[Interactional therapy program for mothers with postpartum mental disorders. First results of a pilot project]

Einbezug der Väter in die stationäre Mutter-Kind-Therapie: „Mit Papa geht es besser“

Hintergrund

Obwohl Forschungsbefunde auf einen großen väterlichen Einfluss hinweisen, gibt es bislang kaum Interventionsprogramme und wissenschaftliche Studien, die den systematischen Einbezug von Vätern in die stationäre Mutter-Kind-Behandlung zum Gegenstand haben.

Ziel der Arbeit

Die Studie untersucht, wie sich der Einbezug von Vätern auf das Outcome stationärer Mutter-Kind-Behandlungen bei postpartalen psychischen Störungen auswirkt. In dieser Pilotstudie wird das Programm „Mit Papa geht es besser“ vorgestellt.

Methodik

Fünfzehn Partner/Kindsväter von behandelten Mutter-Kind-Dyaden durchliefen ein strukturiertes Begleitprogramm parallel zur Mutter-Kind-Behandlung („Mit Papa geht es besser“). Die Mütter in Behandlung wurden in einem Prä-post-Design zu ihrer Symptomatik (Symptom-Checklist 90, SCL-90), Mutter-Kind-Bindung (Parental Bonding Questionnaire, PBQ) und Partnerschaftszufriedenheit (Kurzversion des Partnerschaftsfragebogens, PFB-K) befragt. Diese Gruppe wurden mit einer historischen Kontrollgruppe von 30 behandelten Müttern verglichen, die die Behandlung wie bisher („treatment as usual“, TAU) durchliefen. Die Gruppen wurden post hoc mithilfe einer „Inverse-probability-of-treatment-weighting“(IPTW)-Schätzung von Propensity Scores (PS) balanciert.

Ergebnisse

Mütter in allen Versuchsbedingungen profitierten von der stationären Behandlung. Mütter in der Interventionsgruppe wiesen im Hinblick auf die Zielvariablen ein tendenziell verbessertes Outcome auf, insbesondere für die Veränderung der Partnerschaftszufriedenheit, die Unterschiede erreichten aber keine statistische Signifikanz.

Schlussfolgerung

Die Befunde weisen darauf hin, dass Mütter in stationärer Mutter-Kind-Behandlung vom Einbezug der Väter profitieren könnten. Die Intervention soll nun im Rahmen eines randomisierten kontrollierten Studiendesigns an einer größeren Stichprobe auf ihre Wirksamkeit überprüft werden.

[Assisting the Forgotten Ones - Interventions for Children of Parents with Psychological Disorders]

Assisting the Forgotten Ones - Interventions for Children of Parents with Psychological Disorders Mental diseases are associated with high levels of distress in various areas of life for those, who are affected. Taking a closer look at the social circumstances, not exclusively the people themselves but also their family members are affected, especially children. In adult treatment these children are often neglected, even if they have a higher risk of suffering a mental illness themselves. A huge amount of this risk is related to the special family environment children are often exposed to right after birth. We already find prevention programs helping these children and their parents to protect their mental health. These programs largely differ regarding parental psychopathology, setting or intensity. This article gives an overview of the special circumstances these children may be confronted with and hence derivates possible starting points to support affected families. A few existing programs will be described in detail. Empirical findings presented in the article give hope for the effectiveness of already existing programs and besides highlight the need for further research and changes in the care system.

The NIMHANS (National Institute of Mental Health and Neuro Sciences) Maternal Behaviour Scale (NIMBUS): Development and validation of a scale for assessment of maternal behaviour among mothers with postpartum severe mental illness in low resource settings

PURPOSE

A mother's behaviour towards her infant is an important aspect of assessment in postpartum severe mental illness (SMI). The existing tools for this purpose need formal training, require time and do not include certain aspects of maternal behaviour. Hence, there is a need for a tool that may overcome some of the above problems and be simple to use, especially in limited resource low and middle income countries (LAMIC) settings. The NIMHANS Maternal Behaviour Scale was constructed for this purpose.

METHODS

The 16 items were compiled based on 100 detailed assessments of mother-infant dyads. The NIMBUS is rated based on observations and information from caregivers, health assistants and nurses. The scale which has six domains was administered to 51 mother-infant dyads admitted to an MBU to establish construct validity and internal consistency. Inter-rater, and test retest reliability were also established. External validity was established using the Bethlem Mother infant Interaction Scale (BMIS) and the Postpartum Bonding Questionnaire (PBQ).

RESULTS

The scale was found to have adequate inter-rater and test retest reliability (Cohen's kappa > 0.81). The Cronbach's alpha for internal consistency was 0.94 and it showed adequate external validity when used with the BMIS (R = 0.947, p = 0.000) and PBQ.

CONCLUSION

The NIMBUS appears to be a useful tool to assess maternal behaviour among mothers with SMI in the postpartum especially in LAMIC situations where observations are often made by family members and health assistants rather than trained perinatal nurses.

Mothers with acute and chronic postpartum psychoses and impact on the mother-infant interaction

BACKGROUND

Maternal postpartum psychoses pose a serious risk to the mother-infant interaction. It is unclear how different subtypes of postpartum psychosis, including acute and chronic, might differentially affect the mother-infant interaction.

METHOD

A systematic search of electronic journal databases was performed.

RESULTS

This systematic review yielded 17 studies with adequate overall study quality. They focused on child custody and involvement of social services as indirect indicators of the mother-infant interaction, observed mother-infant interactions as direct indicators, or potential transitional mechanisms, including memory processing, mind-mindedness, and affect recognition, that may partially explain the effects of psychotic disorders. An acute onset of psychosis during the postpartum period (de novo or relapse) was typically related to better mother-infant interactions. Mothers with schizophrenia have the highest risk of child displacement, and interventions by social services were more likely. However, mothers with postpartum schizophrenia did not exhibit more harm to the child or self-harm than mothers with postpartum depression. Heterogeneity of methodology, case definitions, and assessments characterized the studies; hence, they were not pooled.

CONCLUSIONS

In addition to evaluating social risk factors in patients with acute onset and chronic psychoses during the postpartum period, negative preconceptions about motherhood and schizophrenia have to be carefully examined. Clinical research on postpartum psychoses should consider the onset criteria, prevalence of self-harm or harm to the child, significance of specific (e.g., religious) delusions and expressed hostility toward the child. More studies on the impact of first-onset (de novo) postpartum psychoses on the mother-infant interaction are needed.

[Peripartum depression and grief after pregnancy loss: special problem areas in obstetrics]

There is evidence that postpartum depression increases the risk of premature birth and developmental disabilities of the child. Risk factors include a history of depression, prenatal anxiety, lack of social support, intimate partner violence, low socioeconomic status and lack of a relationship. For women in high risk groups antenatal interventions could reveal positive effects to prevent postpartum depression. In the peripartum period routine screening is recommended to detect women at risk of developing depression. Furthermore, prenatal losses during pregnancy, specifically occurring during the first weeks of pregnancy may result in complicated grief disorders. Only very few controlled and randomized intervention studies for the treatment after prenatal loss have been conducted; however, aimed at specific high-risk groups these bereavement interventions demonstrated a high treatment efficacy.

Recognizing and treating peripartum depression

BACKGROUND

In this article, we review current data on the prevalence of, risk factors for, and treatment of peripartum depression.

METHOD

Pertinent publications were retrieved by searches in Medline and the Cochrane Library using the key words "peri/pre/post", "partum/partal/natal", "maternal/motherhood/pregnancy", and "depression/affective disorder".

RESULTS

Depression is the most common peripartal disease: The prevalence of depressive disorders is 18.4% during pregnancy and 19.2% in the puerperium. Prepartum depression is associated with preterm birth, low birth weight, and an abnormal fetal heart rate. In the long run, children of depressed mothers have been found to have impaired cognitive and emotional abilities. Risk factors for peripartal depression include prior depression, poor social support, poor quality of intimate relationship, and negative live events. Peripartum depression can be treated effectively with psychotherapy or drug therapy. Current data support the use of antidepressants during pregnancy and breastfeeding. In many places, pregnancy counseling centers offer low-threshold psychosocial assistance. Nonetheless, no more than 20% of the affected women are identified, even though rapid screening would be possible with instruments such as the Edinburgh Postnatal Depression Scale (EPDS) and the two Whooley questions.

CONCLUSION

Peripartum depression is both common and treatable. Screening for depression should become a routine part of both prepartum care by gynecologists and postpartum care by midwives. This will only be possible, however, with expanded availability of ambulatory and inpatient psychotherapy and psychiatric care for the affected women and their children.