{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T02:02:06Z","timestamp":1792548126908,"version":"4.5.0"},"reference-count":49,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2021,4,24]],"date-time":"2021-04-24T00:00:00Z","timestamp":1619222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>To determine the association between experiencing obstetric violence and the incidence of postpartum post-traumatic stress disorder (PTSD). A cross-sectional study with puerperal women was conducted in Spain following ethical approval. The Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) was administered online. Sociodemographic, clinical, and obstetric violence variables and the risk of dichotomized PTSD (low\/high) were studied by bivariate and multivariate analysis with binary logistic regression. 955 women were invited to participate. 53 women refused to participate, three did not complete all survey questions and, finally, 899 women were included. The risk of PTSD (score \u2265 19) using the PPQ was 12.7% (114). The mean score was 9.10 points (SD = 8.52). Risk factors identified were having a delivery plan that was not respected (aOR: 2.85, 95% CI 1.56\u20135.21), elective caesarean delivery (aOR: 2.53, 95% CI 1.02\u20132.26), emergency caesarean section (aOR: 3.58, 95% CI 1.83\u20136.99), admission of the newborn to the neonatal intermediate care unit (aOR: 4.95, 95% CI 2.36\u201310.36), admission to the intensive care unit (aOR: 2.25, 95% CI 1.02\u20134.97), formula feeding on discharge (aOR: 3.57, 95% CI 1.32\u20139.62), verbal obstetric violence (aOR: 5.07, 95% CI 2.98\u20138.63), and psycho-affective obstetric violence (aOR: 2.61, 95% CI 1.45\u20134.67). Various clinical practices were identified with the risk of PTSD, highlighting various types of obstetric violence. Partner support and early breastfeeding were identified as protective factors. Sensitizing professionals is essential to prevent the risk of PTSD.<\/jats:p>","DOI":"10.3390\/jpm11050338","type":"journal-article","created":{"date-parts":[[2021,4,24]],"date-time":"2021-04-24T21:49:20Z","timestamp":1619300960000},"page":"338","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":70,"title":["Factors Associated with Postpartum Post-Traumatic Stress Disorder (PTSD) Following Obstetric Violence: A Cross-Sectional Study"],"prefix":"10.3390","volume":"11","author":[{"given":"Sergio","family":"Martinez-V\u00e1zquez","sequence":"first","affiliation":[{"name":"Department of Nursing, University of Jaen, 23071 Jaen, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6239-2842","authenticated-orcid":false,"given":"Juli\u00e1n","family":"Rodr\u00edguez-Almagro","sequence":"additional","affiliation":[{"name":"Department of Nursing, Faculty of Nursing of Ciudad Real, The University of Castilla-La Mancha, 13071 Ciudad Real, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9100-1134","authenticated-orcid":false,"given":"Antonio","family":"Hern\u00e1ndez-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of Nursing, Faculty of Nursing of Ciudad Real, The University of Castilla-La Mancha, 13071 Ciudad Real, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Miguel","family":"Mart\u00ednez-Galiano","sequence":"additional","affiliation":[{"name":"Department of Nursing, University of Jaen, 23071 Jaen, Spain"},{"name":"Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,24]]},"reference":[{"key":"ref_1","unstructured":"WHO (2020, October 15). Mental Health Aspects of Women\u2019s Reproductive Health: A Global Review of the Literature. Available online: http:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/43846\/9789241563567_eng.pdf;jsessionid=1A812923347FE5054B9FAFCA9CCA9E96?sequence=1."},{"key":"ref_2","first-page":"4","article-title":"Mental health in pregnant women","volume":"27","year":"2013","journal-title":"Perinatol Hum Reprod."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.jogn.2019.02.004","article-title":"Synthesis of Mixed Research on Posttraumatic Stress Related to Traumatic Birth","volume":"48","author":"Beck","year":"2019","journal-title":"J. Obstet. Gynecol. Neonatal Nurs."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.jad.2017.07.045","article-title":"Maternal posttraumatic stress disorder during the perinatal period and child outcomes: A systematic review","volume":"225","author":"Cook","year":"2018","journal-title":"J. Affect. Disord."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/j.cpr.2014.05.003","article-title":"Prevalence and risk factors of postpartum posttraumatic stress disorder: A meta-analysis","volume":"34","author":"Grekin","year":"2014","journal-title":"Clin. Psychol. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"220","DOI":"10.4103\/jfmpc.jfmpc_272_17","article-title":"The prevalence of posttraumatic stress disorder during pregnancy and postpartum period","volume":"7","author":"Khoramroudi","year":"2018","journal-title":"J. Fam. Med. Prim. Care"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.jad.2017.06.049","article-title":"Factors associated with post-traumatic stress symptoms (PTSS) 4\u20136 weeks and 6 months after birth: A longitudinal population-based study","volume":"221","author":"Ayers","year":"2017","journal-title":"J. Affect. Disord."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1016\/j.jad.2016.10.009","article-title":"The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis","volume":"208","author":"Yildiz","year":"2017","journal-title":"J. Affect. Disord."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1097\/01.grf.0000129919.00756.9c","article-title":"Delivery as a Traumatic Event: Prevalence, Risk Factors, and Treatment for Postnatal Posttraumatic Stress Disorder","volume":"47","author":"Ayers","year":"2004","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cpr.2005.07.002","article-title":"Posttraumatic stress following childbirth: A review","volume":"26","author":"Olde","year":"2006","journal-title":"Clin. Psychol. Rev."},{"key":"ref_11","first-page":"14","article-title":"Recognizing postpartum posttraumatic stress disorder","volume":"48","author":"Ferguson","year":"2018","journal-title":"Nursery"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1728","DOI":"10.3389\/fpsyg.2018.01728","article-title":"The Impact of Postpartum Posttraumatic Stress and Depression Symptoms on Couples\u2019 Relationship Satisfaction: A Population-Based Prospective Study","volume":"9","author":"Horsch","year":"2018","journal-title":"Front. Psychol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1111\/j.1523-536X.2006.00107.x","article-title":"Maternal Request for Cesarean Section due to Fear of Birth: Can It Be Changed Through Crisis-Oriented Counseling","volume":"33","author":"Nerum","year":"2006","journal-title":"Birth"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1891\/0886-6708.VV-D-13-00077","article-title":"Trauma Type and Posttraumatic Stress Disorder as Predictors of Parenting Stress in Trau-ma-Exposed Mothers","volume":"32","author":"Wilson","year":"2017","journal-title":"Violence Vict."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1097\/00006199-200407000-00004","article-title":"Post-traumatic stress disorder due to childbirth: The aftermath","volume":"53","author":"Beck","year":"2004","journal-title":"Nurs Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1016\/j.chiabu.2009.05.004","article-title":"Childhood sexual abuse as a predictor of birth-related posttraumatic stress and post-partum posttraumatic stress","volume":"33","author":"Hallak","year":"2009","journal-title":"Child Abus Negl."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1002\/da.22465","article-title":"PTSD Symptoms Across Pregnancy and Early Postpartum Among Women with Lifetime PTSD Diagnosis","volume":"33","author":"Muzik","year":"2016","journal-title":"Depress. Anxiety"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.wombi.2019.03.008","article-title":"Peri-natal factors related to post-traumatic stress disorder symptoms 1\u20135 years following birth","volume":"33","year":"2020","journal-title":"Women Birth."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.ejogrb.2018.04.012","article-title":"Posttraumatic stress disorder related to postpartum haemorrhage: A systematic review","volume":"225","author":"Zaat","year":"2018","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1111\/wvn.12326","article-title":"Fear of Childbirth, Postpartum Depression, and Birth-Related Variables as Predictors of Posttraumatic Stress Disorder After Childbirth","volume":"15","author":"Durmaz","year":"2018","journal-title":"Worldviews Evid. Based Nurs."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"309","DOI":"10.6061\/clinics\/2018\/e309","article-title":"Post-Traumatic Stress Disorder and se-vere maternal morbidity: Is there an association?","volume":"73","author":"Angelini","year":"2018","journal-title":"Clinics"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"348","DOI":"10.3389\/fpsyt.2018.00348","article-title":"Psychosocial Predictors of Postpartum Posttrau-matic Stress Disorder in Women with a Traumatic Childbirth Experience","volume":"9","author":"Hollander","year":"2018","journal-title":"Front. Psychiatry"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"560","DOI":"10.3389\/fpsyg.2017.00560","article-title":"Childbirth Induced Posttraumatic Stress Syndrome: A Systematic Review of Prevalence and Risk Factors","volume":"8","author":"Dekel","year":"2017","journal-title":"Front. Psychol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1111\/birt.12328","article-title":"The influence of postpartum PTSD on breastfeeding: A longitudinal population-based study","volume":"45","author":"Horsch","year":"2018","journal-title":"Birth"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1080\/01674820802545453","article-title":"Widening the trauma discourse: The link between childbirth and experiences of abuse","volume":"29","author":"Thomson","year":"2008","journal-title":"J. Psychosom. Obstet. Gynecol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12978-017-0389-z","article-title":"Methods used in prevalence studies of disrespect and abuse during facility based childbirth: Lessons learned","volume":"14","author":"Sando","year":"2017","journal-title":"Reprod. Health"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1016\/S0140-6736(19)31992-0","article-title":"How women are treated during facility-based childbirth in four countries: A cross-sectional study with labour observations and community-based surveys","volume":"394","author":"Bohren","year":"2019","journal-title":"Lancet"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-019-2332-5","article-title":"Prevalence of disrespect and abuse during facility based child birth and associated factors, Jimma University Medical Center, Southwest Ethiopia","volume":"19","author":"Siraj","year":"2019","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref_29","unstructured":"Mart\u00ednez-Galiano, J.M., Martinez-Vazquez, S., Rodr\u00edguez-Almagro, J., and Hern\u00e1ndez-Martinez, A. (2020). The magnitude of the problem of obstetric violence and its associated factors: A cross-sectional study. Women Birth, S1871-5192(20)30359-0."},{"key":"ref_30","unstructured":"World Health Organization (2015). WHO recommendations on health promotion interventions for maternal and newborn health. Matern. Newborn Child Adolesc. Health, 1, 90."},{"key":"ref_31","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_32","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_33","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1177\/0884217504266898","article-title":"Making meaning: Women\u2019s birth narratives","volume":"33","author":"Callister","year":"2004","journal-title":"J. Obstet. Gynecol. Neonatal. Nurs. JOGNN"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/s00737-018-0853-y","article-title":"Is childbirth-induced PTSD associated with low maternal attachment?","volume":"22","author":"Dekel","year":"2019","journal-title":"Arch. Women. Ment. Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1016\/S0895-4356(96)00236-3","article-title":"A simulation study of the number of events per variable in logistic regression analysis","volume":"49","author":"Peduzzi","year":"1996","journal-title":"J. Clin. Epidemiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.jad.2019.01.042","article-title":"Postpartum post-traumatic stress disorder: Associated perinatal factors and quality of life","volume":"249","author":"Manzanares","year":"2019","journal-title":"J. Affect. Disord."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1038\/sj.jp.7211562","article-title":"Modification of the Perinatal PTSD Questionnaire to enhance clinical utility","volume":"26","author":"Callahan","year":"2006","journal-title":"J. Perinatol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1038\/jp.2015.9","article-title":"Progress of PTSD symptoms following birth: A prospective study in mothers of high-risk infants","volume":"35","author":"Kim","year":"2015","journal-title":"J. Perinatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1177\/0020764019852656","article-title":"Perinatal anxiety and depression: Awareness and attitudes in Australia","volume":"65","author":"Smith","year":"2019","journal-title":"Int. J. Soc. Psychiatry"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"3859","DOI":"10.1111\/jocn.13800","article-title":"Post-traumatic stress disorder in the perinatal period: A concept analysis","volume":"26","author":"Vignato","year":"2017","journal-title":"J. Clin. Nurs."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Rowlands, I.J., and Redshaw, M. (2012). Mode of birth and women\u2019s psychological and physical wellbeing in the postnatal period. BMC Pregnancy Childbirth, 12.","DOI":"10.1186\/1471-2393-12-138"},{"key":"ref_42","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. Gynaecol."},{"key":"ref_43","first-page":"61","article-title":"Correlation between Kind of Delivery and Posttrau-matic Stress Disorder","volume":"6","author":"Mahmoodi","year":"2016","journal-title":"Ann. Med. Health Sci. Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-017-1371-z","article-title":"The effect of an elective cesarean section on maternal request on peripartum anxiety and depression in women with childbirth fear: A systematic review","volume":"17","author":"Olieman","year":"2017","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref_45","first-page":"347","article-title":"Post-traumatic stress disorder in parents of children hospitalized in the neonatal intensive care unit (NICU): Medical and demographic risk factors","volume":"26","author":"Aftyka","year":"2014","journal-title":"Psychiatr. Danub."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s10880-010-9202-7","article-title":"Prevalence and correlates of posttraumatic stress and postpartum depression in parents of in-fants in the Neonatal Intensive Care Unit (NICU)","volume":"17","author":"Lefkowitz","year":"2010","journal-title":"J. Clin. Psychol. Med. Settings"},{"key":"ref_47","first-page":"1","article-title":"Screening for trauma and anxiety recognition: Knowledge, management and attitudes amongst gynecologists regarding women with fear of childbirth and postpartum post-traumatic stress disorder","volume":"12","author":"Stramrood","year":"2018","journal-title":"J. Matern. Fetal. Neonatal. Med."},{"key":"ref_48","unstructured":"Spanish Ministry of Health (2015). Strategy on Care for Normal Childbirth in the National Health System (Spain). Clin. Pract. Guidel. Care Norm. Childbirth., Available online: https:\/\/www.mscbs.gob.es\/organizacion\/sns\/planCalidadSNS\/pdf\/InformeFinalEAPN_revision8marzo2015.pdf."},{"key":"ref_49","first-page":"395","article-title":"Predictors of Exclusive Breastfeeding 6\u20139 Weeks After Delivery: A Pro-spective Cohort Study. Public Mental Health Perspective","volume":"28","author":"Palavra","year":"2016","journal-title":"Psychiatr. Danub."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/11\/5\/338\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:52:16Z","timestamp":1760161936000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/11\/5\/338"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,24]]},"references-count":49,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5]]}},"alternative-id":["jpm11050338"],"URL":"https:\/\/doi.org\/10.3390\/jpm11050338","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,24]]}}}