[Actual care and funding situation with regard to mother-child units for psychic disorders associated with pregnancy in Germany]

[Postpartum depression-who cares? Approaches to care via midwifery, gynaecology, paediatrics and general practice]

BACKGROUND

Postpartum depression (PPD) is one of the most common mental illnesses in the postpartum period. If left untreated, it can have serious consequences for the mother-child relationship and the development of the child. In order to prevent possible negative effects, early diagnosis of affected mothers and professional care are essential.

AIM OF THE STUDY

This article explores the sense of responsibility of the four primary care providers in the postpartum period-midwives, gynaecologists, general practitioners and paediatricians-and examines how they deal with the disease as well as the barriers and possibilities for optimisation in care.

MATERIALS AND METHODS

The primary care providers of postpartum women in Germany were interviewed in four independent studies. Quantitative questionnaires were used to interview midwives, gynaecologists and general practitioners, and a qualitative telephone survey was conducted with representatives of the German Association of Paediatricians and Adolescents (BVKJ). A systematic comparative analysis was carried out.

RESULTS AND DISCUSSION

Midwives and gynaecologists showed a significantly higher sense of responsibility for the recognition and treatment of PPD than general practitioners and paediatricians. Closer interdisciplinary cooperation and thus a wider range of referral and therapy options were named by all four professional groups as a central prerequisite for improving the care situation in Germany. A uniform regulation of financial remuneration is also an important aspect for all providers.

Unterstützung für Kinder und Jugendliche mit psychisch erkrankten Eltern im „Children of mentally ill parents –network“

Kinder psychisch kranker Eltern sind als Risikogruppe für die Entwicklung eigener Auffälligkeiten bekannt. Gleichwohl weisen viele Unterstützungsangebote einen befristeten Projektcharakter auf, und es ist noch keine familienorientierte Regelversorgung für Kinder und Jugendliche mit psychisch erkrankten Eltern in Deutschland etabliert. Am Beispiel des Verbunds „Children of mentally ill parents – network“ (CHIMPS-NET) wird dargestellt, wie sich neue Versorgungsformen mit den Möglichkeiten des Innovationsfonds des Gemeinsamen Bundesausschusses (GB-A) in die Versorgung implementieren lassen. Das systematische Implementierungsmodell des Verbunds, basierend auf Arbeiten aus Australien und Norwegen, wird vorgestellt. Nach der Implementierung und bei erfolgreicher Evaluation ist eine Übernahme der bedarfsorientierten, familienorientierten Versorgungsformen des Verbunds in die regelhafte Versorgung geplant.

[Parent-Child Treatment in Child and Adolescent Psychiatry: Models and Clinical Implementation Using the Example of a Modular Parent-Child Ward]

The joint treatment of mentally ill children and their parents represents a special treatment concept in child and adolescent psychiatry. A study conducted by the Working Group (BAG) "Early Childhood" shows the current situation of care and possible models of child and adolescent psychiatric parent-child treatment in Germany. Using the parent-child ward of the Child and Adolescent Psychiatry Department in Magdeburg as an example, the combined treatment of mentally ill children and their parents is presented. The treatment approach consists of a three-week diagnostic phase, after which families are discharged again to their home environment followed by a five-week therapy block, for which the families have to be readmitted to the ward. With a focus on the parent-child relationship, the treatment concept - in contrast to regular child psychiatric treatments - is dynamically adapted to the quality of the parent-child interaction and not primarily related to the disorder of the children. First studies indicate the effectiveness of the special treatment setting and illustrate the efficiency of a joint treatment of parents and child, which, however, is associated with increased economic costs. Based on these results, the chances and limitations of parent-child wards are discussed and conclusions for parent-child treatment are drawn.

[Comments on Relationships with Artificial Emotional Intelligence - from "Here and Now" to "There and Then"]

The structure of relationships in the past, the present and the future is shaped by the idea of humanism. Based on this construct, the article illuminates various aspects and configurations of humanism on a timeline from "here and now" to "there and then". The current reality of care goes hand in hand with an emotional alienation of relationships. Advances in technology and reductionist neurobiological ideas can make it difficult to look at a person's mental illness as a whole. Any (communication) technology that has been developed in the past or will be developed in the future will sooner or later find its way into psychiatry and psychotherapy and change relationships. Transhumanism runs the risk that people will become alienated from each other and their species. Neural networks are algorithms that work regardless of the hardware used, be it based on organic carbon units such as humans or non-organic silicon units such as the computer/cyborg. There will be different ways to achieve super intelligence. Intelligence is a "must" and consciousness is a "can". If there is a change from a homocentric to a data-centered world view and the power of humans is transferred to the algorithms, humans could lose their economic value and the humanistic goals of health and happiness would be lost.

[The Role of Partnership Status and Relationship Satisfaction in Inpatient Mother-Child Treatment in Postpartum Mental Disorders]

The Role of Partnership Status and Relationship Satisfaction in Inpatient Mother-Child Treatment in Postpartum Mental Disorders The study examines the partnership status and satisfaction in connection with symptoms of postpartum mental disorders, mother-child attachment and outcome of inpatient mother-child treatment. Two sub-studies were carried out. In the first study, N = 126 mothers with postpartum mental disorders who went to a preliminary consultation for inpatient mother-child treatment stated their symptom burden (SCL-90), mother-child attachment (PBQ) and satisfaction with their partner relationship (PFB-K). Mothers with stressed relationships showed the highest level of symptom burden and impaired attachment. Mothers without a partner reported the least amount of impairment in mother-child attachment. In the second study, N = 41 mothers were examined over the course of inpatient treatment (within-subject design with a waiting-list). The initial relationship satisfaction was not predictive of symptom reduction or improvement in mother-child attachment. An increase in satisfaction during the treatment was though correlated with an improvement in mother-child attachment.

Occurrence and determinants of parental psychosocial stress and mental health disorders in parents and their children in early childhood: rationale, objectives, and design of the population-based SKKIPPI cohort study

PURPOSE

The postnatal period is a vulnerable time for parents and children but epidemiological and health care utilisation data for Germany on parental mental health during early childhood is scarce. This protocol describes the rationale, aim and study design of a population-based cohort study to assess the occurrence and determinants of psychosocial stress and mental health disorders, as well as the use and cost of health care and social services in early childhood.

METHODS

As part of the collaborative SKKIPPI project, we will contact a random sample of 30,000 infants listed in the residents' registration offices of three German towns and we expect to include 6,000 mother-child pairs. Both parents are invited to fill out an online screening questionnaire. Mothers with indications of psychosocial stress will be interviewed to assess mental health disorders, regulatory problems of their children, as well as health care and social services utilisation, with a follow-up assessment after 6 months.

RESULTS

After description of sociodemographic and health data, we will analyse occurrences, patterns, and potential determinants (maternal age, social status, household factors, migration status etc.) of psychosocial stress and mental health disorders in the mothers and their children in early childhood.

CONCLUSIONS

Our study will identify potential risk and protective factors for postnatal mental health and health care utilization of psychosocially burdened families. This will help to improve prevention and treatment strategies to strengthen the parent-child relationship, to reduce persisting vulnerability of children, and to improve health care and social services.

TRIAL REGISTRATION

The study has been registered in the German Clinical Trial Registry on February 8th 2019 (DRKS-ID: DRKS00016653).

[Postpartum mental health problems: healthcare service situation and effectiveness of parent-infant psychotherapy. Presentation of the SKKIPPI project funded by the German Innovationsfonds]

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.

Postpartum Depressive Disorder - Psychosomatic Aspects

Postpartum depression (PPD) is the most common mental illness in mothers following the birth of a child. Since the symptoms of PPD are similar to the normal stress of healthy women following childbirth, it is often difficult for the attending gynaecologist or midwife to diagnose this illness in a timely manner and thus initiate adequate treatment and comprehensive support for the patient. Even if there are options for a screening using evaluated questionnaires and subsequent psychotherapy and/or drug therapy in the treatment of PPD which has proven effective, it is seen that, in most treatment approaches, little consideration is given to the affect-controlled interaction and the bonding behaviour between mother and child. This article presents diagnostic measures and current therapeutic approaches as well as their integration in practice in order to achieve awareness of this topic in everyday clinical practice and show the pathways of appropriate treatment. Specific multiprofessional treatment approaches which centre on the mother-child relationship demonstrate successes with regard to depression in the mothers and also on the development of a secure mother-child bond and are thus a protective factor in the development of the affected children. The now well-known effects of PPD on the fathers as well as the negative impacts of paternal depression on child development make it clear that the treatment should not focus solely on maternal depression, but also always on the family bond between the mother, child and father in the treatment.

[Treatment Satisfaction of Mothers with Postpartum Depression Concerning Circle of Security Intervention]

Treatment Satisfaction of Mothers with Postpartum Depression Concerning Circle of Security Intervention Treatment satisfaction of mothers with postpartum depression who undergo mother-infant treatment is rarely examined, albeit seen as one aspect of treatment success. This study deals with maternal treatment satisfaction concerning the Circle of Security (COS) group intervention, compared to standard-mother-infant treatment (TAU), within a RCT trial. Treatment satisfaction was captured by the Fragebogen zur Beurteilung der Behandlung (FBB-E) of 52 mothers assigned to COS or TAU at children's age between 16 to 18 months. Process quality as well as outcome quality was assessed. Process quality included the evaluation of treatment procedure, information supply, evidence and justification of the measures undertaken, therapist's competence and coordination ability as well as the quality of relationship between therapist and mother. Results showed overall good to high and marginally different treatment satisfaction between both groups. COS-mothers declared themselves significantly more satisfied with the child (FBB-E-subscale: Success concerning the infant) than TAU-mothers. Both groups showed higher treatment satisfaction with the process quality than with the outcome quality of intervention. Overall, COS seem to meaningfully foster the acknowledgment of the child. In mother-infant treatment, particular attention is warranted to aspects of the process quality that attain the mother's treatment satisfaction.

[Practical implementation of an integrated care model in mother-child treatment]

This article summarizes the specific treatment options in the combined mother-child treatment for women with postpartum psychiatric disorders. The incidence of postpartum mental illness is high, especially for postpartum depression that probably occurs in10-15 % of cases. Mental disorders not only have a negative impact on the mental health of the women affected, such as chronification and suicidal tendencies but can also adversely affect the mother-child relationship as well as the emotional and cognitive development of the child. For these reasons it is important, also under the aspects of a primary prevention with respect to the children of mentally ill mothers, to provide a needs-oriented, timely and disorder-specific interactional therapy, which also considers the long-term aspects of treatment. At the Celenus Klinik Carolabad in Chemnitz an integrated treatment model, the "Carola PLUS", could be established that caters for the particularly high demands of combined care and treatment for both mother and child.