PIRI’s Research: Ante & Postnatal Depression, Anxiety, Infancy and Prematurity

An Overview of PIRI’s Research

PIRI conducts basic and applied research, develops evidence-based treatment programs to help parents make the transition to parenthood and to support the early parent-infant relationship. More broadly, our research aims to make a difference by advancing the knowledge underpinning care services provided to mothers, fathers and their young children.

Our main areas of research are:

  • antenatal depression and anxiety
  • postnatal depression and anxiety
  • prematurity
  • infant development and mental health
  • mother-infant relationships
  • wellbeing of fathers in the perinatal period

BASIC RESEARCH IN PND    

Identifying and managing risk factors; effects of anxiety and sleep; maternal and infant weight gain; effects on mother-infant relationships and infant development.

INFANCY    

PIRI’s longstanding interest extends from early findings of a protective role for the mother-infant relationship with a neurophysiologic base, to more recent parent-infant interventions. Professor Jeannette Milgrom established the Parent-Infant Research Read more…

DEVELOPING TREATMENTS FOR SPECIFIC POPULATIONS    

Including pregnant and postpartum women, couples, fathers and in various formats (e.g. self-help, distance therapy, group, individual, Web-based). PIRI’s program for postnatal depression (PND), now replicated in Read more…

EVALUATING INTERVENTIONS IN RCTs DURING THE PERINATAL PERIOD    

A focus of PIRI’s research is the production of validated interventions that are brief, cost-effective Read more…

BRAIN-BEHAVIOUR RELATIONSHIPS    

The relationships between stress and brain development has been a focus of PIRI research and led to longitudinal research in high-risk preterm infants (NHMRC 2006-13). An intervention to train parents as therapists Read more…

THE UTILITY OF SCREENING FOR PND    

PIRI has published one of the most careful estimates of the predictive value of the main screening instrument for PND.

TRANSLATING RESEARCH TO POLICY AND PRACTICE:    

For example, Professor Milgrom was a Chief Investigator on a collaborative national research program funded by beyondblue (2002-06) which led to the Government’s commitment to universal screening Read more…

A NEW BOOK IN PND SCREENING    

Identifying Perinatal Depression and Anxiety, was edited by PIRI’s research directors Professor Jeannette Milgrom and Dr Alan Gemmill, and includes the contributions Read more…

Click here for PIRI’s established evidence-based programs.

PIRI’s current research occurs in collaboration with a number of national and international teams. PIRI’s ED Professor Milgrom is President of the International Marce Society for Perinatal Mental Health.

PIRI’s Research Track Record

PIRI’s Cutting Edge Research and World First Findings include:

  • Parent training can improve brain connectivity of premature infants
  • Antenatal treatment of depression and anxiety is associated with gains in infant development milestones
  • E-treatment is effective for postnatal depression
  • ‘Towards Parenthood’ prevention program in pregnancy reduces depression and anxiety
  • Designing interventions and completing high-quality RCTs in the perinatal period. This has included a number of programs developed to target both the mental health of new mothers and at-risk infants (e.g. stress-reduction intervention in preterm infants). PIRI researchers were amongst the first to show that even when postnatal depression (PND) is treated effectively, this does not reverse the accompanying stress that mediates many of the negative effects of PND on the mother-infant relationship and ultimately infant development. One of our significant papers elegantly relates early interaction deficits to later cognitive outcome.
  • Diversifying the core material of treatment programs for a number of specific populations. This includes perinatal mental health programs for pregnant women, couples, fathers and delivery in different formats (e.g. self-help workbook, distance therapy, group, individual). PIRI focuses on prevention as well as treatment. And has pioneered the treatment of Antenatal Depression and Anxiety to protect later child development. PIRI’s expertise lies in RCTs and developing interventions reflect an ability to synthesize and translate knowledge about mood and behaviour in the perinatal period into effective interventions (research translated to practice).
  • Basic research. A focus of PIRI’s research has been the relative importance of psychosocial risk factors for PND which was determined on a sample of 40,333 women – probably the largest and most demographically comprehensive study of its kind yet conducted anywhere in the world. Individual risk factors of unique importance were partialled out. This is also the first quantification of risk of perinatal depression for Indigenous Australians. Other basic research includes exploration of the relationship between depression, anxiety and sleep, as well as the impact of depression on maternal and child weight.
  • Screening. Key articles have been published on the acceptability and utility of screening for PND. This longstanding and important gap in research was addressed comprehensively with a publication of one of the most careful estimates of the predictive value of the main screening instrument for PND. Recently, PIRI’s Dr Alan Gemmill and Professor Jeannette Milgrom have edited an international book on identifying and managing perinatal depression. Click here for more information on this upcoming book.
  • PIRI has also had a longstanding collaboration with beyondblue and has received funding from the beyondblue Victorian Centre of Excellence to conduct a number of research studies Since 2000, PIRI has been centrally involved in the development of an integrated, evidence-based national strategy towards perinatal depression screening. Beginning with the beyondblue funded National Postnatal Depression Project (2001-2005), key perinatal depression researchers from around the country and 43 health services collaborated in a feasibility study of antenatal and postnatal screening that involved more than 40,000 women over 5 years. PIRI screened over 10,000 women in Victoria and Tasmania. This culminated in a National Action Plan focused on the detailed mapping of perinatal mental health needs in Australia to which PIRI made a substantial contribution as part of the Perinatal Mental Health Consortium (2008). Again working closely with beyondblue and others PIRI contributed to the development of the beyondblue Clinical practice guidelines for depression and related disorders – anxiety, bipolar disorder and puerperal psychosis – in the perinatal period (2011) and led the content of the accompanying online training module for health professionals for screening and management. Ultimately, this sustained program of work has resulted in today’s National Perinatal Depression Initiative. The NPDP resulted in government commitment of $85M for universal screening of perinatal depression. Grounded in the evidence-based recommendations of the Clinical Practice Guidelines, this ongoing, federally-funded initiative mandates universal psychosocial assessment, including depression screening, for every perinatal woman in Australia at least once in pregnancy and at least once in the first year postpartum. PIRI is also involved in the implementation of the National Perinatal Depression Initiative (NPDI). Our Director chaired the beyondblue National Workforce Training Committee in 2013 and PIRI is now involved in training health professionals in assessing and managing perinatal depression and developing resources for the NPDI, including a fact sheet for health professionals about the evidence.

PIRI’s Grant Support- Our Acknowledgements

PIRI has received 47 research grants to date and would like to acknowledge the following research funding bodies: National Health and Medical Research Council, National Institute of Health (NIH-US), beyondblue, Australian Rotary Health, Ian Potter Foundation, Baker Foundation, Austin Medical Research Foundation, Bupa Foundation (Australia), Helen Macpherson Smith Trust, Urquhart Charitable Trust, Australian Research Council Discovery Project, MBF Foundation, Department of Families, Community Services and Indigenous Affairs, Telstra Foundation Community Development Fund, WCF Thomas Charitable Trust, Financial Markets Foundation for Children, Royal Australian and New Zealand College of Psychiatrists, Pfizer, Windermere Foundation Limited, and the Medical Research Foundation for Women and Babies.

We also have received support through international collaborations with two research groups in the UK funded by the National Institute for Health Research & Policy Research Programme and a fellowship funded by the Antonio Meneghetti Scientific and Humanistic Research Foundation in Italy.

Our thanks to the following for assisting PIRI’s activities: Jack Brockhoff Foundation, Alfred Felton Bequest, The William Angliss (Victoria) Charitable Fund, and the Lord Mayor’s Charitable Fund, tender funded from the Department of Education and Early Childhood Development (DEECD).

Current PIRI Projects and Research Collaborations

2014-15 PIRI Research Programs

  1. Mum 2B Mood Booster- Development of an Online Treatment for Antenatal Depression funded by the Ian Potter Foundation
  2. Does Treating maternal antenatal depression and anxiety prevent adverse infant neurodevelopmental outcomes? funded by Australian Rotary Health and Bupa
    1. Chief Investigators: Prof. J. Milgrom, Dr C. Schembri, Dr A. Gemmill, & Dr C. Holt
  3. Development of a Web-based Cognitive Behavioural Therapy for Women with Postnatal Depression funded by National Health and Medical Research Council (NHMRC)
    1. Chief Investigators: Prof. J. Milgrom, Dr B. Danaher, & Dr J. Seeley.
  4. Randomised Trial of a Web-based Cognitive Behavioural Therapy for Women with Postnatal Depression funded bybeyondblue and Windermere Foundation
    1. Chief Investigators: Prof. J. Milgrom, Dr B. Danaher, & Dr J. Seeley.
  5. Help-seeking for postnatal depression as a major public health problem: A Cluster Randomised Controlled Trial of Motivational Interviewing funded by Australian Rotary Health
    1. Chief Investigators: Prof. J. Milgrom & Dr C. Schembri
  6. Improving Neurobehavioural Development in Preterm Infants: Identifying Long-Term benefits of Early Stress Reduction funded by the National Health and Medical Research Council (NHMRC)
    1. Chief Investigator: Prof. J. Milgrom & Prof. P. Martin.Improving Neurobehavioural Development in Preterm Infants: Long-term Benefits of an Intervention in the NICU Compared to a Full-term Cohort. funded by Austin Medical Research Foundation
    2. Chief Investigator: Prof. J. Milgrom,, Dr A. Gemmill, Dr C. Holt, Dr C. Newnham & C. Ferretti.
  7. Early Intervention to Protect the Mother-Infant relationship Following Postnatal Depression- A Randomised Controlled Trial funded bybeyondblue
    1. Chief Investigators: Prof. J. Milgrom & Dr C. Schembri

RECENTLY COMPLETED

Do stressful experiences in the NICU affect the brain development of preterm infants? 

Chief Investigators: Dr. C. Newnham & Prof. J. Milgrom

In this study, funded by The Helen McPherson Smith Trust, we assess the relationship between stress experienced in intensive care units by very preterm infants (born < 30 weeks of pregnancy) and infant brain development measured using MRI scans. The study uses our Neonatal Infant Stressor Scale (NISS) to measure the accumulated stress experienced from invasive but necessary medical procedures in the very earliest days of life and asks if this is linked to developing brain tissue volumes and to the quality of white matter development.

PIRI Collaborative Research

1.PIRI collaboration with Oregon Research Institute (ORI), US

Development of the MumMoodBooster intervention to its delivery-ready stage was led and supported by a team of international experts. Prof. Milgrom (CI), a leading expert in the identification and treatment of PND, has worked in close collaboration with Drs. Danaher and Seeley at the Oregon Research Institute (ORI) who have very considerable expertise in the innovative design and evaluation of Web-based behavioural interventions

With NIMH funding, over the course of almost three years the MumMoodBooster Web-based CBT intervention for PND was developed. The PIRI team worked together with Dr Brian Danaher and Dr John Seeley at ORI. Drawing on our Getting Ahead of Postnatal Depression program, a systematic, iterative development process followed the Science Panel on Interactive Communications and Health guidelines (Henderson et al., 1999) consistent with a staged approach for the development and testing of behavioural interventions. Ongoing trials are in progress.

2.PIRI Collaboration with Deakin University, A/Prof Helen Skouteris

PIRI has collaborated on a number of projects investigating the treatment and impact of weight gain on postpartum women and their children.

A Randomised Controlled Trial to Prevent Primigravid Excessive Gestational Weight Gain and Postpartum Weight Retention. Chief Investigators: Dr H. Skouteris, Prof. M. McCabe, Prof. J. Milgrom, Prof. B. Kent. National Health and Medical Research Council (NHMRC) funding.

How do parenting and parent-child interactions impact on preschool children’s eating, physical activity habits, and subsequent patterns of weight gain? Chief Investigators: Dr H. Skouteris, Prof. M. McCabe, A/Prof. L. Ricciardelli, Prof. J. Milgrom, Prof. L. Baur. Australian Research Council Discovery Research Project funding.

Healthy Mums and Bubs
This new program is being developed to provide healthy eating and physical activity from infancy. This prevention program aims to help mothers and babies develop healthy infant feeding habits to prevent unnecessary weight gain at the start of life, and also manage post-pregnancy weight gain in the mother. The program:

  1. Uses a parenting support approach to enhance knowledge (psychoeducation), skill and confidence of parents supported by reference materials on child feeding, eating practices, and physical activity.
  2. Promotes behaviour change in a fun setting and explores feeding habits in the context of the mother-infant interaction.
  3. Explores the relationships between maternal mood and unhealthy eating traps.
  4. Uses health coaching principles to promote healthy behaviour and identify barriers to changing physical and eating habits, empowering parents to find their own solutions.

3.PIRI Collaborations with the UK

Two major UK trials have drawn on PIRI’s successful ‘Towards Parenthood’ program and involved PIRI staff:

Howard, L., Abel, K., Bick, D., Byford, S., Davidson, S., Hunter, M., Johnson, S., Jones, I, Milgrom, J., Morgan, C., Pariante, C., Pawlby, S., Pickles, A., Rose, D., Stanley, N., Wieck, A. The Effectiveness and Cost- effectiveness of Perinatal Psychiatry Services, National Institute for Health Research & Policy Research Programme, 2012-2016.

Ramchandani, P., O’Mahen, H., Dunkley-Bent, J., Fearon, P., Halligan, S., Lewis, L., Adapting and testing a brief intervention to reduce maternal anxiety during pregnancy. National Institute for Health Research, 2014-2016. Consultants: J. Milgrom & J. Ericksen.

4.Mental Health of Men in the Perinatal Period

PIRI has previously developed evidence-based resources including parenting DVDs for fathers; intervention sessions for partners of women with PND and an online partner’s support portal.

PIRI currently contributes to the research activities and the Advisory Committee of the Paternal Perinatal Depression Initiative. This multi-group research initiative aims to improve identification, awareness and support for new fathers experiencing depression, anxiety or other distress in ways that men can readily engage with. Current projects include development of SMS-based psycho-education and support services to give men the information they need to appreciate and care for their own mental health and to successfully link men with appropriate help. Lead Investigator Dr Richard Fletcher, University of Newcastle.

5.Raising Premmies information online

Collaboration project with the Parenting Research Centre in the development of a Raising Premmies corner on the Raising Children’s Network site.

Click here for more information

6.Collaboration with beyondblue.

We have worked closely with beyondblue on research-related questions for several years to deliver various research projects and research-informed resources and publications, for example:

  1. Perinatal Depression and Anxiety – Evidence relating to infant cognitive and emotional development (available online at www.beyondblue.org.au );
  2. Highet, N. J., Gemmill, A. W., & Milgrom, J. (2011). Depression in the perinatal period: awareness, attitudes and knowledge in the Australian population. Australian & New Zealand Journal of Psychiatry, 45(223-231).
    http://www.ncbi.nlm.nih.gov/pubmed/21438748

Online training for screening with the Edinburgh Postnatal Depression Scale (collaborative project with beyondblue and Genesis)

http://thinkgp.com.au/education/beyond-babyblues-detecting-and-managing-perinatal-mental-health-disorders-primary-care

Student Projects

Current

Maternal sensitivity and its influence on neurodevelopmental outcomes in preterm infants. Carmel Ferretti PhD, Department of Psychology, University of Melbourne.

Health and Wellbeing during Pregnancy and After Birth. Kim Yiong Wee (Alvin), Latrobe University.

Psychological distress across pregnancy and postpartum: A prospective study. Sofia Rallis, Deakin University.

Recently Completed

An exploratory study of coding mother-infant interactions with preterm infants at 30 weeks. Claire Corbett, Masters in Psychology (Clinical), Psychological Sciences, University of Melbourne.

The transition to motherhood: A multifacet group program for primiparous women. Melissa Buultjens

The role of mediating factors in physical and psychological distress during pregnancy and postpartum. Soledad Coo, University of Melbourne.

Longitudinal Outcome of a Preterm Birth: Evaluation of an Intervention Program and an Exploration of Effects of Maternal Environment on Preschool Children Born Preterm. Lisa Milne PhD, Department of Psychology, University of Melbourne.

Developing a Risk Screening Tool for Vulnerable Families. Caroline Murphy (De Paola) PhD., Department of Psychology, University of Melbourne.