Cross-cultural study of posttraumatic growth following childbirth

Posttraumatic growth describes positive changes following challenging events. Although such changes are well documented there remain a number of important areas for further research, some of which are addressed in this thesis. In particular, this thesis aimed to clarify the relationship between growth and adjustment following health events, explore growth in different cultures (UK and Africa), and examine growth following childbirth using a prospective design. First, two systematic reviews were carried out to examine (i) growth following health events and (ii) maternal wellbeing in African women. The first meta-analytic review found that growth following cancer and HIV/AIDS was associated with higher levels of positive mental health, higher subjective physical health, and lower levels of negative mental health. Moderating variables were time since the event, age, ethnicity, and type of negative mental health outcome. The second review found that maternal psychological problems in African women have a similar or slightly higher prevalence than reported in developed countries. Risk factors were broadly comparable although some culture-specific factors were also found. Three research studies were conducted. The first study qualitatively explored 55 Gambian women’s experiences of pregnancy, childbirth, and the postnatal period. Thematic analysis identified five themes: (1) transition to adulthood, (2) physical difficulties, (3) value of children in relation to others, (4) children as a strain, and (5) going through it alone. Prospective studies of growth following childbirth were then carried out in the UK (N=125) and The Gambia (N=101). Women completed questionnaires during their third trimester of pregnancy and up to 12 weeks after birth. A proportion of women in both countries reported growth following childbirth. In the UK, higher levels of growth were associated with caesarean sections and prenatal posttraumatic stress symptoms. In The Gambia, higher growth was associated with lower income, lower education, and higher postnatal social support.