THE RELATIONSHIP BETWEEN TRAUMATIC LIFE EXPERIENCES AND HEALTH OUTCOMES FOR POSTPARTUM WOMEN LIVING WITH LOW SOCIOECONOMIC RESOURCES IN MENA COUNTRIES

L. Walton¹, V. Raigangar², S. Khattab³, F. Waheed³, N. Zaaeed⁴

Background: Traumatic life experiences are prevalent and may have cumulative negative effect in vulnerable populations, including postpartum women. Middle East and North African Countries (MENA) are a diverse growing population, with varying levels of socio-economic resources. Women living with less socio-economic resources have been reported to have higher levels of trauma that may affect health related quality of life (Petersen et al, 2019). Trauma may directly impact maternal health outcomes during pregnancy and in the postpartum period and is directly related to chronic cognitive and physical health issues (Kulwicki et al, 2015; Kira, 2002). The number of traumatic life stressors experienced in childhood is documented and shows a direct association with health risk of disease later in life (Shonkoff JP, Garner, Siegel, Dobbins, Earls, et al, 2012). However, there remains little to no research regarding the relationship of “trauma” type, frequency, and cumulative experiences to maternal executive functions, health related quality of life, chronic pain and health outcomes for women living in MENA countries.    

Purpose: This study aims to study the prevalence, type, and cumulative effect of traumatic life experiences on executive functions, maternal and fetal health outcomes, health related quality of life for a sample of postpartum women living in MENA countries with low socioeconomic resources.  

Methods: This was a prospective cross-sectional, correlation design of 104 (n=104) postpartum women living in MENA countries between the ages of 18-45 years of age. The study was approved by the University Research Ethics Board prior to data collection. All subjects who voluntarily signed an informed consent were enrolled in the study. Subjects completed the following surveys: (1) Health Questionnaire, (2) SF-12, (3) Harvard Trauma Scale and the (4) Behavior Rating Inventory of Executive Functions Test Self-Report (BRIEF) to examine cognitive and physical health outcomes. Statistical analysis was done utilizing SPSS 25.0 and qualitative analysis was extracted from focused questions on the Harvard Trauma Scale.  

Results: Mean age was 30.3 years +/-5.6 SD, parity= 2.4 +/- 1.69 SD, BRIEF Sub-Scores for executive functions: (1) Initiation/Problem solving: Mean= 7.2 +/- SD 1.2; (2) Completion of task: Mean = 5.0 +/- SD 2.4; (3) Future Task Organization: Mean = 8.66 +/- SD 2.7; (4) Self-correct: Mean= 5.22 +/- SD 1.7. The overall score for metacognitive index for executive functions was reported as 65.37 +/- SD 7.6. Participants reported, on average, 3 or more traumatic life events on the Harvard Trauma Scale and 10 or more symptoms of trauma. Mean HRQOL MCS = 45.9, SD = 8.8 and PCS scores = 41.85, SD =8.03, significantly below the norm HRQOL for females in this age group (p <.001).

Conclusion(s): Postpartum women living in MENA countries, with a history of traumatic life events, may be more vulnerable to experiencing poor physical and mental health outcomes, including difficulty with executive functions and reduced coping mechanisms leading to poor physical health outcomes with a high prevalence of chronic disease, pain, and reduced health related quality of life.   

Implications: MENA countries seeking to improve the health related quality of life and reduce the chronic disease burden.

Funding, acknowledgements: This project was funded by the International Academy on Gender Equity and Women's Health, USA, 2017-2020.

Keywords: Traumatic Life Events, Postpartum, Health Outcomes

Topic: Health promotion & wellbeing/healthy ageing/physical activity

Did this work require ethics approval? Yes

Institution: University of Sharjah

Committee: University of Sharjah

Ethics number: 18-01-25-05