Prenatal Attachment, Parental Confidence, and Mental Health in Expecting Parents: The Role of Childhood Trauma

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154515/1/jmwh13034_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154515/2/jmwh13034.pd

Expérience de la grossesse et des soins périnataux chez les femmes des Premières Nations en milieu urbain

Introduction: During pregnancy, many First Nations women must travel to urban areas for perinatal care. Accessibility issues and the presence of certain risk factors (e.g., gestational diabetes) are omnipresent. Mistrust of health care and social services may increase their vulnerability during this period. Objectives: To describe the perinatal experience of First Nations women, their assessment of care received and how they would like to be accompanied by health professionals during this period. Method: A descriptive phenomenological study was conducted with 10 First Nations women transiting to urban areas for care. Individual interviews were analyzed using Giorgi's method (1997). Results: For participants in this study, pregnancy is a positive and holistic experience which all dimensions of health are influenced — physical, psychological, emotional and spiritual. In terms of care, trust is paramount. However, most participants reported negative experiences during their perinatal care (e.g., reactivation of traumas). Finally, in terms of expectations, they would like to receive more information and a sense of acknowledgment of their culture during this perinatal period. Discussion and conclusion: For the participants, motherhood gave them the opportunity to prove their resilience. The use of positive levers promotes the well-being of First Nations women. It is essential to include the realities and cultural particularities of First Nations women in the approaches to care provided by health professionals during this important period.Introduction : Pendant leur grossesse, plusieurs femmes des Premières Nations doivent transiter en milieu urbain pour obtenir des soins périnataux. Les enjeux d’accessibilité et la présence de certains facteurs de risque (ex., diabète gestationnel) sont omniprésents. Or, la méfiance qu’elles entretiennent face aux soins de santé et aux services sociaux pourrait contribuer à accroître leur vulnérabilité lors de cette période. Objectifs : Décrire l’expérience périnatale de femmes des Premières Nations, leur appréciation des soins périnataux reçus et la façon dont elles aimeraient être accompagnées par les professionnel·les de la santé. Méthode : Une étude phénoménologique descriptive a été menée auprès de 10 femmes des Premières Nations transitant en milieu urbain. Des entretiens individuels ont été analysés selon la méthode de Giorgi (1997). Résultats : Pour les participantes, la grossesse se révèle être une expérience positive et holistique, où toutes les dimensions de la santé sont influencées (physique, psychologique, émotionnel et spirituel). En ce qui a trait aux soins, le lien de confiance est primordial. Or, la majorité d’entre elles rapportent des expériences négatives lors des soins périnataux (ex., réactivation des traumas). Finalement, les participantes ont indiqué souhaiter obtenir plus d’information et bénéficier d’un accompagnement inclusif de leur culture lors de la période périnatale. Discussion et conclusion : Pour les participantes, la maternité leur a donné l’occasion de prouver leur résilience. L’utilisation de leviers positifs favorise le mieux-être des femmes des Premières Nations. Il importe d’inclure les réalités et particularités culturelles de celles-ci dans les approches de soins dispensées par les professionnel·les de la santé lors de cette période de transition importante

Association entre la fréquence de consultation des médias d’information et la détresse psychologique chez les femmes enceintes durant la pandémie de COVID-19

OBJECTIVE: Examine the association between news media use frequency during the COVID-19 pandemic and the scale of psychological distress in pregnant women, considering this distress known harmful effects on the fetus development. METHOD: Pregnant women living in Quebec province (N = 1014) have been recruited in April 2020 through social media, while a state of health emergency was declared. Participants were divided in 4 groups, according to self-reported frequency of news media consulting (little or none; one time a day; several times a day; constant). They filled measures of depressive symptoms, negative affects, post-traumatic stress symptoms and anxiety specific to COVID-19. Instrument scores were grouped under a unique factor of psychological distress. RESULTS: An ANCOVA controlling for age, gestational age, education level, household annual revenue and a diagnosed mental disorder present at the time of participation in study shows that news media exposure frequency is significantly associated with psychological distress severity in pregnant women, during COVID-19 pandemic, F(3,998) = 27.02, p < 0.001, η2 partial = 0.08. Given the mean comparisons a posteriori, higher psychological distress rates are found as soon as news media exposure exceeds once a day (effect sizes between 0.38 and 0.81). CONCLUSIONS: The more pregnant women report consulting the news media during the COVID-19 pandemic, the more likely they are to exhibit psychological distress. Results provide one of the first empirical supports to recommendations of World Health Organization, Canada government and psychiatric associations that encourage population to limit their news media consulting during the COVID-19 pandemic

Uptrend in distress and psychiatric symptomatology in pregnant women during the coronavirus disease 2019 pandemic

Introduction: Prenatal maternal distress has a negative impact on the course of pregnancy, fetal development, offspring development, and later psychopathologies. The study aimed to determine the extent to which the coronavirus disease 2019 (COVID-19) pandemic may aggravate the prenatal distress and psychiatric symptomatology of pregnant women. Material and methods: Two cohorts of pregnant volunteer women were evaluated, one that was recruited before the COVID-19 pandemic (n = 496) through advertisements in prenatal clinics in Quebec, Canada, from April 2018 to March 2020; the other (n = 1258) was recruited online during the pandemic from 2 April to 13 April 2020. Prenatal distress and psychiatric symptomatology were measured with the Kessler Distress Scale (K10), Post-traumatic Checklist for DSM-5 (PCL-5), Dissociative Experiences Scale (DES-II), and Positive and Negative Affect Schedule (PANAS). Results: The 1754 pregnant women (Mage = 29.27, SD = 4.23) were between 4 and 41 gestational weeks (M = 24.80, SD = 9.42), were generally educated (91.3% had post-high-school training), and financially well-resourced (85.3% were above the low-income cut-off). A multivariate analysis of covariance controlling for age, gestational age, household income, education, and lifetime psychiatric disorders showed a large effect size (ES) in the difference between the two cohorts on psychiatric symptoms (Wilks’ λ = 0.68, F6,1400 = 108.50, P &lt;.001, partial η2 = 0.32). According to post-hoc analyses of covariance, the COVID-19 women reported higher levels of depressive and anxiety symptoms (ES = 0.57), dissociative symptoms (ES = 0.22 and ES = 0.25), symptoms of post-traumatic stress disorder (ES = 0.19), and negative affectivity (ES = 0.96), and less positive affectivity (ES = 0.95) than the pre-COVID-19 cohort. Women from the COVID-19 cohort were more likely than pre-COVID-19 women to present clinically significant levels of depressive and anxiety symptoms (OR = 1.94, χ2[1] = 10.05, P =.002). Multiple regression analyses indicated that pregnant women in the COVID-19 cohort having a previous psychiatric diagnosis or low income would be more prone to elevated distress and psychiatric symptoms. Conclusions: Pregnant women assessed during the COVID-19 pandemic reported more distress and psychiatric symptoms than pregnant women assessed before the pandemic, mainly in the form of depression and anxiety symptoms. Given the harmful consequences of prenatal distress on mothers and offspring, the presently observed upsurge of symptoms in pregnant women calls for special means of clinical surveillance. © 2020 Nordic Federation of Societies of Obstetrics and Gynecolog

Étude des relations entre la dissociation, le fonctionnement réflexif et les difficultés d'adaptation chez des enfants abusés sexuellement

Cette thèse a pour objectif d'examiner le rôle de deux mécanismes psychologiques cognitifs, la dissociation et le fonctionnement réflexif, pour comprendre l'adaptation d'enfants abusés sexuellement. Elle est composée de deux articles testant des modèles de compréhension de l'émergence des problèmes intériorisés, extériorisés et des comportements sexualisés à la suite d'un abus sexuel. Le premier article suggère que le recours à des états dissociatifs pour se défendre de l'abus joue un rôle médiateur entre l'abus et ses séquelles. L'effet de la nature de l'abus sexuel, du type d'abus et du stade développemental de l'enfant au moment de l'abus (circonscrit ou chronique) sur l'ampleur des difficultés d'adaptation est également vérifié. Le deuxième article examine le fonctionnement réflexif comme variable limitant le développement de la dissociation et des difficultés d'adaptation dans un contexte d'abus sexuel. Les mères de 193 enfants âgés de 2 à 12 ans ont répondu aux questionnaires pour la première étude, tandis que 100 mères et enfants âgés de 7 à 12 ans ont participé à la seconde. Les résultats du premier modèle démontrent que la dissociation a un effet médiateur significatif entre l'abus sexuel et les problèmes intériorisés, extériorisés et les comportements sexualisés. Des caractéristiques de l'abus sexuel, seul le stade développemental de l'enfant au moment de l'abus est associé à la sévérité des séquelles. Les abus sexuels vécus avant l'âge de 3 ans et ceux qui se poursuivent sur plus d'un stade développemental ont des répercussions plus sérieuses que les abus vécus à l'âge scolaire ou circonscrits à un seul stade développemental. Les résultats de la deuxième étude démontrent que les capacités reflexives d'un enfant jouent un rôle médiateur entre l'abus sexuel et les symptômes dissociatifs. Également, la relation négative significative entre le fonctionnement réflexif et les problèmes d'adaptation est expliquée par la dissociation. Cet élément suggère que les fonctions reflexives favorisent l'adaptation des enfants en limitant principalement le développement des réactions dissociatives. Les conclusions des études sont discutées en fonction de la pertinence de considérer les mécanismes cognitifs des enfants abusés sexuellement pour comprendre la façon dont ils s'adaptent. Les implications cliniques des résultats sont également exposées

Développement d’un programme d’accompagnement prénatal pour les adultes ayant été victimes d’abus ou de négligence aucours de leur enfance : étude de consensus par la méthode Delphi

Introduction. La grossesse et la naissance d’un enfant posent des défis particuliers aux adultes ayant été victimes d’abus ou de négligence durant leur enfance. Il existe cependant peu d’interventions prénatales adaptées aux besoins spécifiques de ces personnes. Cette recherche vise à identifier une liste d’actions à mettre en oeuvre dans le cadre d'interventions de groupe destinées aux futurs parents ayant subi des traumatismes relationnels durant leur enfance. Méthodologie. Quinze intervenants représentant neuf organismes communautaires et de soins de santé du Québec travaillant auprès des familles ou des victimes de traumatismes ont participé à un processus de consultation Delphi à deux volets. Dans le premier volet, les trois chercheurs responsables du projet ont élaboré, en se fondant sur la littérature clinique et empirique, 36 actions pertinentes pour les futurs parents ayant subi des traumatismes durant leur enfance. Des intervenants ont ensuite participé à un sondage en ligne anonyme au cours duquel ils avaient à coder l’importance qu’ils accordaient à ces actions ainsi que la similitude entre ces dernières et les interventions pratiquées dans leur milieu clinique. Les intervenants ont ensuite pris part à une journée de consultation en personne, au cours de laquelle ils ont discuté de la pertinence des actions présentées, proposé de nouvelles actions et revu toutes les actions. Un second sondage anonyme a ensuite permis d’en arriver à un consensus sur une liste finale de 22 actions classées en fonction de leur pertinence. Résultats. Le processus de consultation a abouti à deux séries d’actions : une série visant à favoriser la mentalisation à propos de soi et de son rôle de parent et une série visant à favoriser la mentalisation à propos des traumas. Conclusion. Le processus Delphi a aidé à définir les bases de ce que devrait être, du point de vue des professionnels qui assureraient la prestation d’un tel programme, une intervention prénatale ciblant les adultes ayant subi des traumatismes durant leur enfance

Development of a prenatal program for adults with personal histories of childhood abuse or neglect: a Delphi consensus consultation study

Introduction: Pregnancy and the birth of a child present particular challenges for adults with personal histories of childhood abuse or neglect. However, few prenatal interventions address the specific needs of this population. This research aims to determine a list of actions that should be achieved during group interventions designed for expectant parents who experienced childhood trauma. Methods: Fifteen stakeholders representing nine different Quebec health care and community organizations that work with families and/or trauma survivors participated in a Delphi process in two rounds. In round 1, three project leaders identified, from clinical and empirical literature, a set of 36 actions relevant for expectant parents who experienced childhood trauma. Using an anonymized online survey, stakeholders coded how important they considered each action and whether they were already conducting similar interventions in their clinical setting. Stakeholders subsequently participated in a one-day in-person meeting during which they discussed the pertinence of each action, proposed new ones and refined them. This was followed by a second anonymized online survey (round 2). A consensus was reached among the stakeholders regarding a final list of 22 actions. Results: Two central clusters of actions emerged from the consultation process: actions aiming to support mentalization about self and parenthood, and actions aiming to support mentalization of trauma. Conclusion: The Delphi process helped to identify what should be the core of a prenatal intervention targeting adults who experienced childhood trauma, from the viewpoint of professionals who will ultimately deliver such a program

Tracing the Evolution of the Plastome and Mitogenome in the Chloropicophyceae Uncovered Convergent tRNA Gene Losses and a Variant Plastid Genetic Code

International audienceThe tiny green algae belonging to the Chloropicophyceae play a key role in marine phytoplankton communities; this newly erected class of prasinophytes comprises two genera (Chloropicon and Chloroparvula) containing each several species. We sequenced the plastomes and mitogenomes of eight Chloropicon and five Chloroparvula species to better delineate the phylogenetic affinities of these taxa and to infer the suite of changes that their organelle genomes sustained during evolution. The relationships resolved in organelle-based phylogenomic trees were essentially congruent with previously reported rRNA trees, and similar evolutionary trends but distinct dynamics were identified for the plastome and mitogenome. Although the plastome sustained considerable changes in gene content and order at the time the two genera split, subsequently it remained stable and maintained a very small size. The mitogenome, however, was remodeled more gradually and showed more fluctuation in size, mainly as a result of expansions/ contractions of intergenic regions. Remarkably, the plastome and mitogenome lost a common set of three tRNA genes, with the trnI(cau) and trnL(uaa) losses being accompanied with important variations in codon usage. Unexpectedly, despite the disappearance of trnI(cau) from the plastome in the Chloroparvula lineage, AUA codons (the codons recognized by this gene product) were detected in certain plastid genes. By comparing the sequences of plastid protein-coding genes from chloropicophycean and phylogenetically diverse chlorophyte algae with those of the corresponding predicted proteins, we discovered that the AUA codon was reassigned from isoleucine to methionine in Chloroparvula. This noncanonical genetic code has not previously been uncovered in plastids

Beyond abuse and neglect: validation of the childhood interpersonal trauma inventory in a community sample of adults

IntroductionChildhood trauma is not restricted to abuse or neglect and other potentially traumatic experiences need to be pondered in practice and research. The study aimed to collect validity evidence of a new measure of exposure to a broad range of potentially traumatic experiences, the Childhood Interpersonal Trauma Inventory (CITI), by evaluating whether the CITI provides important additional information compared to a gold standard measure of childhood trauma.MethodsThe sample consisted of 2,518 adults who completed the CITI and self-reported measures of trauma (Childhood Trauma Questionnaire; CTQ) and psychiatric symptoms (PTSD Checklist for DSM-5; Kessler Psychological Distress Scale; Dissociative Experiences Scale).ResultsFirst, the sensitivity to properly detect participants having been exposed to childhood maltreatment, as measured by the CTQ (here used as the gold standard), ranged between 64.81% and 88.71%, and the specificity ranged between 68.55% and 89.54%. Second, hierarchical regressions showed that the CITI predicted between 5.6 and 14.0% of the variance in psychiatric symptoms while the CTQ only captured a very small additional part of variance (0.3 to 0.7%). Finally, 25% (n = 407) of CTQ-negative participants screened positive at the CITI. The latter reported higher severity of psychiatric symptoms than participants without trauma, suggesting that the CITI permits the identification of adults exposed to significant traumas that remain undetected using other well-validated measures.DiscussionThe findings underscore the utility of the CITI for research purposes and the latter’s equivalence to a gold standard self-reported questionnaire to predict negative outcomes