Women's Reproductive Choices and Mental Health During Pregnancy and After Birth in Wartime Ukraine

Edinburgh Postnatal Depression Scale

Depressive symptoms will be measured using the Edinburgh Postnatal Depression Scale (Cox et al., 1987). The total score ranges from 0 to 30, with higher scores reflecting greater severity of depressive symptoms. A score of 13 or above will be used as the cut-off for clinically significant depressive symptoms, in accordance with Cox et al. (1987) and Levis et al. (2020). This measure applies to pregnant and postpartum women.

Time frame: Baseline, 3 months, 6 months, and 12 months after enrolment.

The City Birth Trauma Scale

Childbirth-related post-traumatic stress symptoms will be measured using the City Birth Trauma Scale (Ayers et al., 2018). The symptom score ranges from 0 to 60, with higher scores reflecting greater severity of childbirth-related post-traumatic stress symptoms. A score of 29 or above will be used as the cut-off for clinically significant symptoms, in accordance with Osório et al. (2020). This measure applies to postpartum women.

Time frame: Baseline, 3 months, 6 months, and 12 months after enrolment, where applicable.

The City Birth Trauma Scale (Partner version)

Childbirth-related post-traumatic stress symptoms among partners will be measured using the City Birth Trauma Scale, Partner Version (Webb et al., 2019). The symptom score ranges from 0 to 60, with higher scores reflecting greater severity of childbirth-related post-traumatic stress symptoms. No predefined cut-off score will be applied. This measure applies to participating partners.

Time frame: Baseline, 3 months, 6 months, and 12 months after enrolment, where applicable.

The Birth Satisfaction Scale - Revised

Satisfaction with the childbirth experience will be assessed using the Birth Satisfaction Scale - Revised (Martin \& Martin, 2014). The total score ranges from 0 to 40, with higher scores reflecting greater satisfaction with childbirth. No predefined cut-off score will be applied. This measure applies to postpartum women.

Time frame: Baseline, 3 months, 6 months, and 12 months after enrolment.

Desire to Avoid Pregnancy Scale

Attitudes toward pregnancy avoidance will be measured using the Desire to Avoid Pregnancy Scale (Rocca et al., 2019). The total score ranges from 0 to 4, with higher scores reflecting a stronger desire to avoid pregnancy. A cut-point below 2 will be used for pregnancy prediction, in accordance with Hall et al. (2023). This measure applies to non-pregnant women.

Time frame: Baseline, 3 months, 6 months, and 12 months after enrolment.

London Measure of Unplanned Pregnancy

Pregnancy intention will be measured using the London Measure of Unplanned Pregnancy (Barrett et al., 2004). The total score ranges from 0 to 12, with higher scores reflecting greater pregnancy intention. No predefined cut-off score will be applied. This measure applies to pregnant and postpartum women.

Time frame: Baseline, 3 months, and 12 months after enrolment.

Maternal and Partner Sex During Pregnancy Scales

Pregnancy-related sexual attitudes will be measured using the Maternal and Partner Sex During Pregnancy Scales (Jawed-Wessel et al., 2016). The global attitude score ranges from 1 to 6, with higher scores reflecting more positive attitudes toward sex during pregnancy. No predefined cut-off score will be applied. This measure applies to pregnant women and their partners.

Time frame: Baseline, 3 months, 6 months, and 12 months after enrolment.

Motivations Against Sex Questionnaire

Motivations for sexual avoidance will be measured using the Motivations Against Sex Questionnaire (Patrick et al., 2011). Subscale mean scores range from 1 to 5, with higher scores reflecting stronger endorsement of the respective motivation for not engaging in sexual behavior. No predefined cut-off score will be applied. This measure applies to all study cohorts.

Time frame: Baseline, 3 months, 6 months, and 12 months after enrolment.

Domestic Violence Myth Acceptance Scale

Attitudes toward domestic violence will be measured using the Domestic Violence Myth Acceptance Scale (Peters et al., 2008). The total mean score ranges from 1 to 7, with higher scores reflecting stronger endorsement of domestic violence myths. No predefined cut-off score will be applied. This measure applies to all study cohorts.

Time frame: Baseline and 12 months after enrolment.

General Anxiety Disorder - 7

Anxiety symptoms will be measured using the Generalized Anxiety Disorder - 7 (Spitzer et al., 2006). The total score ranges from 0 to 21, with higher scores reflecting greater anxiety symptom severity. A score of 7 or above will be used as the cut-off for clinically significant anxiety symptoms in the perinatal population, according to Gong et al. (2021) and Zhong et al. (2015); a score of 10 or above will be used for partners (Spitzer et al., 2006). This measure applies to all study cohorts.

Time frame: Baseline, 3 months, 6 months, and 12 months after enrolment.

Impact of Events Scale - Revised

Trauma-related distress will be measured using the Impact of Event Scale-Revised (Weiss \& Marmar, 1997). The total score ranges from 0 to 88, with higher scores reflecting greater severity of trauma-related symptoms. A score of 30 or above will be used to indicate a high probability of trauma-related disorder (Krupelnytska et al., 2025). This measure applies to all study cohorts.

Time frame: Baseline, 3 months, 6 months, and 12 months after enrolment.

Suicide Crisis Inventory - 2 Short Form

Suicidal crisis symptoms will be measured using the Suicide Crisis Inventory - 2 Short Form (De Luca et al., 2024). The total score ranges from 0 to 36, with higher scores reflecting greater severity of suicide crisis syndrome. No predefined cut-off score will be applied. This measure applies to all study cohorts.

Time frame: Baseline, 3 months, 6 months, and 12 months after enrolment.

Adverse Childhood Experiences Questionnaire

Exposure to childhood adversity will be measured using the Adverse Childhood Experiences Questionnaire (Felitti et al., 1998). The cumulative score ranges from 0 to 10, with higher scores reflecting exposure to a greater number of adverse childhood experiences before age 18. This measure applies to all study cohorts.

Time frame: Baseline, 3 months, 6 months, and 12 months after enrolment.