Why was PIRI Developed?
The Crucial First Years
PIRI was developed in response to compelling evidence that early life experiences, parental mental health, and prematurity have profound and lasting effects on children, yet timely, evidence-based interventions for families were limited or fragmented.
The first years of life are critical, and when things go wrong, early intervention matters. During this period, the foundations of brain development are formed, at a time when infants are completely dependent on their parents and caregivers. Growing evidence shows that early experiences shape brain structure and neural connections, influencing a child’s cognitive, emotional, and behavioural development both immediately and across the lifespan.
An infant’s environment is strongly shaped by their relationship with caregivers. These early relationships influence stress levels, learning capacity, self-regulation, and the development of secure attachment, which in turn predicts later social and emotional functioning. Investment in the period from birth to toddlerhood is therefore crucial, not only for individual children and families, but for broader community benefit. Economic analyses demonstrate that for every dollar invested in early intervention, more than seven dollars can be saved in future health and social costs [1].
In Australia, more than 300,000 babies are born each year, and approximately 60,000 mothers experience perinatal depression or anxiety. For each annual birth cohort, the estimated lifetime cost of perinatal depression and anxiety to women and their families is $7.3 billion [2], with most costs arising from long-term impacts on children. Comparable estimates have been reported in other countries, including the United Kingdom [3].
Investing in the earliest years to build a brighter future
This compelling evidence highlights the importance of improving infants’ early environments. Addressing dysfunctional or highly stressful caregiving contexts has the potential to improve both brain development and emotional wellbeing. PIRI was developed to respond to this evidence by strengthening early intervention and giving children the best possible start in life.
References:
- 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 and safeguarding children’s development is one of the most effective investments we can make.
Each year in Australia, more than 300,000 women give birth.
Of the 303,478 live births in 2017, approximately 13 percent of mothers experienced postnatal depression. This equates to around 39,000 women, placing significant strain on families and costing the community close to one billion dollars in the first year alone. The estimated lifetime cost for each annual birth cohort exceeds $7 billion. At least as many women experience depression during pregnancy, along with severe anxiety and other mental health conditions, further increasing the burden.
When left untreated, depression during pregnancy and after birth has serious and lasting consequences for women, their partners, and their infants.
The effect of postnatal depression
For women, these consequences can include reduced wellbeing, feelings of failure, being overwhelmed by sadness and hopelessness, difficulties interacting with their baby, and strain on partner relationships. At a time when social expectations focus on joy and fulfilment, untreated depression can be particularly distressing.
Around two in three women experiencing depression at this time also report significant anxiety, including excessive and uncontrollable worry, persistent tension, fatigue, poor concentration, and sleep disturbance. Depression during pregnancy further increases the risk of poor self-care and adverse obstetric outcomes.
The impact on partners and the couple relationship
The transition to fatherhood can also bring unexpected challenges. Around one in twenty men experience heightened emotional stress, anxiety, or depression during the perinatal period. Paternal mental health is critical to family functioning and child development, yet many men remain uninformed about perinatal mental health and are reluctant to seek support.
The mental health and wellbeing of one parent can significantly affect the other, with short- and long-term impacts on the couple relationship and overall family environment.
The impact on infants
Early infancy is a period of rapid brain development and heightened neuroplasticity, making infants particularly sensitive to stressors. Maternal depression can disrupt early parent–infant interactions and has been associated with poorer social and cognitive outcomes into school age, increased attachment difficulties, and behavioural problems.
A growing body of evidence also links antenatal depression, anxiety, and stress to adverse effects on foetal development and long-term neurodevelopmental outcomes. These include increased risk of attention deficit hyperactivity disorder, anxiety, and impairments in cognitive, motor, and language development. Enduring effects of both antenatal and postnatal maternal depression and anxiety have now been observed into late adolescence.
The Parent-Infant Research Institute (PIRI) was developed in response to this evidence, with a focus on protecting the mental health of parents and safeguarding infant development from pregnancy through the first two years of life.
Prematurity and its Impact
Each year in Australia, more than 20,000 infants are born preterm (before 37 weeks’ gestation), representing around 8 percent of approximately 300,000 live births. Premature infants face increased risk of ongoing neurobehavioural difficulties across multiple developmental domains, including cognition, motor development, social and emotional functioning, and behaviour.
As survival rates for preterm infants continue to improve, attention has increasingly turned to strategies that can enhance long-term developmental outcomes for these highly vulnerable children. Between 50 and 75 percent of preterm infants experience some degree of developmental difficulty, with 10 to 15 percent affected at the severe end of the spectrum. In addition, the experience of preterm birth can be traumatic for parents, highlighting the need for appropriate support during this critical period.
PIRI’s Research into Prematurity
While advances in neonatal medical care have significantly improved survival, there remains a gap in evidence regarding the long-term benefits of early environmental and relational interventions for preterm infants. Early stressful experiences, including those associated with medical procedures, are now understood to contribute to poorer developmental outcomes, with preterm infants exposed to multiple sources of pain and stress in neonatal care settings.
PIRI was developed to address this gap by focusing on early intervention during infancy. PIRI has conducted a series of studies designed to support parents in recognising their premature infant’s stress signals while in the Neonatal Intensive Care Unit (NICU) and adapting caregiving responses accordingly. Mothers are also provided with targeted support. The impact of these interventions is being examined through longitudinal follow-up, with early findings showing promising improvements in developmental outcomes. Further details are available through PIRI’s PremieStart study.
The Need for Early Intervention for Mothers, Fathers and Babies
Despite strong and growing evidence demonstrating the benefits of early intervention for perinatal depression and anxiety, including the impact on infants and parent–infant relationships, there remains insufficient research providing clear, evidence-based guidance on how best to intervene when difficulties arise. In response to this gap, PIRI established a unique model clinic and research centre that now leads internationally in the development, evaluation, and application of parent–infant interventions. These approaches have also been applied to address challenges faced by parents and infants following premature birth.
PIRI operates on the principle that early intervention is critical to improving outcomes, not only for parental mental health, but also for infant development and long-term wellbeing. The quality of early relationships plays a fundamental role in shaping resilience and functioning across the lifespan. Effective early intervention supports healthier, more resilient families and can reduce the need for intensive services later in life. Premature birth presents additional risks to infant development and early relationships, and this remains a key focus of PIRI’s research.
A serious service and evidence gap exists in this area. PIRI was developed to address this gap by generating robust evidence, developing practical guidelines, and advocating for accessible, effective early intervention services. PIRI is a dedicated centre committed to the systematic development and implementation of very early treatment and prevention programs, with a strong focus on protecting and promoting infant wellbeing.
All work undertaken by the Parent-Infant Research Institute is aligned with national policy and research priorities, including:
- The National Clinical Practice Guidelines for Depression and Related Disorders in the Perinatal Period
- The National Mental Health Strategy, including early intervention, stigma reduction, and support for parents with mental health difficulties
- National Health Priority Areas, including mental health and depression
- Federal Government policy and strategic directions for the early years, including the Stronger Families and Communities Strategy
- The Department of Human Services Child Protection Program, including High Risk Infants Practice Requirements
- National research priorities focused on a healthy start to life
- Research evidence highlighting 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. However, clear, evidence-based guidance on how to intervene quickly and effectively to improve perinatal mental health and strengthen early parent–infant relationships (0–2 years) remains limited. Addressing this gap is central to PIRI’s mission.
