Daycare Alternative Psychiatric Pregnant women Efficiency Research

During pregnancy there are big physical, social en psychological changes. These
changes can induce psychiatric complaints which makes professional treatment
needed. Approximately 1 out of 8 pregnant women has a psychiatric disorder,
that needs to be treated. Severe depression and anxiety disorders have an
adverse effect on pregnancy, delivery and the development of the child.
Recent studies in Rotterdam confirmed a high prevalence of psychopathology
among pregnant women. 10.8% of the pregnant women had clinical, relevant
depressive complaints and 12,1% had clinical, relevant anxiety complaints.
Among the pregnant women with a non-Dutch etnicity these percentages were even
higher, till 29.8%. 41% of the participated women had a non-Dutch etnicity.
In addition, the number of pregnancy rises among non-Dutch populationgroups,
both relative as absolute. This increasing group of non-Dutch pregnant women
request, based on the high prevalence of psychopathology, in combination with
the adverse obstetrics outcomes for extra psychiatric and obstetrics treatment.
Until now, there is no appropriate treatment for this group. It would be ideal,
if this treatment would be on the interface of psychiatry and obstetrics.
In the Erasmus Medical Centre there is a structered collabration between the
departments of psychiatry and obstetrics.
This was the beginning of the daycare treatment for pregnant women with
psychiatric disorders, started as a pilot from 2005. This groupwise approach is
an unique treatment for a multiculteral group, to manage a decrease of
psychiatric complaints and to promote a medical uncomplicated pregnancy and
delivery.
A real treatment, like a weekly daycare treatment with involvement of a
psychiatrist and gynaecologist seems to be promising but the effectiveness and
efficiency, in a psychiatric and obstetric point of view, has to be proved with
this study.

Primary objective:
To evaluate the efficiency of the daycare treatment of pregnant women with a
psychiatric disorder.

Secondary objective:
Differs groupwise daycare treatment in efficiency towards standard individual
outpatient care, in terms of:
a. Reduction of psychiatric complaints of the mother?
b. Reduction of complicated pregnancies and deliveries?
c. Reduction of care use during and after the pregnancy?

Randomised controlled trial.

Daycare treatment vs 'treatment as usual'
This groupwise daycare treatment is a weekly, structured program on the
department Psychiatry of the Erasmus Medical Center. This contains:
themediscussion with a social psychiatric nurse, psycho-education by a
psychiatrist, psychomotor therapy by a movement therapist focussed on a
connection between mother and child, cognitive behavioral by a psychologist and
relaxingtherapy by an activitycounsellor.

Het invullen van de vragenlijsten elke 5 weken en het wekelijks bijhouden van
een dagboek kost veel tijd en is zeker voor de zwangere vrouw een belasting,
maar mogelijk heeft het een therapeutisch effect.

To fill in the questionnaires every 5 weeks and to fill in a dairy weekly takes
a lot of time, especially for pregnant women. Probably it has a therapeutical
benefit.