Mother-Infant Psychoanalysis Project of Stockholm

Not Applicable

Completed

Interventions: Other: Treatment as Usual at Child Health Centre
Other: Mother-Infant Psychoanalytic treatment (MIP)

Brief Summary: Mother-infant relationship disturbances broadly comprise three areas; maternal distress, infant functional problems, and relationship difficulties. Given the high frequency of such disturbances and the relative paucity of randomized treatment studies, substantial systematic investigation is needed. This project is a randomized controlled study comparing mother-infant psychoanalytic treatment with treatment as usual in cases where mothers and/or health visitors demanded expert help.

Detailed Description: DESIGN

Eighty dyads with infants below 1½ years of age were interviewed and then randomly assigned to MIP or TAU. An end-point interview followed after ½ year, evaluating the intervention effects.

The MIP treatments were performed by IPA psychoanalysts at the Infant Reception Service of the Swedish Psychoanalytic Society. TAU implied contact with a nurse at a Child Health Centre, as part of regular Swedish health care of infants and mothers. Additional treatments within the TAU framework suggested at the initiative by the health visitor or the mother were registered at the end-point interview.

INSTRUMENTS

Mother-report questionnaires; the Ages and Stages Questionnaire:Social-Emotional (ASQ:SE; Squires et al., 2002), the Edinburgh Postnatal Depression Scale (EPDS; Cox et al., 1987), the General Severity Index of the Symptom Check List-90 (Derogatis, 1994)and the Swedish Parental Questionnaire (SPSQ; Östberg et al., 1997).

Time frame: All four instruments were measured at intake interviews and six months later.

Independently rated video-taped mother-infant interactions: the Emotional Availability Scale (EAS; Biringen, 1998).

Relationship assessment: the Parent-Infant Relationship Global Assessment Scale (PIR-GAS; ZERO-TO-THREE, 2005).

Recruitment & Eligibility

Inclusion Criteria

The mother expressed significant concerns about one or more of the following domains: herself as a mother, her infant's well-being, or the mother-baby relationship (this was operationalized as a score < 80 ("perturbed relation") on the PIR-GAS or, alternatively, > 2.5 on the SPSQ).
Infant of any gender, age below 18 months.
Duration of worries exceeding two weeks.
Domicile in Stockholm.
Reasonable mastery of Swedish.

Exclusion Criteria

Maternal psychosis.
Substance dependence according to DSM-IV, to an extent precluding collaboration.

No mothers met these criteria.

Arm && Interventions

Group	Intervention	Description
TAU at Child Health Centres	Treatment as Usual at Child Health Centre	Regular nurse visits at Child Health Centres according to Swedish infant health care.
Mother-Infant Psychoanalytic treatment;MIP	Mother-Infant Psychoanalytic treatment (MIP)	MIP intervention

Primary Outcome Measures

Name	Time	Method
The Parent-Infant Relationship Global Assessment Scale (PIR-GAS; ZERO-TO-THREE, 2005)	Two interviews, six months apart	An observer-rated scale ranging from 0 to 99, from "documented maltreatment" to "well-adapted". Higher scores indicate a better outcome. Inter-rater reliability was measured with an external experienced infant psychotherapist.
the Edinburgh Postnatal Depression Scale (EPDS; Cox et al., 1987)	Two interviews, six months apart	The EPDS (Swedish translation, Lundh \& Gylland, 1990), is a self-report questionnaire containing 10 items each with a 3-point scale. Range: 0 - 30. Higher scores indicate a worse outcome. It is widely used at Swedish CHCs and has been validated on samples in Sweden.
the Ages and Stages Questionnaire: Social-Emotional, (ASQ:SE; Squires et al., 2002	Two interviews, six months apart	Items are mostly rated on a 4-step scale, with 0,5,10 or 15 points per item, where 0 is most optimal. There are three versions for the age ranges of this study: 3-8, 9-14, and 15-20 months. To enable comparison across age groups we report mean scores across all items. Higher scores indicate a worse outcome. Each version was independently translated into Swedish, retranslated and approved by the constructor.

Secondary Outcome Measures

Name	Time	Method
the Swedish Parental Stress Questionnaire, (SPSQ; Östberg et al., 1997)	Two interviews six months apart	A Swedish-language version of the Parenting Stress Index (PSI; Abidin, 1990) with 35 items, each ranging 1-5 points. Higher scores indicate a worse outcome.
General Severity Index of the Symptom Check List-90	two assessments at six month-interval	The Symptom Check List-90 (SCL-90; Derogatis, 1994), with a Swedish language version (Fridell, Cesarec, Johansson, \& Malling Thorsen, 2002), is a self-report questionnaire containing 90 items rated from 0 to 4. Higher scores indicate a worse outcome. The General Severity Index (GSI, or the mean across all items) was used to measure maternal general psychological distress.
the Emotional Availability Scales, Subscale on Sensitivity (EAS; Biringen, 1998)	Two interviews, six months apart	The EAS assessed video-taped mother-baby interactions of 10' duration on three maternal dimensions (Sensitivity, Structuring, Non-intrusiveness) and two infant dimensions (Responsiveness and Involvement. The raw scores of the subscales have different ranges (0-5, 0-7, and 0-9). To enable comparison across subscales, we divided scores in each subscale with its maximal score. This yielded a range for each subscale of 0-1.Thus, the total score range for all subscales was 0-1, with higher scores indicating a better outcome. Here we report results on Sensitivity.