Assessment of Posttraumatic Stress Disorder Among Women After Childbirth Using the City Birth Trauma Scale in Spain

Objective: Postpartum posttraumatic stress disorder (PP-PTSD) affects 3.1-6.3% of women after childbirth. The City Birth Trauma Scale (City-BiTS) is a questionnaire designed to evaluate and diagnose this disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria, including the following groups of symptoms characteristic of posttraumatic stress: reexperiencing, avoidance, negative cognitions and mood, and hyperarousal. The aim of the present study was to evaluate the psychometric properties of the Spanish-language version of this questionnaire (City-BiTS-S), based on a community sample of Spanish women. Method: A total of 207 mothers, recruited at three health centers in southern Spain, completed the City-BiTS-S questionnaire and provided sociodemographic and obstetric data. Results: Exploratory factor analysis of the data replicated the two-factor structure reported in previous studies that explained 47.9% of the variance: Factor 1 of general symptoms and Factor 2 of birth-related symptoms. Both City-BiTS-S (Cronbach's alpha = .90) and the two factors (Cronbach's alpha for Factor 1 = 0.89; Cronbach's alpha for Factor 2 = 0.82) presented high internal consistency. Rasch analysis confirmed the unidimensionality of the two factors as valid subscales of the PP-PTSD. Results suggested reducing response options, reviewing Item 8, and rewording Item 3 in the Spanish version. Conclusions: The City-BiTS-S presents appropriate psychometric properties to measure symptoms of PP-PTSD. Nevertheless, further research is recommended to confirm its validity in a clinical population and in different medical approaches to the birth process.