Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 143 No. 1112 (2013)

The impact of brief psychotherapy centred on parenthood on the anxio-depressive symptoms of mothers during the perinatal period

  • Amir Moayedoddin
  • Dominik A. Moser
  • Nathalie Nanzer
DOI
https://doi.org/10.4414/smw.2013.13769
Cite this as:
Swiss Med Wkly. 2013;143:w13769
Published
10.03.2013

Summary

OBJECTIVES: Depression and anxiety are major causes of distress amongst parents during the perinatal period. Their pervasive effects on the parents’ self-confidence, on the parent-infant relationship and on the child’s development have been well documented. The aims of the present study were to describe the psychological characteristics of mothers consulting during the perinatal period and to assess the effect of brief Psychotherapy Centred on Parenthood (PCP) on the mothers’ depressive and anxiety symptoms. The evolution of the mother-infant relationship is also documented. PCP is a brief mother-infant psychotherapy which focuses on the mother-infant relationship as well as the mother’s mental representations in order to reduce her psychological conflicts.

METHOD: Thirty-four mothers consulting an infant-parent outpatient clinic were assessed with respect to depression, anxiety, global functioning, severity of symptoms and the quality of their adaptation to the infant (T1). They were offered a brief PCP with an average of seven sessions. Outcome measures were collected after the end of the therapy (T2).

RESULTS: Overall, 28 of 34 mothers completed the therapy (83%), and 23 participated in the post-therapy evaluation. Paired samples t-tests showed that completers of PCP displayed significant improvement in post-treatment measures of depression (EPDS: t = 5.13; p <0.001), anxiety (STAI-State: t = 3.06; p = 0.006), clinical impression (CGI: n = 21; t = 4.50; p <0.001), and global functioning (GAF: t = –5.05; p <0.001). The quality of adaptation in the infant-parent relationship showed a tendency to improve (PIRGAS: t = –1.98; p = 0.062).

CONCLUSIONS: These preliminary results suggested that providing PCP to this sample of consulting mothers is feasible and accompanied by high rate of clinical and functional improvement.

References

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington DC: Author. 2000.
  2. Austin MP, Frilingos M, Lumley J, Hadzi-Pavlovic D, Roncolato W, Acland S, et al. Brief antenatal cognitive behaviour therapy group intervention for the prevention of postnatal depression and anxiety: a randomised controlled trial. J Affect Disord. 2008;105(1–3):35–44.
  3. Austin MP, Priest SR, Sullivan EA. Antenatal psychosocial assessment for reducing perinatal mental health morbidity. Cochrane Database Syst Rev. 2008;4:CD005124.
  4. Beck CT. Predictors of postpartum depression: an update. Nurs Res. 2001;50(5):275–85.
  5. Beck CT. Postpartum depression predictors inventory-revised. Adv Neonatal Care. 2003;3(1):47–8.
  6. Cicchetti D, Rogosch FA, Toth SL. The efficacy of toddler-parent psychotherapy for fostering cognitive development in offspring of depressed mothers. J Abnorm Child Psychol. 2000;28(2):135–48.
  7. Clark R, Tluczek A, Wenzel A. Psychotherapy for postpartum depression: a preliminary report. Am J Orthopsychiatry. 2003;73(4):441–54.
  8. Cohen NJ, Lojkasek M, Muir E, Muir R, Parker C. Six month follow-up of two mother-infant psychotherapies: Convergence of therapeutic outcomes. Infant Mental Health Journal. 2002;23:361–80.
  9. Condon J. Women’s mental health: a “wish-list” for the DSM V. Arch Womens Ment Health. 2010;13(1):5–10.
  10. Correia LL, Linhares MB. Maternal anxiety in the pre- and postnatal period: a literature review. Rev Lat Am Enfermagem. 2007;15(4):677–83.
  11. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. Br J of Psychiatry. 1987;150:782–6.
  12. Cramer B. Are Postpartum depressions a mother-infant relationship disorder? Infant Mental Health Journal. 1993; 14(4): 283-297.
  13. Cramer B, Robert-Tissot C, Stern D, Rusconi Serpa S, De Muralt M, Besson G,et al. Outcome evaluation in brief mother-infant psychotherapy: a preliminary report. Infant Mental Health Journal. 1996;11(3):278–300.
  14. Cramer B. Mother-infant psychotherapies: a widening scope in technique. Infant Mental Health Journal. 1998;19(2):151–67.
  15. Cuijpers P, Geraedts AS, van Oppen P, Andersson G, Markowitz JC, van Straten A. Interpersonal psychotherapy for depression: a meta-analysis. Am J Psychiatry. 2011;168(6):581–92.
  16. Cuijpers P, Smit F, Bohlmeijer E, Hollon SD, Andersson G. Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias. Br J Psychiatry. 2010;196(3):173–8.
  17. Dennis CL, Chung-Lee L. Postpartum depression help-seeking barriers and maternal treatment preferences: a qualitative systematic review. Birth. 2006;33(4):323–31.
  18. Fava Vizziello G, Antonioli ME, Cocci V, Invernizzi R. From pregnancy to motherhood: the structure of representative and narrative change. Infant Mental Health Journal. 1993;14:4–16.
  19. Fitelson E, Kim S, Baker AS, Leight K. Treatment of postpartum depression: clinical, psychological and pharmacological options. Int J Womens Health. 2010;3:1–14.
  20. Forman DR, O’Hara MW, Stuart S, Gorman LL, Larsen KE, Coy KC. Effective treatment for postpartum depression is not sufficient to improve the developing mother-child relationship. Development and Psychopathology. 2007;19(2):585–602.
  21. First MB, Spitzer RL, Gibbon M, Williams JB. Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition. (SCID-I/P) New York: Biometrics Research, New York State Psychiatric Institute. 2002.
  22. Gelfand D, Teti DM, Seiner SA, Jameson PB. Helping Mothers Fight Depression: Evaluation of a Home-Based Intervention Program for Depressed Mothers and their Infants. Journal of Clinical Child Psychology. 1996;25:406–22.
  23. Guedeney A, Fermanian J. Validation of a study of the french version of the Edinburgh Post Natal Depression Scale (EPDS): new results about use and psychometric properties. Eur. Psychiatry. 1998;13:83–9.
  24. Guy W. Clinical Global Impressions (CGI) Scale. Modified From: Rush J, et al. Psychiatric Measures, APA, Washington DC. 2000.
  25. Gunlicks ML, Weissman MM. Change in child psychopathology with improvement in parental depression: a systematic review. J Am Acad Child Adolesc Psychiatry. 2008;47(4):379–89.
  26. Horowitz JA, Goodman JH. A longitudinal study of maternal postpartum depression symptoms. Res Theory Nurs Pract. 2004;18(2-3):149–63.
  27. Horowitz JA, Goodman JH. Identifying and treating postpartum depression. J Obstet Gynecol Neonatal Nurs. 200;34(2):264–73.
  28. Manzano J, Palacio Espasa F, Zilkha N. The narcissistic scenarios of parenthood. Int J Psychoanal. 1999;80 (3):465–76.
  29. Marcus SM. Depression during pregnancy: rates, risks and consequences – Motherisk Update 2008. Can J Clin Pharmacol. 2009;16(1):e15-22.
  30. Marcus SM, Flynn HA, Blow FC, Barry KL. Depressive symptoms among pregnant women screened in obstetrics settings. J Womens Health (Larchmt). 2003;12(4):373–80.
  31. Milgrom J, Gemmill A, Westley D. The mediating role of maternal responsiveness in some longer‑term effects of postnatal depression on infant development. Infant Behavior and Development. 2004;27(4):443–54.
  32. Milgrom J, Ericksen J, McCarthy R, Gemmill AW. Stressful impact of depression on early mother-infant relations. Stress and Health. 2006;22:107–12.
  33. Milgrom, J, Schembri C, Ericksen J, Ross J, Gemmill AW. Towards parenthood: an antenatal intervention to reduce depression, anxiety and parenting difficulties. J Affect Disord. 2011;130(3):385–94.
  34. Murray L, Cooper PJ. Postpartum depression and child development. Psychol Med. 1997;27(2):253–60.
  35. Murray L, Cox JL. Sceening for depression during pregnancy with the EPDS. Journal of Reproductive and Infant Psychology. 1990;8:99–109.
  36. Murray L, Carothers AD. The validation of the Edinburgh Post-natal Depression Scale on a community sample. BR J Psychiatry. 1990;157:288–90.
  37. 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;182:420–7.
  38. Nanzer N, Sancho Rossignol A, Righetti-Veltema M, Knauer D, Manzano J, Palacio-Espasa F. Effects of a brief psychoanalytic intervention for perinatal depression. Arch Wom Mental Health, 2012;15:259–68.
  39. Nanzer N, Knauer D, Palacio Espasa F, Qayoom-Boulvain Z, Hentsch F, Clinton P, et al. Manuel de psychothérapie centrée sur la parentalité. Fil Rouge, PUF. Paris 2012.
  40. Nylen KJ, Moran TE, Franklin CL, O’Hara MW. Maternal depression: A review of relevant treatment approaches for mothers and infants. Infant Mental Health Journal. 2006;27(4):327–43.
  41. O’Hara MW, Stuart S, Gorman LL, Wenzel A. Efficacy of interpersonal psychotherapy for postpartum depression. Arch Gen Psychiatry. 2000;57(11):1039–45.
  42. Paris R, Sielman E, Bolton R. Mother-infant psychotherapy: examining the therapeutic process of change. Infant Mental Health Journal. 2009;30(3):301–19.
  43. Pearlstein TB, Zlotnick C, Battle CL, Stuart S, O’Hara MW, Price AB, et al. Patient choice of treatment for postpartum depression: a pilot study. Arch Womens Ment Health. 2006;9(6):303–8.
  44. Raudzus J, Misri S. Managing unipolar depression in pregnancy. Curr Opin Psychiatry. 2009;22(1):13–8.
  45. Righetti-Veltema M, Conne-Perréard E, Bousquet A, Manzano J. Risk factors and predictive signs of postpartum depression. J Affect Disord. 1998;49(3):167–80.
  46. Righetti-Veltema M, Conne-Perréard E, Bousquet A, Manzano J. Postpartum depression and mother-infant relationship at 3 months old. J Affect Disord. 2002;70(3):291–306.
  47. Sinyor M, Schaffer A, Levitt A. The sequenced treatment alternatives to relieve depression (STAR*D) trial: a review. Can J Psychiatry. 2010;55(3):126–35.
  48. Sockol LE, Epperson CN, Barber JP. A meta-analysis of treatments for perinatal depression. Clin Psychol Rev. 2011;31(5):839–49.
  49. Spielberger CD, Gorssuch RL, Lushene, P.R., Vagg, P.R., & Jacobs, G.A. Manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press, Inc. 1983.
  50. Stuart S, Clark E. The treatment of postpartum depression with interpersonal psychotherapy and interpersonal counseling. Sante Ment Que. 2008;33(2):87–104.
  51. Tuohy A, McVey C. Subscales measuring symptoms of non-specific depression, anhedonia, and anxiety in the Edinburgh Postnatal Depression Scale. Br J Clin Psychol. 2008;47(Pt 2):153–69.
  52. Zero to three, Diagnostic classification, 0–3 R: diagnostic classification of mental health and developmental disorders of infancy and early childhood. Zero to three, National Center for Clinical Infant Programs, Arlington, 2005.