Salomonsson Björn, Sandell Rolf
Karolinska Institutet.
Linköping University.
Infant Ment Health J. 2011 Mar;32(2):207-231. doi: 10.1002/imhj.20291.
Mother-infant relationship disturbances occur in three domains: maternal distress, infant functional problems, and relationship difficulties. They constitute common clinical problems. In Sweden, they are usually handled by nurses as part of public Child Health Centre care. Severe cases are referred to child psychiatry services. This randomized controlled trial compared two groups of mother-infant dyads in a Stockholm sample. One received only Child Health Centre care (the "CHCC" group) while the other received mother-infant psychoanalytic treatment plus CHCC (the "MIP" group). Eighty dyads of mothers and infants under 1½ years of age where the mothers had serious concerns about themselves in their role as mothers, their infants' well-being, or the mother-baby relationship were randomly selected for either the MIP or the CHCC group. The primary outcomes were mother-reported depression, mother-reported infant functional problems, and interviewer-based relationship assessments, all at 6 months after joining the project. Secondary outcomes were mother-reported stress and general psychic distress, externally rated video-recorded interactions, and the consumption of healthcare at the CHC, again all after 6 months. Intent-to-treat analyses of Treatment × Time effects significantly favored MIP treatment for maternal depression, mother-infant relationships, and maternal sensitivity. Effects were nearly significant on maternal stress, but nonsignificant on mother-reported infant functional problems, general psychic distress, maternal interactive structuring and nonintrusiveness, infant responsiveness and involvement, and healthcare consumption. MIP treatment improved mother-infant relationships and maternal sensitivity and depression, all of which are known to influence child development. If effects persist and are reproduced, MIP treatment holds promise for more widespread use.
母亲的困扰、婴儿的功能问题以及关系困难。它们构成了常见的临床问题。在瑞典，这些问题通常由护士作为公共儿童健康中心护理的一部分来处理。严重的病例会被转介到儿童精神病学服务机构。这项随机对照试验在斯德哥尔摩的样本中比较了两组母婴二元组。一组仅接受儿童健康中心的护理（“CHCC”组），而另一组接受母婴精神分析治疗加儿童健康中心护理（“MIP”组）。随机选择了80对1岁半以下的母婴二元组，这些母亲对自己作为母亲的角色、婴儿的幸福或母婴关系存在严重担忧，将其分为MIP组或CHCC组。主要结局指标为母亲报告的抑郁、母亲报告的婴儿功能问题以及基于访谈者的关系评估，均在加入项目6个月后进行。次要结局指标为母亲报告的压力和一般心理困扰、外部评级的视频记录互动以及儿童健康中心的医疗保健消费，同样均在6个月后进行。对治疗×时间效应的意向性分析显示，MIP治疗在母亲抑郁、母婴关系和母亲敏感性方面显著更具优势。对母亲压力的影响接近显著，但对母亲报告的婴儿功能问题、一般心理困扰、母亲互动的结构化和非侵入性、婴儿反应性和参与度以及医疗保健消费的影响不显著。MIP治疗改善了母婴关系、母亲敏感性和抑郁，所有这些都已知会影响儿童发育。如果效果持续且能被复制，MIP治疗有望得到更广泛的应用。
