Difficultés psychologiques périnatales : facteurs de risque et développement d’un modèle multifactoriel en population générale. Résultats de l’Etude Longitudinale Française depuis l’Enfance (ELFE)

摘要

Mother’s psychological problems during the perinatal period are frequent and potentiallyserious for both mother and child. Depressive disorders appear to be particularly poorly identifiedand access to mental health care for women in the perinatal period remains a major public healthissue. Few studies have focused on interrelationships between risk factors for occurence ofpostpartum depressive symptoms. The main objective of our work was to study the impact ofvarious risk factors for occurrence of psychological problems during pregnancy and / orpostpartum, in a large sample of mothers in general population. The second objective was todevelop a "multifactorial model of postnatal depressive symptoms" based on the theoretical workof Milgrom, Martin & Negri (1999).Two studies were conducted using data from the ELFE cohort (Etude LongitudinaleFrançaise depuis l’Enfance - French longitudinal study from childhood). The first study (n=15143) showed that socioeconomic vulnerabilities and some characteristics of pregnancy,particularly those concerning antenatal care and obstetrical complications, were independentlyassociated with prenatal psychological distress. About 13% of women report having presentedsuch difficulties and a quarter of them had consulted a mental health specialist. Young age,intermediate educational level and being foreign-born were independently associated with a lowerprobability of access to mental health care. The second study (n=11 643) enabled the developmentof a multifactorial model of postnatal maternal depressive symptomatology. The results show adirect effect of prenatal support from the spouse and baby's self-regulatory capacities on theintensity of postnatal depressive symptoms. Indirect effects of socioeconomic status and maternalunderstanding of the baby’s crying mediated by respectively prenatal support and baby’s selfregulationcapacity are shown.Despite public health strategies to promote an organized screening and psychosocialvulnerabilities perinatal prevention strategies, lack of access to mental health care during theperinatal period remains a major public health issue. Our work confirms the hypothesis thatpostnatal depressive symptoms have multifactorial origins, evolving within a complex interactivemodel. Prenatal support from the spouse and baby-related characteristics seem to have a central