Studies in: Infancy; Antenatal & Postnatal Depression; Screening; Prematurity
PIRI has conducted research in the areas of perinatal depression and prematurity since 2001. Our key findings include:
Beating the Blues Before Birth
This paper aimed to evaluate the efficacy of a brief CBT treatment for maternal depression and anxiety in pregnancy. Both the feasibility study and RCT yielded promising results for adherence, acceptability and improvements in depression and anxiety. Strong reductions in anxiety were observed during pregnancy and improvements in depression were maintained at nine months. Infant outcomes showed effects favouring the intervention in domains including problem solving, self-regulation, and stress reactivity, which were independent of maternal postnatal mood.
Milgrom, J., Holt, C., Holt, C. J., Ross, J., Ericksen, J., & Gemmill, A. W. (In Press). Feasibility Study and Pilot Randomised Trial of an Antenatal Depression Treatment with Infant Follow-up. Archive of Women’s Mental Health, Accepted for Publication 9th February 2015.
MumMoodBooster – Online Treatment for PND
Our previous research with MumMoodBooster has established the usability, feasibility and clinical effectiveness of this internet program. Poor uptake of traditional treatment relates to fear of stigma, poor accessibility of clinic-based programs and expense. Potential strengths of a Web-based intervention for PND are accessibility, privacy and low cost. The potential public health impact of Web-based treatment is therefore enormous given the 300,000 annual births in Australia. Our ongoing work continues to evaluate this validated internet intervention for postnatal depression by comparing it to traditional face-to-face psychological treatment.
Milgrom, J., Danaher, B. G., Holt, C., Holt, C. J., Seeley, J., Tyler, M. S., . . . Gemmill, A. W. (2016). Internet Cognitive Behavioural Therapy for Women with Postnatal Depression: a randomised controlled trial of MumMoodBooster. Journal of Medical Internet Research, 18(3), e54. doi: doi:10.2196/jmir.4993
Danaher, B., Milgrom, J., Seeley, J., Stuart, S., Schembri, C., Tyler, M. et al. (2013). MomMoodBooster Web-Based Intervention for Postpartum Depression: Feasibility Trial Results. Journal of Medical Internet Research, 15(11), e242. https://www.jmir.org/2013/11/e242/
Danaher, B. G., Milgrom, J., Seeley, J. R., Stuart, S., Schembri, C., Tyler, M. et al. (2012). Web-based Intervention for Postpartum Depression: Formative Research and Design of the MomMoodBooster Program. JMIR Research Protocols, 1(2), e13. https://dx.doi.org/10.2196/resprot.2329
Towards parenthood: An antenatal intervention to reduce depression, anxiety and parenting difficulties
This paper describes the effectiveness of an antenatal intervention which targeted risk factors for poor postnatal adjustment, with the dual aim of reducing both postnatal symptoms of depression/anxiety and parenting difficulties.
Milgrom, J., Schembri, C., Ericksen, J., Ross, J., & Gemmill, A. W. (2011). Towards parenthood: an antenatal intervention to reduce depression, anxiety and parenting difficulties. Journal of Affective Disorders, 130: 385-394 doi:10.1016/j.jad.2010.10.045
PremieStart: Protecting the Neurological Development of Premature Infants through Stress-Reduction
The primary aim is evaluate the long-term effectiveness of a simple, inexpensive program of stress-reduction for preterm infants (n=123) on measures of cognition and behaviour. We have already demonstrated some early advantages of the PremieStart program in infant development at 6 months and are now comparing developmental outcomes at 4 and 6 years in intervention and control preterm children, alongside a matched full-term cohort (funded by NHMRC).
Milgrom, J., Newnham, C., Martin, P. R., Anderson, P. J., Doyle, L. W., Hunt, R. W., Gemmill, A. W. (2013). Early communication in preterm infants following intervention in the NICU. Early Human Development, 89(9), 755-762.
Beautiful Beginnings: Early Intervention to Facilitate Brain Development in Preterm Infants
The neurological development of premature infants is severely compromised leading to a high prevalence of long-term neurobehavioural problems. In this work we showed that training parents to minimize stress on their premature neonates results in significant enhancements of early brain development, which are observable on cranial MRI scans. Specifically, white matter microstructure and connectivity were improved by this early intervention.Milgrom, J., Newnham, C., Anderson, P. J., Doyle, L. W., Gemmill, A. W., Lee, K., Inder, T. (2010). Early sensitivity training for parents of preterm infants: impact on the developing brain. Paediatric Research, 67(3), 330-335.
Newnham, C. A., Inder, T. E., & Milgrom, J. (2009). Measuring preterm cumulative stressors within the NICU: the Neonatal Infant Stressor Scale. Early Human Development, 85(9), 549-555. https://dx.doi.org/10.1016/j.earlhumdev.2009.05.002
Newnham, C. A., Milgrom, J., & Skouteris, H. (2009). Effectiveness of a Modified Mother-Infant Transaction Program on Outcomes for Preterm Infants from 3 to 24 months of age. Infant Behavior & Development, 32(1), 17-26. https://dx.doi.org/10.1016/j.infbeh.2008.09.004
Models of Care
A counselling package Overcoming Depression, suitable for delivery by primary care professionals such as nurses in the community was found to be effective at reducing depression and anxiety symptoms.
Milgrom, J., Holt, C., Gemmill, A., Ericksen, J., Leigh, B., Buist, A., & Schembri. (2011). Treating Postnatal Depressive Symptoms in Primary Care: A Randomised Controlled Trial of GP Management, with and without Adjunctive Counselling. BMC Psychiatry, 11(1), 95. https://www.biomedcentral.com/1471-244X/11/95
The Major Antenatal Risk factors for Postnatal Depression in Australia
In this paper recently published by the prestigious Journal of Affective Disorders, we report on what is probably the largest and most demographically comprehensive study of its kind yet conducted anywhere in the world. The relative importance of dozens of psychosocial risk factors have been determined on a sample of 40,333 women. Individual risk factors of unique importance have been partialled out. Among the novel findings in this substantial piece of work, is the first quantification of the risk of perinatal depression for Indigenous Australians.
Milgrom, J., Gemmill, A. W., Bilszta, J. L., Hayes, B., Barnett, B., Brooks, J., Buist, A. (2008). Antenatal risk factors for postnatal depression: a large prospective study. . Journal of Affective Disorders, 108, 147-157. https://dx.doi.org/10.1016/j.jad.2007.10.014
Acceptability of Screening for PND
We have published 3 articles in this area. Well-informed Cost-Utility decisions about healthcare screening procedures require several crucial pieces of information including information on the acceptability to patients. This longstanding and important gap in research into perinatal depression screening was addressed comprehensively by the following papers:
Leigh, B., Milgrom, J., Leigh, B., & Milgrom, J. (2007). Acceptability of antenatal screening for depression in routine antenatal care. Australian Journal of Advanced Nursing, 24(3), 14-18.
Gemmill, A. W., Leigh, B., Ericksen, J., & Milgrom, J. (2006). A survey of the clinical acceptability of screening for postnatal depression in depressed and non-depressed women. BMC Public Health, 6, 211.
Buist, A., Condon, J., Brooks, J., Speelman, C., Milgrom, J., Hayes, B., Bilszta, J. (2006). Acceptability of routine screening for postnatal depression: An Australia-wide study. J Affect Disorders, 93, 233 – 237.
Reliable Identification of PND
Before this paper there had been large screening studies of PND on the one hand and there had been validation studies for PND screening tools on the other. This was the first study to validate a widely used tool in a large representative Australian population against gold-standard diagnostic criteria.
Milgrom, J., Ericksen, J., Negri, L., & Gemmill, A. (2005). Screening for postnatal depression in routine primary care: Properties of the Edinburgh Postnatal Depression Scale in an Australian sample. ANZJ Psychiatry, 39, 833 – 839. https://dx.doi.org/10.1111/j.1440-1614.2005.01660.x
Depression and the Stress of Parenthood
With this paper, we are the first researchers to show that even when 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.
Milgrom, J., Ericksen, J., McCarthy, R., & Gemmill, A. (2006). Stressful impact of depression on early mother-infant relations. Stress and Health, 22(4), 229-238. https://dx.doi.org/10.1002/smi.1101
Women’s experience of depression and barriers to seeking help.
This qualitative project was a series of focus groups with women who had been experiencing depression and it concentrated on their acknowledgement of the condition and their journey towards recovery. This is a population that has been shown to be very difficult to engage in services. Of particular relevance were their attitudes and beliefs about their diagnosis and their perceived barriers to care which provide new insight into service design and delivery for women with depression.
Bilszta, J., Ericksen, J., Buist, A., & Milgrom, J. (2010). Women’s experiences of postnatal depression – beliefs and attitudes as barriers to care. Australian Journal of Advanced Nursing, 27(3), 44-54. https://search.informit.com.au/documentSummary;dn=909929185761432;res=IELHEA
Psychological Treatment of PND is Effective
This paper was an RCT comparing cognitive therapy with less specialized psychological interventions. All were demonstrated as superior to conventional routine care. There are relatively few such studies and this one had the added strengths of a broad community sample, formal clinical diagnosis of depression, manualised interventions and well-validated rating instruments.
Milgrom, J., Negri, L. M., Gemmill, A. W., McNeil, M., & Martin, P. R. (2005). A randomised controlled trial of psychological interventions for postnatal depression. British Journal of Clinical Psychology, 44( 4), 529-542. https://www.ncbi.nlm.nih.gov/pubmed/16368032