Online Intervention Targeting Postnatal Depression and Anxiety in Chilean First-Time Mothers: Feasibility Trial

OBJECTIVE

Internet-based interventions may positively impact maternal symptoms of postnatal depression and anxiety. This study assessed the feasibility, acceptability, perceived usefulness, and preliminary effectiveness of an m-Health version of "What Were We Thinking?" (m-WWWT).

METHODS

A mixed-methods with a 2-arm randomized parallel design was used. From a total of 477 women, 157 met the inclusion criteria. 128 first-time mothers of full-term infants, aged 4-10 weeks, who received health care at primary public health centers in Chile, were randomly assigned to the experimental (EG, n = 65) or control (CG, n = 63) groups; data of 104 of them (53 and 51, respectively) was analyzed. We used percentages and rates to measure feasibility outcomes and mixed analysis of variance (ANOVA) and latent class analyses (LCA) to assess preliminary effectiveness. Participants completed questionnaires on mental health, social support, and maternal self-efficacy upon recruitment and 3 months after completing the intervention. For the qualitative component, 12 women from the EG were interviewed.

RESULTS

Quantitative results show good feasibility outcomes, such as high recruitment (82%), low attrition (EG = 12% and CG = 17%), and high follow-up (EG = 97% and CG = 91%) rates. Qualitative results indicate high acceptability and perceived usefulness of m-WWWT. Mixed ANOVA did not show significant differences between the groups (all p >.05). However, multinomial regression analysis in LCA showed that women with low baseline symptoms of depression and anxiety benefit from the intervention (B = 0.43, 95% confidence interval 1.09-2.16).

CONCLUSION

m-WWWT is feasible to be implemented in Chile; future studies are needed to assess the intervention's effectiveness.

Online intervention to prevent postnatal depression and anxiety in Chilean new mothers: Protocol for a feasibility trial

Symptoms of postpartum depression and anxiety in new mothers are prevalent and negatively impact maternal emotional wellbeing and infant development. Barriers to accessing treatment prevent women from receiving mental health care, a situation that has worsened due to the COVID-19 pandemic. mHealth interventions hold the potential to support women during the transition to parenthood despite these barriers and to promote the use of preventive interventions. This study uses a mixed methods design to assess the feasibility and preliminary effectiveness of a psychoeducational, guided mHealth intervention to prevent postpartum mental health difficulties in women who receive care in primary health centers in Chile. The study will contribute to evidence-based research on the effectiveness of mHealth interventions for new mothers from an understudied cultural background. The findings will also enable the development of a larger randomized controlled trial to assess the effectiveness of the intervention, which, if effective, could significantly contribute to the emotional wellbeing of women and their families.

The therapeutic relationship and change processes in child psychotherapy: a qualitative, longitudinal study of the views of children, parents and therapists

Through the perspectives of children, parents and therapists, this study explored the therapeutic relationship as a change facilitator in different moments of psychotherapy. The children, parents, and therapists (N=15) who formed part of five therapeutic treatments were studied using a qualitative, longitudinal design. Thirty semi-structured interviews were done; half at the beginning and half after four months of psychotherapy. Children’s drawings were incorporated, and data were analysed through grounded theory methods and qualitative analysis guidelines for drawings. Participants identified several aspects of the therapeutic relationship as change facilitators. From the first encounters, the therapists’ close and adaptable attitude promoted an improved motivation for psychotherapy and enhanced engagement among children and parents. Later in the process, a positive, child-centred and affective therapeutic relationship fostered the child’s trust with the therapist as well as a positive relational experience, promoting associated changes in children and the development of socio-affective tools. Parents and therapists saw their own relationship as a change facilitator, as well as a broader understanding in parents of their children and an improved relationship with them. Parent’s and child’s changes helped each other. Specific and common aspects between participants’ perspectives provided a richer understanding of the studied phenomena. This study supports the view that a positive therapeutic relationship facilitates early changes in the motivation of children and parents, and provides them with a healing, relational experience as it develops. A positive parent-therapist relationship is also key for changes to further progress.

The therapeutic relationship in child psychotherapy: integrating the perspectives of children, parents and therapists

This study addresses the therapeutic relationship in child psychotherapy, through an exploration of the experience of the main actors engaged in child psychotherapy.

To describe and analyse the therapeutic relationship integrating the views of children, parents and therapists.

This study employs a qualitative methodology, assuming a discovery-oriented approach which draws from grounded theory. Twelve psychotherapy triads participated, composed of children aged 6-10, their parents and psychotherapists. Semi-structured follow-up interviews were conducted (N=36), including a drawing in the case of the children.

A positive therapeutic relationship with children and parents was viewed as a gradually constructed process, based on a positive emotional encounter between participants. It was facilitated primarily by the therapist's commitment and playful stance, the child and therapist mutual involvement, and the parent's collaboration. These aspects entailed a trustful, validating and caring relationship, that shaped children and parents' motivations towards therapy and facilitated change.

From a multiple-perspective approach, therapy was conceived as a relational experience. The development of positive relationships required different and evolving dispositions from therapy main actors. Therapists' genuine feelings and engagement in therapeutic activity seem central, underlining the importance of addressing relational aspects in child therapy research and training.

[Medium-term effect of an intervention program for adolescent mothers]

Objetivo

Analizar los resultados a mediano plazo de un estudio experimental que evaluó el efecto de visitas domiciliarias realizadas por paraprofesionales en madres adolescentes durante el embarazo y el primer año de vida del hijo/a, exitoso en el corto plazo.

Diseño

De tipo cuantitativo, con seguimiento de cohortes.

Emplazamiento

Dos centros de salud pertenecientes al nivel socioeconómico bajo, en Santiago de Chile.

Participantes

De la muestra inicial de 104 adolescentes, 69 mujeres fueron contactadas a los 48 meses de edad de los hijos/as. La pérdida fue de un 33,6%.

Intervenciones

Las variables de resultado evaluadas fueron: salud mental materna, inserción familiar, social y laboral de la madre, interacción madre-hijo/a y desarrollo del lenguaje y socioemocional en los hijos/as. La variable independiente correspondió a la intervención visita domiciliaria.

Mediciones principales

Las evaluaciones se realizaron a los 12-15 y 48 meses de edad de los hijos/as, en las madres y niños/as de los grupos experimental y control, a través de distintos cuestionarios estandarizados.

Resultados

Los efectos positivos sobre la salud mental materna y el desarrollo del lenguaje del niño/a encontrados a los 12-15 meses no se mantienen a los 48 meses. Solamente hubo efectos estables en la continuación de la relación de pareja.

Conclusiones

Sobre la base de estos resultados se discute la importancia de mantener las intervenciones en el tiempo, para contrarrestar el desvanecimiento de los efectos iniciales.

Reflecting profiles that produce a given phase distribution of light

We give a method to construct, for a given surface and a point source, a one-parametric family of reflecting profiles, each of them with the characteristic property of producing a predetermined phase distribution of light that from the point source is incident on that surface after reflection at the profile. The profiles are constructed as the envelopes of specific families of ellipsoids of revolution. We also study the singularities of these profiles.