論文の公開元へValidity and reliability of the Posttraumatic Growth Inventory among Japanese women with cesarean section
概要
Women who have delivered by cesarean section are at high risk for posttraumatic stress
symptoms and posttraumatic stress disorder (PTSD). In a previous study, women who underwent
an unplanned cesarean section were 3.3 times more likely to experience probable childbirth-related
PTSD than women who had a natural delivery.1 Hernández-Martínez et al2,3 found that, among
Spanish women, cesarean section was one of the risk factors of PTSD, being associated with
3.79–4.80 times more PTSD symptoms than normal vaginal delivery. Further, 14.3% of 890
postpartum Australian women experienced posttraumatic stress symptoms, which, when compared
with normal vaginal delivery, was 2.15 times more likely when it was an elective cesarean section
and 5.17 times more likely when it was an emergency cesarean section.4 Japanese women who
had an emergency cesarean section recognized the intense experiences that overwhelmed their
own and their children’s lives, characterizing their own experiences as traumatic.5 These women
lost confidence in childbirth and as mothers.6 A qualitative study also reported that Australian
mothers who underwent a cesarean section experienced trauma at delivery.7
Postpartum posttraumatic stress symptoms and PTSD contribute to the development of postpartum depression8 and attachment disorders.9 In a mixed-research synthesis, Beck and Casavant10
reported that women’s posttraumatic stress at childbirth adversely affected their relationships with
their infants and partners. However, this is not the case for all postpartum women who experience
posttraumatic stress symptoms and/or PTSD. For women who had a cesarean section, talking
about childbirth helped them process the events that occurred and their feelings.11 Hashimoto and
Kobayashi6 reported that Japanese women who had an emergency cesarean section found that they
gained acceptance of their childbirth experiences by repeatedly talking about them. Therefore,
it is possible that some women will experience personal growth, specifically as mothers, after
enduring posttraumatic stress following a cesarean section.
A woman who experiences a significant amount of stress after a cesarean section can grow
as a person during the recovery process. Posttraumatic growth (PTG) is defined as the positive
psychological change that a person experiences as a result of a struggle with a major life crisis or
traumatic event.12 Although the word “traumatic” is included in the PTG definition, it is not necessarily limited to trauma that causes PTSD, but includes stressful, life, and even crisis events.13
Therefore, by measuring PTG after a cesarean section, it is possible to visualize the growth as
a mother. Several recent studies have examined PTG in mothers after childbirth. For example,
British women who experienced a cesarean section had higher levels of PTG after childbirth
than women who underwent a vaginal delivery.14 In Israel, the PTG of parents with premature
babies was higher than that of parents with full-term babies.15 In two recent studies in Japan,
postpartum primiparas with high social support had higher PTG16; furthermore, primiparas had a
higher level of PTG than multiparous women, and higher resilience was associated with higher
PTG.17 In these studies, PTG was measured with the Posttraumatic Growth Inventory (PTGI).18
The PTGI consists of 21 items and five factors.18 The PTGI has reported that differences
in language, socio-cultural and religious backgrounds, and characteristics of the subjects affect
the factor structure.19 In Israel, the PTGI demonstrated reliability and validity in a sample of
postpartum mothers.20 In Japan, Suzuki et al21 found support for the validity and reliability of
their Posttraumatic Growth Inventory-Japanese version (PTGI-J) for postpartum women based
on the original 21-item PTGI-J.22 The PTGI-J for postpartum women’s version consists of 17
items and three factors, and the Cronbach’s α was 0.93.21 However, the spiritual domain of the
Nagoya J. Med. Sci. 85. ...
