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

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

doi:10.1186/s13063-020-04443-7

Abstract

BackgroundAfter 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/designIn 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.DiscussionThere 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 registrationGerman Register for Clinical Trials, ID: DRKS00016353.

Highlights

After the birth of a child, many mothers and fathers experience postpartum mental disorders like depression, anxiety, obsessive-compulsive disorder, stress or other illnesses
There is increasing demand for well-controlled studies on psychotherapeutic interventions in the postpartum period that do 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
Given the high prevalence of postpartum mental disorders in mothers and the adverse impact on the child, a high-quality study focusing on the efficacy of PIP in Germany is needed

Summary

Discussion

Interventions with a focus on attachment and maternal sensitivity and, in particular, parent-infant-psychotherapeutic interventions, have a good evidence base for the treatment of mental health problems in the postpartum period [15, 19] and the foundation of healthy child development. For the particular case of mental disorders, the trial is expected to reveal the efficacy of PIP in comparison with CAU in inpatient psychiatric settings and in outpatient home visits to contribute to the ongoing discussion in the German health care system. It will be expected to provide information for practitioners, and mothers and fathers on factors contributing to the efficacy of PIP interventions and to improve the future care situation for patients and their families in Germany. The data sets analyzed in the current study will be made available from the corresponding author on reasonable request in anonymized format only.

Background

Methods/design

Findings