Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Trials
Published in: Trials 1/2020

Open Access 01-12-2020 | Psychotherapy | Study protocol

Efficacy of Parent-Infant-Psychotherapy with mothers with postpartum mental disorder: study protocol of the randomized controlled trial as part of the SKKIPPI project

Authors: J. Mattheß, M. Eckert, K. Richter, G. Koch, T. Reinhold, P. Vienhues, A. Berghöfer, S. Roll, T. Keil, F. Schlensog-Schuster, K. von Klitzing, C. Ludwig-Körner, L. Kuchinke

Published in: Trials | Issue 1/2020

Login to get access

Abstract

Background

After the birth of a child, many mothers and fathers experience postpartum mental disorders like depression, anxiety, obsessive-compulsive disorder, stress or other illnesses. This endangers the establishment of a secure attachment between the children and their primary caregivers. Early problems in parent-child interaction can have adverse long-term effects on the family and the child’s well-being. In order to prevent a transgenerational transmission of mental disorders, it is necessary to evaluate psychotherapeutic interventions that target psychologically burdened parents of infants or toddlers. The aim of this trial is to investigate the efficacy of Parent-Infant-Psychotherapy (PIP) for mothers with postpartum mental disorder and their infants (0–12 months).

Methods/design

In this open, randomized controlled intervention trial 180 mother-infant-dyads will be included and randomly allocated to 12 sessions of PIP or care as usual. The interventions take place either in inpatient adult psychiatric departments or in outpatient settings with home visits. The primary outcome is the change in maternal sensitivity assessed by the Sensitivity subscale of the Emotional Availability Scale (EAS) through videotaped dyadic play-interactions after 6 weeks. Secondary outcomes are maternal psychopathology, stress, parental reflective functioning, infant development and attachment after 6 weeks and 12 months. In addition, maternal attachment (AAI) and reflective functioning (AAI) will be analyzed as potential moderators, and resource usage in the German health system as well as associated costs will be evaluated.

Discussion

There is increasing demand for well-controlled studies on psychotherapeutic interventions in the postpartum period that do not only focus on particular risk groups. This randomized controlled trial (RCT) represents one of the first studies to investigate the efficacy of PIP in inpatient psychiatric departments and outpatient care centers in Germany. The results will fill knowledge gaps on the factors contributing to symptom reduction in postpartum mental disorders and improvements in mother-child relationships and help in developing preventive and therapeutic strategies for the fragmented German health care system.

Trial registration

German Register for Clinical Trials, ID: DRKS00016353.
Literature
1.
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(2):97–114.PubMedCrossRef
2.
Lyons-Ruth K. Contributions of the mother–infant relationship to dissociative, borderline, and conduct symptoms in young adulthood. Infant Ment Health J. 2008;29(3):203–18.PubMedPubMedCentralCrossRef
3.
Oates M. Perinatal psychiatric disorders: a leading cause of maternal morbidity and mortality. Br Med Bull. 2003;67:219–29.PubMedCrossRef
4.
Cox JL, Murray D, Chapman G. A controlled study of the onset, duration and prevalence of postnatal depression. Br J Psychiatry. 1993;163:27–31.PubMedCrossRef
5.
6.
Reck C, Struben K, Backenstrass M, Stefenelli U, Reinig K, Fuchs T, et al. Prevalence, onset and comorbidity of postpartum anxiety and depressive disorders. Acta Psychiatr Scand. 2008;118(6):459–68.PubMedCrossRef
7.
Kindler H. [What would a risk inventory for early intervention look like?] Wie könnte ein Risikoinventar für Frühe Hilfen aussehen? In: Meysen T, Schönecker L, Kindler H, editors. Frühe Hilfen im Kinderschutz. Weinheim, München: Juventa; 2009. p. 170–261. ISBN 978-3-7799-2260-5.
8.
9.
Ainsworth MDS, Bell SM, Stayton DJ. Infant-mother attachment and social development: socialisation as a product of reciprocal responsiveness to signals. In: Richards MPM, editor. The integration of a child into a social world. Cambridge: Cambridge University Press; 1974. p. 99–135. ISBN 052120306610.
10.
11.
Grossmann KE, Grossmann K. [Attachment and human development. John Bowbly, Mary Ainsworth and the foundation of attachment theory] Bindung und menschliche Entwicklung. John Bowbly, Mary Ainsworth und die Grundlagen der Bindungstheorie. Stuttgart: Klett-Cotta; 2003. ISBN 978-3-608-94936-0.
12.
Zwönitzer A, Ziegenhain U, Bovenschen I, Pillhofer M, Spangler G, Gerlach G, et al. [Early support and children's cognitive development: a longitudinal pilot study of psychosocial burdened mother-child dyads in early childhood] Frühe Hilfen und kindliche kognitive Entwicklung: Eine längsschnittliche Pilotuntersuchung psychosozial belasteter Mutter-Kind-Paare in der frühen Kindheit. Prax Kinderpsychol Kinderpsychiat. 2016;65(5):340–53 https://​doi.​org/​10.​13109/​prkk.​2016.​65.​5.​340.CrossRef
13.
Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, et al. Effects of perinatal mental disorders on the fetus and child. Lancet. 2014;384(9956):1800–19.PubMedCrossRef
14.
Wan MW, Green J. The impact of maternal psychopathology on child-mother attachment. Arch Womens Ment Health. 2009;12(3):123–34.PubMedCrossRef
15.
Barlow J, Bennett C, Midgley N, Larkin SK, Wei Y. Parent-infant psychotherapy: a systematic review of the evidence for improving parental and infant mental health. J Reprod Infant Psychol. 2016;34(5):464–82.CrossRef
16.
17.
Ludwig-Körner C. [Parent-Infant-Toddler-Psychotherapy] Eltern-Säuglings-Kleinkind-Psychotherapie. Göttingen: Vandenhoeck & Ruprecht; 2016. ISBN 978-3-525-40560-4.CrossRef
18.
Ludwig-Körner C. [Parent-Infant-Toddler-Psychotherapy] Eltern-Säuglings-Kleinkind-Psychotherapie. In: von Sydow K, Borst U, editors. Systemische Therapie in der Praxis. Weinheim: Beltz Verlag; 2018. ISBN 978-3-621-28527-8.
19.
Bakermans-Kranenburg MJ, Van IJzendoorn MH, Juffer F. Less is more: meta-analyses of sensitivity and attachment interventions in early childhood. Psychol Bull. 2003;129(2):195–215.PubMedCrossRef
20.
Euser S, Alink LRA, Stoltenborgh M, Bakermans-Kranenburg MJ, van Ijzendoorn MH. A gloomy picture: a meta-analysis of randomized controlled trials reveals disappointing effectiveness of programs aiming at preventing child maltreatment. BMC Public Health. 2015;15:1068.PubMedPubMedCentralCrossRef
21.
Taubner S, Wolter S, Rabung S. Effectiveness of early-intervention programs in German-speaking countries – a meta-analysis. Ment Health Prev. 2015;3(3):69–78.CrossRef
22.
Letourneau N, Tryphonopoulos P, Giesbrecht G, Dennis C-L, Bhogal S, Watson B. Narrative and meta-analytic review of intervention aiminig to improve maternal-child attachment security. Infant Ment Health J. 2015;36(4):366–87.PubMedCrossRef
23.
Ransley R, Sleed M, Baradon T, Fonagy P. “What support would you find helpful?” The relationship between treatment expectations, therapeutic engagement, and clinical outcomes in parent-infant psychotherapy. Infant Ment Health J. 2019;40(4):557–72.PubMedCrossRef
24.
Lumsden V. Does the evidence support parent-infant psychotherapy?: Commentary on … Cochrane Corner. BJPsych Adv. 2017;23(4):217–21.CrossRef
25.
Sleed M, Baradon T, Fonagy P. New beginnings for mothers and babies in prison: a cluster randomized controlled trial. Attach Hum Dev. 2013;15(4):349–67.PubMedPubMedCentralCrossRef
26.
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(3):377–404.PubMedCrossRef
27.
Murray L, Cooper PJ, Wilson A, Romaniuk H. Controlled trial of the short-and long-term effect of psychological treatment of post-partum depression: 2. Impact on the mother-child relationship and child outcome. Br J Psychiatry. 2003;182(5):420–7.PubMedCrossRef
28.
Cooper PJ, Murray L, Wilson A, Romaniuk H. Controlled trial of the short-and long-term effect of psychological treatment of post-partum depression: I. Impact on maternal mood. Br J Psychiatry. 2003;182(5):412–9.PubMedCrossRef
29.
Mattejat F, Hirt B, Wilken J, Schmidt M, Remschmidt H. Efficacy of inpatient and home treatment in psychiatrically disturbed children and adolescents. Eur Child Adolesc Psychiatry. 2001;10(1):S71.CrossRef
30.
Boege I, Corpus N, Schepker R, Kilian R, Fegert JM. Cost-effectiveness of intensive home treatment enhanced by inpatient treatment elements in child and adolescent psychiatry in Germany: a randomised trial. Eur Psychiatry. 2015;30(5):583–9.PubMedCrossRef
31.
Böge I, Schepker R, Fegert JM. [Visiting forms of treatment for mentally ill children and adolescents] Aufsuchende Behandlungsformen für psychisch kranke Kinder und Jugendliche. Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz. 2019;62(2):195–204.PubMedCrossRef
32.
Cicchetti D, Rogosch FA, Toth SL. Fostering secure attachment in infants in maltreating families through preventive interventions. Dev Psychopathol. 2006;18(3):623–49.PubMed
33.
Lieberman AF, Weston DR, Pawl JH. Preventive intervention and outcome with anxiously attached dyads. Child Dev. 1991;62(1):199–209.PubMedCrossRef
34.
Murray L, Cooper PJ, Wilson A, Romaniuk H. Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression: 2. Impact on the mother-child relationship and child outcome. Br J Psychiatry. Cambridge University Press; 2003;182(5):420–7. https://​doi.​org/​10.​1192/​bjp.​182.​5.​420.
35.
Winberg Salomonsson M, 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. 2015;36(1):12–29.CrossRef
36.
Biringen Z, Derscheid D, Vliegen N, Closson L, Easterbrooks MA. Emotional availability: Theoretical Background, empirical research using the EA Scales, and clinical applications. Dev Rev. 2014;34:114–67.CrossRef
37.
Ainsworth MDS, Blehar MC, Waters E, Wall S. Patterns of attachment: a psychological study of the strange situation. New York: Erlbaum; 1978. ISBN 089859461839.
38.
Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991;59(1):12–9.PubMedCrossRef
39.
Sheehan DV, Lecrubier Y, Harnett-Sheehan K, Janavs J, Weiller E, Bonara LI, et al. Reliability and validity of the M.I.N.I. International Neuropsychiatric Interview (M.I.N.I.): according to the SCID-P. Eur Psychiatry. 1997;12:232–41.CrossRef
40.
41.
Cox L, Holden MH, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150(6):782–6.PubMedCrossRef
42.
Wittchen HU, Boyer P. Screening for anxiety disorders: sensitivity and specificity of the Anxiety Screening Questionnaire (ASQ-15). Br J Psychiatry Suppl. 1998;173:10–7.CrossRef
43.
44.
45.
46.
47.
48.
Aschenbach TM, Rescorla LA. Manual for the ASEBA Preschool Forms & Profiles. In: University of Vermont RCfC, Youth, &TM, Rescorla LA. Manual for the ASEBA Families, editor. Burlington: VT2000. ISBN 9780176085575.
49.
Petermann F, Macha T. [Development test for children at the age of 6 month to 6 years] Entwicklungstest für Kinder im Alter von 6 Monaten bis 6 Jahren – Revision (ET 6–6-R). Frankfurt a. M: Pearson Assessment; 2013. ISBN 9783943274066.51.
50.
Letourneau N, Duffett-Leger L, Stewart M, Hegadoren K, Dennis CL, Rinaldi CM, et al. Canadian mothers' perceived support needs during postpartum depression. J Obstet Gynecol Neonatal Nurs. 2007;36(5):441–9.PubMedCrossRef
51.
Letourneau NL, Dennis CL, Benzies K, Duffett-Leger L, Stewart M, Tryphonopoulos PD, et al. Postpartum depression is a family affair: addressing the impact on mothers, fathers, and children. Issues Ment Health Nurs. 2012;33(7):445–57.PubMedCrossRef
52.
Fluckiger C, Del Re AC, Wampold BE, Horvath AO. The alliance in adult psychotherapy: a meta-analytic synthesis. Psychotherapy (Chic). 2018;55(4):316–40.CrossRef
53.
54.
Martin DJ, Garske JP, Davis MK. Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin Psychol. 2000;68(3):438–50.PubMedCrossRef
Metadata
Title
Efficacy of Parent-Infant-Psychotherapy with mothers with postpartum mental disorder: study protocol of the randomized controlled trial as part of the SKKIPPI project
Authors
J. Mattheß
M. Eckert
K. Richter
G. Koch
T. Reinhold
P. Vienhues
A. Berghöfer
S. Roll
T. Keil
F. Schlensog-Schuster
K. von Klitzing
C. Ludwig-Körner
L. Kuchinke
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Psychotherapy
Published in
Trials / Issue 1/2020
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-020-04443-7

Other articles of this Issue 1/2020

Trials 1/2020 Go to the issue

Study protocol

Efficacy of acupuncture at three nasal acupoints plus acupoint application for perennial allergic rhinitis: A multicenter, randomized controlled trial protocol

Study protocol

Primary or secondary wound healing of the pin sites after removal of the external fixator: study protocol for a prospective, randomized controlled, monocenter trial

Study protocol

A blended eHealth intervention for insomnia following acquired brain injury: study protocol for a randomized controlled trial

Update

The Melanoma Genomics Managing Your Risk Study randomised controlled trial: statistical analysis plan

Study protocol

The relationship between hyperuricemia and contrast-induced acute kidney injury undergoing primary percutaneous coronary intervention: secondary analysis protocol for the ATTEMPT RESCIND-1 study

Study protocol

Protocol for a multi-centre, definitive randomised controlled trial of the effectiveness of Individual Placement and Support for employment support among people with alcohol and drug dependence