCS had PTSD and nine (14.3%) had Profile. One (1%) ELCS had PTSD and 4 (4.1%) had Profile. This survey shows a high prevalence rate of PTSD after EMCS with additional risk factors of preterm labor, inclusion in the Neonatal Intensive Care Unit (NICU), a lack of breastfeeding, and a lack of support from the partner.<\/jats:p>","DOI":"10.3390\/ijerph17051592","type":"journal-article","created":{"date-parts":[[2020,3,3]],"date-time":"2020-03-03T03:13:28Z","timestamp":1583205208000},"page":"1592","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Correlation between Kind of Cesarean Section and Posttraumatic Stress Disorder in Greek Women"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7458-7500","authenticated-orcid":false,"given":"Eirini","family":"Orovou","sequence":"first","affiliation":[{"name":"Department of Midwifery, University of West Attica, 12243 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4871-999X","authenticated-orcid":false,"given":"Maria","family":"Dagla","sequence":"additional","affiliation":[{"name":"Department of Midwifery, University of West Attica, 12243 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Iatrakis","sequence":"additional","affiliation":[{"name":"Department of Midwifery, University of West Attica, 12243 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aikaterini","family":"Lykeridou","sequence":"additional","affiliation":[{"name":"Department of Midwifery, University of West Attica, 12243 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chara","family":"Tzavara","sequence":"additional","affiliation":[{"name":"National and Kapodistrian University of Athens, Faculty of Medicine, 15784 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4494-3089","authenticated-orcid":false,"given":"Evangelia","family":"Antoniou","sequence":"additional","affiliation":[{"name":"Department of Midwifery, University of West Attica, 12243 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,3,1]]},"reference":[{"key":"ref_1","unstructured":"DePierro, J., D\u2019Andrea, W., Spinazzola, J., Stafford, E., van Der Kolk, B., Saxe, G., Stolbach, B., McKernan, S., and Ford, J.D. (2019). Beyond PTSD: Client Presentations of Developmental Trauma Disorder from a National Survey of Clinicians. Psychol. Trauma Theory Res. Pract. Policy."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1675","DOI":"10.1176\/appi.ajp.159.10.1675","article-title":"Genetic and Environmental Influences on Trauma Exposure and Posttraumatic Stress Disorder Symptoms: A Twin Study","volume":"159","author":"Stein","year":"2002","journal-title":"Am. J. Psychiatry"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1017\/S0033291704002594","article-title":"Partial PTSD versus Full PTSD: An Empirical Examination of Associated Impairment","volume":"34","author":"Breslau","year":"2004","journal-title":"Psychol. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/S0165-0327(02)00218-5","article-title":"Partial Posttraumatic Stress Disorder Revisited","volume":"78","author":"Mylle","year":"2004","journal-title":"J. Affect. Disord."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1046\/j.1523-536X.2001.00111.x","article-title":"Do Women Get Posttraumatic Stress Disorder as a Result of Childbirth? A Prospective Study of Incidence","volume":"28","author":"Ayers","year":"2001","journal-title":"Birth Issues Perinat. Care"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1348\/014466500163095","article-title":"Prevalence and Predictors of Post-Traumatic Stress Symptoms Following Childbirth","volume":"39","author":"Czarnocka","year":"2000","journal-title":"Br. J. Clin. Psychol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"8724","DOI":"10.1038\/s41598-017-09314-x","article-title":"Risk Factors for Chronic Post-Traumatic Stress Disorder Development One Year after Vaginal Delivery: A Prospective, Observational Study","volume":"7","author":"Sentilhes","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"348","DOI":"10.3389\/fpsyt.2018.00348","article-title":"Psychosocial Predictors of Postpartum Posttraumatic Stress Disorder in Women With a Traumatic Childbirth Experience","volume":"9","author":"Hollander","year":"2018","journal-title":"Front. Psychiatry"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1001\/archpsyc.1995.03950240066012","article-title":"Posttraumatic Stress Disorder in the National Comorbidity Survey","volume":"52","author":"Kessler","year":"1995","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1007\/s00737-015-0560-x","article-title":"Women\u2019s Experiences of Symptoms of Posttraumatic Stress Disorder (PTSD) after Traumatic Childbirth: A Review and Critical Appraisal","volume":"18","author":"James","year":"2015","journal-title":"Arch. Women\u2019s Ment. Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"177","DOI":"10.5812\/ircmj.2312","article-title":"Post-Traumatic Stress Disorder (PTSD) Following Childbirth: Prevalence and Contributing Factors","volume":"15","author":"Shaban","year":"2013","journal-title":"Iran. Red Crescent Med. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1055\/s-0031-1280408","article-title":"Post-Traumatic Stress Disorder Post Partum","volume":"72","author":"Schwab","year":"2012","journal-title":"Geburtshilfe Frauenheilkd."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1111\/j.1600-0412.2012.01476.x","article-title":"Risk Factors for Developing Post-Traumatic Stress Disorder Following Childbirth: A Systematic Review","volume":"91","author":"Andersen","year":"2012","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"135","DOI":"10.3109\/01674829809025691","article-title":"Psychological Impact of Emergency Cesarean Section in Comparison with Elective Cesarean Section, Instrumental and Normal Vaginal Delivery","volume":"19","author":"Ryding","year":"1998","journal-title":"J. Psychosom. Obstet. Gynecol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"356","DOI":"10.4103\/amhsr.amhsr_397_15","article-title":"Correlation between Kind of Delivery and Posttraumatic Stress Disorder","volume":"6","author":"Mahmoodi","year":"2016","journal-title":"Ann. Med. Health Sci. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1089\/154099904323016473","article-title":"Posttraumatic Stress Disorder after Pregnancy, Labor, and Delivery","volume":"13","author":"Cohen","year":"2004","journal-title":"J. Women\u2019s Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1111\/j.1744-6163.2009.00234.x","article-title":"Prevalence of Negative Birth Perception, Disaffirmation, Perinatal Trauma Symptoms, and Depression among Postpartum Women","volume":"46","author":"Sorenson","year":"2010","journal-title":"Perspect. Psychiatr. Care"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.janxdis.2010.01.008","article-title":"Exploration of a Cognitive Model to Predict Post-Traumatic Stress Symptoms Following Childbirth","volume":"24","author":"Ford","year":"2010","journal-title":"J. Anxiety Disord."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1186\/s12955-017-0692-y","article-title":"Post-Traumatic Stress Disorder in Parturients Delivering by Caesarean Section and the Implication of Anaesthesia: A Prospective Cohort Study","volume":"15","author":"Lopez","year":"2017","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1111\/j.1471-0528.2008.02083.x","article-title":"Risk Factors in Pregnancy for Post-Traumatic Stress and Depression after Childbirth","volume":"116","author":"Wijma","year":"2009","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"856","DOI":"10.3109\/00016349709024365","article-title":"Posttraumatic Stress Reactions after Emergency Cesarean Section","volume":"76","author":"Ryding","year":"1997","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1080\/00016340701507693","article-title":"Sense of Coherence and Symptoms of Post-Traumatic Stress after Emergency Caesarean Section","volume":"86","author":"Tham","year":"2007","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1017\/S0033291715002706","article-title":"The Aetiology of Post-Traumatic Stress Following Childbirth: A Meta-Analysis and Theoretical Framework","volume":"46","author":"Ayers","year":"2016","journal-title":"Psychol. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1016\/j.midw.2014.03.011","article-title":"Predicting Posttraumatic Stress Disorder after Childbirth","volume":"30","author":"Alcorn","year":"2014","journal-title":"Midwifery"},{"key":"ref_25","unstructured":"(2020, January 16). Population and Social Conditions\u2014ELSTAT. Available online: https:\/\/www.statistics.gr\/en\/statistics\/pop."},{"key":"ref_26","unstructured":"(2019, December 28). WHO|WHO Statement on Caesarean Section Rates. Available online: http:\/\/www.who.int\/reproductivehealth\/publications\/maternal_perinatal_health\/cs-statement\/en\/."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Modarres, M., Afrasiabi, S., Rahnama, P., and Montazeri, A. (2012). Prevalence and Risk Factors of Childbirth-Related Post-Traumatic Stress Symptoms. BMC Pregnancy Childbirth, 12.","DOI":"10.1186\/1471-2393-12-88"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1080\/02646830802004909","article-title":"Validation of the Edinburgh Postnatal Depression Scale and Prevalence of Postnatal Depression at Two Months Postpartum in a Sample of Greek Mothers","volume":"27","author":"Leonardou","year":"2009","journal-title":"J. Reprod. Infant Psychol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Papamarkou, M., Sarafis, P., Kaite, C.P., Malliarou, M., Tsounis, A., and Niakas, D. (2017). Investigation of the Association between Quality of Life and Depressive Symptoms during Postpartum Period: A Correlational Study. BMC Women\u2019s Health, 17.","DOI":"10.1186\/s12905-017-0473-0"},{"key":"ref_30","unstructured":"(2019, December 29). Diagnostic and Statistical Manual of Mental Disorders (DSM-5)\u2014ProQuest. Available online: https:\/\/search.proquest.com\/openview\/6b548968301e74806949f2f8bbf5559c\/1?pq-origsite=gscholar&cbl=34821."},{"key":"ref_31","unstructured":"(2019, December 29). Life Events Checklist for DSM-5 (LEC-5)\u2014PTSD: National Center for PTSD, Available online: https:\/\/www.ptsd.va.gov\/professional\/assessment\/te-measures\/life_events_checklist.asp."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1177\/1073191104269954","article-title":"Psychometric Properties of the Life Events Checklist","volume":"11","author":"Gray","year":"2004","journal-title":"Assessment"},{"key":"ref_33","unstructured":"(2019, December 30). PTSD and DSM-5\u2014PTSD: National Center for PTSD, Available online: https:\/\/www.ptsd.va.gov\/professional\/treat\/essentials\/dsm5_ptsd.asp."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/S2215-0366(14)70321-9","article-title":"PTSD and DSM-5: Unintended Consequences of Change","volume":"1","author":"McFarlane","year":"2014","journal-title":"Lancet Psychiatry"},{"key":"ref_35","unstructured":"(2019, December 31). PTSD Checklist for DSM-5 (PCL-5\u2014PTSD: National Center for PTSD, Available online: https:\/\/www.ptsd.va.gov\/professional\/assessment\/adult-sr\/ptsd-checklist.asp."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1037\/pas0000260","article-title":"Psychometric Analysis of the PTSD Checklist-5 (PCL-5) among Treatment-Seeking Military Service Members","volume":"28","author":"Wortmann","year":"2016","journal-title":"Psychol. Assess."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1002\/jts.22059","article-title":"The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and Initial Psychometric Evaluation","volume":"28","author":"Blevins","year":"2015","journal-title":"J. Trauma. Stress"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1089\/jwh.2011.2842","article-title":"Cesarean Section and Postpartum Depression in a Cohort of Chinese Women with a High Cesarean Delivery Rate","volume":"20","author":"Xie","year":"2011","journal-title":"J. Women\u2019s Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"172","DOI":"10.5694\/j.1326-5377.1992.tb137080.x","article-title":"Increased Risk of Postnatal Depression after Emergency Caesarean Section","volume":"157","author":"Boyce","year":"1992","journal-title":"Med. J. Aust."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.midw.2017.04.016","article-title":"Women\u2019s Self-Reported Experience of Unplanned Caesarean Section: Results of a Swedish Study","volume":"50","year":"2017","journal-title":"Midwifery"},{"key":"ref_41","first-page":"802","article-title":"induction of labor at 39 weeks of gestation versus expectant management","volume":"158","author":"Sgayer","year":"2019","journal-title":"Harefuah"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1177\/0884217503252035","article-title":"Posttraumatic Stress Symptoms in Mothers of Premature Infants","volume":"32","author":"Bartlett","year":"2003","journal-title":"J. Obstet. Gynecol. Neonatal Nurs."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"578","DOI":"10.3109\/01612840.2013.789943","article-title":"Prevention of postpartum traumatic stress in mothers with preterm infants: Manual development and evaluation","volume":"34","author":"Shaw","year":"2013","journal-title":"Issues Ment. Health Nurs."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1097\/ANC.0000000000000642","article-title":"Maternal Distress in the Neonatal Intensive Care Unit: A Concept Analysis","volume":"19","author":"Staver","year":"2019","journal-title":"Adv. Neonatal Care Off. J. Natl. Assoc. Neonatal Nurses"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Bonacquisti, A., Geller, P.A., and Patterson, C.A. (2019). Maternal Depression, Anxiety, Stress, and Maternal-Infant Attachment in the Neonatal Intensive Care Unit. J. Reprod. Infant Psychol., 1\u201314.","DOI":"10.1080\/02646838.2019.1695041"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1177\/1941406414541665","article-title":"PTSD and Breastfeeding: Let It Flow","volume":"6","author":"Klein","year":"2014","journal-title":"ICAN Infant ChildAdolesc. Nutr."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1093\/advances\/nmy132","article-title":"Impact of Maternal Anxiety on Breastfeeding Outcomes: A Systematic Review","volume":"10","author":"Hoff","year":"2019","journal-title":"Adv. Nutr."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1177\/1099800405280936","article-title":"Differences between Exclusive Breastfeeders, Formula-Feeders, and Controls: A Study of Stress, Mood, and Endocrine Variables","volume":"7","year":"2005","journal-title":"Biol. Res. Nurs."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1097\/00006842-199505000-00006","article-title":"The Role of Social Relations in Health Promotion","volume":"57","author":"Berkman","year":"1995","journal-title":"Psychosom. Med."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/5\/1592\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:03:04Z","timestamp":1760173384000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/5\/1592"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,1]]},"references-count":49,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,3]]}},"alternative-id":["ijerph17051592"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17051592","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,1]]}}}