City birth trauma scale-updates to the Portuguese version

Dear Editor

In the article “Cross-cultural adaptation of the City Birth Trauma Scale for the Brazilian context” [¹] we described the process of transcultural adaptation and face validity assessment of the City Birth Trauma Scale (City BiTS) to Brazilian Portuguese. This scale is the first to investigate the symptoms of posttraumatic stress disorder related to childbirth in mothers according to current criteria [²]. The importance of the instrument lies in the fact that the condition has a relevant prevalence (community samples: 3.1%; clinical samples: 15.7%) [³] and that screening and diagnosis are not widespread, hindering the implementation of adequate therapeutic approaches [⁴].

Since its publication [⁴], the City BiTS has received great attention from researchers in different countries. It has been transculturally adapted to many languages including Hebrew, Croatian, French, Spanish, Chinese, Turkish, and Slovenian and has been the object of psychometric studies in different populations [⁵,⁶].

Following the conclusion of the study by Donadon et al. [¹], our research group was contacted by investigators from the University Institute for Health Sciences from Porto, Portugal, interested in the development of a unified version of the scale suitable for universal use in speakers of Portuguese. For this purpose, investigators led by Dr. José Carlos Rocha made three independent translations (by two psychologists and a professional translator, all blind in respect to the Brazilian version) of the original English version to European Portuguese, which were unified in a single consensus version. This version was then compared to the Brazilian version and discrepancies were cleared out by the leaders of the two research groups (FLO and JCR), who created a common version. Using this common version as a reference, only those adjustments deemed as most important were incorporated in the Brazilian version, as listed below: (a) Inclusion of the word “bebé” in every occurrence of the word “bebê” in all structures of the scale; (b) inclusion of the adjective “maus” together with adjective “ruins” when referring to dreams in item 4; (c) verbal tense/mode adjustments with the exclusion of gerund forms; and (d) adjustments in sentence construction avoiding the personal pronoun “você”.

The resulting unified version is currently under psychometric assessment in Portuguese (N=140) and Brazilian (N= 343) women, with preliminary positive results concerning validity and reliability.

Furthermore, in 2020, Prof. Susan Ayers, author of the original scale, proposed an adapted version of the scale to assess birth-related posttraumatic stress disorder situations experienced by fathers and partners (City BiTS – Partner version) in which the original instructions of the instrument were adapted [⁷]. A unified version of this scale for Brazil and Portugal is also available and can be found at https://blogs.city.ac.uk/citybirthtraumascale/translations/.

With this work accomplished, Portuguese and Brazilian investigators now have a valuable tool to assess symptoms of birth-related posttraumatic stress disorder from different perspectives, which enhances both the clinical applicability of the scale and its use in research in this field.

References

• ¹
  Donadon MF, Darwin ACR, Bombonatti EA, Pereira-Lima K, Santos RG, Machado-de-Sousa JP, Apolinário Da Silva, poli neto OB, Gaspardo CM, Cantilino A, Dias de Mattos Souza L, Ayres S, Osório FL. Cross-cultural adaptation of the City Birth Trauma Scale for the Brazilian context. Arch Clin Psychiatry. 2020;47(4):110-118. doi: https://doi.org/10.1590/0101-60830000000243
  » https://doi.org/10.1590/0101-60830000000243
• ²
  American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. (5th edn), (DSM-V). Arlington, VA: American Psychiatric Association, 2013.
• ³
  Grekin R, O'Hara MW. Prevalence and risk factors of postpartum posttraumatic stress disorder: a meta-analysis. Clin Psychol Rev. 2014;34(5):389-401. doi: 10.1016/j.cpr.2014.05.003
  » https://doi.org/10.1016/j.cpr.2014.05.003
• ⁴
  Ayers S, Wright DB, Thornton A. Development of a measure of postpartum PTSD: the City Birth Trauma Scale. Front Psychiatry. 2018;9:409. doi: 10.3389/fpsyt.2018.00409
  » https://doi.org/10.3389/fpsyt.2018.00409
• ⁵
  Handelzalts JE, Hairston IS, Matatyahu A. Construct Validity and Psychometric Properties of the Hebrew Version of the City Birth Trauma Scale. Front Psychol. 2018;9:1726. doi: 10.3389/fpsyg.2018.01726
  » https://doi.org/10.3389/fpsyg.2018.01726
• ⁶
  Nakić Radoš S, Matijaš M, Kuhar L, Anđelinović M, Ayers S. Measuring and conceptualizing PTSD following childbirth: Validation of the City Birth Trauma Scale. Psychol Trauma. 2020;12(2):147-155. doi:10.1037/tra0000501
  » https://doi.org/10.1037/tra0000501
• ⁷
  Webb R, Smith AM, Ayers S, Wright DB, Thornton A. Development and validation of a measure of birth-related PTSD for fathers and birth partners: The City Birth Trauma Scale (Partner version). Front Psychol. 2021;12:596779. doi: 10.3389/fpsyg.2021.596779
  » https://doi.org/10.3389/fpsyg.2021.596779

Publication Dates

• Publication in this collection
  28 Feb 2022
• Date of issue
  Nov-Dec 2021

History

• Received
  13 Oct 2021
• Accepted
  27 Nov 2021