L'anxiété spécifique à la grossesse : une entité clinique distincte ? : étude prospective et longitudinale comparée de l'évolution, de l'intensité, des facteurs de risque, des corrélats associés et de la prédiction de l'humeur maternelle postnatale

Abstract : The deleterious effects of anxiety on the course of pregnancy, the fetus, the child and the mother are well documented. However, the definition and evaluation of prenatal anxiety remains open to debate. Recent empirical studies suggest that pregnancy-specific anxiety (PSA) is a distinct clinical entity. The main objective of this thesis is to clarify this question. The specific objectives are: (A) to explore the PSA from a qualitative point of view; (B) to compare its frequency, intensity, and development, and those of its five composing factors, with those of General Anxiety (GA); (C) to identify risk factors, protection factors, and associated correlates; D) to study its ability to predict post-natal maternal mood. This thesis is composed of two parts: a qualitative study and a larger quantitative research. In the first study, interviews were conducted with 11 pregnant women during each trimester of pregnancy in order to collect qualitative data. Subsequently, quantitative data were collected from 155 pregnant women recruited from the Department of Obstetrics at the Montreal University Hospital Centre, in Canada, in their first trimester of pregnancy (8-14 weeks of amenorrhoea). They completed a consent form, a sociodemographic and obstetric questionnaire and measures of Attachment Style Measurement (RSQ); Marital Adjustment (R-DAS); Social Support (SSQ6); Depression (EPDS); PSA (PRAQ); and GA (STAI-Y)). Depression, PSA, and GA measurements were repeated in trimesters 2 (n = 126) and 3 (n = 120). GA and depression measurements were also collected a few weeks after delivery (n = 110). The thesis is presented in three articles. The first is a literature review on attachment style as a risk factor for PSA, a concept that is still poorly supported by empirical studies. However, the theory of attachment offers a promising framework for understanding PSA. The second article describes the results of the qualitative study. It appears from this study that fears of loss and, conversely, of invasion, both related to corporal experience, contribute to give prenatal anxiety its specific character. In addition, the preferred coping mechanisms are emotion-focused rather than problem-focused. As for the quantitative study, the results revealed that GA and PSA provide distinct symptomatology information and that they vary differently. Moreover, protective and risk factors, as well as associated correlates (conjugal adjustment, social support, attachment style, obstetric risk, parity status, previous fetal loss), partly distinguish them. The third article highlighted that a preoccupied style of attachment is a significant predictor of GA and PSA in each trimester of pregnancy. Additional analyses pointed to significant differences between the five PSA factors. Factor 4, "fear of changes", is the only one that contributes to the prediction of post-natal maternal mood without being associated with any of the obstetric variables studied. These findings help document the fact that ASG is a distinct clinical entity. The study of the five PSA factors raised the following question: is PSA a unitary distinct entity or a multidimensional entity? Our work also suggests that the five factors can be grouped into two types of fears: concerns related to obstetric variables (fear for the integrity of the baby, fear of giving birth) and concerns of an identity and relational nature during pregnancy and after childbirth. These findings are discussed in terms of antenatal care routines, collaboration within teams and appropriate therapeutic strategies.
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Nicole Reeves. L'anxiété spécifique à la grossesse : une entité clinique distincte ? : étude prospective et longitudinale comparée de l'évolution, de l'intensité, des facteurs de risque, des corrélats associés et de la prédiction de l'humeur maternelle postnatale. Psychologie. Université Sorbonne Paris Cité, 2017. Français. ⟨NNT : 2017USPCB199⟩. ⟨tel-02277580⟩

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