promoting attachment through healing

Conditions: Stress Disorders, Post-Traumatic; Depressive Disorder; Anxiety Disorders

Summary: intimate partner violence (ipv) is a significant and pervasive public health challenge and is associated with mental illnesses such as depression, anxiety and posttraumatic stress disorder (ptsd). although the perinatal period may be a time of greater risk for experiencing ipv, and greater vulnerability to ptsd symptomatology, a lack of research exists pertaining to the identification/treatment of ipv-related ptsd symptoms during this period. utilizing a mixed-methods approach, and employing a feminist, intersectional framework, the effectiveness of trauma-informed cognitive behavioural therapy (cbt) among pregnant survivors of ipv experiencing ptsd symptomatology on depression, anxiety, ptsd and maternal-infant attachment will be explored.

ipv is a pervasive public health problem \[1\], with estimates of approximately 50% of canadian women experiencing ipv at least once during their lifetime \[2\]. some studies suggest that the perinatal period is a time of higher risk for experiencing ipv \[3-4\]. numerous studies have linked women's experience of ipv with mental health concerns such as depression, anxiety and ptsd \[5-8\] and rates of ptsd are higher for perinatal women compared to the general population \[9-10\]. prevalence rates of ptsd among survivors of ipv range from 31-84% \[7,11\]. the perinatal period may relate to greater risk for re-triggering of ptsd, given the physical/emotional changes, and the intimate/invasive nature of perinatal care. additionally, the medicalized processes involved may contribute to feelings of powerlessness and vulnerability, further compromising at-risk women \[9\]. ptsd can alter psychological functioning and is associated with depression \[12\], disordered eating, substance abuse, sexual risk exposures and re-victimization \[13\] and failure to engage in health promotion strategies such as exercise, diet and routine health care \[14\]; all of which may exacerbate obstetrical risk. furthermore, mental illness and trauma have been associated with infant prematurity, low birth weight and childhood developmental delays \[15\] in addition to adverse effects on maternal functioning such as maternal-child attachment \[15\]. as such, there are enormous personal and societal costs associated with ptsd related to ipv for childbearing women. recently, a significant gap in the literature was identified pertaining to the identification and treatment of ipv-related ptsd of childbearing women \[16\]. there is a critical need for individualized, trauma-informed care to facilitate optimal maternal and child attachment outcomes \[16\]. fortunately, effective ptsd treatments exist, such as cbt; however, research exploring cbt in pregnant populations is lacking \[17\]. as such, the purpose of this study is to explore the effectiveness of cbt for the treatment of ipv-related ptsd among antenatal women.

Eligibility criteria:
inclusion criteria: women who received antenatal cbt treatment from the perinatal nurse specialist at the perinatal mental health clinic (london health sciences centre, london, on, canada) who are: * english speaking * have symptoms consistent with ptsd, depression, and/or anxiety exclusion criteria: * women will be excluded if there is, or if it anticipated that there will be involvement in child protection services under the child and family services act

Keywords: antenatal postpartum mental health