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Trouble du Stress Post-Traumatique suite à l’accouchement : impact sur le bonding mère-enfant. Etude multiculturelle franco-tunisienne

Abstract : Childbirth can be experienced as a traumatic experience by the mother. This event may be associated with the expression of Post-Traumatic Stress Disorder (PTSD) in the postnatal period, but does it have any impact on the development of maternal bonding? What are the factors associated with postnatal PTSD and with the impairment of maternal bonding? Are there differences in risk factors for PTSD and in altered maternal bonding between two populations from two different cultures? To answer these questions, 646 French and Tunisian women were approached during the third trimester of pregnancy. Of these women, 284 were contacted two months after delivery and 190 were recalled at six months postpartum. Within this study, it was possible to adapt and validate a coping strategy scale on the Tunisian population and to build and validate a PTSD specific scale related to childbirth, according to the new diagnostic criteria of DSM 5, on French and Tunisian women. The results of this work showed that at two months after childbirth, 5.2% of French women and 16.5% of Tunisian women had PTSD. At six months postpartum, the prevalence of PTSD was 3.1% for French women and 16.3% for Tunisian women. Hierarchical regression models specific to each population showed that for French women, it was the primiparity and mode of delivery, self-blame used during the prenatal period, prenatal physical pain, as well as the negative perception of support from the health care team during delivery that constituted risk factors for the development of postnatal PTSD. For Tunisian women, it was the primiparity and mode of delivery, the negative perception of support from the health care team during delivery, the use of dramatization and self-blame after delivery that were risk factors for the development of PTSD in the postpartum period. With regard to the effect of PTSD on maternal bonding, the results showed that this disorder had a negative impact on the development of bonding in the postnatal period and more specifically on the alteration of the mother-child bond and child related anxiety for French women. The results also showed that coping strategies such as self-blame, behavioural disengagement and less planning had a mediating role between postpartum PTSD and maternal bonding. For Tunisian women, PTSD had a negative impact on bonding and especially on child related anxiety. Coping strategies that mediated the relationship between post-natal PTSD and maternal bonding in this population were dramatization, self-blame and rumination. This research also provided etiological models on the impact of post-natal PTSD on bonding and the different associated variables for the French and Tunisian populations. In conclusion, the tools developed and validated on both populations in this work as well as the results presented establish important foundations for future interventions to enable better prevention and diagnosis of post-natal PTSD as well as to prevent its deleterious impact on the mother-child bonding.
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Submitted on : Wednesday, April 28, 2021 - 10:22:54 AM
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Nawel Hannachi. Trouble du Stress Post-Traumatique suite à l’accouchement : impact sur le bonding mère-enfant. Etude multiculturelle franco-tunisienne. Psychologie. Université de Lorraine, 2019. Français. ⟨NNT : 2019LORR0327⟩. ⟨tel-03210773⟩

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