{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T19:15:44Z","timestamp":1791832544019,"version":"4.3.4"},"reference-count":66,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T00:00:00Z","timestamp":1650240000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000146","name":"Alberta Innovates","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100000146","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Caesarean section (C-section) deliveries account for nearly 30% of births annually with emergency C-sections accounting for 7\u20139% of all births. Studies have linked C-sections to postpartum depression (PPD). PPD is linked to reduced quality of parent-child interaction, and adverse effects on maternal and child health. New mothers\u2019 perceptions of more negative childbirth experiences, such as unplanned\/emergency C-sections, are linked to post-traumatic stress disorder (PTSD), which in turn is related to PPD. Our objectives were to determine: (1) the association between C-section type (unplanned\/emergency vs. planned) and PPD symptoms, and (2) if postnatal PTSD symptoms mediate this association. Employing secondary analysis of prospectively collected data from 354 mother-child dyads between 2009 and 2013 from the Alberta Pregnancy Outcomes and Nutrition (APrON) study, conditional process modeling was employed. The Edinburgh Postnatal Depression Scale (EPDS) and the Psychiatric Diagnostic Screening Questionnaire (PDSQ) were administered at three months postpartum, to assess for postpartum depressive and post-traumatic stress symptoms. The direct effect of emergency C-section on PPD symptoms was non-significant in adjusted and non-adjusted models; however, the indirect effect of emergency C-section on PPD symptoms with PTSD symptoms as a mediator was significant after controlling for prenatal depression symptoms, social support, and SES (\u03b2 = 0.17 (SE = 0.11), 95% CI [0.03, 0.42]). This suggests that mothers who experienced an emergency or unplanned C-section had increased PTSD scores of nearly half a point (0.47) compared to mothers who underwent a planned C-section, even after adjustment. Overall, emergency C-section was indirectly associated with PPD symptoms, through PTSD symptoms. Findings suggest that PTSD symptoms may be a mechanism through which emergency C-sections are associated with the development of PPD symptoms.<\/jats:p>","DOI":"10.3390\/ijerph19084900","type":"journal-article","created":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T22:04:02Z","timestamp":1650319442000},"page":"4900","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":86,"title":["Associations among Caesarean Section Birth, Post-Traumatic Stress, and Postpartum Depression Symptoms"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2218-0666","authenticated-orcid":false,"given":"Marie-Andr\u00e9e","family":"Grisbrook","sequence":"first","affiliation":[{"name":"Faculty of Nursing, University of Calgary, Calgary, AB T2N 4V8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1323-5832","authenticated-orcid":false,"given":"Deborah","family":"Dewey","sequence":"additional","affiliation":[{"name":"Alberta Children\u2019s Hospital Research Institute, Owerko Centre, Calgary, AB T2N 1N4, Canada"},{"name":"Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada"},{"name":"Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada"},{"name":"Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen","family":"Cuthbert","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, University of Calgary, Calgary, AB T2N 4V8, Canada"},{"name":"Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada"},{"name":"Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila","family":"McDonald","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Ntanda","sequence":"additional","affiliation":[{"name":"Alberta Children\u2019s Hospital Research Institute, Owerko Centre, Calgary, AB T2N 1N4, Canada"},{"name":"Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald F.","family":"Giesbrecht","sequence":"additional","affiliation":[{"name":"Alberta Children\u2019s Hospital Research Institute, Owerko Centre, Calgary, AB T2N 1N4, Canada"},{"name":"Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Letourneau","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, University of Calgary, Calgary, AB T2N 4V8, Canada"},{"name":"Alberta Children\u2019s Hospital Research Institute, Owerko Centre, Calgary, AB T2N 1N4, Canada"},{"name":"Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada"},{"name":"Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada"},{"name":"Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Lanes, A., Kuk, J.L., and Tamim, H. 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