**2. Methods**

This prospective cohort study took place from July to November 2019, at the obstetric Clinic of the University Hospital of Larisa in Greece. The survey was approved by the Ethics Commission of Hospital. Approval: 18838/08-05-2019. This study used a descriptive design to record the prevalence of P-PTSD and PTSD Profile 6 weeks after CS (Criterion F of PTSD, DSM-5) [36]. As well as the risk factors that may lead to the development of these disorders.

#### **2.1 Study participants**

All participants were postpartum women who underwent a CS and had a medical dossier in the specific hospital. From this study excluded all women with issues at a cognitive level, who do not speak Greek or those whose pregnancy was monitored in another hospital. Furthermore, the women who used psychotropic substances or drugs were excluded (Criterion H of PTSD, DSM-5) [36], as well as underage mothers.

#### **2.2 Data and measures**

The data were collected in two stages. The first stage was the second day after CS, and the second stage was the sixth week after childbirth. During the first stage that coincides with the recovery of the woman after cesarean delivery, so that they can answer the questions of the psychometric tools, we collected medical, sociodemographic, past traumatic life events, and the identification or not of the cesarean delivery being a traumatic event from the total sample of 160 women who met the criteria for participation. The specific period of time was selected in order to meet the Criterion F of DSM-5 of PTSD [36]. All measures were made By the National Center of PTSD staff according to the DSM-5 Criteria [5] translated and weighted into the Greek language by the investigator midwife.

#### *2.2.1 Sociodemographic questionnaire*

The research-made questionnaire includes items on medical (obstetric/neonatal), social, demographic, and mental characteristics of the postpartum women. It also

included information on the experience of the traumatic cesarean delivery or conditions associated with neonatal complications.

#### *2.2.2 The life events checklist (LEC-5) of DSM-5*

The LEC-5 is a self-report tool for screen previous traumatic events in a person's life. The measure evaluates exposure to 16 traumatic events known to result in trauma and one item evaluating any other event not captured in 16 items [37]. The LEC-5 is the only measure that the persons can define different exposure status of a traumatic event, while there is no score or rating [38].

### *2.2.3 Posttraumatic stress checklist (PCL-5) of DSM-V*

The (PCL-5) is a self-report measure, authored by the National Center of PTSD according to the DSM-5, which was constructed to assess PTSD symptoms. In this study, the postpartum women answered via telephone to questions that corresponded to four groups of criteria (re-experiencing, avoidance, negative thoughts and feelings, arousal, and reactivity) [39]. The answers range by 0–4 and a score of 1 or more in items of re-experiencing and avoidance, and 2 or more in items of negative thoughts and feelings and arousal and reactivity, are considered as possible PTSD. If all the above criteria are met along with criterion A, the provisional diagnosis of PTSD is made. To diagnose the severity of the symptomatology, the score of the rating from all the answers can be used. A score ≥ 33 of PCL-5 can also considered as a possible PTSD [40–43]. The disorder is divided into two categories: (a) the provisional PTSD diagnosis and, (b) PTSD Profile (which includes some of its basic symptoms) [6, 7, 23]. The PCL-5 has very good psychometric properties and can be used to diagnose PTSD in many population groups [13, 44].
