Integrative-interpersonal dynamic therapy for poststroke depression (INID): study protocol of a randomised controlled pilot trial.

INTRODUCTION: Depression is the most frequent psychiatric disorder following stroke, affecting about one-third of stroke survivors. Patients experience poorer recovery, lower quality of life and higher mortality compared with stroke survivors without depression. Despite these well-known malign consequences, poststroke depression (PSD) is regarded underdiagnosed and undertreated. Evidence of beneficial effects of psychotherapy to treat PSD remains scarce and inconclusive and is limited by heterogeneity in design, content and timing of the intervention. This pilot study aims to assess the feasibility of a newly developed integrative-interpersonal dynamic PSD intervention in an outpatient setting and provide a first estimation of the potential effect size as basis for the sample size estimation for a subsequent definite trial. METHOD AND ANALYSIS: Patients will be recruited from two German stroke units. After discharge from inpatient rehabilitation, depressed stroke survivors will be randomised to short-term psychotherapy (12 weeks, ≤16 sessions) or enhanced treatment as usual. The manualised psychotherapy integrates key features of the Unified Psychodynamic and Cognitive-Behavioural Unified Protocol for emotional disorders and was adapted for PSD. Primary endpoints are recruitment feasibility and treatment acceptability, defined as a recruitment rate of ≥20% for eligible patients consenting to randomisation and ≥70% completion-rate of patients participating in the treatment condition. A preliminary estimation of the treatment effect based on the mean difference in Patient Health Questionnaire-9 (PHQ-9) scores between intervention and control group six months poststroke is calculated. Secondary endpoints include changes in depression (PHQ-9/Hamilton Depression Scale) and anxiety (Generalised Anxiety Disorder 7) of all participants across all follow-ups during the first year poststroke. ETHICS AND DISSEMINATION: The INID pilot study received full ethical approval (S-321/2019; 2022-2286_1). Trial results will be published in a peer-reviewed journal in the first half of 2025. One-year follow-ups are planned to be carried out until summer 2025. TRIAL REGISTRATION NUMBER: DRKS00030378.

Intergenerational transmission of mental health risk in refugee families: The role of maternal psychopathology and emotional availability.

To prevent an intergenerational cycle of malfunction, it is crucial to understand how mothers' exposure to traumatic war experiences contributes to their children's vulnerability to mental health problems. This study examined the role of maternal psychopathology and mother-child emotional availability (EA) in the association between mothers' trauma exposure and children's mental health problems in a sample of 222 Burundian mother-child dyads living in refugee camps in Tanzania. Maternal and child EA were assessed through recorded observations of mother-child interactions. In structured clinical interviews, mothers reported on their lifetime exposure to traumatic events and their psychopathology and both mothers and fathers reported on children's emotional and behavioral problems. Structural equation modeling showed that mothers' higher trauma exposure was indirectly associated with higher levels of children's mental health problems through higher levels of maternal psychopathology. Mothers' higher trauma exposure was also directly associated with lower maternal EA in mother-child interactions, which was in turn related to higher levels of children's mental health problems. The findings suggest that trauma exposure independently affects mothers' mental health and their EA, which can contribute to children's mental health problems. Interventions aiming to reduce mothers' psychopathology and strengthen their EA may be beneficial for children's well-being.