Ricerca
Supporto precoce ai neogenitori E necessario? Serve?
EARLY SUPPORT TO PARENTS: IS IT NEEDED? DOES IT WORK?
MARIA GRAZIA APOLLONIO1, CHIARA BARBIERO1,4, SABRINA BASCUCCI3, TAMARA CHERT1,4, RACHELE NANNI3, ELENA PAVIOTTI1, MARCELLA MONTICO2, FRANCESCO CIOTTI3, GIORGIO TAMBURLINI1
1Unità per la Ricerca sui Servizi Sanitari Istituto per l’infanzia IRCCS “Burlo Garofolo”, Trieste;
2Servizio di Epidemiologia e Biostatistica, Direzione Scientifica, Istituto per l’infanzia IRCCS “Burlo Garofolo”, Trieste;
3Servizio di NPI, AUSL Cesena;
4CSB - ONLUS, Trieste
Novembre 2005 - pagg. 589 -598
Abstract
Early (pre and postnatal) support to parents is widely seen as an effective strategy to improve
both parental and child wellbeing and health. The effects of two different interventions addressing
parents during the first year of life of their baby were evaluated. Both interventions
were based on a peer counsellor (mother-to-mother) approach, but while parents at social risk
received a more complex intervention including home visitations, unselected parents were
offered only the participation to meetings among them, with some professional support. 102
families (53 at risk and 49 not at risk) took part in the study, 31 received the intervention and
71 were controls. Results show that at risk parents are less likely to comply to good health practices
(28.3% vs 83.7%), more likely to be at risk of maternal depression (30.2% vs. 10.2%) less
likely to offer an adequate home environment (13.5% vs. 61.2%); their babies had a lower score
at development scales (although all within the normal range). Families receiving the interventions
in the at risk group improved over time their compliance with good health practices
(42.9% vs 28.3%), the adequacy of the home environment (71.4% vs. 51.3%). Unselected parents
also received some benefit from the intervention. Programmes of early support to parents
need to be promoted at large scale and can be based on non-professional interventions. A simple
multidimensional evaluation approach is recommended.
Parole chiave
Classificazione MeSH
Bibliografia
1. Freud A. Conferenze per genitori e insegnanti.
Torino: Boringhieri, 1986.
2. Winnicott DW. Il bambino e la famiglia. Giunti Barbera, 1973.
3. Bowlby J. Attaccamento e perdita. Vol. 1-3. Torino: Boringhieri, 1972-1983.
4. Bettelheim B. Un genitore quasi perfetto. Milano: Feltrinelli, 1987.
5. Schaffer HR. L’interazione madre-bambino: oltre la teoria dell’attaccamento. Milano: F. Angeli, 1993.
6. Bee H. Lo sviluppo del bambino. Bologna: Zanichelli, 1999.
7. Chapman J, et al. Home visitors and child health: analysis of selected programs. Pediatrics 1990;85:1059.
8. Hendrick D, et al. Does home visiting improve parenting and the quality of home environment? A systematic review and metanalysis. Arch Dis Child 2000;82:443.
9. Barlow J. Systematic review of the effectiveness of parent training programmes in improving behaviour problems in children aged 3-10 years. Health Services Research Unit Oxford, 1999.
10. Barlow J, Coren E. Parent training programmes for improving maternal psychosocial health. Cochrane Review, 2001.
11. Ciotti F. Il sostegno domiciliare come fattore protettivo. Quaderni acp 2001;8(2):56-8.
12. Semprini R. Ci sono fattori di rischio per il bambino, ma anche di protezione. Quaderni acp 2000;6:45.
13. American Academy of Pediatrics. The role of home-visitation programs in improving health outcomes for children and family. Pediatrcs 1998;101(3):486-89.
14. Collins NC, et al. Social Support in pergnancy: psycosocial correlates of birth outcomes and postpartum depression. J Pers Soc Psycol 1993;65:1243-58.
15. Green BL, Rodgers A. Determinants of social support among low income mothers: a longitudinal analysis. American Journal of Community Psychology 2001;29:419-41.
16. Lyons-Ruth K. Dalla nascita all’età scolare: l’influenza dei fattori materni, dell’attaccamento infantile e dell’intervento preventivo sullo sviluppo del bambino a rischio sociale. Prospettive Psicoanalitiche nel Lavoro Istituzionale 1999;1(2):164.
17. Mc Curdy K. Can home visitation enhance maternal social support? American Journal of Community Psychology 2001;29:97-112.
18. Murray L, Cooper PJ. Effects of postnatal depression on infant development. Arch Dis Child 1997;77:99-101.
19. Olds DL. Prenatal and infancy home visiting by nurses: from randomised trials to community replication. Prevention Science 2002; 3:153-72.
20. Olds DL, Henderson CR, Kitzaman H, Eckenrode J, Cole R, Tatelbaum R. Prenatal and infancy home visitation by nurses: a program of research. In: Rovee-Collier C, Lipsitt LP, Hayne H (Eds). Advances in Infancy Research, Vol. 12. Stamford, CT: Ablex Publishing Corp, 1998.
21. Olds DL, Henderson CR, Tatelbaum R, Chamberlin R. Improving the delivery of prenatal care and outcomes of pregnancy: a randomized trial of nurse home visitation. Pediatrics 1986;77:16-28.
22. Olds DL, Hill PL, O’Brien RA, Racine Y, Moritz P. Taking preventive intervention to scale: the nurse family partnership, cognitive and behavioural. Practice, 2002.
23. Olds DL, Kitzman H. Review of research on home visiting. The Future of children 1993; 3:51-92.
24. Olds DL, Robinson JA, O’Brien R, Luckey DW, Pettit LM, Henderson CR, et al. Home visiting by paraprofessionals and by nurses: a randomised controlled trial. Pediatrics 2002; 110:486-96.
25. Olds DL, Eckenrode J, Henderson CR Jr, et al. Long term effects of home visitation on maternal life course and child abuse and neglect: 15 year follow-up of a randomized trial. JAMA 1997;278:637-43.
26. Olds DL, Henderson CR Jr, Kitzman H. Does prenatal and infancy nurse home visitation have enduring effects on qualities of parental caregiving and child health at 25-50 months of life? Pediatrics 1994;93:89-98.
27. Quinlivan JA, Box H, Evans SF. Postnatal home visits in teenage mothers: a randomised controlled trial. Lancet 2003;361:893-900.
28. Byrd ME. A tipology of the potential outcomes of maternal child home visits: a literature analysis. Public Health Nursing 1997;14: 3-11.
29. Rutter M. I disturbi psicosociali dei giovani: sfide per la prevenzione. Roma: Armando Ed, 2002.
30. European Union Public Health Approach to Mental Health in Europe, 1999.
31. Report of the Surgeon General on Mental Health, USA, 1999.
32. WHO Framework for Promoting Mental Health in Europe, 2000.
33. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10 item Edinburgh Postnatal Depression Scale. Br J Psych 1987;150:782-86.
34. Cox JL, Holden JM. Perinatal Psychiatry: use and misure of Edinburgh Postanatal Depression Scale. London: Gaskell, 1994.
35. Cox JL, Holden JM. Perinatral Mental Health: a guide to the Edinburgh Postnatal Depression Scale (EPDS). London: Gaskell, 2003.
36. Forman DN, Videbeach P, Hedegaard M, Salvig Jd, Secher NJ. Postpartum depression: identification of women at risk. Br J Obst Gynaecol 2000;107:1210.
37. Guedeney N, Fermanian J, Guelfi JD, Kumar R. The Edinburgh Postnatal Depression Scale and the detection of major depressive disorders in early postpartum: some concerns about false negative. J Affect Disord 2000; 61:107-12.
38. Matthey S, Barnett B, White T. The Edinburgh Postnatal Depression Scale. Br J Psych 2003;182:368.
39. Scottish Intercolegiate Guidelines Network. Postnatal depression and puerperal psychosis. Guidelines Edinburgh, SIGN, 2002.
40. Abidin RR. Parenting Stress Index: Test Manual. Pediatric Press Charlottesville, 1986.
41. Abidin RR. Parenting Stress Index: Short Form Manual. Pediatric Press Charlottesville, 1990.
42. Abidin RR. Parenting Stress and the utilization of pediatric service. Children’s Health Care 1982;2:70-3.
43. Abidin RR, Wilfong E. Parenting Stress and its relationship to child health care. Children’s Health Care 1989;18:114-17.
44. Caldwell B, et al. Home observation for measurement of the environment: administration manual. University of Arkansas Press, Little Rock, 1984.
45. Capotorti F, Siglienti L, Battaini A, Di Tullio F, Rosenholtz E, Vecerova S, et al. La valutazione dell’ambiente familiare negli studi longitudinali di sviluppo infantile. Medico e Bambino 1987;9:16-23.
46. Capotorti L. La valutazione dell’ambiente familiare: ha un senso per il pediatra di base? Medico e Bambino 1988;8:50-3.
47. Capotorti L, Luchino F, Buccisano E, Ghera MR, La Via L, Siglienti L, et al. Analisi dei fattori familiari che influenzano lo sviluppo del bambino. L’AIRE: uno strumento di valutazione dell’ambiente familiare ad uso del pediatra. Medico e Bambino 1991;9:38-45.
48. Sparrow S, Balla D, Cicchetti D. Adaptive Behavior Scales-Test Manual. Adattamento Italiano a cura di Balboni G e Pedrabissi L. Firenze: OS, 2003.
49. Spadea T, Cois E. I determinanti delle diseguaglianze di salute in Italia. I primi anni di vita. Epidemiologia e Prevenzione 2004;28 suppl:26-31.
50. Ammanniti M. Valutazione degli effetti di un intervento di supporto a madri a rischio psicosociale. Relazione al Convegno “Nascere insieme”. Cesena, marzo 2005.
51. Tamburlini G. Supporto alla funzione genitoriale e promozione della salute mentale in età evolutiva. Atti Conferenza Nazionale sulla salute mentale. Ministero della Salute, Roma, 10-12 gennaio 2001.
2. Winnicott DW. Il bambino e la famiglia. Giunti Barbera, 1973.
3. Bowlby J. Attaccamento e perdita. Vol. 1-3. Torino: Boringhieri, 1972-1983.
4. Bettelheim B. Un genitore quasi perfetto. Milano: Feltrinelli, 1987.
5. Schaffer HR. L’interazione madre-bambino: oltre la teoria dell’attaccamento. Milano: F. Angeli, 1993.
6. Bee H. Lo sviluppo del bambino. Bologna: Zanichelli, 1999.
7. Chapman J, et al. Home visitors and child health: analysis of selected programs. Pediatrics 1990;85:1059.
8. Hendrick D, et al. Does home visiting improve parenting and the quality of home environment? A systematic review and metanalysis. Arch Dis Child 2000;82:443.
9. Barlow J. Systematic review of the effectiveness of parent training programmes in improving behaviour problems in children aged 3-10 years. Health Services Research Unit Oxford, 1999.
10. Barlow J, Coren E. Parent training programmes for improving maternal psychosocial health. Cochrane Review, 2001.
11. Ciotti F. Il sostegno domiciliare come fattore protettivo. Quaderni acp 2001;8(2):56-8.
12. Semprini R. Ci sono fattori di rischio per il bambino, ma anche di protezione. Quaderni acp 2000;6:45.
13. American Academy of Pediatrics. The role of home-visitation programs in improving health outcomes for children and family. Pediatrcs 1998;101(3):486-89.
14. Collins NC, et al. Social Support in pergnancy: psycosocial correlates of birth outcomes and postpartum depression. J Pers Soc Psycol 1993;65:1243-58.
15. Green BL, Rodgers A. Determinants of social support among low income mothers: a longitudinal analysis. American Journal of Community Psychology 2001;29:419-41.
16. Lyons-Ruth K. Dalla nascita all’età scolare: l’influenza dei fattori materni, dell’attaccamento infantile e dell’intervento preventivo sullo sviluppo del bambino a rischio sociale. Prospettive Psicoanalitiche nel Lavoro Istituzionale 1999;1(2):164.
17. Mc Curdy K. Can home visitation enhance maternal social support? American Journal of Community Psychology 2001;29:97-112.
18. Murray L, Cooper PJ. Effects of postnatal depression on infant development. Arch Dis Child 1997;77:99-101.
19. Olds DL. Prenatal and infancy home visiting by nurses: from randomised trials to community replication. Prevention Science 2002; 3:153-72.
20. Olds DL, Henderson CR, Kitzaman H, Eckenrode J, Cole R, Tatelbaum R. Prenatal and infancy home visitation by nurses: a program of research. In: Rovee-Collier C, Lipsitt LP, Hayne H (Eds). Advances in Infancy Research, Vol. 12. Stamford, CT: Ablex Publishing Corp, 1998.
21. Olds DL, Henderson CR, Tatelbaum R, Chamberlin R. Improving the delivery of prenatal care and outcomes of pregnancy: a randomized trial of nurse home visitation. Pediatrics 1986;77:16-28.
22. Olds DL, Hill PL, O’Brien RA, Racine Y, Moritz P. Taking preventive intervention to scale: the nurse family partnership, cognitive and behavioural. Practice, 2002.
23. Olds DL, Kitzman H. Review of research on home visiting. The Future of children 1993; 3:51-92.
24. Olds DL, Robinson JA, O’Brien R, Luckey DW, Pettit LM, Henderson CR, et al. Home visiting by paraprofessionals and by nurses: a randomised controlled trial. Pediatrics 2002; 110:486-96.
25. Olds DL, Eckenrode J, Henderson CR Jr, et al. Long term effects of home visitation on maternal life course and child abuse and neglect: 15 year follow-up of a randomized trial. JAMA 1997;278:637-43.
26. Olds DL, Henderson CR Jr, Kitzman H. Does prenatal and infancy nurse home visitation have enduring effects on qualities of parental caregiving and child health at 25-50 months of life? Pediatrics 1994;93:89-98.
27. Quinlivan JA, Box H, Evans SF. Postnatal home visits in teenage mothers: a randomised controlled trial. Lancet 2003;361:893-900.
28. Byrd ME. A tipology of the potential outcomes of maternal child home visits: a literature analysis. Public Health Nursing 1997;14: 3-11.
29. Rutter M. I disturbi psicosociali dei giovani: sfide per la prevenzione. Roma: Armando Ed, 2002.
30. European Union Public Health Approach to Mental Health in Europe, 1999.
31. Report of the Surgeon General on Mental Health, USA, 1999.
32. WHO Framework for Promoting Mental Health in Europe, 2000.
33. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10 item Edinburgh Postnatal Depression Scale. Br J Psych 1987;150:782-86.
34. Cox JL, Holden JM. Perinatal Psychiatry: use and misure of Edinburgh Postanatal Depression Scale. London: Gaskell, 1994.
35. Cox JL, Holden JM. Perinatral Mental Health: a guide to the Edinburgh Postnatal Depression Scale (EPDS). London: Gaskell, 2003.
36. Forman DN, Videbeach P, Hedegaard M, Salvig Jd, Secher NJ. Postpartum depression: identification of women at risk. Br J Obst Gynaecol 2000;107:1210.
37. Guedeney N, Fermanian J, Guelfi JD, Kumar R. The Edinburgh Postnatal Depression Scale and the detection of major depressive disorders in early postpartum: some concerns about false negative. J Affect Disord 2000; 61:107-12.
38. Matthey S, Barnett B, White T. The Edinburgh Postnatal Depression Scale. Br J Psych 2003;182:368.
39. Scottish Intercolegiate Guidelines Network. Postnatal depression and puerperal psychosis. Guidelines Edinburgh, SIGN, 2002.
40. Abidin RR. Parenting Stress Index: Test Manual. Pediatric Press Charlottesville, 1986.
41. Abidin RR. Parenting Stress Index: Short Form Manual. Pediatric Press Charlottesville, 1990.
42. Abidin RR. Parenting Stress and the utilization of pediatric service. Children’s Health Care 1982;2:70-3.
43. Abidin RR, Wilfong E. Parenting Stress and its relationship to child health care. Children’s Health Care 1989;18:114-17.
44. Caldwell B, et al. Home observation for measurement of the environment: administration manual. University of Arkansas Press, Little Rock, 1984.
45. Capotorti F, Siglienti L, Battaini A, Di Tullio F, Rosenholtz E, Vecerova S, et al. La valutazione dell’ambiente familiare negli studi longitudinali di sviluppo infantile. Medico e Bambino 1987;9:16-23.
46. Capotorti L. La valutazione dell’ambiente familiare: ha un senso per il pediatra di base? Medico e Bambino 1988;8:50-3.
47. Capotorti L, Luchino F, Buccisano E, Ghera MR, La Via L, Siglienti L, et al. Analisi dei fattori familiari che influenzano lo sviluppo del bambino. L’AIRE: uno strumento di valutazione dell’ambiente familiare ad uso del pediatra. Medico e Bambino 1991;9:38-45.
48. Sparrow S, Balla D, Cicchetti D. Adaptive Behavior Scales-Test Manual. Adattamento Italiano a cura di Balboni G e Pedrabissi L. Firenze: OS, 2003.
49. Spadea T, Cois E. I determinanti delle diseguaglianze di salute in Italia. I primi anni di vita. Epidemiologia e Prevenzione 2004;28 suppl:26-31.
50. Ammanniti M. Valutazione degli effetti di un intervento di supporto a madri a rischio psicosociale. Relazione al Convegno “Nascere insieme”. Cesena, marzo 2005.
51. Tamburlini G. Supporto alla funzione genitoriale e promozione della salute mentale in età evolutiva. Atti Conferenza Nazionale sulla salute mentale. Ministero della Salute, Roma, 10-12 gennaio 2001.