Postnatal Depression Clinical Trial
Official title:
Postnatal Depression, Attachment and Self-defining Memories
The specificity of postnatal depression (PND) was acted as full entity within the
depressions, by B. Pitt in 1968, through the description of a specific nosography which
describes "an atypical depression of the post-partum ".
Actually, the epidemiological studies agree on prevalence from 10 to 15 % of PND. With two
peaks of frequency, the first one around the 6th and 12th week comment native and the second
during the second half-year. This rate of PND represents in France 75000 to 100000 women a
year.
The professionals of the perinatal period are interested in this disorder because of the
consequences for the woman herself, and of the impact on the premature interactions
mother-baby. These interactions and the direct effects of the PND on the mother will have for
influence an important slowing down on the development of the baby. Moreover, the study of
Lemaitre and Candilis in 1999, brings the figure of 15 % of the PND which will have an impact
on the development of the baby.
The sensation of the depression testifies of a process of change and of psychic conflict
favored by the psychic transparency of the pregnancy.
Although the first treaty on this specific nosography dates more than 150 years of numerous
questions stay suspends it.
These questions and the reflections which surround them found on their path tools ensuing
from the theory of the attachment, formalized by John Bowlby. For more than three decades,
these profiles of attachment, specified by Mary Ainsworth: secure, anxious-ambivalent,
anxious-avoided and disorganized later, disrupted, is studied, estimated and their evolution
during a life is observed. Thanks to these models well known for the same person at a time t,
it is now their effects in the interpersonal relations which are studied. Between the people
but also on the person himself, its image of her, and its autobiographical memory.
The autobiographical memory represents a central component of the human memory. At a very
general level, it's possible to define it as the capacity of a person to remember its past
experiences. The review of the literature on the functioning of the episodic autobiographical
memory during the depression highlights three main results: the too bi generalization of the
memories, the congruence in the humor and the frequency of the intrusive memories
characterized by an involuntary reminder, fast and effortlessly (Lemogne and al., 2006;
Lemogne and al., 2012). The authors specify that there are links between strategies of
avoidance of the intrusive memories and the phenomenon of generalization. These links ask to
be explored within a model integrating, self and episodic autobiographical memory in the
field of the depression. The use of the memories defining the one could allow to study more
specifically this kind of memories. The memories defining the one were introduced to Ape and
Moffitt (1991) to characterize a specific category of autobiographical memories. The memories
defining the one are important personal memories which help a person to understand whom this
person is as individual. In a way, they build the life story and support the personal
identity. Connected to other similar memories, the self-defining memories contain numerous
sensory details and are often associated to a strong emotional charge. They are also
connected to long-term purposes, to concerns or to unsolved conflicts.
Recent studies used the self-defining memories (French version adapted by Mr van der Linden's
team, Switzerland) as tool to understand better the psychological disorders from which
certain people suffer. The studies show that the self-defining memories undergo modifications
the characteristics of which are in connection with every pathology (works of the team of
J.M. Danion).
In 1994, Moffit and al. studied a group of students with evaluation of the depressive
symptomatology. They established that the presenting subjects of high scores of depression
develop more generalized memories than the other participants when is asked to them a
self-defining memorie positive. For the memories with negative valence, no difference is
found among the tested students. There are no data in the literature on the self-defining
memories and the postnatal depression. Besides, there is only a single search, not published
which explores the links between the attachment and the memories defining the one (Tagini,
Conway and Meins, looks for not published, quoted by Conway, to Ape and Tagini, on 2004). The
authors present the results according to the styles of attachment. So, autobiographical
memories would vary according to the cognitive and emotional dimensions, in connection with
differences in the style of attachment. In every style of attachment would correspond certain
specificities in the contents and in the form of the self-defining memories.
In this context, it seems important to look for if there are specificities concerning the
profiles of attachment and the self-defining memories at the patients suffering from
postnatal depression. Especially as the current literature approaches only little this
subject of public health.
To analyze these specificities, two groups (group postnatal depression versus group control)
will compare by estimating the type of maternal attachment and theirs self-definig memories,
without omitting to look for a possible psychiatric pathology, and a personality problem at
the mother.
The main objective of this study will be to highlight specificities of the style of
attachment and the personal identity in the postnatal depression.
The secondary objectives of this study will on one hand be to look for the existence of links
between the various clinical variables in the postnatal depression.
And on the other hand to look for psychological and clinical factors which can be markers of
vulnerability and\or factors of protection of the depression comment native (comparison
between both groups of subjects).
The participation to this study will be proposed to all the women of both centers, throughout
the inclusion. Those who will have accepted will fill a scale Edinburgh Post-natal Depression
Scale (EPDS). The score which will decide in which group women will be assigned :
- < 11 group control
- > 11 group PND The specific visit in the study will take place in a identical way for
the cases and the witnesses.
The patients will be seen at first by a doctor a child psychiatrist who will make a data
collection sociodemographic and clinical and the signing of various questionnaires : Mini
International Neurospychiatric Interview (MINI), Adult Attachment Narratives (AAN), Camir
scale and Perceived Social Support Questionnaire (QSSP).
Secondly, the patients will be seen by a psychologist to pursue the clinical evaluation
(Trait Anxiety Inventory (STAI), Beck Depression Inventory and self-esteem scale (EES), Scale
of vocabulary (MILL-HILL) and to realize the signing of the questionnaire of the
self-defining memories.
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