PTSD symptoms, moral injury linked to adverse perinatal outcomes among female veterans
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PTSD symptoms and moral injury appeared associated with adverse perinatal outcomes, according to results of a longitudinal survey study of female veterans published in Journal of Traumatic Stress.
Researchers noted that these findings highlight the need to screen for both PTSD and moral injury during the perinatal period.
“This study found that a high percentage of female veterans experienced adverse outcomes and postpartum mental health difficulties during pregnancies that occurred following their separation from military service,” Yael I. Nillni, PhD, of the National Center for PTSD’s Women’s Health Sciences Division at VA Boston Healthcare System, told Healio Psychiatry. “Our findings are consistent with other studies that examined the association between PTSD and adverse pregnancy outcomes in the general population, and they heighten and highlight the importance of mental health for maintaining good pregnancy health.”
With the expansion of roles available to women within the armed services, there has also been an increase in women’s exposure to combat and related potentially traumatic and morally troubling experiences. For example, female veterans may be exposed to moral injury, which the researchers note can be best captured by the widely used Moral Injury Events Scale (MIES). This scale conceptualizes outcomes of exposure to these transgressions, reflecting moral pain such as guilt and shame resulting from these experiences. Research regarding perinatal health outcomes among female veterans is still in its infancy, particularly for the impact of PTSD. Further, no studies exist, to the researchers’ knowledge, regarding the impact of moral injury on pregnancy outcomes.
To address this research gap, Nillni and colleagues examined the impact of PTSD symptoms and moral injury on prospectively assessed adverse perinatal outcomes among 318 women who became pregnant in the first 3 years after separating from U.S. military service. They used the MIES to assess the relationship between severity of distress and transgressions of deeply held moral beliefs, and they assessed PTSD symptoms using the Primary Care PTSD Screen for DSM-5 (PC-PTSD). Experiencing an adverse event (ie, gestational diabetes, preterm birth), postpartum depression and/or anxiety and perceived difficult pregnancy served as perinatal outcomes.
Results showed both PTSD symptoms (adjusted OR [aOR] = 1.16; 95% CI, 1-1.35) and moral injury (aOR = 1.27; 95% CI, 1.06-1.41) significantly predicted adverse pregnancy outcomes; however, only PTSD symptoms significantly predicted postpartum depression and/or anxiety (aOR = 1.43; 95% CI, 1.22-1.68) and perceived difficult pregnancy (beta = .31), when controlling for lifetime trauma exposure, socioeconomic status, age and ethnic/racial minority status.
“There is an immediate need for heightened awareness of the impact of PTSD and moral injury on perinatal outcomes, especially given that many female veterans currently receive obstetric care outside of the VA," Nillni told Healio Psychiatry. "Although depression screening has become more common in obstetric settings, this study suggests that screening for PTSD and moral injury during the perinatal period is also important to identify women who may need treatment for these problems.” – by Joe Gramigna
Disclosures: Healio Psychiatry could not confirm relevant financial disclosures at the time of reporting.