DAPPER-studie.

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. This group of pregnant women request, based on the high prevalence of psychopathology, in combination with the adverse obstetrics outcomes for extra psychiatric and obstetric 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 multicultural 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. In this RCT we compare daycare with treatment as usual. Primary outcome is the psychiatric symptom reduction, based on questionaires (EPDS).

N/A

EPDS at intake (>12 weeks gestational age), during treatment every 5 weeks, until 6 weeks postpartum. BSI and Hamilton depression scale at intake and after 6 weeks postpartum.

RCT: Daycare vs treatment as usual (TAU).



At the Erasmus MC psychiatry department there's a weekly daycare for (max 8) psychiatric, pregnant women. This multidisciplenary treatment consists of the following components:

1. Theme discussion guided by a social psychiatric nurse;

2. Psychoeducation by a psychiatrist;

3. Psychomotor therapy, focused on contact between mother and child;

4. Cognitive-behavioral therapy;

5. Relaxation therapy.



The individual outpatient care (TAU) is a low frequency counseling / treatment provided by a social psychiatric nurse or doctor in training as a psychiatrist, with the primary goal of psychological education and symptom reduction, related to psychiatric symptoms.