Why was PIRI Developed?
The Crucial First Years
The first years of life are critical and when things go wrong we need to intervene early. In these early years, the basic ‘sculpting’ of a child’s brain takes place, a time when infants are completely dependent on their parents and caregivers. There is growing evidence that early experiences influence brain structure and the connections made among brain cells. These connections can affect a child’s immediate and future cognitive, emotional and behavioural development.
A child’s environment is largely influenced by an infant’s relationship to his caregivers, which can powerfully influence levels of stress, and the infant’s ability to learn and self-regulate. Importantly, secure attachment has its roots in the earliest relationships and predicts later ability to relate. Investing in the period from birth to toddlerhood is critical not only for child development but also for greater community benefit. For every dollar spent in early intervention, more than seven dollars can be saved in future expenditures on health and social . In 2017, 303,478 babies were born in Australia. Around 60,000 of these mothers will experience perinatal depression or anxiety.
“For every one-year cohort of births, the most recent economic Australian analysis estimates that the lifetime cost of perinatal depression and anxiety to women and their families is $7.3 billion .”
Most of these costs are associated with the enduring impact on children. Very similar costs are estimated in comparable economies, such as the UK . PIRI aims to act on the compelling evidence on the importance of investing in the early years of a child’s life. The links between what happens to children when they are young and their future wellbeing are strong. Improving an infant’s dysfunctional or stressful environment is now understood to have the potential to improve both brain and emotional development. By giving our children a better start, we all stand to benefit.
Investing in the earliest years to build a brighter future
1. Keating, D., Mustard, J.F. (1996). The National Longitudinal Survey of Children and Youth: An Essential Element for Building a Learning Society in Canada. In Human Resources Development Canada and Statistics Canada. Growing Up in Canada: National Longitudinal Survey of Children and Youth. (Statistics Canada Cat. No. 89-550-MPE, No. 1).
2. Gidget Foundation & Perinatal Depression & Anxiety Australia (PANDA), The cost of perinatal depression and anxiety in Australia, 2019, Report by PwC Consulting: Melbourne.
3. Bauer, A., Parsonage, M., Knapp, M., Iemmi, V., & Adelaja, B. (2014). The costs of perinatal mental health problems. London: London School of Economics and the Centre for Mental Health.
4. Belli, P.C., Bustreo, F. & Preker, A. (2005). Investing in children’s health: what are the economic benefits? Bulletin of the World Health Organization, 83(10), 777-784.
Postnatal Depression, Anxiety and Adjustment
Scope of the problem to be addressed
Good Mental Health for Parents & Safeguarding Children’s Development is Our Best Investment
Each year in Australia over 300,000 women have a baby.
Of the 303,478 Australian live births in 2017, approximately 13 percent of mothers experience postnatal depression. This translates to 39,452 women, costing these women and their families immeasurable strain, and the community close to 1 billion dollars in the first year. The lifetime costs for every one-year cohort of births exceeds $7 billion. At least as many women will experience depression during pregnancy, as well as severe anxiety and other mental health disorders which further add to the burden.
Left untreated, both depression in pregnancy and postnatally, has serious consequences for the woman, her partner and infant.
The effect of postnatal depression
For the woman, these can include diminished well-being, feelings of failure, being overwhelmed by feelings of sadness and hopelessness, difficulties interacting with her baby and relationship problems for her and her partner. At a time when social and personal expectations are focussed on the anticipated joy and fulfilment of motherhood, untreated depression can be devastating. In addition, 2-in-3 women suffering depression at this time will have significant problems with anxiety: excessive worry that is hard to control, constantly feeling on edge, fatigue, difficulty concentrating and problems with sleeping. The impact of depression in pregnancy is further compounded by the increased risk of poor self-care and adverse obstetric outcomes.
The impact on partners and the couple relationship
Becoming a father can bring unforseen challenges for men and around 1-in-20 men will experience heightened emotional stress, anxiety or depression at this time. Paternal mental health is important for the family unit and for child development. However, many men are uninformed about mental health issues and reluctant to acknowledge difficulties and access support services.
Both mothers and fathers can also be affected in the short and longer term by the mental health and wellbeing of their partner, as can their relationship.
The impact on infants
It is now recognized that, due to the plasticity of the brain in early infancy, there may be longer-term consequences of stressors experienced in early infancy. For example, early mother-infant interactions can be disrupted by maternal depression and this can be associated with: poorer social and cognitive outcomes to school age, poorer early school performance, increased attachment difficulties and behavioural problems.
A growing literature also antenatal links depression, anxiety or stress with negative effects on the developing foetus and poor long-term infant neurodevelopment. Problems can include: attention deficit hyperactivity disorder, anxiety and impaired cognitive, motor and language development. Enduring impact of both antenatal and postnatal maternal depression and anxiety on child outcomes has now been reported to late adolescence.
The Parent-Infant Research Institute (PIRI) aims to protect the mental health and wellbeing of new parents and to safeguard the development of their infants, from pregnancy and throughout infancy (0-2 years).
Prematurity and its Impact
There are over 20,000 preterm infants (gestation of less than 37 weeks gestation) born in Australia every year, representing approximately 8% of almost 300,000 live births each year. Premature infants are at risk of ongoing neurobehavioural issues across all developmental domains such as cognition, motor development, social and emotional functioning, and behaviour. As the survival rates of preterm infants is constantly improving, it becomes essential to evaluate strategies that may improve the developmental prospects of these highly vulnerable children. Between 50 and 75% of preterm infants will have developmental problems and 10-15% will experience these problems at the severe end of the spectrum. In addition, the experience of having a premature birth can be traumatic for parents and support is necessary.
PIRI’s Research into Prematurity
While research into the medical care of preterm infants is continually growing, there remains a gap in evidence concerning the long-term benefits of early environmental intervention for these infants. One promising target of intervention has followed the knowledge that early stressful experiences, such as those arising from some medical care, may contribute to poor outcomes (preterm neonates face multiple sources of pain and stress). PIRI has conducted a series of early intervention studies to assist parents to recognise the stress signals of their premature infants whilst in the Neonatal Intensive Care Unit (NICU) and to change their handling of the infant accordingly. Mothers are also provided with support. The impact of this intervention is being followed up through the longitudinal study of these premature infants and early results are very promising. For more information on this research, see our PremieStart study.
The Need for Early Intervention for Mothers, Fathers and Babies
Despite the strong and growing evidence for the need to intervene early when women experience perinatal depression, including the impact on the infant and on parent-infant relationships, there is insufficient research providing evidence-based guidelines on how to improve depression and anxiety and change relationships that are in difficulty. We have established a unique model clinic and research centre, which is leading the field internationally in the development and application of parent-infant intervention. Our interventions have also been applied to tackle the difficulties for both parents and infants following a premature birth.
PIRI operates on the premise that early intervention is the key to better outcomes not only for maternal well-being but for the immediate impact on infants, and also during later life. The quality of early relationships informs outcomes in life generally and early intervention can help promote resilience in individuals and families. With early intervention, families can be healthier and more functional, ultimately requiring fewer resources. In addition, a premature birth can affect the development of the infant and the mother-infant relationship and this is a focus of PIRI’s research. A serious service gap exists in this area: PIRI aims to develop those guidelines and advocate for services.
PIRI is a dedicated Centre committed to developing and rolling out very early treatment and prevention programs in a systematic way, and promoting the needs of infants.
All of the work of the Parent-Infant Research Institute is consistent with:
- The National Clinical Practice Guidelines for Depression and Related Disorders in the Perinatal Period.
- The National Mental Health Strategy which highlights the needs of parents with mental health problems, the eradication of stigma, and the provision of early intervention for children and their families.
- National Health Priorities: Mental Health (with a focus of depression).
- Current Federal Government policy and strategic direction on the Early Years – the Stronger Families and Communities Strategy.
- The Department of Human Services Child Protection Program for the prevention of abuse and neglect, and the High Risk Infants Practice Requirements. National mental health policy highlighting parenting needs of parents with mental health problems, health promotion and early intervention;
- Current policy and strategic directions from Government on the early years – Stronger Families and Communities Strategy;
- National Research Priorities: A Healthy Start to Life;
- Research on the critical importance of infancy for brain development and social functioning
There is growing recognition of the need for early intervention, particularly for vulnerable families. Yet there are few evidence-based guidelines for how to quickly intervene to enhance perinatal mental health and also improve a dysfunctional early parent-infant relationship (0-2 years). This is PIRI’s Mission.