Treating postpartum emotional distress by a short-term psychodynamic infant-parent intervention integrated with child health center care
Sammanfattning: Objective: The thesis had two aims. (1) To qualitatively explore the perspectives of CHC nurses’ (study I) parents’ (II) and psychotherapists’ (III) in receiving/offering SPIPIC (Short-term Psychodynamic Infant-Parent Intervention at Child health centers) and CHC nurses and psychotherapists’ experiences of participating/offering supervision at CHC (I and III). (2) To quantitatively evaluate SPIPIC outcomes on parent-reported depression and child social-emotional functioning (IV). Methods: Data collection was conducted on six CHCs. The first aim was achieved through in-depth interviews with 15 CHC nurses, 13 parents and eight psychotherapists. The material was interpreted using hermeneutic analysis method. The second aim was achieved through a naturalistic survey at CHC where SPIPIC treatments also took place. Two subsamples participated; (1) Families that signaled emotional distress constituted the “SPIPIC Group”. Initially 100 mothers and 59 fathers participated. (2) Families that did not signal any emotional distress during recruitment constituted the “Norm Group”. Initially, 81 mothers and 60 fathers participated. Instruments: Ages and Stages Questionnaire: Social Emotional (ASQ:SE), Edinburgh Postnatal Depression Scale (EPDS), social and medical background data and patient and treatment factors estimated by the psychotherapists after completion of treatment. Results: Study I. The nurses appreciated the availability, the opportunity to learn more about emotional problems, and the psychotherapist as a beneficial resource for parents and children. The criticism included that sometimes there was no transparency on the part of psychotherapists as well as clear frameworks for therapy and supervision. Study II. The parents appreciated nurses who asked about their emotional distress and SPIPIC’s easy accessibility. Psychotherapists who had a holistic family perspective and succeeded in switching between insight promotion and supportive efforts were particularly appreciated. Especially, “the insecure parent” and “the parent in crisis” were served by SPIPIC. Study III. Therapists corresponding to the adaptive approach found ways of collaborating with the nurses and were well integrated in the CHC paradigm. Their supervisions helped the nurses to bridge somatic and psychological perspectives. This approach required that the psychotherapist had a positive view of herself as a therapist, had a high transparency in her work, courage to raise uncomfortable questions and that she worked on the nurses’ commission. The psychotherapist also needed to encompass complex socio-cultural situations in junction with parents’ emotional problems. Study IV. Multilevel growth modeling analysis showed a significant decrease in mothers’ depression and children’s social-emotional functioning. The proportion of mothers who were depressed according to the index “clinically significant change” was halved, from 2/3 to 1/3. Half of them reached “reliable change” on depression estimates and 14% on children estimates. Mothers with higher initial depression estimates tended to have more therapy sessions. Single mothers initially had higher rates of depression than those living with the child’s father. The higher the level of education, the faster the mothers’ depression estimate dropped. Child function estimation was associated with whether or not the child had a medical diagnosis. Fathers’ depression outcomes were inconspicuous, but their ratings of infant functioning improved. Conclusions: SPIPIC seems to contribute to reducing maternal depression and concerns about the child’s social-emotional functioning in both parents. Psychotherapists should work at CHC to allow parents access to psychological care. CHC nurses should receive frequent supervision from the psychotherapist to develop skills, observation and identification of these families as well as good interprofessional collaboration.
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