Traumatic birth experience and posttraumatic stress disorder : The psychometric properties of the Icelandic version of the City Birth Trauma Scale (City BiTS)

Abstract

Objective: The aim of this study was to investigate the psychometric properties of the Icelandic City Birth Trauma Scale (City BiTS) and assess the prevalence of childbirth related post-traumatic stress symptoms and post-traumatic stress disorder in the Icelandic population. Methods: The City BiTS was translated to Icelandic and tested for face-validity (n = 6). Data was collected in 2022 in an online cross-sectional survey among mothers 6–12 weeks postpartum (n = 616). Exploratory Factor Analysis (EFA) was used to test the underlying factor structure. Internal consistency was assessed using Cronbach's alpha and McDonald's Omega. Convergent validity was evaluated with Spearmańs rank correlation with Birth Satisfaction Scale Revised (BSS-R) and Edinburgh Postnatal Depression Scale. Discriminant validity was explored through correlations with BSS-R. Mann-Whitney U test and Kruskal-Wallis test was used for assessment of group differences. Dunn's paired tests were conducted for variables with more than two groups. Results: Of 616 women, 15.6 % had traumatic birth experiences and 2.4 % fulfilled the criteria of childbirth-related post-traumatic stress. EFA showed that a two-factor model presented the best fit, comprising birth-related symptoms and general symptoms. Internal consistency of the Icelandic version of City BiTS was good; for birth-related symptoms subscale (α = 0.88, McDonald's omega = 0.91); for general symptoms subscale (α = 0.87, McDonald's omega = 0.89). Conclusions: This version of the City BiTS is the first measurement in Icelandic, assessing childbirth-related PTSD according to DSM-5 criteria and provides a two-factor model for clinical and research purpose. Subsequent research should further validate the two-factor structure across diverse populations and settings.