Prevalence of inpatient postpartum anxiety and post-traumatic stress symptoms: a cross-sectional study

Background: Mental health conditions are now the leading cause of maternal mortality in the United States, prompting calls for universal postpartum anxiety and post-traumatic stress disorder (PTSD) screening. However, standardized guidelines for screening implementation remain deficient. This cross-sectional study evaluated the prevalence of inpatient postpartum anxiety and PTSD while exploring associated risk factors. Objectives: Over a three-week period, we prospectively assessed adult postpartum patients following all delivery modes (vaginal and cesarean, live and stillbirth) at a single academic institution. Screening was performed within 36 hours of delivery using validated State-Trait Anxiety Inventory (STAI; cut off >=80) and PTSD Checklist for DSM-5 (PCL-5; cut off >=28) questionnaires. Data collection included demographic, obstetric, medical and neonatal variables, with assessments conducted in-person or via telephone for any spoken language. Study design: Cross-sectional study Results: Among 275 eligible patients, 263 (95.6%) completed the screening measures. The prevalences of positive postpartum anxiety and PTSD screening were 12.5% and 4.9% respectively, with 3.8% of patients screening positive for both conditions. Worse STAI scores were associated with ASA >=3, Apgar scores <7 and pre-term birth. Worse PCL-5 scores were associated with spontaneous vaginal delivery, primiparity, ASA >=3, blood transfusion, NICU admission, Apgar score <7, pre-eclampsia and pre-term birth. Factors after adjustment associated with positive anxiety screening were a psychiatric history or medication use. No factors after adjustment were associated with positive PTSD screening. Conclusions: Positive screening for inpatient postpartum anxiety and PTSD occurred in 12.5% and 4.9%, respectively. Positive anxiety screening was independently associated with psychiatric history or medication use. Targeted screening for PTSD may be more appropriate, particularly among patients with pre-existing psychiatric conditions or complicated pregnancies. Future research should focus on determining optimal screening parameters and timing strategies, and intervention guidelines to better support high-risk obstetric populations.