Assessment of posttraumatic stress disorder among women after childbirth using the City Birth Trauma Scale in Spain

Abstract

Postpartum post-traumatic stress disorder (PP-PTSD) affects 3.1-6.3% of women after childbirth. The City Birth Trauma Scale (City-BiTS) is a questionnaire designed to evaluate and diagnose this disorder, according to the DSM-5 criteria, including the following groups of symptoms characteristic of post-traumatic stress: re-experiencing, avoidance, negative cognitions and mood, and hyperarousal. The aim of the present study was to evaluate the psychometric properties of the Spanish-language version of this questionnaire (City-BiTS-S), based on a community sample of Spanish women. A total of 207 mothers, recruited at three health centres in southern Spain, completed the City-BiTS-S questionnaire and provided sociodemographic and obstetric data. Exploratory factor analysis (EFA) of the data replicated the two-factor structure reported in previous studies that explained 47.9% of the variance: Factor 1 of general symptoms, and Factor 2 of birth-related symptoms. Both City-BiTS-S (Cronbach’s α = 0.90) and the two factors (Cronbach’s α for Factor 1 = 0.89; Cronbach’s α for Factor 2 = 0.82) presented high internal consistency. Rasch analysis confirmed the unidimensionality of the two factors as valid subscales of the PP-PTSD. It also confirmed that the item about ‘Not being able to remember details of the birth’ should be reviewed. Rasch analysis also suggested the item ‘Flashbacks to the birth and/or reliving the experience’ should be reworded in the Spanish version. In conclusion, the City-BiTS-S presents appropriate psychometric properties to measure symptoms of postpartum_PTSD. Nevertheless, further research is recommended to confirm its validity in a clinical population and in different medical approaches to the birth process.