Cette recherche exploratoire longitudinale a pour objectif principal d'évaluer l'impact psychologique de la découverte et du traitement de cancer chez la femme enceinte et chez la femme en post-partum. De manière plus précise nous évaluons l'influence de la maternité sur l'ajustement à la maladie cancéreuse et l'influence de la survenue du cancer sur le processus de parentalisation. Cette recherche permet d'appréhender le risque psychopathologique réel de cette situation comportant de nombreux éléments dépressiogènes et anxiogènes ainsi que le risque de pathologisation du lien mère-enfant. L'analyse quantitative et qualitative des données permettra in fine d'établir des recommandations concernant l'accompagnement psychologique des femmes rencontrant cette situation. Ce travail a pour particularité de faire le lien entre deux champs théoriques distincts: la psychologie périnatale et la psycho-oncologie. / This longitudinal exploratory study aims at assessing the psychological impact of the discovery and cancer treatment in pregnant women and in women postpartum. More specifically we evaluate the influence of motherhood on adjusting to cancer disease and the influence of the occurrence of cancer in the parentalisation process. This research allows us to understand the real psychopathological risk of this situation with many elements dépressiogènes and anxiety and the risk of pathologizing the mother-child bond. The quantitative and qualitative analysis of the data will ultimately establish recommendations for counseling of women encountering this situation. This work has the particularity to make the connection between two different theoretical fields: perinatal psychology and psycho-oncology.

L'agressivité excessive chez les jeunes enfants est un problème important en santé mentale, entraînant des dysfonctionnements en famille et en collectivité. Les objectifs de cette étude sont de : a) spécifier les troubles cliniques chez 70 jeunes enfants âgés de moins de 5 ans, orientés pour de l'agressivité physique excessive ainsi que leur profil développemental (tempérament, langage et développement psychomoteur) ; b) cerner les caractéristiques des attitudes éducatives parentales et celles des interactions maternelles et les articuler avec les profils développementaux des enfants ; c) comparer ces données avec celles recueillies auprès d'une population de 80 jeunes enfants typiques du même âge. Les résultats montrent que 60% des enfants cliniques (Age moyen = 3,5 ans) présentent un trouble de la régulation sensorielle. Les enfants cliniques manifestent fréquemment des troubles du sommeil concomitants et un retard de langage. Leur tempérament est caractérisé par une impulsivité importante et des difficultés de contrôle inhibiteur. Les attitudes éducatives parentales sont à la fois laxistes, surréactives et hostiles. Les interactions mère-enfant semblent perturbées et ceci, dès le plus jeune âge. Les résultats sont discutés en termes de stratégies thérapeutiques adaptées qui peuvent être proposées pour aider ces jeunes enfants et leurs parents. / Excessive aggression in young children is of major concern in the field of child mental health. They often disturb family and social life. The first aim of this study is to specify the clinical troubles and the developmental profile (temperament, language and psychomotor development) of 70 preschool children under 5 years referred for excessive physical aggression. The second aim is to define parenting characteristics and mother-child interactions and to articulate them with the children's developmental profile. The third aim is to compare these data with a typical population of the same age. The results show that 60 % of the clinical children (Average age = 3,5 years) present a disorder of the sensory processing. The clinical children show frequently concomitant sleeping disorders and delay of language. Their temperament is characterized by an important impulsiveness and difficulties of effortful control. Parenting is characterized by laxness, overreactivity and hostility. Children with excessive aggression evolve in disrupted mother-infant interactions from the youngest age. The results are discussed in terms of their implications for the therapeutic interventions that may be designed to help these young children and their family.

Nombreuses prévues et études sur la transmission inter et trans-générationnelle du traumatisme nous confirment l'évidence de la transmission sans pour autant en donner une description détaillé du processus qui pourrait être à la base de la transmission directe de la mère au bébé. La compréhension de ce processus pourrait permettre de penser et promouvoir des dispositifs de soin précoce pour les mères traumatisées et leurs bébés. Cela s'avère d'autant plus important dans les contextes de trauma collectif, comme les situations d'urgence humanitaire, où une large partie de la population est exposée à des événements traumatiques extrêmes et répétés. Dans le but d’identifier les déterminantes propres à la transmissions directe du traumatise psychique de la mère au bébé en contexte humanitaire, nous avons recrutées vingt-quatre dyades mère-bébé, en trois pays affectés par la crise politico-religieuse centrafricaine démarrée en 2013 (République Centrafricaine, Tchad et Cameroun). Dans les vingt-quatre dyades, les mères ont été exposées à un ou plusieurs événements traumatiques, en l'absence du bébé, avant sa naissance ou pendant la grossesse ; l'âge de bébé est compris entre un mois et trois ans. Ces Mères et bébés ont étés rencontré lors d'un entretien semi structuré que nous avons filmé. Cela pour permettre une microanalyse des interactions trans-modales (visuelles, corporelles, vocales) entre mère et bébé, dans l'idée de comprendre si pendant la révocation de l'événement traumatique de la part de la mère, les interactions subissaient des modifications et dans ce cas, lesquels. Les interactions dyadiques ont été aussi observées dans une situation de jeu libre sans la présence d'interviewer. Les représentations maternelles ainsi que les marqueurs traumatiques dans le discours ont été pris en compte comme facteurs contributeurs de la transmission traumatique. Les résultats de l'analyse des échanges dyadiques pendant l'entretien, montrent une évidence dans le changement d'interactions dans le moment de révocation traumatique de la mère. Les détails de cette différence d'interaction entre mère et bébé sont présentés dans la session de résultats. Dans la discussion ils sont ensuite mis en relation avec le discours de la mère où nous pouvons remarquer le rôle de représentations maternelle à propos du bébé qui ont une implication importante dans la transmission traumatique. L'analyse de toutes ces composantes multiples semble nous indiquer que le traumatisme maternelle influence les représentations de la mère à propos du bébé, de sa relation avec lui et du mandat transgénérationnelle dont le bébé va être investi. De plus les mères traumatisées, envahies par leur propre état émotionnel négatif ont des difficultés à interpréter correctement les expressions verbales et non verbales du bébé et à trouver des réponses appropriées. Cette difficulté se traduit dans la transmission de son état émotionnel négatif au bébé, qui interprète l'absence de réponse de la mère ou les réponses pas adéquates à ses sollicitations, comme des signaux négatifs vis-à-vis de son propre état émotionnel. Lé bébé et il n'a pas d' autres stratégies que celle d'internaliser l'état affectif négatif maternel et de le transformer dans son propre état interne. Malgré l'évidence de la transmission de l état émotionnel négatif de la mère au bébé, nous avons pu observer certains facteurs de protection qui peuvent préserver les mères et les bébés de l'inévitabilité de cette transmission. Les mères et les bébés montrent plusieurs ressources et compétences internes qui nous laissent penser qu'une réparation est possible ainsi qu'une prévention de la transmission traumatique quand le processus est déjà démarré. Pour conclure ce travail nous présentons de propositions cliniques de prise en charge des mère ayant vécu un traumatisme et leur bébé, dans le but de réduire les effets de la possible transmission du traumatisme au bébé ou, quand possible, de la prévenir. / Several studies on the inter- and trans-gerational transmission of trauma confirm the evidence of transmission without giving a detailed description of the process that could be the basis of mother to child direct transmission. Understanding this process could help to think and promote early care for traumatized mothers and their children. This is especially important in contexts of collective trauma, such as humanitarian emergencies, where a large part of the population is exposed to extreme and repeated traumatic events. In order to identify the determinants of the mother to child direct transmission in a humanitarian context, we recruited twenty-four mother-child dyads, in three countries affected by the Central African political and religious crisis started in 2013 (Central African Republic, Chad and Cameroon). The twenty-four dyads were composed by mothers exposed to one or more traumatic events, in the absence of the child, before childbirth or during pregnancy and their children, aged from one month to three years. We met the mother-child dyads during a semi-structured interview that we filmed in order to allow a microanalysis of the cross-modal (visual, bodily, vocal) interactions between mother and child. The objective was to understand whether interactions underwent modifications during the revocation of the traumatic event by the mother, and if yes, to have a better comprehension of these changes. Dyadic interactions were also observed in a free play situation without the presence of interviewers. Maternal representations as well as traumatic markers in mother discourse have been taken into account as factors contributing to the traumatic transmission. The results of the dyadic exchanges analysis during the interview show some evidences in the modification of interactions during the traumatic revocation of the mother. The details of this difference in mother-child interactions are presented in the results session. In the discussion session, the results from the microanalysis of interactions, have been connected to the mother's speech where we can notice the role of maternal representations about the child that have an important involvement in traumatic transmission. The analysis of all these multiple components seems to indicate that maternal trauma influences the mother's representations about the child, her relationship with him and the intergenerational mandate of which the child will be assigned to. In addition, traumatized mothers who are overwhelmed by their own negative emotional state, have difficulties in interpreting the child's verbal and non-verbal expressions correctly and finding appropriate answers. This difficulty is reflected in the transmission of mother negative emotional state to the child, who interprets the mother's lack of response or inadequate responses to his solicitations, as negative signals about his own emotional state. The child has no other strategies than internalizing the maternal negative affective state and transforming it into its own internal state. Despite the evidence of the transmission of the negative emotional state from the mother to the child, we have observed some protective factors that can preserve mothers and children from the inevitability of this transmission. Mothers and children show many internal resources and skills that suggest a possible recovery as well as give the basis to think about the prevention of traumatic transmission, when the process is already underway. To conclude this work we present clinical applications for the management of traumatized mothers and their young children in order to reduce the effects of the possible transmission of trauma to the child or, where possible, to prevent it. / Diversi studi sulla trasmissione inter e tran-generazionale del trauma confermano l'evidenza della trasmissione, ma senza fornire una descrizione dettagliata del processo che potrebbe essere alla base della trasmissione diretta dalla madre al bambino. Comprendere questo processo potrebbe aiutare a pensare e promuovere la cura precoce delle madri traumatizzate e dei loro bambini. Ciò è tanto più importante nelle situazioni di trauma collettivo, come possono essere le emergenze umanitarie, dove una gran parte della popolazione è esposta a eventi traumatici estremi e ripetuti. Al fine di individuare le caratteristiche specifiche della trasmissione diretta del trauma psichico dalla madre al bambino in ambito umanitario, abbiamo reclutato ventiquattro diadi madre-bambino in tre paesi colpiti dalla crisi politico-religiosa della Repubblilca Centrafricana che ha avuto inizio nel 2013 (Centrafrica, Ciad e Camerun). Nelle ventiquattro diadi, la madre ha assistito a uno o più eventi traumatici in assenza del bambino, prima della nascita o durante la gravidanza e il bambino ha un'età compresa tra un mese e tre anni. Hanno partecipato a un' intervista semi-strutturata che abbiamo filmato per consentire la microanalisi delle interazioni cross-modali (visive, corporee, vocali) tra madre e bambino, con l'obiettivo di comprendere se durante la rievocazione dell'evento traumatico della madre, le interazioni madre-bambino si modificano e in questo caso, come. Le interazioni diadiche sono state osservate anche in una situazione di gioco libero senza la presenza d¿intervistatori. Le rappresentazioni materne e gli elementi identificatori del trauma nel discorso della madre sono stati considerati come fattori che contribuiscono alla trasmissione traumatica. I risultati delle analisi dell'interazione diadica durante l'intervista mostrano un cambiamento evidente dell'interazione nel momento della narrazione traumatica della madre. I dettagli delle differenze osservate nell'interazione madre-bambino sono presentati nella sessione dei risultati e nella discussione sono messi in relazione con il contenuto e la forma del discorso della madre, in cui è possibile vedere il ruolo delle rappresentazioni materne à proposito del bambino, nella trasmissione del trauma. L'analisi di tutti queste componenti multiple suggerisce che il trauma materno ha un impatto sulle rappresentazioni della madre a proposito del suo bambino, del rapporto che ha con lui e del mandato transgenerazionale di cui il bambino sarà portatore. Inoltre, le madri traumatizzate, invase dal proprio stato emotivo negativo, mostrano una difficoltà a interpretare correttamente le espressioni verbali e non verbali del bambino e a trovare delle risposte adeguate alle sue sollicitazioni. Questa difficoltà si traduce nella trasmissione dello stato emotivo negativo della madre al bambino, che interpreta la mancanza di risposta della madre o le risposte inadeguate alle sue richieste, come segnali negativi rispetto al suo stato emotivo. Il bambino non riesce a trovare altre strategie oltre a quella di interiorizzare lo stato emotivo negativo della madre e trasformarlo nel proprio stato emotivo interno. Nonostante le prove della trasmissione dello stato emotivo negativo dalla madre al bambino, abbiamo osservato alcuni fattori protettivi in grado di preservare le madri e i bambini dall'inevitabilità della trasmissione. Madri e bambini mostrano diverse risorse e competenze interne che ci portano a immaginare che una "riparazione" è possibile, cosi come anche la prevenzione della trasmissione traumatica, nel caso in cui il processo è già avviato. Per concludere questo lavoro, presentiamo delle proposte cliniche destinate alle madri traumatizzate e ai loro bambini, al fine di ridurre gli effetti della possibile trasmissione del trauma al bambino o, quando possibile, per impedirla.

I Sverige drabbas ca 10 - 20% av kvinnor av depression under graviditeten eller efter förlossningen. Då tidigare forskning har gett indikationer på att depression kan ha en negativ inverkan på prenatal anknytning och mamma-barn bindning, är syftet med uppsatsen att undersöka detta hos mammor som genomgått internetbaserad kognitiv beteendeterapi (IKBT) för antenatal depression.  Denna uppsats skrevs i samarbete med den randomiserade DANA-studien om IKBT för gravida med depression. Uppsatsen var en prediktions- och sambandsstudie som tillämpar en inomgruppsdesign med tre mättillfällen; före och efter IKBT behandling samt postpartum.  Syftet med uppsatsen var bland annat att undersöka vilka faktorer som förutsäger mamma-barn bindning 8–10 veckor postpartum, samband mellan prenatal anknytning och behandlingsutfall samt samband mellan förändring i depression och förändring i prenatal anknytning under behandlingen. Resultatet indikerar att tidigare missfall samt prenatal anknytning före och efter behandlingen, kunde förutsäga mamma-barn bindning 8-10 veckor postpartum. Prenatal anknytning var inte en signifikant prediktor för förändring i depressionsnivå. Slutligen indikerar resultatet ett signifikant samband mellan förändring i prenatal anknytning samt förändring i depression före och efter behandlingen. / In Sweden, about 10-20% of women suffer from depression during pregnancy or after childbirth. As previous research has given indications that depression can have a negative impact on prenatal attachment and mother-infant bonding, the aim of the essay is to investigate this in mothers who underwent internet-based cognitive behavioral therapy (ICBT) for antenatal depression. This paper was written in collaboration with the DANA randomized trial of ICBT for pregnant women with depression. The design was a prediction and correlation study that applies a within-group design with three measurement occasions: before and after ICBT treatment and 8-10 weeks after childbirth. The purpose of the essay was, among other things, to investigate which factors predict mother-infant bonding 8–10 weeks postpartum, the relationship between prenatal attachment and treatment outcome, and the relationship between change in depression and change in prenatal attachment during treatment. The results indicate that previous miscarriages and prenatal attachment before and after treatment could predict mother-child bonding 8-10 weeks postpartum. Prenatal attachment was not a significant predictor of change in depression level. Finally, the results indicate a significant relationship between change in prenatal attachment and change in depression before and after treatment.

The effects of perceived mental/emotional problems (psychopathology) in the family-of-origin on adult offspring marital satisfaction was tested in a model considering the mediating variables of parental marital satisfaction, mother-child relationship quality, father-child relationship quality, and resolution of issues from the family-of-origin. The nationally representative sample (n = 802) drawn from the RELATionship Evaluation (RELATE) database included mostly college educated, lower-middle-class individuals in their first marriage. This sample was used to test a structural equation model that results showed fit the data well. Results showed that historical (distal) factors (such as psychopathology in the family-of-origin) explain only a small portion of the variance in adult offspring marital satisfaction and suggest that more contemporary (proximal) factors (such as individual characteristics) have a stronger relationship to adult offspring marital satisfaction. Results showed that 56% of the variance in achieving resolution of issues from the family-of-origin was explained by the other variables in the model with the best predictor being parental marital satisfaction. Direct, indirect, and total effects of each of the independent variables were examined. Results showed no direct effect of perceived mental/emotional problems (psychopathology) in the family-of-origin on adult offspring marital satisfaction. Only the mother-child relationship quality had a direct effect on adult offspring marital satisfaction. Clinical implications for practitioners are discussed. This study helps practitioners know how to help a client find resolution to issues stemming from perceived family-of-origin mental/emotional problems. This study also shows that focusing on current interpersonal processes and skills that may be part of achieving resolution is more likely to help a couple with marital problems than focusing on negative effects from the family-of-origin. Future research should focus on exploring the applicability of this model to different variables such as gender, race, income levels, etc. Future research models should also incorporate both historical and contemporary factors to help determine the direct effects of these variables on adult offspring relationship satisfaction.

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[pt] A assistência ao parto no Brasil hoje é pautada predominantemente pelo modelo tecnocrático, com alto índice de intervenções desnecessárias e promotoras de iatrogenia. Os aspectos subjetivos inerentes ao nascimento tendem a ser desconsiderados neste cenário, o que produz riscos para a saúde psíquica da mãe, do pai, e do bebê. Nesse sentido, o objetivo deste estudo foi pesquisar as experiências subjetivas de pais e mães acerca do parto na atualidade no Brasil. Para isso, foi realizado um estudo de caso coletivo no qual foram analisados 30 relatos de parto publicados em blogs pessoais sobre experiências de gestação, parto e parentalidade, sendo 15 escritos por mulheres e 15 por homens. Os resultados apontaram para o desamparo sentido por pais e mães diante de uma assistência tecnocrática, e para a idealização dos cuidados ofertados pelos profissionais que atuam de acordo com o paradigma de humanização. A ideia de escolha apareceu com frequência no discurso dos sujeitos, apontando para um cenário em que a cesariana é entendida como um bem de consumo. A importância do respeito à temporalidade do parto apareceu como sendo fundamental para que este não seja vivenciado de forma traumática e a dor foi relatada como elemento central na elaboração da morte simbólica inerente ao processo de apropriação da parentalidade. A falta de suporte do ambiente apareceu como um fator constitutivo da experiência de violência obstétrica e a escrita dos relatos como um recurso para elaboração dessa experiência traumática. Concluímos que procedimentos médicos como a episiotomia, a anestesia e a cesariana, quando realizados de forma rotineira, sem compartilhamento de decisões e sem amparo psíquico, constituem uma forma de ritualização para manter inconsciente a representação sexual do parto. Tal forma de ritualização conduz à iatrogenia no parto, causando prejuízos psíquicos à saúde materno-infantil. Nesse sentido, o cuidado e o respeito nas relações interpessoais devem ser valorizados como requisitos fundamentais para a atenção ao parto. É de extrema importância que os profissionais que assistem o parto sejam capacitados para compreenderem os aspectos emocionais inerentes ao nascimento, e as trocas interdisciplinares são um recurso potente para garantir a boa qualidade da assistência. / [en] Childbirth assistance in Brazil today is predominantly ruled by the technocratic model, generating a high rate of unnecessary interventions and promoting iatrogenesis. In this context, the subjective aspects that are typical of childbirth tend to be disregarded, which poses risks for the mental health of the mother, father and child. The purpose of this study was to investigate the subjective experiences of parents regarding childbirth in Brazil today. In order to do so, we examined an colective case study in which we analyzed 30 childbirth reports published in personal blogs about gestation, birth and parenthood experiences, in which 15 accounts written by women and 15 written by men. The results showed the helplessness felt by parents in the face of a technocratic assistance, and the idealization of the care offered by professionals who act according to the humanization paradigm. The idea of choice appeared often in the reports of the subjects, pointing towards a scenario in which the cesarean section is understood as a consumer good. Respect towards the temporality of childbirth appeared as a main issue in order to avoid a traumatic experience. Pain was shown as a key element for the elaboration of the symbolic death, a structural part of the process of parenthood appropriation. The lack of support of the environment was a major contributor to the experience of obstetric violence, in which written accounts served as a means for the elaboration of this traumatic experience. We concluded that medical procedures such as episiotomy, anesthesia, and cesarean section, when performed routinely and with no decision sharing or psychological support, represent a form of ritualization to keep unconscious the sexual representation of childbirth. This ritualization leads to iatrogenesis in childbirth, harming the mother-child health. Therefore, care and respect in interpersonal relationships should be seen as fundamental requirements for childbirth support. Professionals that aid in childbirth need to be qualified to understand the emotional aspects inherent to childbirth. Finally, we also understand that interdisciplinary exchange is a powerful tool to guarantee high-quality assistance.

Objective: To explore the longitudinal associations between prepartum fear of childbirth (FOC), birth experience, and postpartum mother-child-bonding, and the potential mediator role of the birth experience. Design: Women from the prospective cohort study DREAM completed questionnaires during pregnancy, 8 weeks, and 14 months after the birth. Participants: A community sample of n = 645 pregnant women from a large city in Eastern Germany participated in the study. Results: In a regression analysis, FOC predicted negative birth experience (β = 0.208, p < 0.001) which in turn predicted poorer mother-child-bonding both at 8 weeks (β = 0.312, p < 0.001) and 14 months postpartum (β = 0.200, p < 0.001). FOC also predicted mother-child-bonding at 14 months postpartum (β = 0.098, p < 0.05). Of note, this association was mediated by birth experience both at 8 weeks, indirect effect ab = 0.065, 95% CI [0.036, 0.098], and 14 months postpartum, indirect effect ab = 0.043, 95% CI [0.023, 0.067]. These effects remained stable even when adjusting for potential confounders. Key Conclusions: This study suggests that the association between FOC and mother-child-bonding is mediated by birth experience, pointing to the importance of a woman's positive subjective experience. Implications for Practice: Findings reveal two targets for peripartum interventions for women at risk for poor mother-child-bonding, namely the implementation of FOC screenings during pregnancy, and birth experience as mediating factor between FOC and mother-child-bonding. Focusing on the mother's subjective birth experience could aid to identify women at risk for impaired bonding who might need additional support.