The development of preeclampsia was mentioned as a stressful and life threatening event in pregnancy for women and their partners
[4–6]. In our study population 8.9% of the women had experienced the death of a child as a consequence of preeclampsia. Additionally, 50.8% of the babies had to be treated in the intensive care unit, so women were separated from their babies after delivery. Women had in most cases to deal with high blood pressure and recovery after caesarean section.
Prior to the diagnosis of preeclampsia, many of these women may have never experienced a significant illness and had been expecting a routine, normal pregnancy. There is evidence, that the severity of preeclampsia has a decreasing impact on HRQoL, as recent data show
. Women with preeclampsia are impaired in their physical and emotional well-being, such as depressive symptoms
 and have to deal with feelings of loss of control over the situation
In this study we compared differences in psychological outcomes (post-traumatic stress, depression and HRQoL) as a function of resilience in women who experienced preeclampsia. Resilience is not merely characterized by the absence of psychopathology but is the dynamic process that enables the individual to successfully adapt to severe adversity over the life course
The strength of the study is the use of well known, international, validated questionnaires as screening tools for post-traumatic stress disorders, depressive symptoms, HRQoL and resilience. Furthermore this is the first study which evaluates resilience in the context of adverse pregnancy outcomes. This study may improve the understanding of resilience as a protective resource after preeclampsia and therefore may help to develop strategies to prevent negative psychological outcomes.
To cope with the severe disease in pregnancy, women need adjustment strategies because of the change from a normal into a high-risk pregnancy
[4, 6]. Women usually get external support during this stage of life. The support of a partner was mentioned as an especially important protective resource against the development of PTSD
. We only found 2.9% with PTSD symptoms above the cut of score. This is consistent with findings in the literature
Nevertheless, we found that women with low-resilience showed significantly more depressive symptoms following preeclampsia. Moreover, women with lower resilience showed depressive symptoms above the screening cut-off score of 10/11 recommended for Austrian population
. It is important to note that the validation study for the German sample is very small consequently the recommended cut-off point must be used with caution. However, highly resilient women showed clearly less depressive symptoms in our population compared to low resilient women. Women with low resilience had also decreased HRQoL on the mental component scale. Based on our results we conclude that resilience may be a significant factor, which protects against emotional distress (e.g., reduce depressive symptoms and improve mental quality of life) after preeclampsia.
We are aware of a relatively small sample that limits the findings of this study. On the other hand this is a clinical group of women we examined and there are not large numbers of them. Another limitation is that the time-interval of index-pregnancy to survey is up to 4 years. However, pregnancy is a unique time in the life of any woman
, and consequently, recall of pregnancy-related events in women even 30 years or later after delivery has been shown to be reproducible and reasonably accurate
[31, 32]. In this study we focused on the outcome parameters HRQoL, depressive symptoms and PTSD-symptoms. In further studies other parameters e.g. anxiety, coping strategies or special interventions could be investigated to get a better insight into emotional distress after preeclampsia.
It is important to examine coping strategies after preeclampsia and being able to offer adequate supportive interventions when they are needed
Women seek information and explanations after this challenging event. Receiving relevant information about their medical and psychological condition gives women an active role and the possibility to cope with their illness and get control over the situation
[14, 21]. Woman will benefit from educational interventions on common responses and adaptive reactions in the acute situation and in the subsequent years after this burdened pregnancy. Consequently, the personal competence of women who have had preeclampsia can be improved, and is therefore an important factor in improving resilience
Resilience is changeable and can increase during psychological treatment and leads to more well-being
[22, 25]. Enhancing the ability to experience positive emotions could play an important role in making people more resilient to depression. A meta-analysis established that interventions as diverse as writing gratitude letters, practising optimistic thinking, replaying positive experiences and socializing have beneficial effects on levels of depression
. Also, mediation-based or mindfulness-based approaches may be promising venues in increasing positive emotions. Additional purpose of life was found to buffer against the negative effects of life-threatening physical illness on mental health in general. A sense of meaning and a purpose in life is something very personal. Prolonged meditation or mindfulness training, in which people are trained to continuously focus their attention on the present moment, may result in an increased awareness of meaning and purpose experienced in daily life situations
. Furthermore, supportive responses from others help individuals to overcome adversity and increase growth following adversity. For these reasons, a special multi-professional outpatient department offering medical and psychological support might improve the HRQoL and well-being after preeclampsia. Especially women with low-resilience will benefit from support after this event and in further pregnancies.