Talk:Childbirth-related post-traumatic stress disorder

MEDMOS

Please see WP:MEDMOS on article organization, and WP:MEDRS on the use of primary sources. SandyGeorgia (Talk) 20:36, 26 January 2012 (UTC)

A good idea, however, this is also a clinical psych. topic, not simply a medical topic. The situation is a bit more complex than you portray. There IS value in consulting the articles you suggest, to be sure. It's just not the whole story.Tom Cloyd (talk) 22:03, 26 January 2012 (UTC)

If there are secondary reviews that cover the topic, primary sources should not be used to the exclusion of secondary reviews, or when they contradict them. And there are a good number of secondary reviews-- I've listed below only the most recent, but there are plenty. In terms of the sources available and the text currently in the article, there is no useful distinction between psych/medical-- the text in the article is medical, and secondary review have evaluated psychological treatment and management. By the way, for starters, we need to know if there is any such diagnosis, and if the article is correctly named (I moved it from the original misnamed article, but don't know if this is where it belongs). SandyGeorgia (Talk) 22:11, 26 January 2012 (UTC)

No need to reiterate what I'm already in agreement with - better sources are needed.

My point about medicine versus psychology is that the one deals with organicity and the other with learning, which, as yet, cannot be much reduced to organic dynamics, except in theory, which isn't all that useful. This is an essential assertion.

Medicine deals with hardware, psychology with software. The complete picture can only be attained by considering the models and research of both. A simple idea. We are collaborators.Tom Cloyd (talk) 22:16, 26 January 2012 (UTC)

Fine, but there's still nothing in the article that is distinct medical vs. psych, and there are secondary sources that should be used. It's unfortunate that editors are plowing ahead, adding text here that will eventually be removed, when I've listed below secondary sources that could be used. I'd do it myself, but I don't have access to the full text of the sources. SandyGeorgia (Talk) 22:20, 26 January 2012 (UTC)

In agreement on all points! We'll get back here, and work to fix things, shortly. I'll assume the active editors are learning, and that this well may be their first efforts at WP. We sure had our own beginner days. I'd rather see the energy and drive, and do some cleanup later, than see merely a wimpy stub or a blank page. Am not worried. Tom Cloyd (talk) 05:42, 27 January 2012 (UTC)

Yes, I've heard back from one of the editors involved. She would like to continue contributing, but feels a little overwhelmed by the feedback so far. --jbmurray (talk • contribs) 20:44, 28 January 2012 (UTC)

Jb, although they didn't engage on talk, they did begin using WP:MEDRS-compliant secondary reviews, so ... I think we're in good shape to move forward. I've removed everything that didn't belong there, renamed the article to what the sources most often call it, and if they stick with the numerous MEDRS-compliant sources we've got (now in the article and listed in Further reading), the task of completing the article shouldn't be too daunting. Diving in to medical editing on Wikipedia is, in fact, harder than in some other realms, because we have sourcing standards. If they can be encouraged to add sections compliant with WP:MEDMOS, and stick with reviews, moving forward shouldn't be difficult now. Thanks, Jb !! SandyGeorgia (Talk) 20:57, 28 January 2012 (UTC)

Yes, I don't want to speak for her--I've encouraged her to speak for herself. But if we give her and her students some time, I think all will be well. By the way, as far as I can see this is not a class assignment, just an idea proposed by some of her students from her lab. I think we should be encouraging this, as it fits well within what Mike Christie was arguing a little while back. --jbmurray (talk • contribs) 21:05, 28 January 2012 (UTC)

Reviews

This article relies on primary studies (pls see WP:MEDRS). Here are some recent secondary reviews that should be used instead-- since there are plenty of recent reviews, there is no reason to use primary studies here:

• Lapp LK, Agbokou C, Peretti CS, Ferreri F (2010). "Management of post traumatic stress disorder after childbirth: a review". J Psychosom Obstet Gynaecol. 31 (3): 113–22. doi:10.3109/0167482X.2010.503330. PMID 20653342. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Elmir R, Schmied V, Wilkes L, Jackson D (2010). "Women's perceptions and experiences of a traumatic birth: a meta-ethnography". J Adv Nurs. 66 (10): 2142–53. doi:10.1111/j.1365-2648.2010.05391.x. PMID 20636467. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Lev-Wiesel R, Daphna-Tekoah S (2010). "The role of peripartum dissociation as a predictor of posttraumatic stress symptoms following childbirth in Israeli Jewish women". J Trauma Dissociation. 11 (3): 266–83. doi:10.1080/15299731003780887. PMID 20603762.
• Vythilingum B (2010). "Should childbirth be considered a stressor sufficient to meet the criteria for PTSD?". Arch Womens Ment Health. 13 (1): 49–50. doi:10.1007/s00737-009-0118-x. PMID 20127456. {{cite journal}}: Unknown parameter |month= ignored (help)
  • Unless this is incorporated, the article may be POV. SandyGeorgia (Talk) 21:36, 26 January 2012 (UTC)
• Sawyer A, Ayers S, Smith H (2010). "Pre- and postnatal psychological wellbeing in Africa: a systematic review". J Affect Disord. 123 (1–3): 17–29. doi:10.1016/j.jad.2009.06.027. PMID 19635636. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Beck CT (2009). "Birth trauma and its sequelae". J Trauma Dissociation. 10 (2): 189–203. doi:10.1080/15299730802624528. PMID 19333848.

I do not have access to the full text of these journal reports, but based on reading the abstracts, a good deal of the information now in the article is incorrect or is information based on primary studies that is not supported by secondary reviews. I'll wait a few days before deleting text, in case someone wants to access these reviews and improve the text. SandyGeorgia (Talk) 22:05, 26 January 2012 (UTC)

Your observations and sources are very helpful. I absolutely agree with the need to upgrade the article. However, I did not originate it, and am extremely busy elsewhere at Wikipedia, so it will take a few days to return and help out with the upgrade. I am not at all sure this should even be an article separate from the PTSD article. We'll see.

I have a great interest in this subject, for two reasons: I'm a mental health professional who treats PTSD (and DID) as a specialty, and I have a great concern about the fact that more than 2/3s of the individuals with PTSD are women, and they typically do not get assessed correctly, much less treated. The public thinks only about the military, relative to PTSD. This is a huge misdirection of our public health effort - although military victims certainly deserve diagnosis and treatment.

The better delineated the case is for giving attention to female victims, the more the public will realize and fund treatment access for everyone. This is a major national public health issue, in my mind.

Tom Cloyd (talk) 22:11, 26 January 2012 (UTC)

I'm also unsure if this should even be an article, or if content should be merged to the PTSD article. Without having full access to the sources, I can't tell. But again, it's unfortunate that editors are plowing ahead here, ignoring guidelines and policy. SandyGeorgia (Talk) 22:22, 26 January 2012 (UTC)

Exactly my concerns and I am going to start (or try to continue) a discussion regarding this in another section.--Literaturegeek | T@1k? 00:19, 27 January 2012 (UTC)

I track PTSD-related professional news rather closely, and I've seen NO advocacy at all for the idea that there is some special sort of PTSD that is only seen in the context of childbirth. The only real news is WHERE it's now being seen, NOT WHAT is being seen there. For that reason, there is no advocacy in the DSM-V world for any additional diagnostic category or subcategory - there's just no reason for that. Advocacy of a "new flavor of PSTD" would require demonstration of categorically distinct symptom profile emergent in this causal environment. Such a demonstration is completely unknown to me. I would be fascinated to see it, but...I have not. Tom Cloyd (talk) 00:57, 28 January 2012 (UTC)

Cleanup needs

Please see WP:LEAD (we start off the article with epidemiology, and there is no lead). Also, please see WP:WIKIFY, and the article is starting to take on some overquoting-- we need to write it in our own words. SandyGeorgia (Talk) 22:47, 26 January 2012 (UTC)

YES! These are highly appropriate recommendations. Even if article is merged, going through the process of getting the format conformant to Wikipedia standards is a very good idea. The format is anything but arbitrary, I assure you. It is actually a time tested way of rapidly communicating well. Tom Cloyd (talk) 19:52, 27 January 2012 (UTC)

Delete or boldly merge this article in PTSD article

I and others have wondered whether this article should exist. Really, this article is just on a single possible cause of post-trauma, but there are potentially hundreds, possibly even thousands of possible causes for PTSD! Why is pregnancy related PTSD singled out for special attention? What makes it notable? Are the authors of this article going to produce articles on the hundreds/thousands of possible causes of PTSD? Would it not make more sense to choose 2 or 3 review sources written preferably in the past 5 or max 10 or so years and write a few lines in the main PTSD article section on causes, about pregnancy related PTSD? That would be my instinct. Perhaps we could get a discussion on the pros and cons of keeping versus merging this article? Lets discuss, or if you all are in the mood for it even debate! ;-) --Literaturegeek | T@1k? 00:26, 27 January 2012 (UTC)

As a PTSD treatment professional, I delighted to see active interest taken in this topic. The point above does need to be taken seriously, however. I VERY much doubt that postpartum PTSD is in any way different from any other kind, other than in its proximate causes, and therefore does not really deserve its own article.

What IS certainly very important about this topic, to my mind, is that PTSD related to medical events, and developing in women, have both received seriously inadequate attention until now. This is beginning to change, and it's about time.

One plan that might make a lot of sense would be to use this present article as temporary location to develop the topic, using good (i.e., predominantly secondary) sources, then reduce it to a terse and powerful summary and move its content into the main PTSD article. I really do think that is where things need to go eventually.

Tom Cloyd (talk) 05:50, 27 January 2012 (UTC)

I agree, Tom, that it is encouraging to see people taking an interest in this subject and I don't fault the editor(s) of this article for that and I hope that they stick around wikipedia. I think that if things are eventually going to be moved to PTSD, why not do it now? :-P

If the causes section of the PTSD article gets too big, an article on 'causes of PTSD' may be justified some time in the future, rather than lots of individual causes articles.--Literaturegeek | T@1k? 12:44, 27 January 2012 (UTC)

Is there a DSM diagnosis that covers this article or not? If not, is it proposed for DSM V? We need to get some square answers from folks who have the sources so we can decide what to do with this text. SandyGeorgia (Talk) 16:52, 27 January 2012 (UTC)

Answer (this is my field, remember, so it's likely that I have above-average familiarity with the research literature and with the DSM and proposed changes for DSM-V):

• DSM diagnosis extant? - absolutely not;
• proposed for DSM V? - absolutely not.

PTSD resulting from medical procedures is identical to all other PTSD. There are many paths to the same outcome. To think otherwise is a common layman's error. PTSD is not about the observable causal event, but the subjective affective response to that event. PTSD is PTSD, period. This is heart of the argument that there is no justification for this article's having an existence separate from the PTSD article. That said, I personally have no objection to allowing the authors of the present article develop their material for a while before it is reduced to essentials and merged into PTSD. What must be avoided is the representation of PTSD deriving from birth events as something unique. I know of NO justification for that assertion. We do not need 37 flavors of PTSD. From the perspective of symptoms, there is but one. Tom Cloyd (talk) 20:07, 27 January 2012 (UTC)

Yes, I've already uncovered the DSM info-- see later sections here (I see you're catching up in order-- perhaps fast forward to the bottom of the page). SandyGeorgia (Talk) 20:10, 27 January 2012 (UTC)

Citation problem in "Causes"

This citation code <ref name=Creedy2000/>, in this section, references a tagged reference which does not yet exist, so the parser cannot make sense of it. An easy error to make! Whoever knows the original citation should supply it at the point that code exists, and the problem will vanish. Tom Cloyd (talk) 11:27, 27 January 2012 (UTC)

I fixed it. OK, what's going on with this article? We have three new accounts editing the article, not one of them has engaged on talk, we have three experienced editors cleaning up after them, we don't know if this is a class project or sockpuppetry or meatpuppetry, and no one has yet determined if this article should even exist. Unless someone has an idea of how to get these new accounts to discuss their edits, should we request protection to force them to come to talk and discuss? The latest new editor wiped out the WP:LEAD, and they all share the characteristic that they won't engage on talk, so perhaps an SPI is needed? I'm unclear now if I can restore a lead to the article without breaching 3RR. Will someone add a lead, please? SandyGeorgia (Talk) 16:59, 27 January 2012 (UTC)

OK, one of our new editors appears to be a psych professor at a University, and the other appears to be a practicing psychologist in the same town. This looks like coordinated editing, and it would be nice if the two (or three) of them would engage on talk. SandyGeorgia (Talk) 17:14, 27 January 2012 (UTC)

This is basically good news. Now we just need a little getting-up-to-speed-with-Wikipedia. I sure can help with this, but they need to make contact!!!Tom Cloyd (talk)

As SandyG dropped me a note, and in that one of these new editors is apparently a colleague of mine (though I don't know her), I have sent her an email. FWIW. --jbmurray (talk • contribs) 20:33, 28 January 2012 (UTC)

Tom Cloyd, in this edit, you changed some text correctly, but you also altered the title in some citations. Please fix. For example, see PMID 17931469 where you have now introduced an error into the citation. I'm doing all the cleanup here, which means I may breach 3RR. SandyGeorgia (Talk) 17:06, 27 January 2012 (UTC)

Yeah, I knew I screwed up, and I thought I fixed all the mistakes. Will revisit and repair. Not sure how I missed this on the second pass. Thanks! Tom Cloyd (talk) 00:33, 28 January 2012 (UTC)

OK - all repaired, I believe. Good catch. Thanks.Tom Cloyd (talk) 00:44, 28 January 2012 (UTC)

DSM V and POV concerns

Review article, it looks to me like we may have a POV issue in here:

• Condon J (2010). "Women's mental health: a "wish-list" for the DSM V". Arch Womens Ment Health. 13 (1): 5–10. doi:10.1007/s00737-009-0114-1. PMID 20127444. {{cite journal}}: Unknown parameter |month= ignored (help)

This article highlights four areas of mental health affecting women in the reproductive age group which, in the author's opinion, are poorly dealt with in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM IV) (American Psychiatric Association 1994). These are depression occurring during pregnancy; childbirth-related post-traumatic stress disorder ...

So, perhaps the correct name should be Childbirth-related posttraumatic stress disorder, if that is being pushed for in DSMV? The 2006 Olde review (PMID 16176853) also refers to it as "Childbirth-related PTSD". If the article is moved to that name, then the LEAD can state that it is proposed for inclusion to DSM-V, but not currently a diagnosis.

Are primary sources being used to here to beef up the push for this to be included in DSMV? The article was initally created by highlighting incidence in the first sentence. I cannot find any indication here that childbirth-related PTSD is being considered in DSM-V, so I'm wondering if this article is pushing a POV by overreliance on primary sources? Since there seems to be some evidence of coordinated editing here, this needs to be examined.

Further, I've now located the source for the original version,[1] claiming this was more common than PTSD in returning vets in Canada-- that is an outdated source, a press release, and does not even mention childbirth-related PTSD, so we have synthesis, original research from the get-go. The 2002 press release doesn't tell us if the Canadian data looks at Canadian forces when they were mostly involved in peacekeeping, so even if that sentence wasn't original research, it's all dubious and needs to be removed and looks very much like a POV is being pushed in here. SandyGeorgia (Talk) 18:18, 27 January 2012 (UTC)

Excellent research. However, since these are professionals (according to you), it is more likely that what we are seeing is simply naivete, and lack of knowledge of some of the conventions of Wikipedia. If so, the problem can be quickly corrected. Perhaps I'm being overly optimistic, but at this point we don't really have enough information. Polemicists in professional mental health DO exist, but they are rare, in my experience. We'll soon see.

As for anything in Wikipedia having influence on the editorial and research teams involved with DSM-V, I very very seriously doubt that we need to have any worries there. Of course, the active content-editors here may be naive about that as well!

All that's really new here is the growing realization in medicine and mental health that this is yet another medicine-related area of practice which produces significant PTSD; I've been watching this for some time. I don't see in this, however, any justification whatsoever for a separate article in Wikipedia.Tom Cloyd (talk) 00:52, 28 January 2012 (UTC)