Effect of The Relationship Between Childhood Trauma and Depression, Anxiety and Stress Levels on the Delivery Style of Midwives

Öz

Aim: This study aims to investigate the relationship between midwives’ exposure to childhood trauma and their depression, anxiety and stress levels and the effect of these psychological variables on midwives’ birth method choices. Material and Methods: The data of this cross-sectional descriptive study were collected via an online survey from 342 midwives working in inpatient healthcare institutions across Türkiye who volunteered to participate. The Childhood Trauma Questionnaire and the Depression, Anxiety, and Stress Scale were used as data collection tools. Results: The findings show that there are positive and significant relationships between childhood trauma and depression (r=0.416), anxiety (r=0.413) and stress (r=0.384) levels (p<0.01). In addition, it was observed that emotional abuse (7.55±3.93; p=0.009), physical abuse (6.52±3.31; p=0.002), denial (10.98±2.98; p=0.005), depression (5.93±5.13; p<0.001) and stress (6.92±4.88; p<0.001) scores were significantly higher in individuals with no children. In individuals with psychiatric diagnosis, the total CTQ score (74.24±18.69; p<0.001) and all subscales except physical neglect and all DASS-21 scores were found to be significantly higher; Especially the increase in the levels of sexual abuse (11.38±8.36; p=0.001), overprotection (14.52±3.40; p<0.001), depression (8.71±6.68; p=0.028) and anxiety (8.38±5.84; p=0.002) is remarkable. It was determined that individuals whose first child was born by cesarean section had higher CTQ total score (58.61±10.66; p=0.003), sexual abuse (6.47±3.13; p<0.001), physical neglect (8.45±3.37; p<0.001) and emotional neglect (10.08±4.24; p=0.038) compared to those who gave birth vaginally. Conclusion: This study revealed that midwives’ exposure to childhood trauma is significantly associated with their levels of depression, anxiety, and stress in adulthood, and that these psychological states may affect midwives’ preferences for delivery methods. The research findings show that physical and emotional abuse and neglect experienced in childhood pave the way for psychological problems in adulthood, and that these problems increase the tendency towards more controlled delivery methods such as cesarean section.

Anahtar Kelimeler

• anxiety
• birth
• childhood trauma
• depression

Kaynakça

1. 1. Girouard N, Bailey H. Adverse childhood experiences: A qualitative study with child welfare workers. Child Adolesc Soc Work J. 2017;34(2):123–31.
2. 2. Çelik IE, Hocaoglu C. The relationship between childhood trauma and dissociative experiences. Anadolu Psychiatry J. 2018;19(2):141–8.
3. 3. Kessler RC, McLaughlin KA, Green JG, Gruber MJ, Sampson NA, Zaslavsky AM, et al. Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys. Br J Psychiatry. 2010;197(5):378–85.
4. 4. Nelson CA, Scott RD, Bhutta ZA, Harris NB, Danese A, Samara M. Adversity in childhood is linked to mental and physical health throughout life. BMJ. 2020;371:m3048.
5. 5. World Health Organization. Adverse Childhood Experiences International Questionnaire (ACE-IQ). Geneva: WHO;2020. Available from: https://www.who.int/publications/i/item/ adverse-childhood-experiences-international-questionnaire [Accessed 2024 Mar 20]
6. 6. Ulukol B, Tuncer OB, Karabekiroglu A, Gumuscu S, Ozyurt G, Uslu R, et al. Turkey Child and Adolescent Mental Health Policy Document. Ankara: Turkish Association of Child and Adolescent Psychiatry;2014. [Accessed 2024 Mar 20]
7. 7. Dube SR. Adverse childhood experiences and the risk of premature mortality. Am J Prev Med. 2018;55(3):344–50.
8. 8. Kalmakis KA, Chandler GE. Health consequences of adverse childhood experiences: A systematic review. J Am Assoc Nurse Pract. 2015;27(8):457–65.

9. 9. Norman RE, Byambaa M, De R, Butchart A, Scott J, Vos T. T he long-term health consequences of child physical abuse, emotional abuse, and neglect: A systematic review and metaanalysis. PLoS Med. 2012;9(11):e1001349.
10. 10. Kuzminskaite E, Andersson A, Valentin JB, Nissen J, Jørgensen MB, Dalsgaard S, et al. Childhood trauma and its associations with clinical characteristics in adult ADHD. J Affect Disord. 2021;292:424–32.
11. 11. Negele A, Kaufhold J, Kallenbach L, Leuzinger-Bohleber M. Childhood trauma and its relation to chronic depression in adulthood. Depress Res Treat. 2015;2015:650537.
12. 12. Shonkoff JP, Garner AS, Committee on Psychosocial Aspectsof Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, Section on Developmental and Behavioral Pediatrics. The lifelong effects of early childhood adversity and toxic stress. Pediatrics. 2012;129(1):e232–46.
13. 13. De Bellis MD, Zisk A. The biological effects of childhood trauma. Child Adolesc Psychiatr Clin N Am. 2014;23(2):185–222.
14. 14. Stokes B, Strobl C, Nater UM. The effect of childhood adversity on adult health: The role of rumination and emotion regulation. Psychoneuroendocrinology. 2017;84:62–70.
15. 15. Choi KW, Sikkema KJ, Vythilingum B, Geerts L, Faure SC, Watt MH, et al. Maternal childhood trauma, postnatal depression and infant social-emotional problems in South Africa. J Affect Disord. 2021;278:292–9.
16. 16. Jung SJ, Oh Y. A study of the influence of adverse childhood experiences on depression and suicidal ideation among Korean university students. Child Youth Serv Rev. 2020;113:104999.
17. 17. Faul F, Erdfelder E, Buchner A, Georg Lang A. Statistical power analyses using G*Power 3. 1: Tests for correlation and regression analyses. Behav Res Methods. 2020;41:1149–60.
18. 18. Bernstein DP, Fink L, Handelsman L, Foote J, Lovejoy M, Wenzel K, et al. Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry. 1994;151(8):1132–6.
19. 19. Şar V, Necef I, Mutluer T, Fatih P, Türk-Kurtça T. A revised and expanded version of the Turkish Childhood Trauma Questionnaire (CTQ-33): Overprotection-overcontrol as additional factor. J Trauma Dissociation. 2021;22(1):35–51.
20. 20. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33:335–43.
21. 21. Sarıçam H. The psychometric properties of Turkish version of Depression Anxiety Stress Scale-21(DASS-21) in health control and clinical samples. J Cogn Behav Psychother Res. 2018;7(1):19–30.
22. 22. Karagöz Y. SPSS-Amos-Meta applied statistical analysis. 2nd ed. Ankara: Nobel Academic Publishing;2019.
23. 23. Gürsoy MY, Mechmet FC. Correlations between childhood trauma and depression, anxiety, and stress levels in nurses. Arch Psychiatr Nurs. 2023;45:164–8.
24. 24. Çınaklı Ş, Arslantaş H. Childhood trauma, postpartum depression and maternal attachment in adolescent and nonadolescent mothers. Çukurova Med J. 2021;46(1):1–10.
25. 25. Al Maqbali M, Al Sinani M, Al-Lenjawi B. Prevalence of stress, depression, anxiety and sleep disturbance among nurses during the COVID-19 pandemic: A systematic review and metaanalysis. J Psychosom Res. 2021;141:110343.
26. 26. Işık O, Tengilimoğlu D, Tosun N, Zekioğlu A, Tengilimoğlu O. Evaluating the factors (stress, anxiety and depression) affecting the mental health condition of nurses during the COVID-19 pandemic. Eval Health Prof. 2022;45(1):86–96.
27. 27. Opoku Agyemang S, Ninnoni JP, Enyan NIE. Prevalence and determinants of depression, anxiety and stress among psychiatric nurses in Ghana: A cross-sectional study. BMC Nurs. 2022;21(1):179. 28. Mechmet FC, Gürsoy MY. Childhood traumas among nursing students and associated factors. Arch Psychiatr Nurs. 2023;43:98–105