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Costantini I, López-López JA, Caldwell D, Campbell A, Hadjipanayi V, Cantrell SJ, Thomas T, Badmann N, Paul E, James DM, Cordero M, Jewell T, Evans J, Pearson RM. Early parenting interventions to prevent internalising problems in children and adolescents: a global systematic review and network meta-analysis. BMJ MENTAL HEALTH 2023; 26:e300811. [PMID: 37907332 PMCID: PMC10619111 DOI: 10.1136/bmjment-2023-300811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/14/2023] [Indexed: 11/02/2023]
Abstract
QUESTION We compared the effectiveness of different types of parenting interventions based on an a priori taxonomy, and the impact of waitlists versus treatment as usual (TAU), in reducing child internalising problems. STUDY SELECTION AND ANALYSIS We conducted a systematic review and network meta-analysis of published and unpublished randomised controlled trials (RCTs) until 1 October 2022 that investigated parenting interventions with children younger than 4 years. EXCLUSION CRITERIA studies with children born preterm, with intellectual disabilities, or families receiving support for current abuse, neglect, and substance misuse. We assessed the certainty of evidence using the Confidence in Network Meta-Analysis framework. We used random-effects network meta-analysis to estimate standardised mean differences (SMDs) with 95% credible intervals (CrIs). FINDINGS Of 20 520 citations identified, 59 RCTs (18 349 participants) were eligible for the network meta-analysis. Parenting interventions focusing on the dyadic relationship (SMD: -0.26, 95% CrI: -0.43 to -0.08) and those with mixed focus (-0.09, -0.17 to -0.02) were more effective in reducing internalising problems than TAU at the first time point available. All interventions were more effective than waitlist, which increased the risk of internalising problems compared with TAU (0.36, 0.19 to 0.52). All effects attenuated at later follow-ups. Most studies were rated as with 'high risk' or 'some concerns' using the Risk of Bias Assessment Tool V.2. There was no strong evidence of effect modification by theoretically informed components or modifiers. CONCLUSIONS We found preliminary evidence that relationship-focused and mixed parenting interventions were effective in reducing child internalising problems, and the waitlist comparator increased internalising problems with implications for waiting times between referral and support. Considering the high risk of bias of most studies included, the findings from this meta-analysis should be interpreted with caution. PROSPERO registration number CRD42020172251.
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Affiliation(s)
- Ilaria Costantini
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
- Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
- Division of Psychiatry, University College London, London, UK
| | - José A López-López
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
- Department of Basic Psychology and Methodology, University of Murcia, Murcia, Spain
| | - Deborah Caldwell
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
- NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Amy Campbell
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | | | - Sarah J Cantrell
- Department of Paediatrics, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, South Africa
| | | | | | - Elise Paul
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Deborah M James
- Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
| | - Miguel Cordero
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
- Centro de Epidemiología y Políticas de Salud, Universidad del Desarrollo Facultad de Medicina Clínica Alemana, Las Condes, Chile
| | - Tom Jewell
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Jonathan Evans
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Rebecca M Pearson
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
- Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
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Wright B, Fearon P, Garside M, Tsappis E, Amoah E, Glaser D, Allgar V, Minnis H, Woolgar M, Churchill R, McMillan D, Fonagy P, O’Sullivan A, McHale M. Routinely used interventions to improve attachment in infants and young children: a national survey and two systematic reviews. Health Technol Assess 2023; 27:1-226. [PMID: 36722615 PMCID: PMC9900465 DOI: 10.3310/ivcn8847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Attachment refers to an infant's innate tendency to seek comfort from their caregiver. Research shows that attachment is important in promoting healthy social and emotional development. Many parenting interventions have been developed to improve attachment outcomes for children. However, numerous interventions used in routine practice have a limited evidence base, meaning that we cannot be sure if they are helpful or harmful. OBJECTIVES This research aimed to conduct a large-scale survey to identify what interventions are being used in UK services to improve child attachment; conduct a systematic review to evaluate the evidence for parenting attachment interventions; and develop recommendations for future research and practice. DESIGN AND METHODS We worked closely with our Expert Reference Group to plan a large-scale survey focused on relevant UK services. We then conducted two systematic reviews. One searched for all randomised controlled trial evidence for any attachment parenting intervention. The second searched for all research for the top 10 routinely used interventions identified from the survey. RESULTS The survey collected 625 responses covering 734 UK services. The results identified the 10 most commonly used interventions. The responses showed a limited use of validated measures and a wide variety of definitions of attachment. For the first review, seven studies were included from 2516 identified records. These were combined with results from previous reviews conducted by the team. Meta-analyses showed that, overall, parenting interventions are effective in reducing disorganised attachment (pooled odds ratio 0.54, 95% confidence interval 0.39 to 0.77) and increasing secure attachment (pooled odds ratio 1.85, 95% confidence interval 1.36 to 2.52). The second review searched the literature for the top 10 routinely used interventions identified by the survey; 61 studies were included from 1198 identified records. The results showed that many of the most commonly used interventions in UK services have a weak evidence base and those with the strongest evidence base are not as widely used. CONCLUSIONS There is a need for better links between research and practice to ensure that interventions offered to families are safe and effective. Possible reasons for the disparity include the cost and accessibility of training. There is also a need for improved understanding by professionals regarding the meaning of attachment. LIMITATIONS Although the survey had good geographical spread, most respondents were based in England. For review 2 we were unable to access a large number of papers; however, we conducted extensive reference checking to account for this. FUTURE WORK There is a need for robust research to test the efficacy of routinely used attachment interventions. Research could also explore why routinely used interventions are not consistently subject to thorough evaluation; how to embed dissemination, cost-effectiveness, fidelity and sustainability into research; and how to keep clinical practice up to date with research developments. STUDY REGISTRATION This study is registered as PROSPERO CRD42019137362. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Barry Wright
- Hull York Medical School, University of York, York, UK
| | - Pasco Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Megan Garside
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Eleni Tsappis
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Elaine Amoah
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Danya Glaser
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Victoria Allgar
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Helen Minnis
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Lebiger-Vogel J, Rickmeyer C, Leuzinger-Bohleber M, Meurs P. Fostering Emotional Availability in Mother-Child-Dyads With an Immigrant Background: A Randomized-Controlled-Trial on the Effects of the Early Prevention Program First Steps. Front Psychol 2022; 13:790244. [PMID: 35465509 PMCID: PMC9033293 DOI: 10.3389/fpsyg.2022.790244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/18/2022] [Indexed: 11/21/2022] Open
Abstract
Background In many Western countries like Germany, the social integration of children with an immigrant background has become an urgent social tasks. The probability of them living in high-risk environments and being disadvantaged regarding health and education-related variables is still relatively higher. Yet, promoting language acquisition is not the only relevant factor for their social integration, but also the support of earlier developmental processes associated with adequate early parenting in their first months of life. The Emotional Availability Scales (EAS) measure the quality of caregiver-child-interactions as an indicator of the quality of their relationship and thus of such early parenting, focusing on mutual and emotional aspects of their interaction. Method This pilot study examined in a randomized controlled trial the effects of the prevention project First Steps regarding the hypothesis that the Emotional Availability (EA) improved to a greater extent in "difficult-to-reach" immigrant mother-child dyads in a psychoanalytically oriented early intervention (A, FIRST STEPS) compared to a usual care intervention (B) offered by paraprofessionals with an immigrant background. A sample of N = 118 immigrant women in Germany from 37 different countries and their children was compared with regard to the parental EA-dimensions sensitivity, structuring, non-intrusiveness and non-hostility and the child dimensions responsiveness to and involvement of the caregiver in the pre-post RCT design. Results and Conclusion Different from what was expected, repeated ANOVAs revealed no significant pre-post group differences for the parental dimensions. For the child dimensions the effect of time of measurement was highly significant, which can be interpreted as mostly natural developmental effects. Still, on the level of simple main effects for each intervention, only in the FIRST STEPS groups child responsiveness significantly improved. When controlled for confounding variables, a significant interaction effect for maternal sensitivity in favor of the FIRST STEPS intervention was found. The systematic group differences indicate that the more extensive and professional intervention, focusing on the individual needs of the participants, is more suitable to support the quality of the mother-child-relationship amongst immigrant mother-child dyads than usual care. The results are discussed taking into account the context of the maternal migration process and potential maternal traumatization. Clinical Trial Registration [https://clinicaltrials.gov], identifier [DRKS00004632].
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Affiliation(s)
| | | | | | - Patrick Meurs
- Sigmund-Freud-Institut, Frankfurt, Germany
- University of Kassel, Kassel, Germany
- Katholieke Universiteit Leuven, Leuven, Belgium
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Georg AK, Dewett P, Taubner S. Learning from mothers who received focused parent-infant psychotherapy for the treatment of their child's regulatory disorders. Psychother Res 2022; 32:805-819. [PMID: 35021957 DOI: 10.1080/10503307.2021.2023778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Gaining a deeper understanding of how focused parent-infant psychotherapy (fPIP) works by asking mothers about their experiences. METHOD Purposeful sampling was used to select participants who before had participated in an RCT on fPIP. Nine mothers of infants with early regulatory disorders who had received fPIP were interviewed. Eight cases received full-protocol treatment, one case was a treatment drop-out. Semi-structured interviews were audio-recorded, transcribed verbatim and analyzed applying grounded theory methodology. RESULTS Seven major categories evolved: (1) engaging in therapy while maintaining autonomy, (2) relating to an emotionally responsive therapist and resolving ruptures, (3) involvement of partners in therapy facilitates multiple perspectives, (4) understanding the meaning of the child's signals and increasing acceptance of difficult behaviors, (5) feeling supported by advice that is attuned to the families' needs, (6) insight into parental contributions to the child's problems and (7) feeling strengthened as a mother and recognizing one's own needs. CONCLUSION Findings highlight which aspects of fPIP mothers find most helpful and most challenging. Aspects that compromised the change process seemed related to the specific needs of this population and therapeutic setting. The results may guide therapists and inspire future development in interventions for treating infant regulatory disorders.
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Affiliation(s)
- Anna Katharina Georg
- Centre for Psychosocial Medicine, University Hospital Heidelberg, Institute for Psychosocial Prevention, Heidelberg, Germany
| | - Priya Dewett
- Centre for Psychosocial Medicine, University Hospital Heidelberg, Institute for Psychosocial Prevention, Heidelberg, Germany
| | - Svenja Taubner
- Centre for Psychosocial Medicine, University Hospital Heidelberg, Institute for Psychosocial Prevention, Heidelberg, Germany
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Kaminski JW, Robinson LR, Hutchins HJ, Newsome KB, Barry CM. Evidence base review of couple- and family-based psychosocial interventions to promote infant and early childhood mental health, 2010-2019. JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:23-55. [PMID: 34783041 PMCID: PMC10995740 DOI: 10.1111/jmft.12570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 10/23/2021] [Indexed: 06/13/2023]
Abstract
Infant and early childhood mental health (IECMH) has been defined as the capacity of infants and young children to regulate their emotions, form secure relationships, and explore their environments. For this special issue, we conducted a review of IECMH outcomes from evaluations of couple- and family-based psychosocial interventions not explicitly designed for trauma exposure published from 2010 through 2019, following Evidence Base Update criteria and the current convention of classifying general categories of intervention approaches rather than the former practice of evaluating specific brand-name packaged programs. Full-text review of 695 articles resulted in 39 articles eligible for categorization into intervention approaches, taking into consideration the theoretical orientation of the treatment, the population served, the intervention participants, the target outcomes, the treatment theory of change, and the degree to which the intervention was standardized across participants. Four intervention approaches were identified in this review as Probably Efficacious: Behavioral Interventions to Support Parents of Toddlers, Interventions to Support Adolescent Mothers, Tiered Interventions to Provide Support Based on Assessed Risk, and Home Visiting Interventions to Provide Individualized Support to Parents. Other intervention approaches were classified as Possibly Efficacious, Experimental, or did not have sufficient evidence in this time period to classify under these criteria. Further research could explore how to ensure that all families who need support can receive it, such as by increasing the reach of effective programs and by decreasing the number of families needing additional support.
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Affiliation(s)
- Jennifer W. Kaminski
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control & Prevention, Atlanta, Georgia, USA
| | - Lara R. Robinson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control & Prevention, Atlanta, Georgia, USA
| | - Helena J. Hutchins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control & Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, Centers for Disease Control and Prevention Research Participation Programs, Oak Ridge, Tennessee, USA
| | - Kimberly B. Newsome
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control & Prevention, Atlanta, Georgia, USA
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Quinze ans après le rapport de l’Inserm. L’efficacité de la psychanalyse ré-évaluée. EVOLUTION PSYCHIATRIQUE 2021. [DOI: 10.1016/j.evopsy.2020.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Fifteen years after the INSERM report. Psychoanalysis's efficacy reevaluated. EVOLUTION PSYCHIATRIQUE 2021. [DOI: 10.1016/j.evopsy.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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8
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Georg AK, Cierpka M, Schröder-Pfeifer P, Kress S, Taubner S. The Efficacy of Brief Parent-Infant Psychotherapy for Treating Early Regulatory Disorders: A Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry 2021; 60:723-733. [PMID: 32976954 DOI: 10.1016/j.jaac.2020.06.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 05/20/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Early regulatory disorders (ERD) place considerable strain on the parent-infant relationship and are associated with high parental distress. Brief (4-session) psychodynamic-based focused parent-infant psychotherapy (fPIP) treats ERD by strengthening the quality of the parent-infant relationship. This randomized controlled trial investigates the efficacy of fPIP for treating ERD compared to standard pediatric care (treatment as usual [TAU]). METHOD Participants were 154 mothers and infants from 4 to 15 months who met criteria for persistent excessive crying, sleeping disorders, feeding disorders, or regulation disorders of sensory processing and were randomly assigned to fPIP (n = 81) or TAU (n = 73). Assessments took place at baseline and at the end of treatment after 12 weeks. Primary outcomes were the infants' regulatory symptoms and remission rate. Secondary outcomes were parents' psychological distress, depression, parenting stress, maternal self-efficacy, parental reflective functioning, and observer-rated emotional availability. RESULTS fPIP was superior to TAU in reducing infants' overall symptoms (p = .004, η2 = 0.05, CI = 0.01-0.12), night-waking disorders (p = .030, odds ratio = 3.12, CI = 1.21-9.22), and mothers' psychological distress (p = .000, η2 = 0.08, CI = 0.03-0.16) and depression (p = .002, η2 = 0.06, CI = 0.02-0.13). There was a trend suggesting that fPIP led to increased maternal self-efficacy and parental reflective functioning. CONCLUSION Results underscore the efficacy of brief fPIP in significantly reducing symptoms in infants with ERD and their mothers. Generalizability is restricted to low psychosocial risk samples with highly distressed mothers and comorbid ERD with a predominance of night-waking disorders. CLINICAL TRIAL REGISTRATION INFORMATION The Efficacy of a Brief Parent-Infant Psychotherapy for the Treatment of Early Regulatory Disorders: A Randomized Controlled Trial; https://www.drks.de/drks_web/; DRKS00005739.
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Affiliation(s)
- Anna Katharina Georg
- Heidelberg University Hospital, Germany; Ruprecht Karl University Heidelberg, Germany.
| | | | - Paul Schröder-Pfeifer
- Heidelberg University Hospital, Germany; Ruprecht Karl University Heidelberg, Germany
| | - Sandra Kress
- Institute for Psychoanalytical Child- and Adolescent Psychotherapy Heidelberg, Germany
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Lemoigne S, Bouvard M, Sutter-Dallay AL. [Early mother-infant care, definition and effectiveness: A review of the literature]. Encephale 2021; 47:470-483. [PMID: 33994160 DOI: 10.1016/j.encep.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/16/2021] [Accepted: 02/01/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Professionals agree on the need for early joint mother-baby care, but its effectiveness remains poorly studied. The aim of our work is to propose a review of the literature on this subject. METHODS We included randomized or non-randomized controlled clinical trials of interventions targeting the mother-baby dyad which can begin during pregnancy or during the first three years of life. RESULTS Forty-one studies met the inclusion criteria and focused on mother-baby psychotherapy, educational or guidance programs, care for premature infants, infant massage, and home visits. The results show an improvement of the quality of the interactions whatever the type of approach, but according to different indications or modalities. The heterogeneity of intervention methods and indications make the comparison of results almost impossible. CONCLUSION This work highlights the lack of consensus on mother-child care methods, both for their indications and their effectiveness. The isolated evaluation of interactions is an insufficient criterion for judging the effectiveness of care. Finally, whatever the theoretical models, the interventions must take into account the environment of the child.
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Affiliation(s)
- S Lemoigne
- Pôle universitaire de psychiatrie de l'enfant et de l'adolescent, centre hospitalier Charles-Perrens, Bordeaux, France.
| | - M Bouvard
- Pôle universitaire de psychiatrie de l'enfant et de l'adolescent, centre hospitalier Charles-Perrens, Bordeaux, France
| | - A-L Sutter-Dallay
- Inserm 1219, Réseau de psychiatrie perinatale, pole universitaire de psychiatrie de l'enfant et de l'adolescent, centre hospitalier Charles-Perrens, Bordeaux et Bordeaux Population Health Research Center, Bordeaux University, Bordeaux, France
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Eckert M, Richter KM, Mattheß J, Koch G, Reinhold T, Vienhues P, Berghöfer A, Roll S, Keil T, Schlensog-Schuster F, von Klitzing K, Ludwig-Körner C, Kuchinke L. [Postpartum mental health problems: healthcare service situation and effectiveness of parent-infant psychotherapy. Presentation of the SKKIPPI project funded by the German Innovationsfonds]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:1538-1547. [PMID: 33146761 DOI: 10.1007/s00103-020-03242-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 10/13/2020] [Indexed: 01/30/2023]
Abstract
After the birth of a child, parents may experience episodes of stress and psychological strain. Some infants show psychological or somatic stress in the form of early regulatory disorders. While the close connection between parental psychological stress, early regulatory disorders, and the development of the parent-child relationship is well documented, current data on effective treatment options are lacking. Previous care services mostly operate on a preventive basis; evidence-based psychotherapeutic services with a special focus on the parent-child relationship are rare.SKKIPPI is a multicenter research project (Berlin, Flensburg, Hamburg, Leipzig) and consists of several study parts with a mixed methods approach: an epidemiological cohort study, two randomized controlled intervention studies (RCTs), and a qualitative study. A population-based cohort study records the occurrence and determinants of psychosocial stress and mental health disorders, as well as the use of health and social services by parents and their children within the first two years of life, using online questionnaires and telephone interviews. The aim of the two RCTs is to evaluate the efficacy of a focused, dyadic parent-infant psychotherapy (Eltern-Säugling-Kleinkind-Psychotherapie, ESKP) compared to routine treatment in inpatient and outpatient settings. The focus of these RCTs is on the improvement of maternal sensitivity and on mother-child attachment, as well as child development and the reduction of mother-child psychopathological symptoms. The qualitative study intends to reconstruct the perspectives of parents on the assistance system and to explore reasons for underuse. The results are expected to help develop preventive as well as therapeutic strategies in the German health system.
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Affiliation(s)
- Melanie Eckert
- Psychosoziale Intervention, International Psychoanalytic University, Berlin, Deutschland
| | - Katharina M Richter
- Psychosoziale Intervention, International Psychoanalytic University, Berlin, Deutschland
- Fachklinik für Psychiatrie, Psychosomatik und Psychotherapie, DIAKO Nordfriesland, Flensburg, Deutschland
| | - Janna Mattheß
- Psychosoziale Intervention, International Psychoanalytic University, Berlin, Deutschland
| | - Gabriele Koch
- Psychosoziale Intervention, International Psychoanalytic University, Berlin, Deutschland
| | - Thomas Reinhold
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Petra Vienhues
- Fachklinik für Psychiatrie, Psychosomatik und Psychotherapie, DIAKO Nordfriesland, Flensburg, Deutschland
| | - Anne Berghöfer
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Stephanie Roll
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Thomas Keil
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
- Institut für Klinische Epidemiologie und Biometrie, Universität Würzburg, Würzburg, Deutschland
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Bad Kissingen, Deutschland
| | - Franziska Schlensog-Schuster
- Klinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Kai von Klitzing
- Klinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | | | - Lars Kuchinke
- Methodenlehre und Evaluation, International Psychoanalytic University, Stromstr 3b, 10555, Berlin, Deutschland.
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Flowers AGD, Mcgillivray JA, Galbally M, Lewis AJ. Perinatal maternal mental health and disorganised attachment: A critical systematic review. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12145] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | - Jane A. Mcgillivray
- School of Psychology, Faculty of Health, Deakin University, Melbourne, Victoria, Australia,
| | - Megan Galbally
- School of Psychology and Exercise Science, Murdoch University, Perth, Western Australia, Australia,
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia,
- Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia,
- Harry Perkins Institute of Medical Research, Fiona Stanley Hospital, Perth, Western Australia, Australia,
| | - Andrew J. Lewis
- School of Psychology and Exercise Science, Murdoch University, Perth, Western Australia, Australia,
- Harry Perkins Institute of Medical Research, Fiona Stanley Hospital, Perth, Western Australia, Australia,
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Salomonsson B, Kornaros K, Sandell R, Nissen E, Lilliengren P. Short-term psychodynamic infant-parent interventions at Child health centers: Outcomes on parental depression and infant social-emotional functioning. Infant Ment Health J 2020; 42:109-123. [PMID: 33155706 DOI: 10.1002/imhj.21893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Randomized controlled trials (RCTs) demonstrate efficacy of parent-infant psychotherapy, but its applicability and effectiveness in public health care are less known. The method followed is Naturalistic study evaluating Short-term Psychodynamic Infant-Parent Interventions at Child Health Centers (SPIPIC) in Stockholm, Sweden. One hundred distressed mothers with infants were recruited by supervised nurses. Six therapists provided 4.3 therapy sessions on average (SD = 3.3). Sessions typically included the mothers, often with the baby present, while fathers rarely attended sessions. The Edinburgh Postnatal Depression Scale (EPDS) and the Ages and Stages Questionnaire: Social-Emotional (ASQ: SE) were distributed at baseline and at 3 and 9 months later. Data from a nonclinical group were collected simultaneously to provide norm data. Multilevel growth models on the mothers' questionnaire scores showed significant decreases over time on both measures. Nine months after baseline, 50% achieved a reliable change on the EPDS and 14% on the ASQ: SE. Prepost effect-sizes (d) were 0.70 and 0.40 for EPDS and ASQ: SE, figures that are comparable to results of other controlled studies. Psychotherapists integrated with public health care seem to achieve good results when supporting distressed mothers with brief interventions in the postnatal period. SPIPIC needs to be compared with other modalities and organizational frameworks.
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Affiliation(s)
- Björn Salomonsson
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Katarina Kornaros
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Rolf Sandell
- Department of Psychology, Lund University, Lund, Sweden
| | - Eva Nissen
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Peter Lilliengren
- Department of Health Care Sciences, St. Lukas Educational Institute, ErstaBräckeSköndal University College, Stockholm, Sweden
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Huang R, Yang D, Lei B, Yan C, Tian Y, Huang X, Lei J. The short- and long-term effectiveness of mother-infant psychotherapy on postpartum depression: A systematic review and meta-analysis. J Affect Disord 2020; 260:670-679. [PMID: 31550613 DOI: 10.1016/j.jad.2019.09.056] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND It has been suggested that mother-infant psychotherapy may offer an alternative approach to treating postpartum depression, but little is known about its effectiveness. This review presents a summarized effectiveness of mother-infant psychotherapy on postpartum depression. METHODS Multiple electronic databases were searched including Pubmed, Cochrane Library, EMBase, MEDLINE, et al. Hand searching of references was also performed. Randomized controlled trials reporting on mother-infant psychotherapy targeting postpartum depression were included if they used a validated measure of prescribing appropriateness. Evidence quality was assessed using the Cochrane risk of bias tool. RESULTS A total of 13 randomized controlled trials met inclusion criteria and were included in the final analysis. In the short-term effect analysis, mother-infant psychotherapy reduced standardized mean depressive scores (-0.25, 95% CI -0.40, -0.09) and risk ratio (0.71, 95% CI 0.55, 0.91). In the long-term effect analysis, mother-infant psychotherapy did not improve maternal mood, mother-infant interaction and infant attachment. LIMITATIONS Clinical heterogeneity was observed among included studies in mother-infant psychotherapy intervention, suggesting the existence of potential moderators such as intensity, frequency, trimester of pregnancy or type of mother-infant psychotherapy. CONCLUSION Mother-infant psychotherapy appears to be effective for the treatment of maternal depression in the short-term. Future studies with better design/execution and larger sample size are needed to confirm the effect of mother-infant psychotherapy on short-term and to explore its effect on long-term depression.
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Affiliation(s)
- Ruirui Huang
- Xiang Ya Nursing School of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan Province, China; School of Nursing, Hunan University of Medicine, Huaihua, Hunan, China
| | - Dongqi Yang
- Xiang Ya Nursing School of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan Province, China
| | - Beimei Lei
- Xiang Ya Nursing School of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan Province, China
| | - Chunli Yan
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan Province, China
| | - Yumei Tian
- School of Nursing, Hunan University of Medicine, Huaihua, Hunan, China
| | - Xin Huang
- Department of Preventive Medicine, School of Medicine, Hunan Normal University, Changsha, Hunan, China
| | - Jun Lei
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan Province, China.
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McLuckie A, Landers AL, Curran JA, Cann R, Carrese DH, Nolan A, Corrigan K, Carrey NJ. A scoping review of mental health prevention and intervention initiatives for infants and preschoolers at risk for socio-emotional difficulties. Syst Rev 2019; 8:183. [PMID: 31337424 PMCID: PMC6651971 DOI: 10.1186/s13643-019-1043-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/13/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Infant mental health has emerged as a unique area of practice and research distinguished from child and youth sub-specialties by its advocacy for a relational practice framework with an emphasis on parents/caregivers being integral to assessment, treatment, and prevention initiatives. A diverse array of initiatives offered across a broad spectrum of delivery methods is available to clinicians. However, to date, a large-scale mapping of the research evidence regarding these interventions has yet to be completed to help inform clinician's decisions regarding the best approaches for their clients. To address this knowledge gap, this study aimed to report on the landscape of research pertaining to mental health interventions for infants and preschoolers (0-5 years), and their families at risk for socio-emotional difficulties and negative developmental outcomes. METHOD A scoping review methodology was used to conduct a large-scale mapping of the intervention research pertaining to infants and preschoolers (0-5) at risk for socio-emotional difficulties. We searched MEDLINE, PsycINFO, EMBASE, Web of Science, The Cochrane Library, CINAHL, LILACS, ProQuest Nursing & Allied Health Source, World Cat, and ClinicalTrials.gov , from inception to December 31, 2012. We extracted information regarding publication date, geographical location, study design, level of risk, population, key intervention mechanism, and outcome measures. RESULTS We identified 533 potential studies from 1233 title and abstracts after the first round of screening. Full text article review in the second round of screening resulted in a total of 162 included articles for the final analysis. Results indicated that over 50% of interventions evaluated were randomized controlled trials conducted in Westernized countries. Most studies could be subdivided by level of risk within a preventative public health framework including universal, selected, indicated, and direct treatment for children formally diagnosed with a mental disorder. Risk factors experienced by children and their families were heterogeneously defined and numerous outcome measures across included studies. The results of this study are limited to the last search date of 2012. CONCLUSIONS Key intervention mechanisms spanned a range of approaches including parenting groups, dyadic, in-home, cognitive-behavioral therapy, and day care-based interventions. The findings are discussed in terms of implications for broad trends and gaps in research and policy for this population.
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Affiliation(s)
| | - Ashley L Landers
- Department of Human Development, Virginia Polytechnic Institute & State University, 7054 Haycock Road, Falls Church, VA, 22043, USA.
| | | | | | - Domenica H Carrese
- Department of Human Development, Virginia Polytechnic Institute & State University, 7054 Haycock Road, Falls Church, VA, 22043, USA
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Kornaros K, Zwedberg S, Nissen E, Salomonsson B. A hermeneutic study of integrating psychotherapist competence in postnatal child health care: nurses' perspectives. BMC Nurs 2018; 17:42. [PMID: 30258284 PMCID: PMC6151071 DOI: 10.1186/s12912-018-0311-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 09/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background There is a considerable prevalence of and an increasing attention to emotional problems in families with infants. Yet, knowledge is scant of how to create efficient and accessible mental health services for this population. The study qualitatively explored public health nurses' conceptions of a clinical project, in which psychotherapists provided short-term consultations and supervisions for nurses at Child Health Centres in Stockholm. Methods In-depth interviews with fifteen nurses. The guideline of the interviews contained open-ended questions that were analysed applying a hermeneutical approach. Results Four main themes crystallized; The nurses' conceptions of their psychosocial work, Trespassing on another professional role, Interprofessional collaboration at the Child Health Centre, and The nurses' conceptions of the psychotherapist's function. In a second step, an analysis that clustered the nurses' attitudes towards handling mental health problems yielded one last theme with three "Ideal types"; nurses who expressed "I don't want to", "I want to but I cannot", and "I want to and I can" (take care of families' emotional problems at the CHC). Conclusion The nurses appreciated the easy referral and accessibility to the psychotherapists, and the possibilities of learning more about perinatal mental illness and parent-infant interactions. For a successful cooperation with the nurses, the therapist should be a team member, be transparent about his/her work, and give feedback about cases in treatment. The study also shows how the organization needs to clarify its guidelines and competence to improve psychological child health care. The paper suggests improvements for an integrated perinatal mental health care.
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Affiliation(s)
- Katarina Kornaros
- 1Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Eva Nissen
- 1Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Björn Salomonsson
- 1Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Bark C, Georg A, Taubner S. Säuglings-/Kleinkind-Eltern-Psychotherapie (SKEPT). PSYCHOTHERAPEUT 2018. [DOI: 10.1007/s00278-018-0302-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Winberg Salomonsson M, Barimani M. THERAPISTS' EXPERIENCES OF MOTHER-INFANT PSYCHOANALYTIC TREATMENT: A QUALITATIVE STUDY. Infant Ment Health J 2017; 39:55-69. [PMID: 29281749 DOI: 10.1002/imhj.21683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
As part of a larger research project in Sweden, a qualitative study investigated psychotherapists' experiences of mother-infant psychoanalysis (MIP). A randomized controlled trial compared two groups of mother-infant dyads with psychological problems. One had received Child Health Center care, and the other received MIP. Previous articles on long-term effects have found that mothers who had received MIP were less depressed throughout a posttreatment period of 3½ years, and their children showed better global functioning and psychological well-being. The present study's objectives were to describe the therapist's experiences of MIP and deepen the understanding of the MIP process. Six months after treatment began, all therapists were interviewed. Transcribed interviews with therapists from 10 (of 33 total) MIP treatments were randomly selected and analyzed in detail by thematic analysis. Therapists worked successfully with mother and infant together and found different ways of cooperation during MIP sessions. Therapists reported overall positive experiences; however, in cases where mothers needed more personal attention, it would be important to adapt the method to them.
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Rayce SB, Rasmussen IS, Klest SK, Patras J, Pontoppidan M. Effects of parenting interventions for at-risk parents with infants: a systematic review and meta-analyses. BMJ Open 2017; 7:e015707. [PMID: 29284713 PMCID: PMC5770968 DOI: 10.1136/bmjopen-2016-015707] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Infancy is a critical stage of life, and a secure relationship with caring and responsive caregivers is crucial for healthy infant development. Early parenting interventions aim to support families in which infants are at risk of developmental harm. Our objective is to systematically review the effects of parenting interventions on child development and on parent-child relationship for at-risk families with infants aged 0-12 months. DESIGN This is a systematic review and meta-analyses. We extracted publications from 10 databases in June 2013, January 2015 and June 2016, and supplemented with grey literature and hand search. We assessed risk of bias, calculated effect sizes and conducted meta-analyses. INCLUSION CRITERIA (1) Randomised controlled trials of structured psychosocial interventions offered to at-risk families with infants aged 0-12 months in Western Organisation for Economic Co-operation and Development (OECD) countries, (2) interventions with a minimum of three sessions and at least half of these delivered postnatally and (3) outcomes reported for child development or parent-child relationship. RESULTS Sixteen studies were included. Meta-analyses were conducted on seven outcomes represented in 13 studies. Parenting interventions significantly improved child behaviour (d=0.14; 95% CI 0.03 to 0.26), parent-child relationship (d=0.44; 95% CI 0.09 to 0.80) and maternal sensitivity (d=0.46; 95% CI 0.26 to 0.65) postintervention. There were no significant effects on cognitive development (d=0.13; 95% CI -0.08 to 0.41), internalising behaviour (d=0.16; 95% CI -0.03 to 0.33) or externalising behaviour (d=0.16; 95% CI -0.01 to 0.30) post-intervention. At long-term follow-up we found no significant effect on child behaviour (d=0.15; 95% CI -0.03 to 0.31). CONCLUSIONS Interventions offered to at-risk families in the first year of the child's life appear to improve child behaviour, parent-child relationship and maternal sensitivity post-intervention, but not child cognitive development and internalising or externalising behaviour. Future studies should incorporate follow-up assessments to examine long-term effects of early interventions.
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Affiliation(s)
- Signe B Rayce
- Department for Child and Family, VIVE – The Danish Centre of Applied Social Science, Copenhagen, Denmark
| | - Ida S Rasmussen
- Department for Child and Family, VIVE – The Danish Centre of Applied Social Science, Copenhagen, Denmark
| | - Sihu K Klest
- Faculty of Health Sciences, University of Tromsø, Arctic University of Norway, Tromsø, Norway
| | - Joshua Patras
- Faculty of Health Sciences, University of Tromsø, Arctic University of Norway, Tromsø, Norway
| | - Maiken Pontoppidan
- Department for Child and Family, VIVE – The Danish Centre of Applied Social Science, Copenhagen, Denmark
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Salomonsson B, Winberg Salomonsson M. Intimacy thwarted and established: Following a girl from infancy to child psychotherapy. THE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS 2017. [DOI: 10.1111/1745-8315.12682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cierpka M, Scholtes-Spang K, Kress S, Georg AK. Manualisierte psychoanalytische Fokalpsychotherapie der frühkindlichen Regulationsstörungen. ACTA ACUST UNITED AC 2017. [DOI: 10.21706/ka-25-3-231] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Winberg Salomonsson M, Barimani M. MOTHERS’ EXPERIENCES OF MOTHER-INFANT PSYCHOANALYTIC TREATMENT-A QUALITATIVE STUDY. Infant Ment Health J 2017; 38:486-498. [DOI: 10.1002/imhj.21649] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Zeanah CH, Lieberman A. DEFINING RELATIONAL PATHOLOGY IN EARLY CHILDHOOD: THE DIAGNOSTIC CLASSIFICATION OF MENTAL HEALTH AND DEVELOPMENTAL DISORDERS OF INFANCY AND EARLY CHILDHOOD DC:0-5 APPROACH. Infant Ment Health J 2016; 37:509-20. [PMID: 27574772 DOI: 10.1002/imhj.21590] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 06/02/2016] [Accepted: 06/12/2016] [Indexed: 11/06/2022]
Abstract
Infant mental health is explicitly relational in its focus, and therefore a diagnostic classification system for early childhood disorders should include attention not only to within-the-child psychopathology but also between child and caregiver psychopathology. In this article, we begin by providing a review of previous efforts to introduce this approach that date back more than 30 years. Next, we introduce changes proposed in the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood DC:0-5 (ZERO TO THREE, in press). In a major change from previous attempts, the DC:0-5 includes an Axis I "Relationship Specific Disorder of Early Childhood." This disorder intends to capture disordered behavior that is limited to one caregiver relationship rather than cross contextually. An axial characterization is continued from the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood DC:0-3R (ZERO TO THREE, 2005), but two major changes are introduced. First, the DC:0-5 proposes to simplify ratings of relationship adaptation/maladaptation, and to expand what is rated so that in addition to characterizing the child's relationship with his or her primary caregiver, there also is a characterization of the network of family relationships in which the child develops. This includes coparenting relationships and the entire network of close relationships that impinge on the young child's development and adaptation.
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Fonagy P, Sleed M, Baradon T. RANDOMIZED CONTROLLED TRIAL OF PARENT-INFANT PSYCHOTHERAPY FOR PARENTS WITH MENTAL HEALTH PROBLEMS AND YOUNG INFANTS. Infant Ment Health J 2016; 37:97-114. [PMID: 26939716 DOI: 10.1002/imhj.21553] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 10/05/2015] [Accepted: 12/14/2015] [Indexed: 11/07/2022]
Abstract
There is a dearth of good-quality research investigating the outcomes of psychoanalytic parent-infant psychotherapy (PIP). This randomized controlled trial investigated the outcomes of PIP for parents with mental health problems who also were experiencing high levels of social adversity and their young infants (<12 months). Dyads were clinically referred and randomly allocated to PIP or a control condition of standard secondary and specialist primary care treatment (n = 38 in each group). Outcomes were assessed at baseline and at 6-month and 12-month follow-ups. The primary outcome was infant development. Secondary outcomes included parent-infant interaction, maternal psychopathology, maternal representations, maternal reflective functioning, and infant attachment. There were no differential effects over time between the groups on measures of infant development, parent-infant interaction, or maternal reflective functioning. Infant attachment classifications, measured only at the 12-month follow-up, did not differ between the groups. There were favorable outcomes over time for the PIP-treated dyads relative to the control group on several measures of maternal mental health, parenting stress, and parental representations of the baby and their relationship. The findings indicate potential benefits of parent-infant psychotherapy for improving mothers' psychological well-being and their representations of their baby and the parent-infant relationship.
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Affiliation(s)
- Peter Fonagy
- University College London and Anna Freud Centre, London
| | | | - Tessa Baradon
- Anna Freud Centre, London and University of Witwatersrand, Johannesburg
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Salomonsson MW, Sorjonen K, Salomonsson B. A LONG-TERM FOLLOW-UP STUDY OF A RANDOMIZED CONTROLLED TRIAL OF MOTHER-INFANT PSYCHOANALYTIC TREATMENT: OUTCOMES ON MOTHERS AND INTERACTIONS. Infant Ment Health J 2015; 36:542-55. [DOI: 10.1002/imhj.21536] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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von Klitzing K, Döhnert M, Kroll M, Grube M. Mental Disorders in Early Childhood. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:375-86; quiz 386. [PMID: 26149380 PMCID: PMC4496484 DOI: 10.3238/arztebl.2015.0375] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 01/19/2015] [Accepted: 01/19/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND About 17% of all children suffer from a mental disorder in early childhood, defined as the period up to the age of 6 years. METHODS This review is based on publications retrieved by a selective search in PubMed and the Web of Science, as well as on the authors' clinical and scientific experience. RESULTS In children up to age 2, disorders of emotional and motor regulation are common (ca. 7%), as are feeding problems (25%), which persist in 2% of children to meet the diagnostic criteria for a feeding disorder. Reactive attachment disorder, a serious mental illness, has a prevalence of about 1%: it is more common among children in situations of increased risk, e.g., orphanages and foster homes. Preschool children can develop anxiety disorder and depressive disorder, as well as hyperactivity and behavioral disorders (the latter two mainly in boys). Parent training and parent-child psychotherapy have been found to be effective treatments. There is no evidence that psychotropic drugs are effective in early childhood. CONCLUSION The diagnostician should act cautiously when assigning psychopathological significance to symptoms arising in early childhood but should still be able to recognize mental disorders early from the way they are embedded in the child's interactive relationships with parents or significant others, and then to initiate the appropriate treatment. Psychotherapy in this age group is still in need of validation by efficacy studies and longitudinal studies of adequate quality.
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Affiliation(s)
- Kai von Klitzing
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig
| | - Mirko Döhnert
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig
| | - Michael Kroll
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig
| | - Matthias Grube
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig
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Barlow J, Bennett C, Midgley N, Larkin SK, Wei Y. Parent-infant psychotherapy for improving parental and infant mental health. Cochrane Database Syst Rev 2015; 1:CD010534. [PMID: 25569177 PMCID: PMC8685508 DOI: 10.1002/14651858.cd010534.pub2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Parent-infant psychotherapy (PIP) is a dyadic intervention that works with parent and infant together, with the aim of improving the parent-infant relationship and promoting infant attachment and optimal infant development. PIP aims to achieve this by targeting the mother's view of her infant, which may be affected by her own experiences, and linking them to her current relationship to her child, in order to improve the parent-infant relationship directly. OBJECTIVES 1. To assess the effectiveness of PIP in improving parental and infant mental health and the parent-infant relationship.2. To identify the programme components that appear to be associated with more effective outcomes and factors that modify intervention effectiveness (e.g. programme duration, programme focus). SEARCH METHODS We searched the following electronic databases on 13 January 2014: Cochrane Central Register of Controlled Trials (CENTRAL, 2014, Issue 1), Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, BIOSIS Citation Index, Science Citation Index, ERIC, and Sociological Abstracts. We also searched the metaRegister of Controlled Trials, checked reference lists, and contacted study authors and other experts. SELECTION CRITERIA Two review authors assessed study eligibility independently. We included randomised controlled trials (RCT) and quasi-randomised controlled trials (quasi-RCT) that compared a PIP programme directed at parents with infants aged 24 months or less at study entry, with a control condition (i.e. waiting-list, no treatment or treatment-as-usual), and used at least one standardised measure of parental or infant functioning. We also included studies that only used a second treatment group. DATA COLLECTION AND ANALYSIS We adhered to the standard methodological procedures of The Cochrane Collaboration. We standardised the treatment effect for each outcome in each study by dividing the mean difference (MD) in post-intervention scores between the intervention and control groups by the pooled standard deviation. We presented standardised mean differences (SMDs) and 95% confidence intervals (CI) for continuous data, and risk ratios (RR) for dichotomous data. We undertook meta-analysis using a random-effects model. MAIN RESULTS We included eight studies comprising 846 randomised participants, of which four studies involved comparisons of PIP with control groups only. Four studies involved comparisons with another treatment group (i.e. another PIP, video-interaction guidance, psychoeducation, counselling or cognitive behavioural therapy (CBT)), two of these studies included a control group in addition to an alternative treatment group. Samples included women with postpartum depression, anxious or insecure attachment, maltreated, and prison populations. We assessed potential bias (random sequence generation, allocation concealment, incomplete outcome data, selective reporting, blinding of participants and personnel, blinding of outcome assessment, and other bias). Four studies were at low risk of bias in four or more domains. Four studies were at high risk of bias for allocation concealment, and no study blinded participants or personnel to the intervention. Five studies did not provide adequate information for assessment of risk of bias in at least one domain (rated as unclear).Six studies contributed data to the PIP versus control comparisons producing 19 meta-analyses of outcomes measured at post-intervention or follow-up, or both, for the primary outcomes of parental depression (both dichotomous and continuous data); measures of parent-child interaction (i.e. maternal sensitivity, child involvement and parent engagement; infant attachment category (secure, avoidant, disorganised, resistant); attachment change (insecure to secure, stable secure, secure to insecure, stable insecure); infant behaviour and secondary outcomes (e.g. infant cognitive development). The results favoured neither PIP nor control for incidence of parental depression (RR 0.74, 95% CI 0.52 to 1.04, 3 studies, 278 participants, low quality evidence) or parent-reported levels of depression (SMD -0.22, 95% CI -0.46 to 0.02, 4 studies, 356 participants, low quality evidence). There were improvements favouring PIP in the proportion of infants securely attached at post-intervention (RR 8.93, 95% CI 1.25 to 63.70, 2 studies, 168 participants, very low quality evidence); a reduction in the number of infants with an avoidant attachment style at post-intervention (RR 0.48, 95% CI 0.24 to 0.95, 2 studies, 168 participants, low quality evidence); fewer infants with disorganised attachment at post-intervention (RR 0.32, 95% CI 0.17 to 0.58, 2 studies, 168 participants, low quality evidence); and an increase in the proportion of infants moving from insecure to secure attachment at post-intervention (RR 11.45, 95% CI 3.11 to 42.08, 2 studies, 168 participants, low quality evidence). There were no differences between PIP and control in any of the meta-analyses for the remaining primary outcomes (i.e. adverse effects), or secondary outcomes.Four studies contributed data at post-intervention or follow-up to the PIP versus alternative treatment analyses producing 15 meta-analyses measuring parent mental health (depression); parent-infant interaction (maternal sensitivity); infant attachment category (secure, avoidant, resistant, disorganised) and attachment change (insecure to secure, stable secure, secure to insecure, stable insecure); infant behaviour and infant cognitive development. None of the remaining meta-analyses of PIP versus alternative treatment for primary outcomes (i.e. adverse effects), or secondary outcomes showed differences in outcome or any adverse changes.We used the Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE) approach to rate the overall quality of the evidence. For all comparisons, we rated the evidence as low or very low quality for parental depression and secure or disorganised infant attachment. Where we downgraded the evidence, it was because there was risk of bias in the study design or execution of the trial. The included studies also involved relatively few participants and wide CI values (imprecision), and, in some cases, we detected clinical and statistical heterogeneity (inconsistency). Lower quality evidence resulted in lower confidence in the estimate of effect for those outcomes. AUTHORS' CONCLUSIONS Although the findings of the current review suggest that PIP is a promising model in terms of improving infant attachment security in high-risk families, there were no significant differences compared with no treatment or treatment-as-usual for other parent-based or relationship-based outcomes, and no evidence that PIP is more effective than other methods of working with parents and infants. Further rigorous research is needed to establish the impact of PIP on potentially important mediating factors such as parental mental health, reflective functioning, and parent-infant interaction.
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Affiliation(s)
- Jane Barlow
- Warwick Medical SchoolDivision of Mental Health and WellbeingUniversity of WarwickGibbett Hill RoadCoventryUKCV4 7LF
| | - Cathy Bennett
- Coventry UniversityCentre for Technology Enabled Health Research (CTEHR)Priory StreetCoventryUKCV1 5FB
| | - Nick Midgley
- University College LondonResearch Department of Clinical, Educational and Health PsychologyGower StreetLondonUKWC1E 6BT
| | - Soili K Larkin
- University of WarwickDivision of Health SciencesGibbets Hill RoadCoventryUKCV4 7AL
| | - Yinghui Wei
- University of PlymouthSchool of Computing and MathematicsPlymouthUK
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Salomonsson B. Psychodynamic therapies with infants and parents: a review of RCTs on mother-infant psychoanalytic treatment and other techniques. Psychodyn Psychiatry 2014; 42:617-640. [PMID: 25494583 DOI: 10.1521/pdps.2014.42.4.617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This article critically examines the existent evidence base for Psychodynamic Therapy with Infants and Parents (PTIP), specifically focusing on the available RCTs (Randomized Controlled Trials) in the literature. The author also discusses how these studies influenced the design of an RCT of a related novel treatment method, Mother-Infant Psychoanalytic treatment (MIP). He found that certain types of mothers and infants may be more likely to benefit from MIP. In addition to providing guidance on therapeutic techniques, this article also effectively outlines ways in which PTIP, as well as psychotherapy for emotional issues during pregnancy, can be better integrated into the comprehensive health care system. Local health care units comprised of a nurse group and one therapist may be a better way of handling mother-infant interactional difficulties than centralized, specialized perinatal psychiatry centers.
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Affiliation(s)
- Björn Salomonsson
- Psychoanalyst, Department of Women's and Children's Health, Karolinska Institute, Stockholm
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Salomonsson MW, Sorjonen K, Salomonsson B. A LONG-TERM FOLLOW-UP OF A RANDOMIZED CONTROLLED TRIAL OF MOTHER-INFANT PSYCHOANALYTIC TREATMENT: OUTCOMES ON THE CHILDREN. Infant Ment Health J 2014; 36:12-29. [DOI: 10.1002/imhj.21478] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Mesman J, Emmen RA. Mary Ainsworth’s legacy: a systematic review of observational instruments measuring parental sensitivity. Attach Hum Dev 2013; 15:485-506. [DOI: 10.1080/14616734.2013.820900] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Guedeney A, Guedeney N, Wendland J, Burtchen N. Treatment - mother-infant relationship psychotherapy. Best Pract Res Clin Obstet Gynaecol 2013; 28:135-45. [PMID: 24045134 DOI: 10.1016/j.bpobgyn.2013.08.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 06/28/2013] [Accepted: 08/22/2013] [Indexed: 11/28/2022]
Abstract
In this chapter, we briefly describe several modes of parent-infant-psychotherapy, an efficient way of treating parent-infant relationship disorders. We then focus on treatment for postnatally depressed mothers. Perinatal depression defines an episode of major or minor depression occurring during pregnancy or the first 12 months after birth. Attachment-based parent-infant interventions are particularly helpful in the context of maternal perinatal depression, as postpartum depression has a special link with unresolved trauma and losses in the mother's childhood. The goal of treatment is to improve the mother's mood but also to prevent or reduce the effects of postpartum depression on the child. Infants of perinatally depressed mothers are at risk for a large array of negative outcomes, including attachment insecurity (particularly disorganised attachment), social-skills deficits, cognitive difficulties, behaviour problems, and later psychopathology. The 'ghosts in the nursery' concept refers to the painful or disturbed early childhood experiences coming from the mother's past, which haunt the present mother-infant relationship. By addressing the mother's unresolved attachment conflicts (in her relationship to her own parents), it is believed that the development of a more adaptive parenting and a more secure and less disorganised attachment between the mother and her infant is facilitated. Changes in parent- infant interaction are not dependent on the port of entry (e.g. child's behaviour, parent's representation or parent-infant relationship). The perspective of attachment is key to install a therapeutic alliance with parents.
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Affiliation(s)
- Antoine Guedeney
- Hospital Bichat Claude Bernard APHP, University Denis Diderot Paris 7, Policlinique Ney, 124 blvd Ney, Paris 75018, France.
| | | | - Jaqueline Wendland
- University Paris Descartes, Psychopathology and Health Processes Laboratory, France; Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Institute of Psychology, Paris, France
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Müller JM, Achtergarde S, Frantzmann H, Steinberg K, Skorozhenina O, Beyer T, Fürniss T, Postert C. Inter-rater reliability and aspects of validity of the parent-infant relationship global assessment scale (PIR-GAS). Child Adolesc Psychiatry Ment Health 2013; 7:17. [PMID: 23705962 PMCID: PMC3679830 DOI: 10.1186/1753-2000-7-17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 05/16/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The Parent-Infant Relationship Global Assessment Scale (PIR-GAS) signifies a conceptually relevant development in the multi-axial, developmentally sensitive classification system DC:0-3R for preschool children. However, information about the reliability and validity of the PIR-GAS is rare. A review of the available empirical studies suggests that in research, PIR-GAS ratings can be based on a ten-minute videotaped interaction sequence. The qualification of raters may be very heterogeneous across studies. METHODS To test whether the use of the PIR-GAS still allows for a reliable assessment of the parent-infant relationship, our study compared a PIR-GAS ratings based on a full-information procedure across multiple settings with ratings based on a ten-minute video by two doctoral candidates of medicine. For each mother-child dyad at a family day hospital (N = 48), we obtained two video ratings and one full-information rating at admission to therapy and at discharge. This pre-post design allowed for a replication of our findings across the two measurement points. We focused on the inter-rater reliability between the video coders, as well as between the video and full-information procedure, including mean differences and correlations between the raters. Additionally, we examined aspects of the validity of video and full-information ratings based on their correlation with measures of child and maternal psychopathology. RESULTS Our results showed that a ten-minute video and full-information PIR-GAS ratings were not interchangeable. Most results at admission could be replicated by the data obtained at discharge. We concluded that a higher degree of standardization of the assessment procedure should increase the reliability of the PIR-GAS, and a more thorough theoretical foundation of the manual should increase its validity.
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Affiliation(s)
- Jörg M Müller
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Schmeddingstr, 50, Münster, 48149, Germany.
| | - Sandra Achtergarde
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Schmeddingstr. 50, Münster, 48149, Germany
| | - Hanna Frantzmann
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Schmeddingstr. 50, Münster, 48149, Germany
| | - Kathrin Steinberg
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Schmeddingstr. 50, Münster, 48149, Germany
| | - Olena Skorozhenina
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Schmeddingstr. 50, Münster, 48149, Germany
| | - Thomas Beyer
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Schmeddingstr. 50, Münster, 48149, Germany
| | - Tilman Fürniss
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Schmeddingstr. 50, Münster, 48149, Germany
| | - Christian Postert
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Schmeddingstr. 50, Münster, 48149, Germany,Department of Applied Health Sciences. Study Programme Occupational Therapy, University of Applied Sciences, Universitätsstraße 105, Bochum, D-44789, Alemanya
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Salomonsson B, Sandell R. Maternal experiences and the mother–infant dyad’s development: introducing the Interview of Mother’s Experiences (I-ME). J Reprod Infant Psychol 2012. [DOI: 10.1080/02646838.2012.673218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Salomonsson B, Sandell R. A randomized controlled trial of mother-infant psychoanalytic treatment: II. Predictive and moderating influences of qualitative patient factors. Infant Ment Health J 2011; 32:377-404. [DOI: 10.1002/imhj.20302] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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