Effects of postpartum PTSD on maternal mental health and child socioemotional development - a two-year follow-up study

Abstract

Background

Postpartum posttraumatic stress disorder (PP-PTSD) is a prevalent, yet often unrecognized mental health problem, particularly in low- and middle-income countries. Moreover, the long-term effects of PP-PTSD symptoms on maternal well-being and child socioemotional development beyond the first year postpartum remain largely unknown. This study focused on the association between PP-PTSD symptoms within one year after childbirth and maternal depressive symptoms and child behavioral problems two years later.

Methods

Russian women (n = 419) completed the City Birth Trauma Scale and the Edinburgh Postnatal Depression Scale evaluating symptoms of PP-PTSD and postpartum depression (PPD) via a web-based survey. Mothers also filled in the Beck Depression Inventory that assessed their depressive symptoms and the Child Behavior Checklist that assessed child’s behavioral problems 2.24 years later.

Results

The regression analysis showed a significant association between PP-PTSD and elevated depressive symptoms 2 years later even after adjustment for PPD (β = 0.19, 95% Confidence Interval 0.11, 0.26, p < 0.01). Children of mothers with higher PP-PTSD symptoms had higher internalizing, externalizing, and total behavioral problems, independent of PPD and concurrent depressive symptoms (β > 0.12, p < 0.01 for all).

Conclusions

Childbirth-related PTSD presents risk for maternal psychological well-being and child socioemotional development beyond comorbidity with maternal depression. Raising awareness about PP-PTSD among families, communities, healthcare providers, and policymakers is essential in order to decrease stigma of childbirth-related distress, particularly, in low- and middle-income countries like Russia, improve support system during the postpartum period, promote mother–infant bonding in affected women, and, thus, prevent long-term consequences of traumatic childbirth for maternal and child mental health outcomes.

Clinical trial number

Not applicable.

Introduction

Giving birth is a challenging experience for women, requiring exertion of physical and emotional resources. Childbirth can be a distressing experience, as it brings forth the fear of enduring a serious injury or death for a woman and for a baby. According to a number of studies, from 3 to 45.5% of women perceive their childbirth experience as traumatic [1], and 3.1–43% of women subsequently develop postpartum post-traumatic stress disorder (PP-PTSD) [2]. PP-PTSD involves reliving trauma through nightmares, flashbacks, and intrusive memories, avoiding trauma-related stimuli, sleep disturbances, and negative changes in thinking and mood, leading to significant distress or social difficulties [3].

However, PP-PTSD has only recently become the focus of research work [2]. Evidence suggests it is linked to higher postpartum depression (PPD) rates, lower marital satisfaction, and can have not only immediate, but also long-term negative impact on maternal well-being [4,5,6]. For example, Garthus-Niegel et al. showed that PP-PTSD was associated with mother’s insomnia 8 weeks and 2 years postpartum [7]. Traumatic birth experience can negatively influence future reproduction, specifically, it is associated with decreased number of subsequent children and the longer intervals to the subsequent pregnancies [8]. Some qualitative studies show that mothers can suffer from PP-PTSD symptoms for a significant number of years after the childbirth [9].

Furthermore, PP-PTSD can affect not only maternal mental health and well-being, but child development as well. A population-based study further reports that children of mothers, who experienced PTSD, demonstrate poorer socioemotional development 2 years postpartum [10]. Data from the British longitudinal study also suggests that PP-PTSD has a negative impact on a child’s cognitive development 17 months postpartum [11]. In a systematic review of the studies exploring the associations between maternal PP-PTSD and child outcomes Cook et al. demonstrated that perinatal PTSD was linked with low birth weight, lower rates of breastfeeding, mother-infant bonding, infant salivary cortisol levels, and eating/sleeping difficulties in children [12]. However, the authors indicated that many studies had methodological weaknesses, some results were contradictory or based on single studies.

Thus, despite these few studies, evidence regarding the long-term effects of PP-PTSD on child development is still scarce and controversial [13]. Importantly, the studies that are available are based on the data from high-income countries, while the long-term consequences of PP-PTSD on both maternal mental health and child development in middle- and low-income studies remains unknown. At the same time, perinatal mental health problems are most prevalent in middle-income countries, with rates averaging 25.3%, compared to 10–20% in high-income countries [14]. In Russia, which is classified as an upper middle-income country by the World Bank [15], the prevalence of clinically significant PP-PTSD symptoms has been estimated at 20.5% on a sample of 2,579 women [16]. Moreover, PP-PTSD symptoms were significantly higher among Russian women with lower socioeconomic status in comparison to participants with higher income [17]. Nevertheless, this issue is often overlooked in low- and middle-income countries due to maternity healthcare limitations and cultural perceptions of postpartum mental health problems as normal [18, 19]. Thus, it is essential to shed light how PP-PTSD may continuously impact maternal mental health and the development of the children in such a context.

Therefore, the aim of the present study was to investigate the long-term effects of PP-PTSD symptoms on maternal mental health during the early stages of parenthood and on child socioemotional development in Russia. We examined the association between PTSD symptoms during the first year postpartum and maternal depression in two years after giving birth, while controlling for PPD symptoms. We hypothesized that higher levels of PP-PTSD would predict higher maternal depressive symptoms two years postpartum. Furthermore, we explored the association between PP-PTSD and child behavioral and emotional problems at the mean age of 2.24 years. Our hypothesis was that PP-PTSD symptoms would be associated with higher levels of child emotional and behavioral problems, even after adjustment for maternal postpartum and concurrent depression.

Materials and methods

Procedure and participants

The present study has a longitudinal design. The data was collected from three cohorts of Russian women in February–March 2020, February–March 2021, and May-September 2022 (Stage 1). Participants were invited to take part in the web-based survey via childbirth education classes, and communities for new parents, the doctors and midwives in maternity hospitals, social media communities for expecting and new parents, and perinatal health professionals. In total, 4,831 women completed the survey in 2020–2022. The inclusion criteria were: the participant was 18 years old or above, could read and type in Russian, gave birth to a live-born child within one year prior to taking part in the survey, and childbirth took place in Russia.

In August 2022-July 2023 the participants received an invitation via email to participate in the next stage of the study. The printed survey forms were sent via mail to those women, who agreed to take part in the follow-up. The data on the mothers’ mental health and their child’s development was collected (Stage 2). Of all the participants from the three cohorts, 589 returned the filled in questionnaire forms. After the quality control procedure (matching the unique ID numbers from Stage 1, excluding duplicates, and excluding those who did not provide critical information), 419 mother-child pairs with full information from both stages of the study were included in the study sample.

Postpartum PTSD measure

Postpartum PTSD symptoms were assessed by the Russian version [19] of the City Birth Trauma Scale (CBiTS) [20]. It is a self-report 31-item questionnaire, including 23 questions about the frequency of the PTSD symptoms. The participant is asked to rate the items on a 4-point Likert-type scale ranging from 0 (‘not at all’) to 3 (‘5 or more times’). CBiTS includes two questions about fear of death or serious injury during labor and three questions measuring degree of distress, disability, and potential physical causes, scored as yes/no/maybe (sometimes); and two questions assessing onset (before childbirth/in the first 6 months following birth/later than 6 months after giving birth) and duration (less than 1 month, 1–3 months, more than 3 months) of symptoms. In the original study, the CBiTS demonstrated high internal consistency (Cronbach’s α = 0.92); the Russian version showed the comparable validity in the present study (Cronbach’s α = 0.91).

Depression measures

At Stage 1 postpartum depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale (EPDS) [21]. This tool has high reliability in postpartum depression assessment. The EPDS consists of ten questions about a mother’s well-being during the previous seven days. The participant is asked to rate each of them on a 4-point Likert scale, ranging from 0 to 3. A score of 10 and higher is suggested to be a cut-off point for clinically significant symptoms of depression. The validated Russian version (Cronbach’s α = 0.87) [22] was used, with the reliability in the present study of Cronbach’s α = 0.88.

At Stage 2 the assessment was conducted after the postpartum period and women completed the 21-item Beck Depression Inventory (BDI-II) [23] for depressive symptoms. BDI-II is a 21-item, self-report questionnaire, items are scored on a scale from 0 to 3, e.g., 0: “I do not feel irritated more often than usual,” 1: “I feel irritated a little more often than usual,” 2: “I often feel irritated” 3: “I feel irritated all the time”. A score of 14 and higher is suggested to be a cut-off point for clinically significant symptoms of depression. The internal consistency value for the Russian version is Cronbach’s α = 0.91 [24], in the present study it is Cronbach’s α = 0.89.

Child development measures

At Stage 2 mothers completed the Child Behavior Checklist (CBCL 1½ − 5) [25]. CBCL consists of 3 scales, evaluating a child’s emotional and behavioral problems: internalizing problems, externalizing problems and total problems. A parent is asked to rate each child’s emotional or behavioral problem on a 4-point scale from 0 (not true) to 2 (very or often true). The child’s mean age in the study sample at Stage 2 was 2.24 years (SD = 0.59). Raw scores were transformed to the t-scores. The internal validity of the scales in the Russian version [26] is Cronbach’s α = 0.75, the value in the present sample is Cronbach’s α = 0.82.

Demographic and obstetric characteristics

The survey of demographic characteristics of the sample was designed to collect the information on maternal age, level of education (higher/secondary/tertiary), family status (married/have a partner/single), socioeconomic status (SES) (low/middle/high). At Stage 1 women were also asked to report obstetric characteristics, such as gestational week at birth, mode of birth (vaginal/planned cesarean/emergency cesarean/instrumental vaginal birth), while at Stage 2 they also reported their child’s age and chronic medical conditions.

Statistical analysis

Spearman correlation analysis was used to examine the associations between PP-PTSD, PPD and concurrent maternal depression; PP-PTSD, maternal age and gestational age at birth. Spearman correlation analysis was also used to explore the associations between CBCL scores, maternal age, child’s age and child’s gestational age at birth.

The data on all the questionnaires was normally distributed according to One-Sample Kolmogorov-Smirnov Test (p < 0.01 and p < 0.05).

Univariate analysis was used to explore the association between CBCL scores, mode of birth and chronic medical conditions; PP-PTSD, mode of birth and child’s chronic medical conditions.

Linear regression analysis examined the association between concurrent maternal depression at Stage 2 and PP-PTSD scores at Stage 1. The regression model was adjusted for maternal level of education, family status, SES, age at testing (Stage 2), and PPD symptoms.

Linear regression analysis further examined the association between PP-PTSD and child externalizing, internalizing and total problems at toddlerhood. Regression Model 1 was adjusted for maternal level of education, family status, SES, maternal age (Stage 2) as well as gestational age at birth, and mode of birth (Stage 1), child age and child’s chronic medical conditions (Stage 2). Regression Model 2 included all the variables from Model 1 and was further adjusted for PPD scores. Regression Model 3 included all the variables from Model 1 and was additionally adjusted for concurrent maternal depression. CBCL scores were standardized to facilitate interpretation.

The data was homogeneous for child chronic medical conditions (p = 0.91) and for mode of birth (p = 0.15). The level of significance was set to α = 0.05.

All analyses were performed using SPSS 27 software [27].

Results

The sample mainly consisted of married women with higher education with middle and high socioeconomic status. The characteristics of the sample are presented in Table 1. Of the participants, 148 (35.3%) demonstrated clinically significant symptoms of PPD (Stage 1) and 5.2% reported clinically significant symptoms of PP-PTSD (Stage 1). Furthermore, 43 (10.3%) of participants had clinically significant concurrent depressive symptoms at Stage 2.

Table 1 Characteristics of the sample

Maternal mental health

PP-PTSD significantly correlated with PPD scores (rho = 0.59, p < 0.01) and with BDI scores (rho = 0.42, p < 0.01). PP-PTSD also negatively correlated with gestational week at birth (rho = -0.11, (p = 0.024), while there were no significant associations between PP-PTSD and mode of birth (p = 0.78).

The regression analysis shows a statistically significant association between PP-PTSD and depressive symptoms 2 years later after the adjustment for the demographic and obstetric covariates as well as the PPD symptoms (β (95% CI) = 0.19 (0.11, 0.26), p < 0.01).

Child development

There were no significant associations between CBCL scores, child’s age and gestational week at birth (p-values for all > 0.05). However, both total (F = 3.81, df = 418, p = 0.023), externalizing (F = 2.99, df = 418, p = 0.05) and internalizing (F = 5.71, df = 418, p < 0.01) problems were significantly lower in the group of children with vaginal mode of birth. Total (F = 5.07, df = 418, p = 0.025) and internalizing (F = 8.29, df = 418, p < 0.01) problems were significantly higher in the group of children with chronic medical conditions. Internalizing problems and total problem scores negatively correlated with maternal age (rho = -0.11, p = 0.03 and rho =-0.13, p < 0.01, respectively).

The regression model showed statistically significant association between PP-PTSD symptoms and all of the problem scale scores. Associations remained significant in the models with PPD (Model 2) and maternal depression at Stage 2 (Model 3) inclusion (Table 2). There were no statistically significant associations between CBCL scores and PPD, but concurrent maternal depression was also significantly related to all three CBCL scales (Table 2).

Table 2 Regression models: association between PP PTSD at Stage 1 and CBCL scores (stage 2), excluding and including PPD and concurrent depression

Discussion

The aim of this study was to examine the long-term effects of PP-PTSD symptoms on maternal mental health and child socioemotional development based on a 2-year cohort study in Russia. According to the results, women, who had high PP-PTSD symptoms within the first one year after giving birth, also had elevated depressive symptoms two years later, independent of the level of PPD symptoms after childbirth. Furthermore, child behavioral problems at the mean age of 2.24 years were associated with maternal PP-PTSD symptoms after childbirth independently of depressive symptoms either during the postpartum period or concurrently with the child assessment. Children of mothers with higher PP-PTSD symptoms within one year after childbirth had higher internalizing, externalizing, and total behavioral problems two years later.

The results of this study indicate that PP-PTSD symptoms were highly correlated with depressive symptoms measured simultaneously within the one year postpartum period and 2 years later. These findings are in line with previous reports of a high comorbidity between PP-PTSD and PPD [28, 29]. Söderquist et al. suggested that this may be explained by shared common vulnerabilities and risk factors between PP-PTSD and PPD, such as depression in early pregnancy, severe fear of childbirth, and ‘pre’-traumatic stress in late pregnancy [30].

However, our study is among pioneering works that examined the effects of PP-PTSD on maternal mental health beyond the first year after childbirth. It shows that higher PTSD symptoms postpartum may present risk for higher depressive symptoms 2 years later, even after correction for the level of postpartum depressive symptoms. This finding suggests that PP-PTSD is a significant yet often disregarded mental health problem, presenting risk not only for PTSD symptoms becoming chronic, but for general maternal psychological well-being. Moreover, while there is ample evidence indicating that PPD significantly increases the risk of depression in later life [31, 32], to our knowledge our research marks the first instance of uncovering a similar long-term risk associated with PP-PTSD. Unlike merely correlating with depression during the postpartum period, PP-PTSD independently presents a risk factor for subsequent depression years later.

Although there has been progress, PP-PTSD still frequently goes undiagnosed or misdiagnosed as PPD, possibly due to the lack of recognition either in widely used American (DSM-5) or international (ICD-11) classifications of mental disorders, unlike PPD [33]. Lack of awareness about PP-PTSD may be further strengthened by public difficulty to recognize childbirth as a potentially traumatic event whereas it is normally considered as a positive occasion. This may be especially relevant in low- and middle-income countries with patriarchal cultures and strong religious influences, where childbirth is viewed as a woman’s duty and maternal health, particularly maternal mental health, is viewed as less valuable than child’s health [34,35,36]. In Russia, like in many low- and middle-income countries, there are neither specialized maternal mental health services nor routine checks for the symptoms of postpartum depression or PTSD in obstetric and maternity care facilities [19]. Therefore, many women are left without the help and support they need, sometimes, on the contrary, feeling stigmatized and judged by their family members and community rather than being understood and cared for [18]. This stigma may further increase women’s reluctance to share their experiences and seek professional assistance which, in turn, may increase the risks for depression and other mental health problems years after childbirth. In her call for a formal diagnosis of childbirth-related PTSD, Sharon Dekel suggests that awareness of PP-PTSD and formal label of PTSD with onset and relation to childbirth in the major diagnostic manuals and guidelines could improve recognition and understanding of the symptoms for mothers and families, healthcare professionals, and the community [33]. It could further stimulate the development of targeted interventions in order to reduce maternal distress during the postpartum period, prevent long-term consequences of traumatic childbirth experiences for maternal psychological well-being, and promote mother–infant bonding in affected women.

The other important finding of this study that confirmed our hypothesis was the discovered significant associations between maternal PTSD symptoms within one year postpartum and child internalizing, externalizing, and total behavioral problems at child’s mean age of 2.24 years. Importantly, these associations remained significant after the adjustment for PPD symptoms, maternal depressive symptoms concurrent with the assessment of the children’s behavioral problems, and other important covariates (child’s chronic medical conditions, gestational age at birth, mode of birth, maternal age, level of education, family status, SES, place of living, and parity).

These results align with previous large population-based study from Norway, where the authors also discovered a significant association between maternal PTSD symptoms at 8 weeks postpartum and poor child socioemotional development 2 years later, which remained significant after adjustment for PPD symptoms [37]. Furthermore, a small study based on a sample of 52 mother-child dyads from a primarily low-income, urban, ethnic/racial minority group also found that maternal PTSD symptoms at 6 months postpartum predicted infant externalizing, internalizing, and dysregulation symptoms at 13 months [38]. Altogether, these findings may shed light on unique strong long-term effects of maternal childbirth-related PTSD symptoms on child socioemotional development that are different from mere comorbidity with maternal depression, either during the postpartum period or later in life.

There are several plausible pathways based on the four clusters of PP-PTSD symptoms [20]. First, the symptoms of intrusion (i.e. flashbacks, nightmares, getting upset when reminded of childbirth) may contribute to sleep problems, isolation, and overall emotional distress which, in turn, may reflect in higher irritability and lower quality of communication of the affected women with people around, including their children. Second, avoidance symptoms might manifest in minimizing the physical and emotional contact of women with their children as they may be perceived as constant reminders of the traumatic events of childbirth. This may lead to lack of mother-child bonding and lower rates of breastfeeding [39], which subsequently may account for less optimal developmental outcomes in children [40, 41]. Third, negative mood and cognition as well as hyperarousal symptoms might result in self-blame or blaming others, lack of joy of parenting, loss of interest in taking care of the baby, and high irritability. Contrarily, women may experience emotional numbing which may lead to mothers being emotionally unavailable or presenting only negative emotions towards their children. Several studies show that lower maternal emotional sensitivity and availability has been associated with higher negative affect during the still-face procedure at the age of 6 months [42], more externalizing problems, less prosocial behavior, and worse theory of mind at the age of 4 years [43]. Furthermore, in a task-free functional magnetic resonance imaging (fMRI) study maternal sensitivity during a free play interaction at 8 months, but not at 2.5 years, was positively associated with children’s brain functional connectivity of the prefrontal cortex, one of the key brain regions related to emotional and cognitive regulation [44]. The authors suggest that these findings add to the research on a key role of mother–child interaction during the sensitive period of infancy in children’s psychosocial development [44, 45]. Finally, it is important to consider that our study was conducted in Russia, where awareness about maternal mental health is still low, women’s concerns about their symptoms after childbirth-related trauma are often disregarded, and their difficulties with parenting are considered a cultural norm, the phenomena that are common in low- and middle-income countries [18, 34]. Thus, women with PP-PTSD in these countries may lack social support that is associated with better child outcomes, particularly in the presence of maternal mental health problems [46, 47].

Therefore, PP-PTSD symptoms may prevent the mother from effective parenting, timely sensitive reactions in response to child’s emotional cues and needs, and forming secure bonds and attachment with the child, which are essential for the child’s optimal development [48]. Future longitudinal studies with big sample sizes are warranted to investigate the effects of maternal PTSD symptoms after childbirth on child lifelong development and risk of mental health problems. Moreover, while there are few promising studies of potential interventions, such as mother-infant skin-to skin contact and supportive counseling after childbirth, that might mitigate the effects of childbirth-related trauma and benefit both immediate mother-child bonding and consequent child socioemotional development [49, 50], more work with multiple measurements is needed to establish their long-term efficiency.

Interestingly, we found that the regression models indicate that in the presence of PP-PTSD predictor PPD symptoms were not associated with any of the domains of child behavioral problems, whereas concurrent depressive symptoms had even stronger effects sizes than the PP-PTSD symptoms and were significantly associated with both internalizing, externalizing, and total behavioral problems at the child’s mean age of 2.24 years. These results do not follow those from the study of Garthus-Niegel and colleagues, where in the regression model predicting child socioemotional development at the age of 2 years, both PTSD and depressive symptoms measured at 8 weeks postpartum were associated with poorer child development [37]. Furthermore, in a newer study on a sample of 295 mother-infant dyads Huffhines et al. showed that PPD symptoms and parenting stress, rather than posttraumatic stress symptoms, were associated with greater infant socioemotional health problems [51]. This discrepancy may be due to the different measurement tools of both PTSD symptoms and child development as well as different timing of the measurements and varying sets of included covariates. More replication studies using consistent methodologies are warranted in order to address these concerns.

On the other hand, the present findings confirm our previous results of long-term effects of maternal depression on child socioemotional development on the Russian sample, where concurrent, but not postpartum depressive symptoms correlated with all three domains of child behavioral problems, with children of mothers with consistently high depressive symptoms having the highest internalizing, externalizing, and total problems [32]. It is possible that similar mechanisms are at work here, as the correlation analysis showed that mothers with higher PP-PTSD symptoms also had higher depressive symptoms 2 years later. Mughal and colleagues identified maternal history of depression and inadequate social support as the primary indicators of the persistent depression trajectory [52]. Similarly, previously diagnosed mental health problems and insufficient support are well-established risk factors for PP-PTSD [28, 53]. Extensive research consistently demonstrates that a history of trauma and abuse, childhood maltreatment, social isolation, intimate partner violence, poverty, and other socioeconomic factors pose risks for both PTSD and depression in adults, as well as developmental delays and behavioral issues in children who share the same environment with their mothers [54, 55]. Thus, future policies, research, interventions, and prevention programs should prioritize not only the impact of maternal mental health problems on child development, but also the improvement of social support systems for mothers, their children, and families as a whole. In order to achieve that, an international group of expert researchers and clinicians from 33 countries created a set of recommendations for practices that include respectful trauma-informed care for women and birth partners; for policy that increases awareness about childbirth-related PTSD; and for research and theory that is based on understanding childbirth through a neuro-biopsychosocial framework [56]. The adoption of these suggestions has the potential to reduce traumatic births on a global scale, thereby improving the well-being of women and their children.

Strengths and limitations

The strengths of our study include the longitudinal study design, which allows us to estimate long-term effects of maternal PTSD symptoms after childbirth on maternal mental health and child development two years later. The data on both PP-PTSD and PPD was collected within the first one year postpartum, which increases its reliability. The use of validated questionnaires and control for a number of significant covariates (such as child’s gestational age at birth, child chronic medical conditions, maternal education, and socio-economic status) can also be considered as strengths. Importantly, as PP-PTSD has been consistently demonstrated to be highly comorbid with PPD [16, 28, 29], we controlled the regression analyzes of the association between PP-PTSD symptoms and both maternal depressive symptoms and child behavioral problems at Stage 2 for PPD symptoms.

However, several limitations should be noted.

First, we did not have the PTSD symptom measurement at Stage 2 of the study. This decision was made based on the characteristics of the CBiTS questionnaire we used at Stage 1 as well as the reports that women who had experienced traumatic childbirth had increase of their negative emotions over time, whereas women whose birth-related emotions had been positive, reported the emotions remaining the same intensity [57, 58]. However, other measures of posttraumatic stress could have been used to evaluate the risk of PTSD symptoms becoming chronic, which should be taken into consideration in future studies.

Second, while Russia is considered a middle-income country, the data for our study was mostly collected in big cities among women with higher education as well as middle and high income, which might not be representative of the whole population, indicating the need for future investigation of other social strata.

Next, the information on child development is based only on the mother’s reports which could have been biased by the presence of depressive symptoms. Inclusion of reports from fathers and other caregivers could enrich the obtained results and increase their reliability.

The data was collected during the pandemic and the period of conflict. These social factors could potentially have an impact on the obtained results. However, according to our previous research, PP-PTSD and PPD symptoms did not change significantly before and during the pandemic [59].

Finally, our findings lack objective medical information on both maternal PTSD and depressive symptoms at both stages of the study, obstetric data, and child medical conditions and rely solely on self-reports, which is a common limitation in the countries without available registry-based data.

Conclusions

Maternal childbirth-related PTSD is a serious public health problem which presents risk for lifelong maternal psychological well-being and socioemotional development of their children. Our study delved into the enduring impact of PP-PTSD symptoms on both maternal mental health and child socioemotional development over a two-year period in Russia. The findings revealed a significant association between high PP-PTSD symptoms within the first one year postpartum and elevated depressive symptoms in mothers two years later, irrespective of postpartum depressive symptoms. Additionally, maternal PP-PTSD symptoms correlated with child behavioral problems at the age of 2.24 years, independent of concurrent maternal depression and other covariates. These results underscore the long-term repercussions of PP-PTSD on both maternal and child well-being, highlighting its importance as a distinct mental health concern beyond the postpartum period. The study also sheds light on the insufficient recognition of PP-PTSD, particularly in low- and middle-income countries like Russia, where maternal mental health stigma is still high, while supportive services are scarce. Addressing this gap is crucial for providing adequate support to affected mothers and promoting optimal child development. Moreover, our findings underscore the need for further research and development of interventions and prevention programs aimed at mitigating the impact of childbirth-related trauma on both maternal and child outcomes, emphasizing the importance of trauma-informed care and increased awareness about PP-PTSD on a global scale.