Goodman Janice H, Prager Joanna, Goldstein Richard, Freeman Marlene
School of Nursing, MGH Institute of Health Professions, 36 1st Ave, Boston, MA, 02129, USA,
Arch Womens Ment Health. 2015 Jun;18(3):493-506. doi: 10.1007/s00737-014-0483-y. Epub 2014 Dec 20.
An integrated approach addressing maternal depression and associated mother-infant relationship dysfunction may improve outcomes. This study tested Perinatal Dyadic Psychotherapy (PDP), a dual-focused mother-infant intervention to prevent/decrease maternal postpartum depression and improve aspects of the mother-infant relationship related to child development. Women recruited from hospital postpartum units were screened using a three-stage process. Forty-two depressed first-time mothers and their 6-week-old infants were enrolled and randomized to receive the PDP intervention or usual care plus depression monitoring by phone. The intervention consisted of eight home-based, nurse-delivered mother-infant sessions consisting of (a) supportive, relationship-based, mother-infant psychotherapy, and (b) a developmentally based infant-oriented component focused on promoting positive mother-infant interactions. Data collected at baseline, post-intervention, and three-month follow-up included measures of maternal depression, anxiety, maternal self-esteem, parenting stress, and mother-infant interaction. Depression and anxiety symptoms and diagnoses decreased significantly, and maternal self-esteem increased significantly across the study time frame with no between-group differences. There were no significant differences between groups on parenting stress or mother-infant interaction at post-intervention and follow-up. No participants developed onset of postpartum depression during the course of the study. PDP holds potential for treating depression in the context of the mother-infant relationship; however, usual care plus depression monitoring showed equal benefit. Further research is needed to explore using low-intensity interventions as a first step in a stepped care approach and to determine what subset of at-risk or depressed postpartum mothers might benefit most from the PDP intervention.
一种综合解决产妇抑郁症及相关母婴关系功能障碍的方法可能会改善结局。本研究对围产期二元心理治疗（PDP）进行了测试，这是一种双重点的母婴干预措施，旨在预防/减少产妇产后抑郁症，并改善与儿童发育相关的母婴关系方面。从医院产后病房招募的女性经过三阶段流程进行筛查。42名首次患抑郁症的母亲及其6周大的婴儿被纳入研究并随机分组，分别接受PDP干预或常规护理加电话抑郁监测。干预包括八次由护士上门提供的母婴治疗课程，内容包括（a）支持性的、基于关系的母婴心理治疗，以及（b）以婴儿发育为基础的、以促进积极母婴互动为重点的部分。在基线、干预后和三个月随访时收集的数据包括产妇抑郁、焦虑、产妇自尊、育儿压力和母婴互动的测量指标。在整个研究时间段内，抑郁和焦虑症状及诊断显著减少，产妇自尊显著提高，且组间无差异。在干预后和随访时，两组在育儿压力或母婴互动方面无显著差异。在研究过程中，没有参与者出现产后抑郁症发作。PDP在母婴关系背景下治疗抑郁症具有潜力；然而，常规护理加抑郁监测显示出同等益处。需要进一步研究以探索将低强度干预作为阶梯式护理方法的第一步，并确定哪些有风险或患抑郁症的产后母亲亚组可能从PDP干预中获益最大。
