N. Séjourné

Pregnancy after perinatal loss: association of grief, anxiety and attachment

Objectives: The aim of this study was to explore the psychological experience of pregnancy after a previous perinatal loss and to bring to light the risk factors of psychological distress and disorders in instituting antenatal attachment with the subsequent child. Methods: 96 pregnant women, having experienced a previous perinatal loss answered several questionnaires which measured the feelings of perinatal grief (PGS), anxio‐depressive symptomatology (HADS), acceptance of pregnancy, identification with the maternal role (PSEQ) and perinatal attachment (MAAS). The control group included 74 women with no experience of perinatal loss. Results: Women having suffered from perinatal loss reported significantly higher scores of grief and anxio‐depressive symptoms compared to the control group. These variables were significant predictors of prenatal attachment. Conclusion: Findings reveal the intense psychological distress during pregnancy following a perinatal loss and underscore the need for psychosocial and clinical care when there is a perinatal loss, care that should be extended up to the birth of the subsequent child.

Negative emotions, childbirth pain, perinatal dissociation and self-efficacy as predictors of postpartum posttraumatic stress symptoms

Objective: The aim of the study was to assess the contribution of negative emotions, childbirth pain, perinatal dissociation, and feelings of self-efficacy to the development of posttraumatic stress disorder (PTSD) symptoms following childbirth. Patients and methods: A prospective longitudinal study was carried out on 98 women from the south of France area. Four questionnaires were completed at 2–3 days postpartum: the Peritraumatic Emotions List (PEL), the French version of the McGill Pain Questionnaire, the Peritraumatic Dissociative Experience Questionnaire (PDEQ) and the Childbirth Self-efficacy Inventory (CBSEI). The Impact of Event Scale-Revised (IES-R) assessing posttraumatic stress symptoms was also completed 6 weeks after delivery. Results: Pain and negative emotions were significant predictors of the intensity of posttraumatic stress symptoms at 6 weeks postpartum. Although higher levels of pain contribute to increased PSTD symptoms, and higher negative emotion also contributes to PTSD symptoms, the effect of pain on PSTD is stronger when there are high levels of negative emotion. Discussion and conclusion: Our findings highlight that pain, negative emotions and their interaction were significant predictors of posttraumatic stress symptoms and confirm the importance of developing more specific treatments focusing on support and prevention.

Effets du congé de paternité sur la dépression du post-partum maternelle

OBJECTIVES The aim of this study was to explore the role of the paternity leave in the appearance of the maternal postpartum depression. PATIENTS AND METHODS Fifty-one couples took part in the whole study. Between the second and the fifth day after the childbirth, the mother completed the Edinburgh Postnatal Depression Scale (EPDS), which measures the symptoms of depression and the Multidimensional Scale of Perceived Social Support (MSPSS) which measures the social support the mother has become. The father completed the EPDS. Two months and then the second time four months after the childbirth, the mother received the EPDS, the MSPSS, and questionnaires measuring the temperament of the baby, the maternal skills, the feeling of being a mother and the quality of life postpartum. In order to evaluate the paternal involvement, the father completed the EPDS and questions about paternal skills and involvement. RESULTS The paternity leave seemed not to have any consequences on the results at the EPDS or other questionnaires. However, lack of paternal involvement was a significant predictor of the intensity of the depressive symptoms of the mothers. DISCUSSION AND CONCLUSION It is not the presence of the father wich seems important to take into account for detection and the traitement of postpatum depression but his participation in the care of the baby.

Posttraumatic Stress Disorder and psychological distress following medical and surgical abortion

Objective: Abortion can be a difficult event to cope with and can lead to the development of psychological disturbance. The aim of this prospective and longitudinal study was to assess and to predict Posttraumatic Stress Disorder (PTSD) symptoms following abortion. Moreover, this study aimed to assess whether the type of abortion had an impact on women’s experience. Method: Eighty-six women were approached a few hours after the abortion and then 6 weeks later. Several questionnaires were completed: the Impact of Event Scale Revised (IES-R), the Multidimensional Scale of Social Support (MSPSS), the Peritraumatic Dissociative Experience Questionnaire (PDEQ), the Peritraumatic Emotions List (PEL), the Hospital Anxiety and Depression Scale (HADS), the Perinatal Grief Scale (PGS) and the Texas Grief Inventory (TGI). Results: Six weeks after the abortion, 38% of women reported a potential PTSD and a significant decrease of the anxious symptomatology was also highlighted. Peritraumatic dissociation and peritraumatic emotions were the main predictors of the intensity of post-abortum PTSD symptoms. Compared to surgical abortion, medical abortion was associated with increasing the risk of developing a possible PTSD. Conclusion: By providing evidence on some of the main risk factors, this study highlights the need for psychological support for women and strategies of prevention to be developed.

Traumatic Grief and Traumatic Stress in Survivors 12 Years after the Genocide in Rwanda

The relationship between exposure to traumatic events and traumatic grief and the role of mediating and moderating variables [peritraumatic distress, post traumatic stress disorder (PTSD) symptoms and symptoms of depression] were studied in survivors of the genocide of Batutsi in Rwanda in 1994. One hundred and two survivors (70 women, mean age 45 ± 7.53 years) participated in this retrospective study. All of them had lost a member of their family. The severity of traumatic exposure (Comprehensive Trauma Inventory), peritraumatic distress (Peritraumatic Distress Inventory), current PTSD symptoms (PTSD Checklist), depressive symptoms (Beck Depression Inventory) and traumatic grief symptoms (Inventory of Traumatic Grief) was evaluated. A hierarchical multiple regression analysis was then conducted to examine the relative contribution of each variable to the symptoms of traumatic grief. The severity of traumatic exposure was related to traumatic grief symptoms (B=0.06, R=0.6, R(2) =0.36 and ß=0.6, t=7.54, p=0.00). The Baron and Kenny procedure (1986) (including three separate regressions), along with the Sobel test, was used to test mediation effects. Peritraumatic distress and PTSD symptoms may be mediating variables between traumatic exposure and traumatic grief. Traumatic grief is a complex but assessable entity, where previous distress and suffering result from both psychological trauma and the loss of a loved one.

Les femmes face à la douloureuse expérience de l’interruption médicale de grossesse

OBJECTIVE When the antenatal diagnosis reveals a serious anomaly of the fetus, the couple can envisage a therapeutic abortion. This qualitative study aims to bring a better understanding of emotional impact and perinatal grief after a therapeutic abortion. PATIENTS AND METHODS Seven women who have had a therapeutic abortion participated in a semidirective interview. RESULTS The analysis of the collected data reveals the psychological trauma caused by a therapeutic abortion, the significant distress of the mothers accentuated by omnipresent guilt feelings, persistent symptoms of depression and anxiety. Different reactions within the couple are perceived and can lead to marital conflict. DISCUSSION AND CONCLUSION Results show a need for a psychological follow-up of the individual as well as the couple.

Appréhension et vécu d’une grossesse obtenue après un don d’ovocyte anonyme

OBJECTIVES This qualitative study focuses on feelings of women who receive an anonymous oocyte donation. PATIENTS AND METHODS A heterogeneous group of 12 women who were mothers or pregnant following a oocyte donation or who were waiting for a donation took part in the study. All women participated in a face to face or a telephone semi-directive interview. Questions dealt with desire for children, feelings about difficulties to have a child, place of the oocyte donor and position about revelation of origins. RESULTS Several key ideas about the experience of oocyte donation can be brought out from the analysis of those interviews, particularly the psychological process implied in losing ones hope for a biological child, ambivalence towards donors, and questionings about this specific mode of conception. DISCUSSION AND CONCLUSION Womens satisfaction when the project for having a child is brought to its completion, hides neither complexity nor psychological questionings entailed by the donation process which includes a third during the conception. This study underlines the need for psychological accompaniment.

Maternal burn-out: an exploratory study

Abstract Introduction: Maternal burn-out is a psychological, emotional and physiological condition resulting from the accumulation of various stressors characterised by a moderate but also a chronic and repetitive dimension. Little research has focused on this syndrome. Objective: The current study aims to assess maternal burn-out rate and to identify factors associated with this state of exhaustion. Method: 263 French mothers aged between 20 and 49 years answered five scales quantifying maternal burn-out, perceived social support, parental stress, depression and anxiety symptoms and history of postnatal depression. Results: About 20% of mothers were affected by maternal burn-out. The main factors related to maternal burn-out were having a child perceived as difficult, history of postnatal depression, anxiety, satisfaction of a balance between professional and personal life and parental stress. Conclusion: This research shows the need for further work on maternal burn-out to better understand and prevent this syndrome.

Internet forums following a miscarriage: a place for women in particular pain?

Abstract Objective: Miscarriage is a frequent event, but one which might be particularly difficult to cope with. The main aim of this study was to explore the features of the women using Internet forums following a miscarriage. Methods: A sample of 211 women who experienced miscarriage and who use the Internet completed an online questionnaire. Sociodemographic data were gathered and three scales were completed: the Hospital Anxiety and Depression Scale, the Texas Grief Inventory adjusted to miscarriage and the Dyadic Adjustment Scale. Results: Our results show that these women reported a great amount of pain compared to a more standard sample. Interestingly, our findings show that while women reported wishing to be supported, only a few of them sought such support. Conclusion: Further study focusing on support for women who experience miscarriage must be developed and Internet-based programmes are warranted.