Mother-Infant Psychoanalysis Project of Stockholm - Full Text View

Purpose

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.

Condition	Intervention	Phase
Mother-Infant Relational Disturbances	Other: Treatment as Usual at Child Health Centre Other: Mother-Infant Psychoanalytic treatment (MIP)	Phase 3

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	A Randomized Controlled Trial of Mother-Infant Psychoanalytic Treatment and Treatment As Usual at Child Health Centres

Resource links provided by NLM:

MedlinePlus related topics: Depression

U.S. FDA Resources

Further study details as provided by Karolinska Institutet:

Primary Outcome Measures:

the Parent-Infant Relationship Global Assessment Scale (PIR-GAS; ZERO-TO-THREE, 2005) [ Time Frame: Two interviews, six months apart ] [ Designated as safety issue: No ]
the Edinburgh Postnatal Depression Scale (EPDS; Cox et al., 1987) [ Time Frame: Two interviews, six months apart ] [ Designated as safety issue: No ]
the Ages and Stages Questionnaire: Social-Emotional, (ASQ:SE; Squires et al., 2002 [ Time Frame: Two interviews, six months apart ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

the Swedish Parental Stress Questionnaire, (SPSQ; Östberg et al., 1997) [ Time Frame: Two interviews six months apart ] [ Designated as safety issue: No ]
the Emotional Availability Scales, (EAS; Biringen, 1998) [ Time Frame: Two interviews, six months apart ] [ Designated as safety issue: No ]

Enrollment:	80
Study Start Date:	October 2005
Study Completion Date:	December 2008
Primary Completion Date:	December 2008 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: Mother-Infant Psychoanalytic treatment;MIP MIP intervention	Other: Mother-Infant Psychoanalytic treatment (MIP) MIP (Norman, 2001; 2004) is a psychoanalytic method adapted to the requirements of the infant as analysand in the presence of his mother. The analyst strives to recruit the baby for an emotional interchange, though this does not imply any belief whatsoever that the infant understands verbal communication. Rather, the analyst addresses the baby to help him liberate emotions consolidated in symptoms such as screaming, avoiding maternal eye contact, and breast refusal. The analyst takes great care in enrolling the participant mother. This is to enhance her understanding of the baby's predicament and the nature of their relation, as well as giving her all space needed to vent her own frustration, depression and anxiety.
Active Comparator: TAU Treatment as usual	Other: Treatment as Usual at Child Health Centre TAU involved scheduled health visitor calls at the local Child Health Centre (CHC), with paediatric checkups at 2 and 6 months of age. The health visitor is encouraged to promote attachment and to detect postnatal depressions. Mothers may be offered parental groups, infant massage or guidance promoting interaction, as well as appointments with a paediatrician or a child psychiatric psychologist. Within the TAU framework, additional treatment may be initiated by the health visitor or the mother. This will be registered at the end-point interview.

Arms

Assigned Interventions

Experimental: Mother-Infant Psychoanalytic treatment;MIP

MIP intervention

Other: Mother-Infant Psychoanalytic treatment (MIP)

MIP (Norman, 2001; 2004) is a psychoanalytic method adapted to the requirements of the infant as analysand in the presence of his mother. The analyst strives to recruit the baby for an emotional interchange, though this does not imply any belief whatsoever that the infant understands verbal communication. Rather, the analyst addresses the baby to help him liberate emotions consolidated in symptoms such as screaming, avoiding maternal eye contact, and breast refusal. The analyst takes great care in enrolling the participant mother. This is to enhance her understanding of the baby's predicament and the nature of their relation, as well as giving her all space needed to vent her own frustration, depression and anxiety.

Active Comparator: TAU

Treatment as usual

Other: Treatment as Usual at Child Health Centre

TAU involved scheduled health visitor calls at the local Child Health Centre (CHC), with paediatric checkups at 2 and 6 months of age. The health visitor is encouraged to promote attachment and to detect postnatal depressions. Mothers may be offered parental groups, infant massage or guidance promoting interaction, as well as appointments with a paediatrician or a child psychiatric psychologist. Within the TAU framework, additional treatment may be initiated by the health visitor or the mother. This will be registered at the end-point interview.

Detailed Description:

DESIGN

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

The MIP treatments are performed by IPA psychoanalysts at the Infant Reception Service of the Swedish Psychoanalytic Society. TAU implies contact with a Health Visitor at a Child Health Centre. Additional treatments within the TAU framework suggested at the initiative by the health visitor or the mother are registered at the end-point interview. Each TAU case will also be investigated via CHC records.

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)and the Swedish Parental Questionnaire (SPSQ; Östberg et al., 1997).

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).

Prognostic assessment: the Mother-Baby Interview (MOBI; Salomonsson, 2009). Interview-based assessments of psychoanalytic aptitude and quality of the process.

Ideal typing (Stuhr&Wachholz, 2001) of "maternal types" and "infant types."

Eligibility

Ages Eligible for Study:	up to 18 Months
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

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.

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00923559

Locations

Sweden
Deptartment of Woman and Child Health, Child and Adolescent Psychiatry Unit, Karolinska Institute
Stockholm, Sweden, 17176

Sponsors and Collaborators

Karolinska Institutet

Investigators

Study Director:

Per-Anders Rydelius, Professor

Dept. of Woman and Child Health, Child and Adolescent Psychiatry Unit, Karolinska Institute

More Information

Publications:

Salomonsson B. "Talk to me baby, tell me what's the matter now". Semiotic and developmental perspectives on communication in psychoanalytic infant treatment. Int J Psychoanal. 2007 Feb;88(Pt 1):127-46.

Salomonsson B. Semiotic transformations in psychoanalysis with infants and adults. Int J Psychoanal. 2007 Oct;88(Pt 5):1201-21.

Responsible Party:	Björn Salomonsson, Dept. of Woman and Child Health, Child and Adolescent Psychiatry Unit, Karolinska Institute
ClinicalTrials.gov Identifier:	NCT00923559 History of Changes
Other Study ID Numbers:	MIPPS-01
Study First Received:	June 17, 2009
Last Updated:	June 17, 2009
Health Authority:	Sweden: Swedish Research Council

ClinicalTrials.gov processed this record on May 16, 2013

Mother-Infant Psychoanalysis Project of Stockholm (MIPPS)