Title

The Perinatal Self-Care Index: Development of an Evidence-Based Assessment Tool for Use With Child Sexual Abuse Survivors

Publication Title

The Journal of Perinatal & Neonatal Nursing

Publication Date

12-2012

Document Type

Article

DOI

10.1097/JPN.0b013e318252dd9a

Keywords

perinatal self-care index, evidence-based assessment tool, child sexual abuse survivors

Disciplines

Nursing

Abstract

Every ninth woman presenting for prenatal care reports having experienced childhood sexual abuse. Many develop mental health disorders, including posttraumatic stress disorder (PTSD). In response to PTSD, pregnant women survivors of childhood sexual abuse engage in negative perinatal self-care behaviors that can lead to adverse perinatal outcomes. Currently, promotion of perinatal self-care does not consider childhood sexual abuse or PTSD. This study aimed to develop a Perinatal Self-Care Index, determine sensitivity of the index to differences in behaviors of childhood sexual abuse survivors (PTSD-affected and PTSD-resilient), and validate usefulness in relation to birth weight. Secondary analysis was conducted using data from a prospective cohort study of the effects of PTSD on pregnancy outcomes. The index explained 6.5% of variance in birth weight. Prediction improved to 9.4% once PTSD and socioeconomic status were considered. The index is sensitive to differences in PTSD-affected versus PTSD-resilient survivors of childhood sexual abuse and a useful predictor of birth weight in this analysis.

Childhood sexual abuse affects the health of survivors across the lifespan. Many childhood sexual abuse survivors develop mental health disorders, including posttraumatic stress disorder (PTSD). Posttraumatic stress disorder affects health directly through chronic stress pathophysiology 1 and indirectly through deficits in self-care and risk behaviors.2 It also affects perinatal outcomes,3 probably by both physiological and behavioral pathways.4 Approximately 3% to 24% of women starting prenatal care have PTSD.5 The literature suggests that these women may be most symptomatic with PTSD during pregnancy because of the psychosexual nature of pregnancy, the potentially triggering intrusive procedures of prenatal care, and the dynamics of relationships with healthcare providers.6,7 Anecdotal findings in qualitative studies suggest that these survivor moms use maladaptive coping strategies for stress management and are more likely than other pregnant women to use self-soothing methods such as smoking, alcohol/illicit drug use, or excessive eating and are less likely to exercise.7 Pregnant survivors of childhood sexual abuse, especially those with PTSD, thus appear to engage in inadequate self-care behaviors (eg, early and adequate prenatal care) and in negative self-care behaviors (eg, substance use, high-risk sex).5,8–10 Problematic perinatal health behaviors, in turn, contribute to adverse perinatal outcomes, above and beyond the direct effects of PTSD.3 Currently, promotion of perinatal self-care often does not consider childhood sexual abuse or PTSD. A trauma-informed health behavior index could guide care. The purpose of this study was to develop a Perinatal Self-Care Index (PSCI), determine sensitivity to differences in behaviors of childhood sexual abuse survivors (PTSD-affected and PTSD-resilient), and validate usefulness in relation to the outcome of birth weight.