Gynaecological and peripartum psychology - Research

Around a quarter of all births after assisted reproduction (ART) in Germany are multiple births (German IVF Register 2020). Multiple pregnancies and births are associated with a number of risks for the pregnant woman and the (future) children.
The aim of this study is to descriptively record the attitudes towards singleton vs. twin pregnancies and possibly embryo transfer after prolonged culture (advantages and disadvantages) among couples in assisted reproduction in a university fertility clinic against the background of their previous information, previous treatment experience, existing children, risk tolerance, age and level of education. Both partners will be interviewed using a self-generated questionnaire.
The data collection in the form of a quantitative cross-sectional study will be carried out on all participating couples at the Heidelberg University Women's Hospital's Fertility Clinic who are undergoing IVF or ICSI treatment between 15 July 2022 and 31 December 2023.

We are also researching the knowledge of the general population in relation to fertility, "artificial insemination" and multiple pregnancies/births. We welcome active participation from all those interested in the topic, regardless of age, gender, current desire to have children, level of education, origin and sexual identity. This online survey is completely anonymous and no conclusions can be drawn about you as an individual; it will be available until February 2024.
Thank you for your participation! Gillian Kugler and Prof Dr Tewes Wischmann
> click here for the survey <

Registration: DRKS00029620

Duration: 2022-2024

Funding: intramural

Supervision: Ariane Germeyer, Verena Holschbach, Tewes Wischmann (PhD student: Gillian Kugler)

Contact: Tewes Wischmann

Publication: n/a

STRESS EXPERIENCE AND CHILD DEVELOPMENT DURING THE COVID-19 PANDEMIC

Pregnancy and the first time with a baby are often a period of life accompanied by feelings of happiness. However, this time can also bring many challenges
Special circumstances, such as the COVID-19 pandemic, can be additional stress factors in the transition to parenthood and influence the mental well-being of young families.

Aim and procedure of the study

The SCHWAN study investigates how the subjective experience of stress and the physical stress response (recorded via saliva samples) in the transition to parenthood can affect the
couple and parent-child relationship as well as child development. The study comprises four appointments from pregnancy to the end of the child's first year. Participants take part in the first two appointments online from home. When the child is 9 or 12 months old, we invite the participants and their child to one of our two study locations in Heidelberg or Munich.

Interested in taking part?

• You are at least 18 years old
• You are at least 26 weeks pregnant and not expecting multiples
• The participation of your partner (online questionnaire) is desirable, but not a prerequisite

If you are interested and have any questions, please contact us by email:
schwan.psych(at)med.uni-heidelberg.de or by telephone on 06221 56 37006

Or start the study directly at:
https://ww2.unipark.de/uc/schwan-studie/

We look forward to hearing from you!

Prof. B. Ditzen & Dr N. Nonnenmacher, Heidelberg University Hospital
Prof. A.-L. Zietlow, TU Dresden
Prof. C. Reck, LMU Munich

Duration: 2020 to 2024

Funding: DFG since 2022

Management: Prof. Dr Beate Ditzen, Dr Nora Nonnenmacher, Prof. Dr Corinna Reck (LMU Munich), Prof. Dr Anna-Lena Zietlow (TU Dresden)

Contact: Heidelberg site: Linda Stürmlinger

Publications: none yet

The birth of a child is a formative biographical life event for many (expectant) parents and is an individual experience for each family, which is perceived very differently by the parents. Whether a birth is perceived as positive, negative or even traumatic depends not only on objective (medical) birth measures, but also to a large extent on psychological factors such as fears during the birth, feelings of control, social support experienced and previous expectations. Various studies have now shown that the subjective birth experience plays an important role in a variety of psychological factors in parents after the birth, such as well-being, health-related quality of life, subjective health status and the occurrence of postpartum depression.

Aims of the study:

The aim of this study is to investigate how parents experienced the birth of their child, whether stressful experiences were made and how these were dealt with. We also want to record which support services were perceived as particularly helpful by the parents in order to be able to draw conclusions for future prevention and intervention programmes.

In addition to the subjective, individual experience of the birth, we are also looking at the question of whether stressful birth experiences make it more difficult to adjust in the postpartum period and what effects this has on the parents' relationship with their child. Here, too, the focus is on the question of which support measures affected parents would like and which were perceived as helpful.

We are particularly interested in the views of fathers, as they have received little attention in research on this topic to date.

The knowledge gained from this study should contribute to the development of prevention and intervention approaches.

Procedure of the study:

The survey will take place at the Institute of Medical Psychology at Heidelberg University Hospital - we cordially invite you as parents to a joint appointment. The appointment will last about one to one and a half hours. We will also provide you with a set of questionnaires that you can complete at home.

Interested in taking part? For the study we are looking for mothers and fathers who:

• have recently (up to 6 months ago) given birth to a child and experienced the birth as stressful
• are at least 18 years old
• speak German with the child

If you are interested and have any questions, please contact us by e-mail:
BELA.PMED(at)med.uni-heidelberg.de or by telephone on 06221 56 34438

We look forward to hearing from you!

Dr N. Nonnenmacher, Britta Zipser and Prof B. Ditzen

Duration: 2024

Funding: Manfred Lautenschläger Foundation

Management: Dr Nora Nonnenmacher, Britta Zipser, Andrea Mayer, Prof. Dr Beate Ditzen

Contact: Andrea Mayer; Britta Zipser

Publications: none yet

Flyer

Endometriosis is a complex disease that affects 10-15% of all women of childbearing age. Chronic pain is the main symptom of the disease. Social factors, such as living together in a relationship, influence pain management and the degree of stress caused by the disease.

AIM AND PROCESS OF THE STUDY

The study investigates the influence of social interactions between endometriosis patients and their partner on the processing of chronic lower abdominal pain. This is done with the help of short everyday life interviews (EMA) (twice 7 days with a 3-week break) and a mini-couple intervention. In addition, we are investigating the role of the hormone oxytocin using saliva samples.

The study will be remunerated with 150 euros/person.

INTERESTED IN TAKING PART?

We are looking for women with diagnosed endometriosis and their partner. Participation is possible if:

• You are participating as a couple
• You are between 18 and 45 years old
• the relationship has lasted longer than 6 months and you live together as a couple
• the person diagnosed with endometriosis has a monthly menstrual cycle
• there are no additional diagnoses of other chronic pain disorders
• you are not pregnant
  

If you are interested or have any questions, please contact us by email: sip(at)med.uni-heidelberg.de

We look forward to hearing from you!

Heidelberg University Hospital
M.Sc. Zoe Wörner
Prof. B. Ditzen

Menstrual pain is widespread: Most women experience more severe or less severe pain at times during their menstruation. An estimated 5 - 15% of all women have endometriosis, a common gynaecological condition that is often associated with pain. The study examines people with and without endometriosis and their partners. Using fMRI and EMA, the pain perception of these people will be analysed in relation to stress, hormone levels and social interactions. This is being done in collaboration with the Department of Gynaecological Endocrinology and Fertility Disorders at the Women's Clinic of Heidelberg University Hospital.

The project examines infertility-related quality of life and personal gender role behaviour of infertile couples in Germany, Hungary and Jordan. The project focuses on possible common and different psychosocial aspects of the couples, who come from different cultural backgrounds.

The "FertiQoL" questionnaire has been developed internationally to assess the emotional, cognitive-physical, couple-related and social aspects of fertility-specific quality of life. In the project, the questionnaire is being tested on a sample (N=596) of German couples and women with an unfulfilled desire to have children from Heidelberg (N=452 women and men), Lübeck (N=119 women) and Munich (N=25 women).
Registration number: DRKS00014707

Qualitative and quantitative study of unfulfilled desire for children in men in connection with life satisfaction, role constructs and control beliefs. In addition, the duration and intensity of the treatment process and reasons for childlessness were analysed in relation to life satisfaction.

In co-operation with the State Institute for Family Research at the University of Bamberg and the German Association for Fertility Counselling (BKiD) an online evaluation of psychosocial fertility counselling was carried out. All psychosocial fertility counselling professionals and their clients were able to take part in this anonymous survey.

This study uses a randomised controlled pre-post design to test the effectiveness of a smartphone-based psychosocial intervention for women and men undergoing fertility treatment. For this purpose, an intervention and a comparison intervention group of n=60 couples each undergoing fertility treatment will be examined at two points in time at four-week intervals. During the fourteen-day waiting period between egg retrieval and pregnancy test (or return of menstruation), both groups will receive either positive orientation techniques, i.e. one of thirteen statements to induce positive cognitions or behaviours (intervention group) or cognitive thinking tasks (comparison intervention group) via smartphone on a daily basis. The study is being conducted together with the Fertility Outpatient Clinic and the Research Centre for Psychotherapy.
Registration number: NCT03118219

Supporting couples with recurrent spontaneous abortions (RSA) is a diagnostic and therapeutic challenge, as only a few causes for the occurrence of RSA are known and no risk factor can be identified in around half of those affected. The couples' level of suffering is high, which means that a detailed diagnosis and treatment strategy is often required after an abortion. As a rule, WSA trigger grief processes in affected women and their partners, the intensity and timing of which can vary greatly from individual to individual.

This study aims to identify risk factors such as anxiety, depression and low social support as well as dysfunctional coping strategies in women with WSA and their partners. In addition, the experience of WSA and how the affected patients and their partners deal with it will be precisely recorded. Another important aspect of the treatment is the satisfaction of the patients (and their partners) with the entire process of medical treatment and psychological counselling as well as the support provided by the social environment and the partner. In the long term, the expected results of this study should enable psychologically vulnerable patients (and their partners) to receive more targeted medical and psychological treatment and counselling tailored to their individual needs.

This is a quantitative cross-sectional questionnaire study of couples. A sample with a total size of n=100 couples is planned.

Registration number: DRKS: DRKS00014965

Everyday decision-making situations usually offer the person acting numerous possible reactions. Before a decision can be made, a manageable number of options must therefore first be generated. Based on increasing findings on the affective, motivational and cognitive effects of the menstrual cycle, we are investigating in this project whether (1) the number and the creative and social quality of the generated options for action in everyday decision-making processes changes over the menstrual cycle, and whether (2) these changes can be observed in all women and in different situations.

Summary of the study see here.

Participating centres and responsible persons

• D: Heidelberg (A. Germeyer/PI: T. Wischmann; PhD student: P. Pätsch, PhD student: Carla Thanscheidt), Berlin (H. Kentenich)
• A: Innsbruck (B. Toth/B. Sperner-Unterweger)
• CH: St. Gallen (F. Häberlin/I. Siercks), Basel (S. Tschudin/V. Ehrbar)

Aim of the study

Identification of protective factors (self-efficacy) and risk factors (anxiety, depression, lack of social support, negative cognitions) in women and men prior to fertility treatment

Survey instruments

ScreenIVF-R, "Infertility Self-Efficacy Scale", Sociodat (+ medical data from files)

Survey period and sample size

May 2018 to July 2019, n > 500 couples (with first contact at the respective centre)

Registration number

DRKS: 00014260

Literature

Verhaak, C. M., A. M. E. Lintsen, A. W. M. Evers and D. D. M. Braat (2010). "Who is at risk of emotional problems and how do you know? Screening of women going for IVF treatment." Hum. Reprod. 25: 1234-1240.

Cousineau, T. M., T. C. Green, E. A. Corsini, T. Barnard, A. R. Seibring and A. D. Domar (2006). "Development and validation of the Infertility Self-Efficacy scale." Fertil Steril 85(6): 1684-1696.

Between July 2014 and July 2015, 150 women and 146 men with fertility problems were examined at the Heidelberg University Women's Hospital using psychological questionnaires on risk factors, such as anxiety and depression, and coping strategies(Volmer, Rösner et al. 2017). To date, little is known about the medium-term course of psychological factors and medical predictors in couples who have remained childless (after unsuccessful or prematurely terminated treatment) or in couples with children after reproductive medical treatment. All 296 people who took part in the initial project will be surveyed by post using a questionnaire in the first half of 2020.

The main objective of this study is to identify psychological and medical predictors (psychological: protective and risk factors and coping strategies, medical: risk factors such as smoking, diet, overweight or underweight, lifestyle aspects) in couples who have unsuccessfully completed fertility treatment (without childbirth) or who have prematurely terminated treatment ("drop-outs") five years after starting fertility treatment.

A secondary objective is to record possible psychological and medical predictors from the set of variables collected in the initial project 2014/15 for pregnancy/childbirth within five years of starting treatment. A further secondary objective is to analyse the absolute and relative stability of the coping strategies surveyed five years ago in couples who remained childless.

Registration number: DRKS: DRKS00018378

The study will be conducted simultaneously in Heidelberg and Munich.

Objectives:
The study investigates families in which the mothers are suffering from depression and/or anxiety disorders in the period surrounding the birth. We are particularly interested in the interaction between the parents and their child, but also the couple interaction and the child's development over the first two years of life.

Background:
Mental disorders in the period around the birth (= peripartum period) are a burden for the affected families. Around 12% of women are affected by depression during pregnancy and around 6% in the postpartum period (= time after giving birth). Alongside depression, anxiety disorders are among the most common mental disorders associated with pregnancy and childbirth. Around 7% of all women are affected by anxiety disorders during pregnancy and around 11% during the first three months postpartum.

The study examines the effects of maternal depression and/or anxiety disorders on child development within the first two years of life, taking into account parent-child interaction. The research shows that it is not only the mother's mental disorder that affects the child's development, but rather that the mother-child interaction plays a decisive role. We are investigating the influence of dyadic interaction between mother and child and father and child on child development. We are also particularly interested in how parents interact with each other as a couple. Furthermore, we are interested in the influence of psychobiological variables, more specifically in the child's sensitivity to stress (cortisol, α-amylase, heart rate) in interaction with the parents as well as in the parents' sensitivity to stress in the couple interaction. In addition, we are investigating the role of the maternal hormone oxytocin in connection with the mother's interaction behaviour.
The results of this study will serve as a basis for the development of suitable support programmes for affected families.

Study procedure:
The prospective longitudinal study comprises several appointments over the first two years of the child's life and starts 3 months after birth with a first video appointment in which the interaction behaviour between parents and child is examined. At this appointment, the parents' interaction with each other (couple interaction) is also recorded. Interviews are conducted with the parents to record any current psychological stress.

At further examination appointments at 12, 18 and 24 months of age, the focus is on recording the child's development. The child's socio-emotional and cognitive development is examined in a playful way, the parent-child interaction is recorded again and the current mood, handling of emotions, own parenting behaviour, the quality of the partnership and the child's behaviour are surveyed using interviews and questionnaires. Saliva samples are taken from both the parents and the child to determine their sensitivity to stress and the heart rate is recorded during the parent-child and couple interaction using electrodes attached to the upper body of the study participants and the child. Both procedures are completely painless. In order to record the hormone oxytocin - also known as the "bonding hormone" - in the mother, a blood sample is taken from her. Oxytocin plays an important role in social relationships and the mother's emotional bond with her child and is therefore relevant to the study in this context.

Duration: 2017 to 2021

Funding: Federal Ministry of Education and Research (BMBF)

Head: Dr Nora Nonnenmacher, Prof Dr Corinna Reck (LMU Munich), Prof Dr Anna-Lena Zietlow (TU Dresden)

Contact: Dr Nora Nonnenmacher

Publication:https://bmjopen.bmj.com/content/12/1/e050437

Objectives:
This study focuses on mothers who have difficulties establishing an emotional relationship with their newborn child. This study investigates whether a neurofeedback intervention can help mothers to improve their relationship with their 3-4 month old child.
The mothers practise using MRI to positively influence their brain activity in response to images of their child.

Background:
The period after birth is a formative phase for both mother and child, requiring constant attention and effort from the mother in particular. Many mothers experience a so-called "baby honeymoon" after the birth - a state that awakens in them the desire to be constantly close to their child, to care for it and to be able to take on the efforts of motherhood. This state lays the foundation for the baby's positive development.

Some mothers find it more difficult to establish an emotional bond with their child after the birth. This is often accompanied by self-reproach, including the shame of not being able to react as positively to their child as they would like.

This study aims to help mothers improve their relationship with their 3-4 month old child by training them to positively influence their brain activity in response to images of their child. To do this, the mothers' brain activity is measured while they are lying in the magnetic resonance imaging (MRI) scanner and fed back to them live. This intervention deliberately does not use medication and therefore represents a new method of sustainably improving the relationship between mother and child.

Study procedure:
The study comprises a total of three appointments (3, 6 and 12 months after birth), at which mothers with and without attachment difficulties come to the Centre for Psychosocial Medicine together with their babies. At these appointments, in addition to interviews on the mother's health status and bonding with the child and other questionnaires, the mother-child interaction is also recorded and an examination is carried out in the magnetic resonance tomograph (MRT).

For mothers taking part in the intervention to improve maternal bonding, there are three additional training sessions at intervals of around 14 days, in which they practise using MRI to upregulate brain activity in response to images of their own child.

In addition, a blood sample is taken from the mother to measure the bonding hormone oxytocin.

At the age of 12 months, the child's development is also recorded in a playful way using a general development test.

Duration: 2016 to 2022

Funding: Dietmar Hopp Foundation

Head: Prof Dr Beate Ditzen, Dr Monika Eckstein, Dr Anna-Lena Zietlow (TU Dresden)

Contact: Dr Monika Eckstein, Dr Marlene Krauch

Publications:http://dx.doi.org/10.1136/bmjopen-2018-027747

Supported by the VW Foundation

Study management:
Prof. Dr phil. Dipl.-Psych. Corinna Reck, Ludwigs-Maximilians-Universität München, Universitätsklinikum Heidelberg

In cooperation with:
"Social Brain" project: The brain - an organ of relationships: Interdisciplinary perspectives on the development of socially induced abilities
Study director: Prof. Dr med. Dr phil. Thomas Fuchs, Heidelberg University Hospital


Contact:
Dipl.-Psych. Nora Nonnenmacher
Telephone: 06221/56 37006

Objectives:
The study presented examines the question of the conditions under which biologically inherent social skills can develop. Specifically, it will focus on the intuitive skills of mothers when interacting with their infants and analyse the social-cognitive development of children and their attachment security over the first 18 months of life.

Background:
Previous research has impressively demonstrated that mothers have a broad repertoire of behaviours at the birth of their child that are complementary to the child's maturational deficits and can be spontaneously recalled in interaction with the infant (e.g. nursemaid language or imitation). However, it is unclear whether successful recall of these intuitive competences depends on anchoring them in the child's own early positive relationship experiences.
In addition, the significance of postpartum depression for the mother-child relationship and the child's development is to be investigated. It is already known that the interaction behaviour of depressed mothers can be characterised by more negative affect, a lack of responsiveness and passivity. These behaviours go hand in hand with a lack of intuitive skills and stand in the way of important prerequisites for social exchange processes. This in turn can have an unfavourable effect on the child's development. In this context, it is still unclear under which circumstances intuitive competences can be activated by the affected mothers despite an acute depressive illness and which specific factors (e.g. a current secure attachment style of the mother) promote this recall or make it possible in the first place. This question is particularly relevant with regard to the development of specific, mother-child-centred therapeutic interventions.

Study design:
The prospective longitudinal study comprises four appointments to which mother and child are invited and starts at an infant age of 3 to 4 months with a first video appointment in which interaction patterns between mother and child are examined in a still-face situation. In addition, interviews are conducted with the mother, focusing on psychological problems (SKID) and her current relationship behaviour (ASI). Questionnaires are used to gather further information such as traumatic experiences in childhood and adolescence (CECA-Q), remembered parenting behaviour (FEE) and expectations associated with the parental role.
In addition, the development of cognitive and emotional structures on the part of the children is tracked at the other examination dates at the ages of 9, 12 and 18 months. Possible effects of characteristics of early mother-child interaction and current maternal attachment representations on social-cognitive developmental measures, such as communicative competences and object learning, as well as the children's general level of cognitive development will be investigated in more detail. In addition to observable behaviour, associated neurophysiological parameters of mother and child (e.g. cortisol and heart rate) should also provide information about possible correlations.
In addition, prospective correlations will be established between the videographed dyadic interaction patterns in early childhood, the current attachment representations of the healthy and depressed mothers and the child's attachment pattern in the stranger situation test at 18 months.

Funded by the VW Foundation (2013-2016)

Study director:
Prof. Dr phil. Dipl.-Psych. Corinna Reck, Ludwigs-Maximilians-University Munich, University Hospital Heidelberg

In cooperation with:
Project "Cognition through interaction: On the development of personal, object and self-knowledge"
Study director: Prof. Dr med. Dr phil. Thomas Fuchs, Heidelberg University Hospital

Contact person:
Dipl.-Psych. Nora Nonnenmacher
Telephone: 06221/ 56 37006

Aims and background:
This study focusses on child development at the age of 4 years. The sample, which has already been analysed over the first 18 months of life, is made up of children of depressed mothers and children of healthy mothers. The study investigates the extent to which mother-child interaction is associated with child development in addition to a depressive illness after birth. The focus is particularly on the child's flexibility of perspective, i.e. the child's ability to comprehend different points of view. To date, the influence of maternal postpartum psychopathology and children's learning experiences in mother-child interactions on the child's ability to develop perspective flexibility at the age of 4 years has hardly been investigated. Specific development-promoting interactions, in which the child's ability to self-regulate and differentiate between different perspectives are practised, play an important role.

In addition to the ability to differentiate perspectives, the influence of mother-child interaction on the child's mental abilities and behaviour at the age of 4 will be investigated. Furthermore, a possible genetic predisposition and epigenetic modification of depression will also be investigated - this part of the study is optional. Should the quality of the mother-child interaction prove to be a moderator for the influence of maternal psychopathology on the child's cognitive development, this would provide an excellent approach for the early prevention of developmental disorders.

Study procedure:
The examination takes place when the children are 4 years old and includes two examination appointments, each lasting approx. 2 hours. At the first appointment, the interaction between mother and child is examined by observing behaviour and recorded on video. This is followed by a series of playful tasks to determine the extent to which the child is already able to adopt different perspectives and thus change their perspective. An abbreviated diagnostic interview (SKID-I) is carried out to identify any current psychological stress the mother may be experiencing. At the end of the examination appointment, the parents receive a number of questionnaires about their current mood, how they deal with emotions, their own parenting behaviour, the quality of their relationship and the child's behaviour. Parents also receive a questionnaire on their child's behaviour, which should be completed and returned by the child's teacher/additional carer.

At the second appointment, the child's level of development is measured using the Hannover-Wechsler Intelligence Test for Preschool Age-III (HAWIVA-III). This measures the child's mental and linguistic abilities in an age-appropriate manner. We will also carry out tests with the child to assess executive functions. Executive functions are mental functions that serve to control behaviour. These include, for example, setting goals, planning actions or controlling attention. To test these abilities, we will carry out tasks in which cards are sorted according to certain rules, certain automatic reactions are suppressed and sequences are reproduced correctly.

In addition, the study consists of an optional part that will investigate the genetic predisposition and epigenetic modification in the development of depression. This requires a small amount of saliva from the mother and child, which can be dispensed into a tube.

A follow-up study of the study "Anxiety disorders in the postpartum period: cognitive development, interaction behaviour and child neurophysiology"

Funded by the German Research Foundation (DFG) (2011-2014)

Study director:

Prof. Dr phil. Dipl.-Psych. Corinna Reck, Ludwigs-Maximilians-University Munich, University Hospital Heidelberg

Co-operation:

• Prof Dr phil Sabina Pauen, Institute of Psychology, University of Heidelberg
• Prof. Dr Eva Möhler, Heidelberg University Hospital, Child and Adolescent Psychiatry
• Prof. Dr med. Dr phil. Thomas Fuchs, Heidelberg University Hospital

Contact person:

Dipl.-Psych. Alexandra Tietz
Phone: 06221/ 56 4420

Content and aims:

To date, the influence of maternal postpartum anxiety and childhood learning experiences in mother-child interaction on later childhood behavioural problems and temperamental characteristics has hardly been investigated. The aim of this prospective study is to investigate the predictive significance of maternal anxiety disorders in the postpartum period for children's behaviour at preschool age. For the first time, it is possible to take into account central moderator variables such as mother-child interaction. The sample already analysed in the postpartum period consists of children of mothers with anxiety disorders on the one hand and children from a healthy control group on the other. In the follow-up study, the child's temperament ("behavioural inhibition"), behavioural abnormalities, executive abilities and the child's level of cognitive development are recorded at the age of five. In addition, the influence of postpartum anxiety symptoms on the child's stress reactivity is to be determined using the cortisol level in the saliva before and after the experimental survey of behavioural inhibition. If the quality of the mother-child interaction proves to be a moderator for the influence of maternal psychopathology on the child's affective, social and cognitive development, this would provide an excellent approach for the early prevention of developmental disorders.

"Anxiety disorder in the postpartum period: cognitive development, interaction behaviour and child neurophysiology"

Funded by the German Research Foundation (DFG)

Study director:
Dr phil. Dipl.-Psych. Corinna Reck, Head Psychologist, Department of General Psychiatry, Heidelberg University Hospital

In cooperation with:

• Prof. Dr phil. Sabina Pauen, Institute of Psychology at Heidelberg University Prof. Dr med. Eva Möhler, Heidelberg University Hospital, Child and Adolescent Psychiatry
• PD Dr phil. Matthias Backenstraß, Klinikum Stuttgart, Bürgerhospital
• Prof. Dr med. Dr phil. Thomas Fuchs, Heidelberg University Hospital
• Edward Tronick, PhD, Child Development Unit, Harvard Medical School, Boston, USA
• George Downing, PhD, Salpêtrière Hospital, Paris

Staff members:

• Alexandra Tietz
• Britta Zipser
• Dipl.-Psych. Ulrich Stefenelli
• Prof Christoph Mundt, MD
• Dr Christina Gluth
• Sarah Groß

The study, which has been running since September 2006, is currently still looking for mothers with anxiety disorders and healthy control mothers whose children should be between three and six months old.

Unfortunately, no new subjects can be included in this study as the data analysis has begun.
We would like to take this opportunity to thank all the mothers whose participation made this study possible in the first place!

Contact:
Alexandra Tietz
Phone: 06221/ 56 4420

Content and aims:
The aim of the research project is to analyse specific behavioural patterns in the course of illness in mothers with anxiety disorders and their infants. Interactional and psychophysiological reaction patterns on the maternal and infant side are examined during the first 18 months of the infant's life in connection with the course of the mother's illness. The central question is the connection between the anxiety disorder, the quality of the mother-child interaction and the early childhood psychophysiological reaction patterns during the course of the illness. The study also includes the effects of the anxiety disorder on child development.

Background:
The influence of anxiety disorders (DSM IV) on mother-child interaction, infant stress reactions and developmental patterns has been investigated in only a few studies to date. Therapeutic interventions that affect mother-child interaction are desirable, but are currently not usually affordable. There are long waiting lists for inpatient, day-care and outpatient treatment places that include both the mother and the child. Psychological counselling for vulnerable mothers during pregnancy, birth and the puerperium would be desirable, but has rarely been practised to date. The study is intended to provide further insights into the causes of peripartum anxiety disorders as well as the effects on mother and child and the resulting therapeutic options.

Study procedure:
The recruited mothers were examined after initial contact via various recruitment measures with the help of a telephone interview, which provided initial insights into the maternal and child situation.
After group allocation, the mother-child interactions were examined videographically in structured face-to-face interactions and microanalysed at three measurement points (3rd, 6th and 18th month of the child's life). In addition, the child's level of development was assessed at two further measurement points (7th and 12th month of life).
All the parameters analysed were recorded and compared in mothers with anxiety disorders and their children as well as in a healthy control group matched according to the age and gender of the child and the mother's level of education. Some of the examinations were reported back as individual results, and counselling sessions were also held as part of the study at the mothers' request.

"Anxiety disorders in the postpartum period as a predictor of children's temperament, behavioural problems and cognitive development at pre-school age"

A follow-up study to the study "Anxiety disorders in the postpartum period: cognitive development, interaction behaviour and child neurophysiology"

Funded by the German Research Foundation (DFG) Duration 2012-2015

Study management:
PD Dr Corinna Reck

In cooperation with:

• Prof. Dr phil. Sabina Pauen, Institute of Psychology at the University of Heidelberg
• Prof. Dr Eva Möhler, Heidelberg University Hospital, Child and Adolescent Psychiatry
• Prof. Dr med. Dr phil. Thomas Fuchs, Heidelberg University Hospital

Staff members:

• Alexandra Tietz
• Star Dubber

Contact:
Alexandra Tietz
Phone: 06221/ 56 4420

Content and aims:
To date, the influence of maternal postpartum psychopathology and infant learning experiences in mother-child interactions on later infant behavioural problems and temperamental characteristics has hardly been investigated. The aim of this prospective study is to investigate the predictive significance of maternal anxiety disorders in the postpartum period for children's behaviour at preschool age. For the first time, it is possible to take into account central moderator variables such as mother-child interaction. The sample already analysed in the postpartum period consists of children of mothers with anxiety disorders on the one hand and children from a healthy control group on the other. In the follow-up study, the child's temperament ("behavioural inhibition"), behavioural problems and level of cognitive development are recorded at the age of five. In addition, the influence of postpartum anxiety symptoms on the child's stress reactivity will be determined using the cortisol level in the saliva before and after the experimental survey of behavioural inhibition. If the quality of the mother-child interaction proves to be a moderator for the influence of maternal psychopathology on the child's affective and cognitive development, this would provide an excellent approach for the early prevention of developmental disorders.

THE STILL-FACE PARADIGM

The so-called still-face paradigm is used as a standardised video analysis method to analyse the child's ability to regulate mother-child interaction. The procedure of our "still-face experiment" (based on Tronick et al., 1987) is divided into four 2-minute phases: The first phase involves a free play situation in a typical face-to-face setting (child sits opposite the mother in a child seat). In the second phase, the actual breastfeeding face-to-face situation, the mother-child interaction is interrupted and the mother is asked not to make any gestures or facial expressions. The third phase is the so-called reunion phase, in which the mother turns back to the child in her usual way. The last phase is a face-to-face situation with a staff member who is categorised as sensitive and who is a stranger to the child.

The aim of this study is to record the impairments, but also the resources of endometriosis sufferers in various areas of life and to gain insights into helpful measures for dealing with endometriosis. These findings can be helpful in the development of effective counselling and therapeutic interventions for endometriosis sufferers (and their partners). A brochure for sufferers and their partners has been developed.

Members of the "Endometriosis Network" are: Angelika Eck (Karlsruhe), Julia Hahnfeldt (Berlin), Julia Immendörfer (Karlsruhe), Laura Hatzler (Berlin), Matthias Korell (Neuss), Karina Kranz (Heidelberg), Katja Materne (Berlin), Johanna Netzl (Berlin), Lena Ullinger (Karlsruhe), Julia Stahl (Frankfurt/M.), Katharina van Stein (Heidelberg), Birte Walter (Berlin), Tewes Wischmann (Heidelberg). The network was presented at the 64th DGGG Congress in Munich on 12 October 2022, as were the initial results of this online survey.

The online questionnaire was partially analysed anonymously as part of a psychological bachelor's thesis; the full analysis is being carried out as part of a medical doctoral thesis.

By February 2024, the supplementary study EndoGrowth was conducted by means of video interviews .

In collaboration with the Department of Gynaecological Endocrinology and Fertility Disorders at the Women's Clinic of Heidelberg University Hospital, the relationship between partnership and sexuality in women with and without endometriosis and their partners as well as the influence of psychosocial variables such as pain experience, stress, depression, anxiety, spirituality and the desire to have children in relation to endometriosis are being researched.

Registration number: DRKS-No.: 00014362

Everyday decision-making situations usually offer the person acting numerous possible reactions. Before a decision can be made, a manageable number of options must therefore first be generated. Based on increasing findings on the affective, motivational and cognitive effects of the menstrual cycle, we are investigating in this project whether (1) the number and the creative and social quality of the generated options for action in everyday decision-making processes changes over the menstrual cycle, and whether (2) these changes can be observed in all women and in different situations.

In this study, fertility-related quality of life (FertiQoL) was investigated in connection with dyadic coping (DCI) in couples at the fertility clinic of the Heidelberg University Women's Hospital

Duration: 2010-2011

Funding: intramural

Head: Tewes Wischmann (together with Sabine Rösner and Mariana Lallinger)

Contact: Tewes Wischmann

Publication: Lallinger M et al: Quality of life and coping in couples with an unfulfilled desire to have children [in preparation]

Evaluation of an information brochure for endometriosis patients and their partners and the partnership experience of endometriosis

Duration: 2015

Funding: intramural

Head: Sabine Rösner, Tewes Wischmann

Contact: Tewes Wischmann

Publication: n/a

In this study, psychological risk profiles (ScreenIVF) in connection with the coping style (COMPI) were examined in couples at the Fertility Clinic of the Heidelberg University Women's Hospital

Duration: 2014-2015

Funding: intramural

Head: Tewes Wischmann (together with Sabine Rösner and Lea Volmer)

Contact: Tewes Wischmann

Publication: Volmer L, Rösner S, Toth B, Strowitzki T, Wischmann T (2017): Infertile partners' coping strategies are interrelated - implications towards targeted psychological counselling. Obstetrics and Gynaecology 77: 52-58

To record the attitudes of women and men to the controversial topic of precautionary egg freezing using an anonymised online survey. In particular, the influence of different socio-cultural milieus on attitudes towards 'social freezing' in Germany will be analysed.

Content and aims
The aim of the study is to examine women during pregnancy for depression, anxiety disorders and their risk factors. The effects of anxiety and depression on the hormone status, particularly cortisol, of the mother and child will be investigated at various times during pregnancy and immediately after birth. We want to find out more precisely what effects these factors have on the course of pregnancy and labour, as well as on the child's development.

Background
The significance of pregnancy-associated psychological problems such as anxiety and depressive symptoms is generally underestimated in Germany. Attention rarely seems to go beyond the entry "psychological stress situation" in the maternity record. Yet it is precisely these abnormalities that appear to increase the probability of a lower birth weight and gestational age. In the newly launched prospective Heidelberg Peripartum Study II, the effects on the child's development and mother-child relationship will be investigated in addition to the correlations between prepartum mental health problems and gestational age at delivery and foetal birth weight. Particular attention will be paid to the stress hormone cortisol both during pregnancy and after birth. The aim of the study is to examine test subjects in the first, second and third trimester 24 hours after birth and four weeks postpartum. Mothers with depression, comorbid illnesses in the sense of anxiety disorders and depression and healthy test subjects are sought.

Study procedure
Women are recruited in early pregnancy. Using the Structured Clinical Interview for DSM IV - Axis I diagnoses (SKID I), various questionnaire sets, saliva and hormone analyses in the hair, child development examination according to Bayley III and mother-child interaction using the still-face paradigm, mother and child are examined at five different study time points:

T1: 9th-12th week of pregnancy
T2: 19th-22nd week of pregnancy
T3: 29th-32nd week of pregnancy
T4: 4 weeks after birth
T5: 3-4 months after birth

Funding: German Research Foundation (DFG)

Head: Prof Dr Corinna Reck (LMU Munich)

Applicants involved
PD Dr med. Eva Möhler, Head of the Research Unit 'Developmental Psychopathology of Early Childhood'
PD Dr med. Holger Maul, Chief Physician for Gynaecology, Kath. Marienkrankenhaus Hamburg GmbH
Prof. Dr med. Prof. Dr h.c. Christof Sohn, Managing Director of the Heidelberg University Women's Hospital

Cooperation with
Prof. Bea Van den Bergh, PhD, Pediatric Psychology Section, Tilburg University
Prof. Dr C. Kirschbaum, Head of Biological Psychology at the Technical University of Dresden

Contact: Dr Nora Nonnenmacher

Content analysis of maternal verbalisation in mother-infant interaction:
A controlled study with postpartum depressed and anxious mothers

We would like to thank the Heidehof Foundation
for their financial support in making this study possible.


Study management:
PD Dr phil. Dipl.-Psych. Corinna Reck, Head Psychologist, Department of General Psychiatry, Heidelberg University Hospital


Staff:
Britta Zipser (Research Assistant)
Mitho Müller (Research Assistant)

Contact:
Britta Zipser
Telephone: 06221/ 56 6194
britta.zipser@med.uni-heidelberg.de

Content and aims:
The aim of the research project is to analyse the content of maternal language addressed to the infant in postpartum depressed and anxious mothers and to develop a language score that allows the categorisation of maternal language in terms of sensitivity and developmental quality.

Background:
Postpartum depression and anxiety disorders are studied to varying degrees with regard to their influence on mother-child interaction and child development patterns. To date, very few studies have been dedicated to postpartum anxiety disorders (DSM-IV).
In view of the great importance of mother-child interaction as a source of initial emotional
learning experiences in the developmentally sensitive phase of the first months of life and the
proven links between maternal language and the child's
emotional and cognitive development, the investigation of disorder-specific maternal
verbalisations is of particular interest in this context. In particular, considering the high clinical relevance of maternal language for child development and the previously unstudied associations between the occurrence of postpartum anxiety disorder and specific characteristics of maternal verbalisations, we derive a need for research in the described area.
The identification of disorder-specific maternal verbalisations using a validated sensitivity score offers an excellent starting point for the planning of preventive measures in the postpartum period and is therefore forward-looking. In addition to the non-verbal side, the verbal aspects could also be integrated in a well-founded manner as part of video-supported mother-child intervention therapy.

Study procedure:
The video recordings collected as part of two studies on postpartum depression and anxiety disorders within the framework of the still-face paradigm also allow an investigation of maternal interaction with regard to the elements of maternal language.
Maternal language is analysed and evaluated using a coding system (SCMS) developed specifically for this purpose in the mother-child project.
A group comparison of postpartum depressed mothers, postpartum anxious mothers and a healthy control group will lead to further results.
Subsequently, a language score will be developed that allows a categorisation of maternal language with regard to sensitivity and development-promoting quality.

Duration: 2012-2015

Funding: Heidehof Foundation

Head: Prof Dr C. Reck

Contact:Britta Zipser

Publications: none (Master's/PhD theses/presentations)

Mentalisation-based parent training for mentally ill parents - helping families with access to the psychiatric support system to avoid passing on their own stress to the next generation

The aim of UBICA II is to support stressed parents in their relationship with their children and to better understand the effects of parental stress on the parent-child relationship. The stress may be due to their own mental illness, their own difficult childhood experiences or a current difficult life situation.

Director of Studies:

Prof. Dr phil. Dipl.-Psych. Corinna Reck, Clinical Psychology of Childhood and Adolescence and Counselling Psychology, LMU Munich
Doctoral student: Dipl.-Psych. Sarah Groß

In cooperation with:

Prof. em. Dr Manfred Cierpka, Institute for Family Therapy and Psychosomatic Cooperation Research
Dr Consolata Thiel-Bonney

Contact:
Sarah Groß

The questionnaire with evaluation instructions and the related publications can be requested via the following e-mail address:
Sarah_Gross@gmx.de

Content and aims:
Development and evaluation of a questionnaire to assess early childhood regulatory ability in the behavioural areas of crying, feeding and sleeping

Background:
The questionnaire on crying, feeding and sleeping (SFS) developed as part of the study serves to obtain an overview of all areas of infant behaviour regulation and associated difficulties with the help of parent assessments. Questions are asked about the triad of 1. problems of early childhood behavioural regulation (e.g. crying time, length of sleep, distractibility), 2. dysfunctional communication patterns in the contexts relevant to the behavioural problem (calming strategies, bedtime rituals, approach to feeding) and 3. an overload syndrome on the part of the primary caregivers (interpretations and explanations for the parents' problem, own stress). In addition, the validation is carried out using a quasi-criterion with the help of a comparison with a sleep/crying/feeding diary, which is completed by the parents over a period of 4 days. One difficulty with the diaries is the effort required to complete them over several days, which means that they are often not completed or completed inaccurately, which motivated the development of the questionnaire.

Study procedure:
The infant crying, feeding and sleeping questionnaire (SFS) constructed on a theoretical and factor-analytical level will be investigated with regard to the internal consistencies of the scales, the scale intercorrelations and the correlations with a behaviour diary. The differences between a clinical and a non-clinical sample are analysed. The sample of a total of 704 infants under one year of age is made up of various subsamples. The mean differences on the questionnaire scales are analysed using 134 children who were presented by their parents at the special outpatient clinic for parents with infants and toddlers and a corresponding comparison group. The principal component analysis yields three easily interpretable, mutually correlated scales, all of which have a high internal consistency. The correlations with the diary entries and the mean differences between the clinical and non-clinical sample are found in the expected direction. The results show consistency between the SFS including the "Wessel criterion" and the behaviour diary and clinical diagnostics. The SFS is valid with regard to these criteria and can therefore be used in research and practice for the first year of life to record the extent of difficulties with crying, feeding and sleeping.

Supported by the Dietmar Hopp, Jung and Köhler Foundation

Study management:
PD Dr Corinna Reck, Head Psychologist, Department of General Psychiatry, Heidelberg University Hospital

in co-operation with:

• PD Dr Birgit Träuble, Institute of Psychology, University of Heidelberg
• http://www.psychologie.uni-heidelberg.de/ae/entw/inhalt/ma_traeuble_projekt.htm

Staff members:

• Anna-Lena Zietlow
• Kristina Dieterich

Contact:
Anna-Lena Zietlow
Phone: 06221/56 35795

Content and aims:
This study is a follow-up study of the so-called Interaction Study, which dealt with the analysis of specific behavioural patterns in the course of illness of postpartum depressed mothers and their infants depending on the severity of the mother's depression.
The purpose of the study is to analyse the mother-child relationship and the child's development following a mother's depression or anxiety disorder in the postpartum period. The aim is to examine whether and to what extent the mother-child relationship and the child's development are influenced by the mother's illness in the first weeks/months of life. The results of this study will serve as a basis for the further development of specific therapeutic interventions to prevent child development problems and an unfavourable development of the mother-child relationship.

Background:
Depression and anxiety disorders are the most common mental illnesses in the postpartum period. Disorders of the parent-child relationship as well as child behavioural and emotional abnormalities have been repeatedly demonstrated in connection with these postpartum mental illnesses.
Several research studies have shown that maternal depression is associated with an increased risk of the child developing an insecure attachment representation. In contrast to postpartum depression and infant attachment quality, no explicit studies are available for anxiety disorders despite the high prevalence rates.

Study design:
In a prospective longitudinal design, sick and healthy mothers and their children are examined. The study takes place when the children are between 2 and 5 years old. We record the child's attachment to the mother through behavioural observation in the so-called stranger situation test. This involves recording and analysing the mother-child interaction with the help of video tapes. In addition to a set of questionnaires to assess the child's behaviour, the mother's well-being, her bonding experiences and family situation, a diagnostic interview on the mother's well-being is conducted. We also record the children's level of cognitive development. The mother's and child's ability to recognise emotions and to make assumptions about the consciousness of other people (theory of mind) are also recorded. Questionnaire data is also collected from fathers and other carers, e.g. educators or childminders.

Director of Studies:

• PD Dr phil. Dipl.-Psych. Corinna Reck , Head Psychologist, Clinic for General Psychiatry, Heidelberg University Hospital

In co-operation with:

• Prof. Dr med. Dr phil. Thomas Fuchs, Senior Physician at the Psychiatric Outpatient Clinic, Department of General Psychiatry, Heidelberg University Hospital
• Prof. Dr Manfred Cierpka, Institute for Family Therapy and Psychosomatic Cooperation Research
• Dr Consolata Thiel-Bonney, Institute for Family Therapy and Psychosomatic Cooperation Research
  

Contents and aims:
In the first part of the project, the relationship between the mother's pre-, peri- and postnatal stress and the quality of mother-child interaction in infancy is investigated in a prospective study. The second part of the research project deals with the question of the extent to which increased stress levels or self-regulation disorders of the child, which manifest themselves in excessive infant crying, sleeping or feeding problems, influence the social interaction between mother and child.

Background:
The basic assumption here is that stress rarely affects one person in isolation, but always has consequences for the social environment. The effects of maternal stress in the prenatal period on the development of the foetus illustrate this, as does a stressed infant, which can have an unfavourable influence on family dynamics. This is clearly documented by the high demand for counselling appointments in the parent-infant consultation. It is therefore to be expected that increased stress on the part of the mother and/or the child will have negative consequences for the interaction behaviour of the mother-infant dyad. It has been repeatedly demonstrated that emotional maternal stress after birth has an unfavourable effect on the child's self-regulation in mother-child interaction and that increased stress or traumatic experiences of the mother at birth also cause an early regulatory disorder in the infant.

Study procedure:
The relevant study groups are recruited from pre- and perinatally stressed mothers and from children with self-regulation disorders whose parents attend the parent-infant consultation in Heidelberg. The mother's current stress level is determined with the help of questionnaires and physiological parameters, while the child's stress level is determined using questionnaires to be completed by the parents, physiological parameters and 24-hour protocols. The so-called still-face situation is used as a standardised video analysis method to analyse the child's ability to regulate itself in the interaction situation. The still-face situation is a frequently used experimental paradigm consisting of three two-minute phases. In phases 1 (play situation) and 3 (reunion phase), mother and child each spend two minutes in free dialogue. In phase 2 (interruption of the interaction, still-face), the mother neither plays nor talks to the child, nor does she make eye or physical contact with him.

Study management:
PD Dr phil. Dipl.-Psych. Corinna Reck, Head Psychologist, Clinic for General Psychiatry, Heidelberg University Hospital'

Staff members:

• Dipl.-Psych. Kerstin Struben
• Dipl.-Psych. Kirsten Pabst
• Dipl.-Psych. Katja Reinig-Bisdorf
• Britta Zipser
• Dipl.-Psych. Ulrich Stefenelli
• Dipl.-Biol. Eva Stehle
• PD. Dr med. Eva Möhler
• Prof. Dr med. Dr phil. Thomas Fuchs
• Prof. Dr Christoph Mundt

Content and objectives:
The main aim of the prospective study was to investigate the predictive significance of maternal psychopathology and interactional behaviour for the emotional development of the child. In a previous study, 'depressed' and 'healthy' mother-child dyads had already been compared three months postpartum. Now a follow-up study of the mother-child dyads of both groups at the age of 3-3.5 years and 4-5 years was aimed at the emotional development and attachment of the child. In addition, both the paternal psychopathology and the family system as a whole were to be considered. Systematic consideration of specific characteristics of the course of the disorder, such as the severity and chronicity of maternal depression and anxiety disorders, was planned. The long-term goal was to acquire basic knowledge for the planning of disorder-specific mother-child and family-centred interventions with the aim of preventing child development deficits and attachment disorders.

Background:
The significance of postpartum mental illnesses such as depression or anxiety disorders is generally underestimated in Germany. Postpartum depression and postpartum anxiety disorders are not diagnosed - firstly because those affected are ashamed of not conforming to society's image and their own ideas of the happy young mother, and secondly because postpartum mental illnesses have received little attention in the German psychiatric and gynaecological literature to date. In contrast to this apparent insignificance, it is estimated that 10-20% of young mothers in the postpartum period suffer from depression and anxiety disorders that require treatment. It is not only the mother's mental health that makes professional treatment of postpartum mental illnesses extremely important. Both postpartum depression and postpartum anxiety disorders have a detrimental effect on the development of a stable mother-child relationship as well as on the intellectual and emotional development of the child. In previous studies, little attention has been paid to fathers, although they often take over many of the mother's functions when the child is mentally ill and also experience a high level of psychological stress. For this reason, it seems important to us to take a closer look at co-operation within the family system in addition to an additional survey of fathers.

Study procedure:
In a prospective longitudinal design, "depressed", "anxiety-disordered" and "healthy" mother-child pairs and triads were examined in comparison to a healthy control group. The aim of the planned study was to investigate the significance of postpartum depression and anxiety disorders for the child's emotional-affective development. In a prospective longitudinal design, children of postpartum depressed (N=62) and postpartum anxiety disordered mothers (N=114) were examined at a total of two main measurement points at the ages of 3-3.5 years and 4-5 years in comparison to a healthy control group.
The following analyses were carried out at both measurement points as part of a multifactorial model: Child attachment pattern (FST), mother's attachment representation (AAP), mother's mental health (SKID-I), family alliance (LTP), child's social and emotional development (CBCL 1 ½ - 5), socio-demographic data (questionnaire set) and father's mental health (questionnaire set). The time interval between the two measurement points was 4-6 weeks.

Initial results:
Six per cent of the participating mothers suffered from postpartum depression, while eleven per cent were diagnosed with an anxiety disorder and a further 55 with so-called baby blues. In addition, 9% of all mothers surveyed were found to have an impaired relationship with their infant, both emotionally and behaviourally. It was found that the more severe the depression, the more impaired the relationship between mother and child.
Mothers with postpartum depression rated their maternal self-efficacy significantly lower than healthy mothers. Maternal self-efficacy is the mother's belief in her own ability to have a positive influence on the child's behaviour and development. The assessment of their self-efficacy also fell the more severe the depression was.
Even if these psychological abnormalities are only present to a small extent, this can already have an influence on the child's development. This influence has so far only been investigated in the Anglo-American region.

Publications:

• Reck C, Klier CM, Pabst K, Stehle E, Steffenelli U, Struben K, Backenstrass M. (2006). The German version of the Postpartum Bonding Instrument: Psychometric properties and association with postpartum depression. Archives of Womens' Mental Health 9, 265-271.
• Reck C, Struben K, Backenstrass M, Stefenelli U, Reinig K, Sohn C, Mundt Ch (2008). Prevalence, Onset and Comorbidity of Postpartum Anxiety and Depressive Disorders. Acta Psychiatrica Scandinavica 118, 459-468.
• Reck C, Stehle E, Reinig K, Mundt, C (2009). Maternal Blues as a Predictor of Postpartum Depression and Anxiety Disorders in a German community sample. Journal of Affective Disorders, 113:1-2, 77- 87.

Content and aims:

The aim of the research project was to analyse specific behavioural patterns in the course of illness of postpartum depressed mothers and their infants in relation to the severity of the mother's depression. Interactional patterns on the maternal and infant side were analysed during the first months of the infants' lives in connection with the severity of depression and the course of the mother's illness. The central question was the relationship between the severity of depression, the quality of the mother-child interaction and early childhood psychophysiological reaction patterns during the course of the illness.

Background:
Depression is the most common mental illness in the postpartum period. Disorders of mother-child interaction as well as infant emotional and cognitive developmental deficits have been repeatedly demonstrated in connection with postpartum depression. The findings reported in the literature indicate that maternal interaction behaviour plays a central role as a mediating variable between maternal depressive symptoms and child developmental deficits. According to previous research findings, these interaction processes are significantly impaired in postpartum depression, which has an unfavourable effect on the emotional and cognitive development of the infant as well as the course of the mother's illness. However, it is still largely unclear whether an improvement in maternal depression is also accompanied by a positive development of interactional behaviour patterns, or whether the unfavourable patterns developed during the depressive phase persist - with lasting consequences for the child's further development.

Study procedure:
The quality of the mother-child relationship and the extent of early childhood stress reactions were predicted on the basis of the severity of depression during the course of the illness. The mother-child interactions were analysed videographically in structured face-to-face interactions and evaluated microanalytically and macroanalytically at two measurement points ('acute phase of depression, T1' and 'remission of depression, T2'). The analysed parameters of the videotaped face-to-face interactions and the infant stress reactions of the depressed mothers and their infants were compared with the data of a healthy control group at both measurement times. As part of the controlled follow-up design of the projected study, differential indication criteria for the use of specific mother-child-centred interventions in the treatment of postpartum depression were to be determined.

First results:
In the macroanalytical evaluation of maternal interactional sensitivity, a clear difference between the groups was found when comparing the depressed and healthy mother-child dyads at both measurement times T1 (acute phase of illness) and T2 (phase of remission). The depressed mothers showed significantly more intrusive and less sensitive behaviour than the healthy mothers. Furthermore, they exhibited a higher degree of withdrawal behaviour and less positive engagement in the interaction with their infants. The infants of the depressed mothers made less eye contact with their mothers compared to the infants of the healthy mothers and showed less engagement in the neutral affect domain.
At the same time, however, the difference between the two measurement times T1 (acute depression) and T2 (remission of depression) was not statistically significant in either group. Accordingly, there were no changes in the mothers' sensitivity, intrusiveness and withdrawal behaviour over the course of the illness. These results make it clear that in addition to the treatment of maternal depression, interaction therapy of the mother-child dyads is always essential.
In order to prevent child development disorders as a result of early childhood exposure to stress in mother-child interaction, the knowledge gained from this study on early mother-child interaction in cases of maternal depression is directly incorporated into the clinical practice of the mother-child unit located here in the form of early video-microanalytic therapy according to Downing.
In order to determine differentiated indication criteria for the use of specific mother-child-centred interventions in the treatment of postpartum depression, further case-specific evaluations will follow based on the interactions between the infant and "strangers", e.g. with regard to the avoidance of eye contact. The video coding for this has already been carried out.

Study management:
Prof. Dr Corinna Reck (LMU Munich)

in cooperation with: Prof. Dr Dr Th. Fuchs, Heidelberg University Hospital; Prof. Dr Christoph Mundt, Heidelberg University Hospital

Contact: Dr Nora Nonnenmacher

Follow-up study:
In the follow-up study (so-called attachment study), the attachment behaviour of the child to the mother, the attachment representations of the mother and the intra-family relationships are now to be investigated at pre-school age (3rd - 5th year of life). The systematic consideration of specific characteristics of the course of the disorder, such as the severity and chronicity of the mother's mental illness, is planned. The long-term goal is the acquisition of basic knowledge for the planning of disorder-specific mother-child and family-centred interventions with the aim of preventing childhood developmental deficits and attachment disorders.