Key words: Attachment; mother-infant relationship; prematurity; post-traumatic stress disorder.
Abstract
According to the National Institute of Health and Medical Research (INSERM), the number of premature births continues to increase worldwide and concerns 50 to 60,000 children in France, 5% of whom are born very premature (at less than 28 Weeks of Amenorrhea (SA)) (INSERM, 2016). Medical advances have increased the survival rate of premature infants, but some long-term sequelae and health consequences are still significant. Perinatal hospitalization is likely to result in post-traumatic stress symptoms for the mother, which can impact the quality of interactions within the mother-child dyad, the child’s attachment representations, and will therefore lead to developmental difficulties in the child. Indeed, attachment representations influence the child’s psycho-affective, cognitive, social and language skills in the long term. The objective of this study is to identify the extent to which the presence of symptoms of post-traumatic stress disorder (PTSD) in mothers can persist over time and influence the security of attachment representations towards their three-year-old children (born very premature). We will also seek to study the link between the attachment style of mothers with PTSD and the quality of their children’s attachment representations in the context of prematurity. The aim of this research is to highlight the importance of early identification and to adapt the management of mothers affected by PTSD symptoms in order to avoid the consequences on the quality of dyadic relationships and the child’s attachment representations. This research work is part of a larger doctoral study that examines the influence of representations and the level of maternal stress on the attachment style of children born very premature. This study is conducted with several mother-child dyads from the “Amplify” study cohort and followed by the “Grandir Ensemble” network at the Nantes and Angers university hospitals. A self-administered questionnaire, the Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) (Pierrehumbert et al., 2004), was administered to the mothers in order to assess their posttraumatic reactions to the birth of their premature child. Attachment representations were explored through a semi-structured interview : ” the Attachment Multiple Model Interview “: AMMI (Miljkovitch et al., 2015) for the mothers and a guided play session: ” the Stories to Complete “: HàC (Miljkovitch & Pierrhumbert, 2008) for the 3-year-old children, born very preterm. For constraining reasons related to the health crisis and the complex administrative procedures within the CHU, the data collection has been delayed. Thus, to date, the lack of data does not allow us to pursue this research towards a quantitative analysis and the realization of statistics. Therefore, in the absence of quantitative results, this research will continue towards a qualitative analysis. As a result, one or more case studies will be presented. Currently, the case studies are in progress and cannot be finalized due to the fact that we are waiting for certain data (results of the questionnaires and the coding of the interviews conducted with the mothers). Once all the data has been collected, the case studies can be completed and we can then move on to discuss the hypotheses. Finally, the limits of the study can also be exposed, before concluding with a presentation of the perspectives that could complete this research work.
Virginie Blanchet