Anne Denis

Post-traumatic stress disorder related to birth: a prospective longitudinal study in a French population

The objective of the current study is to determine the prevalence of post‐traumatic stress disorder (PTSD) following birth in a French sample, as well as to examine predictive variables. This study collected data from women at four different times: 48 h, 1 month, 4 months and 9 months post‐partum. PTSD symptoms were measured using the Impact of Events Scale‐Revised (IES‐R). Predictive variables were examined with four questionnaires: the Labor Agentry Scale (LAS), the Multidimensional Scale of Perceived Social Support (MSPSS), the Edinburgh Postnatal Depression Scale (EPDS) and a researcher‐designed personal information form. PTSD rates varied from 5% (1 month post‐partum) to 2.9% (9 months post‐partum). Primiparity, birth preparation classes, transfer to a tertiary care centre, perception of external control, feeling of pain during birth and depressive symptoms were significant predictors of the global IES‐R score. Results provide a basis for considering changes in healthcare delivery and prevention programs within the French perinatal healthcare system.

Premature birth: subjective and psychological experiences in the first weeks following childbirth, a mixed-methods study

Objective: The aim of the study was to explore the experience of premature infants’ mothers, the way they are taken care of, how they cope with this traumatic experience as well as the psychopathological and psychosocial consequences post delivery. Method: A qualitative and quantitative study was carried out on 27 women from the south of France area who delivered preterm infants still hospitalised in a neonatal intensive care unit. Two questionnaires were completed, the IES-R and the EPDS, assessing posttraumatic stress and postpartum depressive symptoms. A semi-structured interview was also conducted. Results: Trauma of premature birth and caesarean, feelings of guilt, anxiety, ambivalence towards the infant, the medical staff and the infant’s hospital discharge, were all part of their perception. Furthermore, difficulties for mothers to define themselves as such and the importance of sharing with women who have been through the same experience were evidenced. Postpartum depression and posttraumatic stress disorder were also highlighted. Conclusion: Our findings highlight that premature birth can be traumatic and lead to the development of psychopathological symptoms. Moreover, this study suggests the need to develop a specific support focusing on the sharing of experience and prevention in order to prevent disorders from developing.

Factors implicated in moderating the risk for depression and anxiety in high risk pregnancy

Objective: The aim of the study was to evaluate depressive and anxious symptoms while examining the impact of self-esteem, social support and coping strategies on these symptoms in women who have been hospitalised for high-risk pregnancies. Method: Fifty-five women from the south of France area hospitalised or on bed rest for high-risk pregnancy completed five scales: the Edinburgh Post-Natal Depression Scale (EPDS), the High Risk Pregnancy Stress Scale (HRPSS), the Revised Prenatal Coping Inventory (NuCPI), the ‘Questionnaire du Soutien Social Perçu’ (QSSP), and the Rosenberg Self-Esteem Scale (RSES). Results: The results show that over half of these women manifest symptoms characteristic of pre-natal depression and the entire sample showed high levels of anxiety symptoms. Predictive factors for depression included informational support and self-esteem; for anxiety, predictive factors were patient age and EPDS scores. Conclusion: This study underscores the importance of providing appropriate psychological support for women with high-risk pregnancies in order to avoid depressive disorders and any potential negative consequences on the perinatal period.

Fatigue and Breastfeeding: An Inevitable Partnership?

Postpartum fatigue is a normal condition that most women experience. Breastfeeding is often associated in women’s minds as contributing to the feeling of overall perceived fatigue, and many women indicate that they have ceased breastfeeding because of fatigue. However, the relationship between feeding choice and perceived fatigue has never been established. Two hundred and fifty-three women participated in a study examining whether perceived fatigue differed for bottle-feeding and breastfeeding women at 3 different times during the postpartum period (2-4 days, 6 weeks, and 12 weeks postpartum). Results showed no significant differences for these 2 groups, suggesting that perceived fatigue during the postpartum period is not dependent on feeding choice. Additional analyses examining other variables with a potential effect were nonsignificant. Because perceived physical fatigue does not appear to be dependent on feeding choice, women should be prepared for the feeling of perceived fatigue during the postpartum period while at the same time be reassured that feeding choice is not correlated.

The relationship between maternal self-esteem, maternal competence, infant temperament and post-partum blues

Background: Several studies emphasise the link between infant temperament and maternal cognitions, particularly in terms of maternal self-esteem and feelings of competence, and how this may affect the post-partum period. Objective: The aim of this study is to evaluate the link between infant temperament, maternal cognitions and post-partum blues. Methods: At 2 days post-partum, 69 women completed three questionnaires along with a form providing sociodemographic data: the Edinburgh Postnatal Depression Scale (EPDS), the Maternal Self-Report Inventory (MSI), and the Mother and Baby Scale (MABS) measuring post-partum blues symptoms, maternal self-esteem and perceptions of competency and infant temperament, respectively. Results: Correlation analyses showed a link between post-partum blues intensity and low maternal self-esteem, an impression of lacking competence in caretaking and feeding abilities, and the perception of the infant as ‘difficult’. A multiple regression analysis showed that the perception of the infant as difficult was predictive of post-partum blues intensity. Conclusion: The data demonstrate how some variables appear to influence post-partum blues and may provide insight into how to better organise both prevention and intervention strategies in this population.

Influence de certaines variables psychologiques, psychosociales et obstétricales sur l’intensité du baby blues

AIM Within days following birth, most women show signs of mood changes, commonly named baby blues. Baby blues can result in postpartum depression. Hence it appears important to explore in more details the clinical background related to the intensity of postpartum blues. The aim of this study is to investigate the contribution of psychological, psychosocial and obstetrical factors to the intensity of postpartum blues. METHOD One hundred and forty-eight women participated in the study and completed questionnaires three days after delivery. A questionnaire was built to collect information on psychosocial and obstetrical factors. The Maternity Blues (Kennerley and Gath, 1989) was used to assess postpartum blues. Psychological factors were measured with the Maternal Self-Report Inventory (Shea et Tronick, 1988), the Perceived Stress Scale (Cohen, Kamarch et Mermelstein, 1983) and the Sarasons Social Support Questionnaire (1983). RESULTS Four multiple regression analyses were conducted to predict the intensity of postpartum blues by entering psychosocial factors, history of depression, obstetrical factors and psychological and relational factors. Significant predictors (maternal self-esteem, marital status, previous psychotherapeutic treatment, previous antidepressant treatment) were entered in a multiple regression analysis predicting the intensity of postpartum blues. This model accounted for 31% of the variance in the intensity of postpartum blues (F(4, 143)=17.9; P<0.001). Maternal self-esteem (beta=-0.37; P<0.001), marital situation (beta=-0.16; P=0.02) were significant predictors. Previous antidepressant treatment (beta=0.13; P=0.05) was almost a significant predictor. CONCLUSION The preventive implication of this study is important. Some psychological and psychosocial variables predicted the intensity of postpartum blues and may be used in order to detect women who exhibit risk factors.

Étude de validation française de la version courte du Maternal Self-report Inventory

BACKGROUND Self-esteem is defined as the opinion of ones self that one establishes and maintains during the lifetime. Self-esteem is considered to be based on general as well as specific elements that define the individuals identity. Whereas overall self-esteem evolves over the lifespan, specific elements change regularly and thus have an impact on these specific types of self-esteem. Maternity is a central defining element of a womans life, and it is believed that a woman can develop a specific self-esteem based on her experience of motherhood. Many studies have shown how overall self-esteem is affected during the perinatal period, and the relationship between self-esteem and other variables, notably post-partum depression. OBJECTIVES The objective of this study was to translate, evaluate, and validate the short version of the Maternal Self-Esteem Inventory (MSI, Shea & Tronick in 1988) for use in French populations. The MSI short form is a 26-item questionnaire using a Likert response format in five points. METHOD The sample was composed of 251 French female participants (mean age 30; SD=4.52) who had given birth two days earlier. Participants completed the MSI and the Edinburgh Post-natal Depression Scale (EDPS). RESULTS The results of a factorial analysis showed five factors which partially correspond to the original English version of the MSI short form. These five factors were negatively correlated to the EPDS. The five factors showed good to excellent internal consistency. CONCLUSIONS The current study provides a translated and validated version of the MSI short form in French. It provides a specific indicator of self-esteem with regards to motherhood and the experience of maternity. The MSI can provide useful data that can help identify women at risk for negative feelings about themselves, which can lead later to manifestations of perinatal psychopathology (e.g, post-partum depression).

Intrusive thoughts in patients with obsessive compulsive disorder and non-clinical participants: a comparison using the International Intrusive Thought Interview Schedule

Abstract The International Intrusive Thought Interview Schedule (IITIS) was used to assess and compare the unwanted intrusive thoughts (UITs) reported in a group of patients with obsessive compulsive disorder (OCD) and a non-clinical group. Although all participants reported at least one type of intrusion, OCD patients experienced more intrusive thoughts than non-clinical participants, and this difference was statistically significant. In the OCD group, intrusive thoughts were more frequent, interfered more with daily life, were considered to be more important to get out of the mind, and were more difficult to stop than in non-clinical participants. The two groups did not differ significantly in terms of five appraisals of the most distressing intrusive thought. One appraisal (importance) was used far more by the OCD group than the non-clinical group. For three appraisals (intolerance of anxiety, need to control, and intolerance of uncertainty), the difference was smaller. Only two of the strategies for controlling the most upsetting intrusive thought (ritual and avoidance) were of value in differentiating between the two groups. The IITIS (an instrument used to assess intrusions in non-clinical samples) appears to be of value for the assessment of patients with OCD.

Cognitive factors and post-partum depression: What is the influence of general personality traits, rumination, maternal self-esteem, and alexithymia?

OBJECTIVES The objective was to assess the impact of cognitive factors on post-partum depression (PPD) symptoms. Because most of the literature data concern the immediate post-partum period or the first year post-partum, we notably sought to assess the longer term impact of cognitive factors on the symptoms of PPD. METHODS Two studies were performed. In a pilot study, 1-month post-partum, 63 women filled out a sociodemographic information sheet and completed the abbreviated, revised Eysenck Personality Questionnaire, the Ruminative Responses Scale, the Maternal Self-Report Inventory, and the Edinburgh Post-Natal Depression Scale. In the main study, 124 women additionally completed the Toronto Alexithymia Scale. The main study population was divided into 2 subgroups: women in the first year post-partum (n = 74) and those in the second year post-partum (n = 50). RESULTS In the pilot study performed 1-month post-partum, brooding rumination and low self-esteem were significant predictors of the PPD symptom intensity. Neuroticism, brooding rumination, and low maternal self-esteem were also significant predictors of the PPD symptoms reported in the first year post-partum. Lastly, ruminative thoughts and alexithymia were significant predictors of the PPD symptoms reported in the second year post-partum. CONCLUSIONS Our results suggest that alexithymia may be an important predictor of the incidence of this condition. The observation of differences in the PPD models as a function of the post-partum period may open up opportunities for developing novel PPD prevention/treatment programs.

Examen des propriétés psychométriques de la traduction française de la Maternal Antenatal Attachment Scale (MAAS)

BACKGROUND Prenatal attachment (PA) is defined as the relationship that develops between a woman and her foetus. Three measurements exist for evaluating PA: the Maternal Foetal Attachment Scale (MFAS), the Maternal Antenatal Attachment Scale (MAAS) and the Prenatal Attachment Inventory (PAI). Of these three, only the PAI has been used in French. OBJECTIVES The overall objective of the current study was to evaluate the psychometric properties of this second measure of PA: the MAAS. This scale was developed in 1993 by Condon. The MAAS is a 19-item self-report questionnaire which allows for calculating a total attachment score and two subscale scores; one score estimating the quality of the affective attachment experience and the other that estimates the intensity of concern about the foetus. For each item, the future mother provided an appreciation on a 5-point Likert scale (1=absence of feelings for the foetus; 5=very strong feelings for the foetus). METHOD The sample was composed of 117 primiparous French females (27.5 ± 4.27 years) in the third trimester of pregnancy (32.84 ± 3.77 weeks of amenorrhea). The study was carried out over a period of 5 months (January-May 2012). Each woman was asked to provide demographic data, a French version of the MAAS, a validated French version of the PAI, and a scale evaluating depressive symptoms (Edinburgh PostNatal Depression Scale, EPDS). RESULTS The MAAS demonstrated moderately good psychometric properties. Condons two-factor structure of MAAS was not supported in our sample. Four factors were identified with exploratory factor analysis. Internal consistency was satisfactory for the global scale and for the factor 1 but not sufficiently adequate for the other factors. Concurrent validity was indicated by moderate correlations between the global MAAS scores with the total PAI score. A weak but significant inverse correlation was found between the MAAS and the EPDS suggesting good divergent validity. CONCLUSION The authors suggest that additional research be conducted on the measurement before confirming the validity of the French version.