[Effectivity of Inpatient and Day-clinic Psychosomatic-Psychotherapeutic Treatment]. / Effektivität stationärer und teilstationärer psychosomatisch-psychotherapeutischer Behandlung.

AIM: (Partial) inpatient psychotherapy is well implemented in Germany. To better understand efficacy factors and effects, efficacy studies are necessary. This naturalistic study investigates the effectiveness of inpatient and day clinic psychotherapy as well as patient-and disorder-related factors influencing individual symptom improvements. METHODS: Patients at a psychosomatic-psychotherapeutic university hospital treated from 2015 to 2019 who completed the BSI-18 either at admission and discharge (n=1366) or at admission and three-month catamnesis (n=497) were included in the analysis. RESULTS: Improvements in global symptom severity showed moderate effect sizes. Descriptively, these were larger for day clinic patients than for those receiving treatment as inpatients-especially in the follow-up comparison (immediately after discharge: dinpatient=0.401, dday clinic=0.482; three months after discharge: dinpatient=0.403, dday clinical=0.807). Day hospitalized patients differed significantly from inpatients-slightly in age, employment status, ability to work and initial symptom burden, moderately in the number of mental comorbidities and strongly in their main diagnoses. Socio-demographic factors showed no positive influence on symptom improvement, initial symptom severity a moderate positive influence and the number of mental comorbidities a complex influence. DISCUSSION: In general, this study confirms the effectiveness of (partial) inpatient psychosomatic therapy. The relevance of day clinic offers is emphasised in the context of cost efficiency and good integration into everyday life, but under consideration of individual treatment indications.

[Improvement of Mental Health and Bonding in Women with Mental Disorders in the Postpartum Period - Evaluation of an Interaction-Centered Treatment of a Mother-Baby Day Clinic]. / Verbesserung der psychischen Gesundheit und Bindung bei postpartal psychisch erkrankten Frauen ­ Evaluation einer interaktionszentrierten Therapie in einer Mutter-Kind-Tagesklinik.

OBJECTIVE: Women with postpartum mental disorders often have a delayed bonding to their child with negative consequences for the child's development. In several countries it has been demonstrated that a specific mother-child treatment has positive effects on maternal psychopathology and mother-child bonding. Data for German-speaking countries are rare, partly due to the lack of adequately financed mother-baby units. The objectives of this study were to characterize the patients and to evaluate the treatment in a psychosomatic-psychotherapeutic mother-child day clinic. METHODS: A total of 270 patients were examined at admission and discharge from the mother-child day clinic. The evaluation included main and secondary diagnoses according to ICD-10, duration of treatment, medication, information on the child, and psychometric questionnaires on maternal psychopathology, mother-child bonding, and parental sense of competence. RESULTS: Of the women examined, 75% had more than one, on average 2.3 mental diagnoses. The most frequent main diagnoses were affective disorders (38.5%), neurotic, stress and somatoform disorders (30.7%) and personality and behavioral disorders (20.4%). About 56% reported impaired mother-child bonding. The average duration of therapy was 32 treatment days. Between admission and discharge, a highly significant improvement in symptoms was observed with a high effect size [F=288.557 (df=1), p<0.001, Eta²=0.549]. At discharge, 86.6% of patients showed no signs of mother-child bonding disorder. DISCUSSION: The results indicate high potential effects of an interaction-centered treatment on maternal mental health and mother-child bonding. CONCLUSIONS: The joint treatment of mother and child should be a fixed and financed component of the mental health system in order to prevent chronification and negative developmental consequences for the child.

Maladaptive personality styles in a clinical sample of women with postpartum depression.

BACKGROUND: Personality traits are associated with the onset and course of postpartum depression. The impact of maladaptive personality traits on mother-child bonding and parenting is less studied. Therefore, the aims of this study are to investigate: a) the frequency of maladaptive personality styles in women with postpartum depression; b) the association between personality styles and the course of maternal psychopathology; and c) the association between personality styles and mother-child bonding and parenting competence. METHODS: We examined n = 123 patients of a mother-baby unit with the Personality Style and Disorder Inventory (PSSI) at admission and instruments assessed maternal psychopathological symptoms (BSI), mother-child bonding (PBQ), and parenting sense of competence (PSOC) at admission and discharge. RESULTS: Maladaptive personality styles were frequent. Women with postpartum depression had higher scores on the schizoid, avoidant, obsessive-compulsive, negativistic, dependent, borderline, depressive, and self-forgetting PSSI scales than women of the general population. The presence of maladaptive personality styles was associated with higher psychopathology, impaired mother-child bonding, and lower parenting sense of competence at admission. From admission to discharge, women showed significant improvements on psychopathology, bonding and parenting irrespective of the presence of maladaptive personality styles. However, mothers with maladaptive personality styles still had higher psychopathology and impaired mother-child bonding at discharge compared to mothers with normal PSSI scores. LIMITATIONS: Data is based upon a clinical sample of women hospitalized in a mother-child unit. Results are not representative for all women with postpartum depression. CONCLUSIONS: Our results underline the need for early identification of maladaptive personality styles and for the adequate treatment and monitoring of women with postpartum depression. It can be anticipated that women suffering from maladaptive personality styles will need ongoing care to prevent long-term negative outcomes.