Background to development of Towards Parenthood€¦ · • Rehearsal ways of coping with problem scenarios (eg, baby not gaining weight). • 10 tip sheets for quick reference. Piri

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Piri March 2009

An intervention to prepare for the changes and challenges of a new baby

Jeannette Milgrom, Jennie Ericksen, Charlene SchembriParent-Infant Research Institute

Piri March 2009

The ParentThe Parent--Infant Research Institute (PIRI)Infant Research Institute (PIRI)

ParentParent--Infant Infant Research InstituteResearch Institute

CEO: CEO: Professor Jeannette MilgromProfessor Jeannette Milgrom (Director, Clinical & Health (Director, Clinical & Health Psychology)Psychology)

Board Members: Board Members: Lance Coburn, Graeme Lance Coburn, Graeme HenshawHenshaw, Graeme , Graeme WoolacottWoolacott, Felicity Broadbent,, Felicity Broadbent,Dr John Ferguson, Jennifer Ericksen, Wendy Peter, Barbara WellesDr John Ferguson, Jennifer Ericksen, Wendy Peter, Barbara Wellesleyley

Minute Secretary:Minute Secretary: Barbara FrazerBarbara Frazer

Coordinator Infant Clinic:Coordinator Infant Clinic: Jennifer EricksenJennifer EricksenSenior Project Officer:Senior Project Officer: Dr. Alan Dr. Alan GemmillGemmillPostdoctoral Fellow: Postdoctoral Fellow: Dr. Carol NewnhamDr. Carol NewnhamResearch Assistants:Research Assistants: Chris Holt, Elizabeth Chris Holt, Elizabeth BarbanteBarbanteClinical Researchers:Clinical Researchers: Elizabeth Loughlin, Charlene Elizabeth Loughlin, Charlene SchembriSchembri, Sarah Philips, Megan Andrew,, Sarah Philips, Megan Andrew,

HettieHettie DubowDubowResearch Students:Research Students: Carmel Carmel FerrettiFerretti, Lisa Milne, Vanessa McKay, Lisa Bates, Lisa Milne, Vanessa McKay, Lisa Bates

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Major aim of PIRI –

Research

Direct Service

Provision

Public Health& CommunityDevelopment

PractitionerDevelopment

To develop and apply treatments to improve parent /infant mental health

Parent-Infant Research Institute

Piri March 2009

Background to development ofTowards Parenthood

Piri March 2009

The beyondblue

National Postnatal Depression Program(2001-2006)

An Australian screening and preventive intervention initiative

Piri, Victorian and Tasmanian Project ManagementPiri March 2009

What was the beyondblue National Postnatal Depression Program?

A collaboration between beyondblue: the national depression initiative and leading

Australian perinatal mental-health specialists

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A Focus on Depression

• lowered mood• sad,tearful,irritable

• loss of interest• sex,hobbies,self

• changes in appetite• eating too much or little

• changes in sleep patterns

• trouble sleeping or waking

• feeling worthless• guilty,low self esteem

• lack of energy• tired all the time

• reduced concentration• confused,trouble

deciding,slow thinking• psychomotor changes

• slowed or agitated movtor speech

• thought about death• preoccupation or

suicidal thoughtsPiri March 2009

1 in 10 women

have ante or perinatal depression (10-20%)

Most women do not seek

help

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Objectives NPDPDevelop, implement and evaluate screening and early intervention programs for antenatal and postnatal depression(PND)Increase community and health professional awareness of perinatal depression and decrease stigmaProvide education to women at risk & health professionalsLarge database (recommendations have led to federal government commitment of $85 )

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NPDP Screening ProtocolANTENATAL SCREENING (ALL WOMEN)AT MATERNITY HOSPITALS

•26-32 weeks antenatally with demographics/PSRF and an EPDS; 10% to also receive K10 & Sphere

STANDARD INTERVENTION PACKAGE•Education & Resource booklet (all mothers); notification and management guide (GPs);

tailored education packages (GPs, MCHNs and Midwives).

Towards ParenthoodSTATE-BASED TARGETED INTERVENTION

POSTNATAL SCREENING (ALL WOMEN)•6-8 weeks postpartum with EPDS only

END EVALUATION• New mothers at 12 weeks postpartum surveyed with EPDS, vignette,

services used & evaluation of education booklet• Health professionals surveyed with vignette, knowledge questionnaire,

evaluation of EPDS and referral patternsFOLLOW-UP OF

TARGETED INTERVENTION

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Why target antenatal women?

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• The woman herself (ongoing mood symptoms)

• Her infant (62% dysfunctional relationship, infant cognitive difficulties)

• Her partner (relationship breakdown)

Antenatal Depression places Women at Increased Risk for PND( Milgrom et al 2008 J Affective Disorders)

Long-term consequences of postnatal depression on:

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Piri March 2009

Differential Psychosocial Risk Factors:predicting parenting stressAntenatal depression

-low self-esteem,antenatal anxiety,social support,negative cognitive style,major life event,low income and history of abuse

Postnatal Depression-antenatal depression and history of

depression

Parenting Stress-postnatal depression was the only

significant predictor Piri March 2009

Both Behaviour and Depression/Stress in Pregnancy Influence Perinatal Outcomes

Lifestyle Behaviours OutcomesAntenatal/Postnatal

Smoking

Exercise (< or >)

Diet

Psychological status

Depression

Anxiety/stress

Medical, environmental and genetic influences

Self care

Nutrition

Birth weight

Preterm birth

Eclampsia

Adverse obstetric outcome

Postnatal depression

Parenting difficulties

Crying

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Pregnancy Stress and Infant Outcomes

Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus:links and possible mechanisms.A ReviewBea et al neuroscience and Behavioural Reviews 29 (2005)237-258-antenatal maternal mood is linked to fetal behaviour-substantial long-term effects on behaviourvia fetal programming may invove the HPA-axis

Campbell & Mottola, 2001 Piri March 2009

Summary:the Need for Antenatal Preventive Programs• Antenatal depression(AND) predicts postnatal

depression (PND)and both AND and PND have long term effects on the infant.

• Perinatal health outcomes • Current antenatal prevention programs

largely target PND but not parenting.• Poor results to date may be due to limitations

of methodology (e.g. sample size).• The need for innovative programs that take

into account that risk factors for parenting difficulties and PND overlap.

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Do infants of depressed mothers cry more?

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Depression and infant cryingMilgrom, Westley & McCloud 1995

• Compared the crying behaviour of infants of depressed (29) and non depressed (44) mothers at 3 & 6 months of age

• Depressed mothers – gaze & rock infants less – are less decisive and active– less well timed responsiveness– lower levels of warm acceptance (Field et al 1985, Murray 1988,

Bettes 1988)

• Infants of depressed mothers– more drowsy, distressed and fussy– looking at mother less and are more self directed activity (Cox 1988)

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Measures• Depressed mothers from inpatient MBU average age 31.4

years

• Comparison group from MCHN average age 30.6 years

• 24 hour diary of the amount of infant crying for 1 week at 3 and at 6 months completed by mothers (Barr et al 1988)

• Australian Temperament scale revised short form completed by mothers

• Edinburgh postnatal depression scale for mothers

• Parenting Stress Inventory , subscale ‘Infant demandingness’ completed by mothers and fathers

Piri March 2009

Findings• Excessive crying in infants at 3 months

may be related to maternal depression– Infants of depressed mothers cried longer– The difference is not due to temperament– No differences at 6 months

• Crying peaked in the afternoon and early evening for all infants at 3 months with a trend showing a reduction in total crying per week by 6 months. In line with other studies. (St James-Roberts et al 1989, 1993)

Piri March 2009 Piri March 2009

Infant, maternal and paternal factors associated with infant cry behaviour

McKay & Milgrom 2008

• No single infant, parental or environmental factor has been reliably associated with problematic infant cry behaviour. review McKay 2008

• 51 m-f dyads from community completed 4 surveys over infants’ first 6 months. – Infant cry pattern questionnaire– Personal resources, health & parenting competency, – Social resources, marital & social support– Parental emotional outcome coping & depressive

symptoms– Infant temperament

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Findings• Parents who rated as more competent and were coping

better, appraised their infant’s cry behaviour as less problematic and distressing and their infant as less difficult on an infant temperament scale

• Greater father involvement was associated with less problematic cry behaviour, more positive partner relationship and levels of social support. However was not associated with maternal variables such as distress and coping.

• Negative appraisal of infant crying was associated with poor mother emotional outcomes on mood and coping but not for fathers

Piri March 2009

An intervention to prepare for the changes and challenges of a new baby

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Piri March 2009

“Towards Parenthood”Development of Package

• Intervention targets selected on basis of “clinical wisdom” and exhaustive empirical review via PsycInfo of risk factors impacting on parenting outcomes.

• Incorporating biopsychosocial risk factors for PND.

• Extensive review of existing local and international parenting support programs.

• Piloted on sample of women via antenatal clinic and community MCHN & midwives.

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Towards Parenthood Objectives

An intervention designed to prevent early parenting difficulties in depressed and non-depressed women.

To support couples through the transition to parenthood and thus reduce the impact of postnatal depression.

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Intervention Targets Generated• Antenatal Attachment to Foetus. Eg Making

Space for a New Love Relationship:coping with negative feelings about foetus;reflective exercises on family of origin and potential impact on parenting.

• Expectations Regarding Transition to and Demands of Parenthood.

• Relationship Changes and Difficulties.• Coping With Stress and Depression.• Family of Origin Experiences.• Practical Parenting skills.

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The intervention• TP 1, Couples receive separate self-directed

guidebooks comprised of 9 units; 8 antenatal (includes 3 CBT) and 1 integrative post birth module. In TP 2 guidebook was restructured for parents and coping healthy thinking message reinforced

• Composed of cartoons, didactic information, interactive exercises.

• Weekly phone calls from telephone counsellor to monitor compliance and engagement with content.

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Procedure: Women screened with EPDS at 32 weeks pregnancy 2public maternity hospital antenatal clinics

Measures: Beck Depression, Anxiety and Parenting Stress Inventory

Randomized Design:

• Non Depressed EPDS <13

• 50 Toward Parenthood

• 50 Control

• DepressedEPDS >13

• 50 Toward Parenthood

• 50 ControlPiri March 2009

Unit 1:Baby Love –Making Space for a New Love Relationship

• Encouragement of maternal reverie using Cranley’s Maternal Foetal Attachment Scale.

• Coping with negative feelings about fetus.• What do babies need?• Reflective exercises on family of origin &

potential impact on parenting.• Suggestions for play and bonding.

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Piri March 2009

Unit 2: We’re Expecting!• Reflective questions about birth, difficult & fun parts of parenting.• Past experiences of coping with change.• Specific changes in roles, emotions,

finances, relationships, leisure, body image.

• Quiz exploring unrealistic expectations.• Normalising information re emotions.

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We’re Expecting cont...

• Specific training in problem-solving skills.• Brainstorming exercises for common

problems (eg, not enough rest, baby cries constantly, breast feeding problems). Practical suggestions provided in interactive format.

• Cut out “cue card” with realistic messages.



Unit 3: Lovers to Parents

• Reflective questions to explore communication style within relationship.

• Interactive exercises to encourage identification of their vision for a “parenting partnership”, conceptualised in terms of boundaries, investment, control, roles.

• Identification of expectations of each other as a “good mother” and “good father”

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Lovers to Parents continued...

• Interactive exercises to identify influence of parental relationship models.

• Tips for communication & solving conflict.• Tips for maintaining intimacy.• Practical interactive exercise to plan “who

will do what” in terms of baby care and household chores.

• In memory of and gratitude to SherrylPope.


Piri March 2009

Unit 4: Stress Busters• Exercises to identify typical

ways of coping.• Influence of parental models of coping

style• Assessing personal life stressors.• Tips for coping with exhaustion, negative

emotions, loneliness, boredom.• Cognitive behavioural stress management.• Identifying warning signs of depression. Piri March 2009

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Piri March 2009

Unit 5, 6 & 7: Managing Stress and Depression

• Start by analysing your behaviour.• Healthy relationships, healthy self.• Developing skills in changing your self-

talk.

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Piri March 2009

Unit 8: Caring for Newborns• Breastfeeding issues.• Practical advice & normalising difficulties. • Sleep needs, crying, settling suggestions.• Quiz to test ideas & engage with material.• Rehearsal ways of coping with problem

scenarios (eg, baby not gaining weight).• 10 tip sheets for quick reference.

Piri March 2009

Piri March 2009

Unit 9: Welcome to the Club!

• Integrating and reflecting on the birth experience.

• Utilizing problem solving skills to cope with challenges.

• Getting to know your baby: infant communication and temperament.

• Strategies for coping with negative feelings.

Piri March 2009

Unit 9 continued...

• Interactive cognitive therapy exercises to cope with negative emotions.

• Noticing & managing changes in your relationship (based on themes in unit 3).

• Reminder communication tips.• Ideas to help you nurture your relationship with

your child.

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What do women think about Towards Parenthood?Does it

help?Two evaluations funded by

beyond blueTPI and TPII

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About the MeasuresTPI n=200

Piri March 2009xx

Consumer Feedback• telephone survey• therapist notes

xParenting Stress Index

xx(part A)

Relationships & Additional Treatment

xxBeck anxiety InventoryxxBeck Depression Inventory

Additional Questionnaires for Pilot Study

xEdinburgh Postnatal Depression Scale

xDemographic & Psychosocial Form

Questionnaires for National Program

Post-natal

Ante-natal

TO

WA

RD

PA

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NT

HO

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SE

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NS

8 an

tena

tal,

1 po

stna

tal

Piri March 2009

Screening with the EPDS

John Cox et al developed the scale 198710 item self rating screening scale

Cut off 12.5 detects 86-95% depressed womenI have looked forward with enjoyment to things:

As much as I ever didRather less than I used toDefinitely less than I used toHardly at all

I have felt sad or miserable:Yes, most of the timeYes, quite oftenNot very oftenNo, not at all

Piri March 2009

Parenting Stress Index (PSI, Abidin)Parent Domain

Depression

Attachment

Restriction of role

Sense of competence

Social isolation

Relationship with spouse

Parent health

Child Domain

Adaptability to change

Acceptability of child to parent

Demandingness

Mood

Distractibility/hyperactivity

Reinforces Parent

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Piri March 2009

Screening, baseline data collection & recruitment

Allocation

Compliance

Evaluation

Women screened at the Northern Hospital and Royal Women’s Hospital

n = 1,810

EDS ≤ 12 n = 1,554

EDS ≥ 13 n = 256

Women with odd birth dates omitted

n = 937

Eligible n = 873

Randomised n = 200

EDS ≤ 12 Intervention

n = 50

EDS ≤ 12 Routine Care

n = 50

EDS ≥ 13 Intervention

n = 50

EDS ≥ 13 Intervention

n = 50

Full attendance, n = 19 8 sessions, n = 4 7 sessions, n = 2 6 sessions, n = 1 5 sessions, n = 1 4 sessions, n = 1 3 sessions, n = 1 2 sessions, n = 2 Non-attenders, n = 19

Full attendance, n = 10 8 sessions, n = 1 7 sessions, n = 1 5 sessions, n = 2 4 sessions, n = 4 3 sessions, n = 2 2 sessions, n = 4 1 sessions, n = 1 Non-attenders, n = 25

n = 50 n = 50

Follow-up data n = 41

(n = 26 attenders, n = 15 non-



(n = 18 attenders, n = 9 non-


Observed cases analysed, n = 41

Analysed per intention-to-treat, n = 50







Consort diagram

Piri March 2009

139.42 (33.14)129.75 (30.12)123.36 (23.83)121.84 (28.29)PSI parent

12.96(9.42)12.26 (11.46)7.89 (9.96)7.2 (5.84)Postnatal BDI

22.79 (11.66)21.02 (10.76)9.06 (6.12)8.29 (4.02)Antenatal BDI

Routine CareInterventionRoutine CareInterventionM (SD)High EPDS >13Low EPDS <13

Antenatal and Postnatal Scores on BDI and PSI (TPI)

Piri March 2009

Low EPDS (n = 100)

High EPDS (n = 100)

Compliance Routine Care

(n = 50) Intervention

(n = 50) Routine Care


(n = 50)

All sessions 38% 20%

No sessions 38% 50%

At least one session 62% 50%

At entry those most depressed were least likely to comply.

Compliance

Piri March 2009

After controlling for antenatal BDI, postnatal BDI scores were significantly different across treatment groups, rsPc = .62, p < .05. Participants receiving the Toward Parenthood intervention had significantly lower depression scores postnatally than those receiving routine care.

A significant effect of treatment was found for the parent domain of the PSI,rsPc = .68, p < .05, indicating that participants receiving the Toward Parenthood intervention reported significantly lower stress on the Parent Domain than those receiving routine care.

Ordered Heterogeneity Test Results

Piri March 2009

Summary of consumer feedback survey (n=36)

i. Why sessions not completed…?

ii. Did you like the program ?

iii. Was the program helpful ?

iv. Your feedback on specific areas ?

v. GP or other assistance ?

Too busy (60%)Illness/medical problem (30%)Other (10%)

Yes/positive response (90%)No/negative or neutral (10%)Yes/positive response (95%)No/negative or neutral response

(5%)Time needed for sessionsOkay (84%), too many (16%)Time needed for questionnairesOkay (58%), too long (33%)Can’t recall (8%)GP (17%), counsellor (2.5%), none (78%), can’t recall (2.5%)

Question Response

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How effective was Towards Parenthood II?

Changes made included:Shorter sessions

Community networkingCombining maternal and paternal workbooks

Broadening high risk to include risk of parenting difficulties

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Piri March 2009

The Risk Assessment Checklist (RAC)

C. De Paola & J. Milgrom

Risk factors targetedHistory of mental health problemsUnhappy childhood historyUnstable housing situationLack of prenatal obstetric careSubstance abuseLack of social supportsMultiple stressesPerception of the infantAnger managementDomestic violence

The Risk Assessment Checklist is a 12 item screening tool for identifying women who are vulnerable to parenting difficulties. It contains three demographic and 9 psychosocial items

Piri March 2009

RAC(De Paola & Milgrom)

6. I have experienced a miscarriage, an abortion or given a child up for adoption.

More than twiceTwiceOnceNever

3. During my pregnancy, my baby’s growth was regularly checked by a doctor/nurse.

During the whole nine monthsOnly during the last six monthsOnly during the last three monthsNot at all

5. I am happy with the number of people I can rely on for help in my life.

UsuallySometimesHardly everNever

2. I have felt secure in my housing situation over the last few years.

AlwaysMostlyHardly everNot at all

4. I have (now or in the past) used marijuana, cocaine, heroin, speed, etc.

RegularlyFrequentlyOccasionally Never

1. The memories of my childhood are happy ones.Most of them Some of themNot manyNone

Please colour in the circle to indicate the answer which is closest to your feelings and experience.

Piri March 2009

Low Risk (n = 100)

High Risk (n = 43)

Compliance Routine Care


(n = 50) Routine Care


(n = 21)

All sessions 58% 33%

No sessions 18% 29%

At least one session 82% 71%

TPII: Compliance

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14.56 (13.64)22.24 (8.69)High Risk Intervention

27.83 (13.89)25.27 (10.91)High Risk Routine Care

5.87 (4.81)7.82 (4.91)Low Risk Intervention

7.23 (6.78)6.08 (5.33)Low Risk Routine Care

Postnatal BDIM (SD)

Antenatal BDIM (SD)

TPII: Antenatal and Postnatal Scores on BDI

Piri March 2009

After controlling for antenatal BDI scores, participants who received the intervention reported significantly lower levels of depression postnatally than participants in the routine care condition, F (1,86) = 7.82, p< .01.

Significant differences in the same direction were also found for:• DASS anxiety, F (1, 86) = 7.35, p < .01• DASS stress, F (1, 85) = 7.73, p < .01• PSI total, t ( 59.39) = 2.06, p <.05• PSI Parent domain, t (69.86) = 1.98, p = .05

TPII: ANCOVA results

Piri March 2009The bar charts for DASS anxiety and DASS stress look almost identical to this bar chart.

n = 30n = 38

n = 12

n = 9

TP II: Postnatal BDI

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Piri March 2009Correlation between antenatal BDI and change in BDI for Routine Care condition was not significant.

TPII: Relationship between Antenatal BDI and change in BDI for intervention condition

Piri March 2009

n = 27 n = 38

n = 12

n =6

TPII: Parenting Stress

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TPII: Partner Depressive Symptoms(anxiety and stress similar)

n = 13 n = 15 n = 23

n =26

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Summary of participant feedback coded from clinical notes by therapists

1. Making Space for a New Relationship

2. We’re Expecting! Helping you Prepare for Parenthood

- family of origin issues- expectations/worries/fears of motherhood- opened discussion with husband

- problem solving skills- allowed reflection on transition to/responsibility

of parenthood

Session What the women liked

Piri March 2009


3. Lovers and Parents: Managing Relationship Changes

4. Coping Tips & Stress Busters

- enhanced communication with partner

- communication tips helpful (though less relevant for single mothers)

- support services list useful resource

- distraction and self talk techniques useful


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5-7. Managing Stress & Depression

- model of relationship between thoughts, feelings and behaviours very useful

- useful to identify contributors to low mood- recognising passive, aggressive,

assertive communication styles- discussion of self-esteem useful in trying

to be a role model to own children- related to concept of thoughts affecting

feelings- helped recognise thinking traps- strategies for increasing

positive/decreasing negative thoughts useful


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8. Parenting Suggestions for Managing Newborns

9. Welcome to the “The Club”(postnatal session)

- the most helpful unit as it assisted in a practical way

- parenting tip sheets good- feeding section good/non-

judgemental/did not give preference to breastfeeding

- great review of strategies learnt in program

- program helped organise my thinking about my baby


Piri March 2009

Discussion

• Effective intervention• Suitable for rural or remote women as

utilizes telephone counselling• ACER publishing contract


Acknowledgements

• Ms Karen McDonald, Northern Hospital• Cate Teague, Sharleen Cook, Louise

Ryan for consultation• Bronwyn Leigh for conducting telephone

surveys• Open-minded parents-to-be!• Rachael McCarthy, Bella Saunders,

Bronwyn Leigh and Jennie Ericksen for the endless re-writes

Piri March 2009

Contact Details for Order Forms

The Parent-Infant Research InstituteDepartment of Clinical and Health Psychology Austin Health Heidelberg Repatriation HospitalPO Box 5444Heidelberg West Victoria 3081AustraliaPh: +613 9496 4496Fax: +613 9496 4148Email: [email protected]

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TPII: Partner Anxiety Symptoms

n = 13

n = 15

n = 23

n =26

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TPII: Partner Stress Symptoms

n = 13

n = 15

n = 23

n =26


Additional slides

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Mood & Mode of Delivery

• Women with normal births more likely to feel positive about the experience –

• 69% feel positive after normal delivery• 26% feel positive after emergency LUSC• 36% feel positive after forceps • Significant difference (p<0.0001)• However, no significant relationship to

EPDS score

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Returned data

EPDS < 13 EPDS >12

data returned . number passed end-point

data returned . number passed end-point

Intervention - Attended at least one session

26 30

12 19

Intervention - Did not attend 14 19

7 22

Routine care 34 48

21 41

Totals 74 97

40 82

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Piri March 2009

Unit 3: Lovers to Parents

e.g.• Interactive exercises to encourage

identification of their vision for a “parenting partnership”, conceptualised in terms of boundaries, investment, control, roles.

• Practical interactive exercise to plan “who will do what” in terms of baby care and household chores.

Piri March 2009

Unit 4: Stress Busters

e.g.• Exercises to identify typical ways of

coping.• Identifying warning signs of depression.

Piri March 2009

Unit 2: We’re Expecting!

e.g.• Reflective questions about birth, difficult

and fun parts of parenting.• Past experiences of coping with change.• Specific changes in roles, emotions,

finances, relationships, leisure, body image.

Piri March 2009

Unit 5, 6 & 7: Managing Stress and Depression

• Start by analysing your behaviour.• Health relationships, healthy self.• Developing skills in changing your self-

talk.

Piri March 2009

Unit 8: Caring for Newborns

e.g.• 10 tip sheets for quick reference.

Piri March 2009

Unit 9: Welcome to the Club!

e.g.• Getting to know your baby: infant

communication and temperament.• Strategies for coping with negative

feelings.

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Piri March 2009

The Risk Assessment Checklist (RAC)

C. De Paola & J. Milgrom

Risk factors targeted• Mental illness• Unhappy childhood history• Unstable housing situation• Lack of prenatal obstetric care• Substance abuse• Lack of social supports• Multiple stresses

Piri March 2009

• Family relationship problems• Exposure to domestic violence• Distorted perception of infant • Difficulties with anger management• Single marital status• Male partner unemployed • Low educational attainment• Economic disadvantage• Young maternal age

The Risk Assessment ChecklistRisk factors targeted cont.

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TOWARD PARENTHOOD PRELIMINARY STATS

EPDS < 13 EPDS ≥13

Age(95% CI)

31.17(30.12 – 32.22)

30.25(29.07 – 31.43)

Number of children(95% CI)

1.05(.84 – 1.26)

1.59(1.25 – 1.92)

Weeks pregnant(95% CI)

27.64(27.17 – 28.11)

25.22(23.89 – 26.56)

University education

29.6% 14.0%

Modal income($Aus)

40-60,000 40-60,000

History of depression

13.0% 31.4%

Born in Australia 79.0% 75.3%

BDI(95% CI)

8.58(7.55 – 9.62)

21.36(19.13 – 23.59)

BAI(95% CI)

8.34(7.14 – 9.54)

18.63(16.14 – 21.13)

N 100 100

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12-week postnatal BDI, BAI & PSI mean scores with 95% CI

EPDS <13 EPDS >12 Intervention Routine care Intervention Routine care attendance attendance

y n y n 7.00

(4.54 – 9.46) 7.14

(3.91 – 10.38) 8.88

(6.01 – 11.76) 12.36

(6.16 – 18.57) 21.00

(7.58 – 34.42) 13.05

(8.45 – 17.64) 4.31

(2.40 – 6.21) 4.57

(1.85 – 7.30) 5.59

(3.48 – 7.70) 7.91

(4.46 – 11.35) 14.86

(3.18 – 26.54) 8.86

(5.06 – 12.65)

95.16 (88.48 – 101.84)

90.58 (80.68 – 100.49)

90.55 (83.76 – 97.33)

91.82 (81.99 – 101.65)

94.00 (80.61 – 107.39)

95.90 (85.54 – 106.26)

121.12 (108.70 – 133.54)

121.45 (105.04 – 137.86)

121.61 (112.96 – 130.25)

131.91 (117.62 – 146.19)

135.67 (91.77 – 179.57)

138.95 (122.09 – 155.80)

217.24 (199.65 – 234.83)

216.09 (197.27 – 234.91)

212.91 (199.30 – 226.52)

225.18 (207.07 – 243.30)

229.83 (175.28 – 284.39)

238.00 (213.06 – 262.94)

26 14 34 12 7 21

Total returned datasets = 114

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Baseline BDI & BAI mean scores with 95% CI

EPDS <13 EPDS >12 Intervention Routine

care Intervention Routine

care attendance attendance

y n total y n total BDI 8.63

(7.28 – 9.99) 7.26

(5.10 – 9.43) 8.10

(6.95 – 9.25) 9.06

(7.30 – 10.82) 17.68

(13.55 – 21.81) 23.50

(18.71 – 28.29) 20.64

(17.54 – 23.74) 22.43

(19.13 – 25.72)

BAI 8.60 (6.57 – 10.63)

8.00 (5.11 – 10.89)

8.40 (6.82 – 9.98)

8.37 (6.49 – 10.25)

14.48 (10.71 – 18.25)

23.00 (17.32 – 28.68)

18.65 (15.17 – 22.14)

18.61 (14.91 – 22.31)

N 31 19 50 50 25 25 50 50

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To note:

For the intervention group, antenatal BDI score had a significant effect on session attendance, with antenatal BDI score being negatively, although weakly, correlated with

number of sessions attended (r = -.341, p = .001).

0 2 4 6 8 10

sessions

0

10

20

30

40

50

BDI score

Intervention attendance

BDI score

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Piri March 2009

A 2-way ANCOVA, controlling for antenatal BDI score and session attendance, showed postnatal BDI scores were not significantly affected by EPDS group (p = .551) or treatment group (p = .849). (No significant interaction between EPDS and treatmentgroup (p = .760)).

Antenatal BDI (1) & postnatal BDI (2) scores for participants who returned 12-week data by group.

A 2-way ANCOVA, controlling for antenatal BAI score and session attendance, showed postnatal BAI scores were also not significantly affected by EPDS group (p = .774) or treatment group (p = .934). (No significant interaction between EPDS and treatment group (p = .662)).

Piri March 2009

Antenatal BAI (1) & postnatal BAI (2) scores for participants who returned 12-week data by group.

A 2-way ANCOVA, controlling for session attendance, showed postnatal PSI scores were significantly affected by EPDS group (p = .042) but not treatment group (p = .790). (No significant interaction between EPDS and treatment group (p = .368)).

Piri March 2009

Toward Parenthood Numbers Recruited

1577978Total recruited

884444“Low risk”

693534“At risk”

TotalControlNo TP

Treatmentwith TP

EPDSScores

Piri March 2009

12. More bad things happen in my life than most people.

Some of the timeHardly everNot at all

9. I feel that my relationship with my partner / family, causes me a great deal of stress.

Most of the timeQuite oftenNot muchNot at all

11. I have recently been frightened by the level of my anger outbursts.

A lotOccasionallyHardly everNot at all

8. I believe that my baby does things on purpose, which makes it difficult for me to handle him/her.

Most of the timeSometimesNot very oftenNot at all

10. I have (now or in the past) received services from a counsellor, psychologist or psychiatrist.

RegularlyFrequentlyOccasionallyNever

7. There have been times when I have been concerned for my safety, or the safety of my children, from someone I know.

A lotOccasionallyHardly everNever

RAC

Piri March 2009

Risk factors targeted cont.Family relationship problemsExposure to domestic violenceDistorted perception of infant Difficulties with anger managementSingle marital statusMale partner unemployed Low educational attainmentEconomic disadvantageYoung maternal age

The Risk Assessment Checklist

Documents

Background to development of Towards Parenthood€¦ · • Rehearsal ways of coping with problem scenarios (eg, baby not gaining weight). • 10 tip sheets for quick reference. Piri