Jeannette Milgrom - Academia.edu (original) (raw)

Papers by Jeannette Milgrom

Research Square (Research Square), Jul 3, 2023

Background Substantial evidence indicates that maternal depression during pregnancy (i.e., antena... more Background Substantial evidence indicates that maternal depression during pregnancy (i.e., antenatal depression) is associated not only with maternal wellbeing but also with child emotional and behavioural development. Children of antenatally depressed women are at risk of emotional and behavioural problems, including internalising problems (e.g., anxiety and depression) and externalising problems (e.g., attention problems), that may last at least to adolescence. These enduring effects also constitute an enormous economic cost. Despite the seriousness of this problem, until recently there existed very few controlled studies evaluating whether active psychological treatment for antenatal depression can prevent adverse child outcomes. Our previous pilot randomised controlled trial (RCT) exploring the effect of cognitive behavioural therapy (CBT) for antenatal depression on child outcomes showed promising results. We aim to assess whether treating antenatal depression with an evidence-based 8-week structured CBT program can prevent or ameliorate adverse child developmental outcomes at 2 years of age. Methods Pregnant women ≤ 30 weeks gestation diagnosed with a depressive disorder are recruited and randomised to CBT or treatment as usual (TAU). The target sample size is 230 and the primary outcome measure is the infant Internalising scale of the Child Behaviour Checklist (CBCL) at 24 months of age. Secondary infant outcome measures at 24 months are the Externalising scale of the CBCL and the motor and cognitive development subscales of the Ages & Stages Questionnaire (ASQ-3). Additional secondary outcome measures are subscales of the Revised Infant Behaviour Questionnaire (IBQ-R), ASQ-3 and the ASQ-Socio-Emotional (ASQ-SE) at 3 and 12 months of age and the quality of mother-infant interaction at 3 and 24 months. Maternal measures, including demographic data, depression diagnosis, depressive and anxiety symptoms, perceived stress and parenting stress, are collected across all time points. Discussion The trial is ongoing and recruitment was slowed due to the COVID-19 pandemic. If results suggest a bene cial effect of antenatal depression treatment on infant outcomes, the project could have repercussions for standard antenatal care, for maternal and infant health services and for preventing the intergenerational transmission of mental health disorders.

BMC Psychiatry

Background Depression in pregnancy is prevalent, under-treated, and has serious impacts on the we... more Background Depression in pregnancy is prevalent, under-treated, and has serious impacts on the wellbeing of women and on child development. Internet programs can reach women who may not access traditional treatments due to distance, stigma or concern about taking medication. We adapted our online postnatal depression program, MumMoodBooster, for antenatal use. We aimed to trial feasibility, acceptability, and potential efficacy of the new Mum2BMoodBooster intervention with depressed pregnant women. Methods Twenty-seven pregnant women with Edinburgh Postnatal Depression Scale score > 11 used the program in a feasibility trial. Twenty-one had current diagnoses of major or minor depression on the Structured Clinical Interview for the DSM-IV. Assessment of symptoms occurred at screening/baseline, post-test (8 weeks post-enrollment), and at follow-up (3 months postpartum) using the Patient Health Questionnaire (PHQ-9) and the Depression Anxiety Stress Scales (DASS-21). Results In this...

Journal of Medical Internet Research, 2021

Background Previous research has confirmed that symptoms of postnatal depression (PND) can be ame... more Background Previous research has confirmed that symptoms of postnatal depression (PND) can be ameliorated through internet-delivered psychological interventions. Advantages of internet-delivered treatment include anonymity, convenience, and catering to women who are unable to access face-to-face (FTF) treatments. To date, no research has examined the efficacy of such interventions compared directly with FTF treatments in women clinically diagnosed with PND. Objective This study aims to compare the efficacy of one of the first web-based cognitive behavioral therapy (CBT) interventions (internet CBT+coach calls) for PND (MumMoodBooster [MMB]) with FTF-CBT in a randomized controlled trial (RCT). Methods In this study, 116 postnatal women with a Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) diagnosis of major or minor depression were randomized to MMB (39/116, 33.6%), FTF-CBT (39/116, 33.6%), or a treatment-as-usual (TAU) control condition (38/116, 32.8...

The Lancet Psychiatry, 2021

International Journal of Environmental Research and Public Health, 2019

Social support before and after childbirth is a possible protective factor for perinatal depressi... more Social support before and after childbirth is a possible protective factor for perinatal depression. Currently, there is a lack of longitudinal studies beyond the first year postpartum exploring the relationship of social support with depression and anxiety. Social support is also a possible protective factor for adverse child development, which is a known consequence of perinatal depression. The present study followed up a cohort of depressed women (n = 54) from a randomised controlled trial of psychological treatment for antenatal depression. We examined the trajectory of the relationships between perceived social support (Social Provisions Scale), depression (Beck Depression Inventory), and anxiety (Beck Anxiety Inventory) twice in pregnancy and twice postpartum up to two years. The influence of social support on child development and parenting-related stress was also explored. Two aspects of social support, Reassurance of Worth and Reliable Alliance, were strongly related to per...

International Journal of Social Psychiatry, 2019

Background:Better community mental health literacy is associated with positive help-seeking behav... more Background:Better community mental health literacy is associated with positive help-seeking behaviours and reduced stigma. There are relatively few published surveys of perinatal mental health literacy.Aims:To provide a profile of current awareness, knowledge and attitudes in relation to the mental health of women and men in the perinatal period.Method:A cross-sectional online survey ( n = 1,201) of adults (⩾ 18 years) in each state and territory of Australia was conducted in early 2016. Survey questions were based on a previous 2009 survey, with the addition of several novel items designed to assess knowledge around both perinatal anxiety and men’s perinatal mental health.Results:Depression (including postnatal depression) was the most frequently cited general health problem for women in the first postnatal year (52% of spontaneous first responses). Over 70% of adults believed that postnatal depression requires specialised treatment and checks for depressive symptoms should occur r...

SAGE Open Medical Case Reports, 2019

There are few studies of cognitive behavioral therapy for women with antenatal depression includi... more There are few studies of cognitive behavioral therapy for women with antenatal depression including qualitative and quantitative data, and yet, individual cases can provide valuable information on personal experiences of treatment effectiveness and acceptability. The purpose of this case report is to explore the long-term qualitative outcomes following cognitive behavioral therapy for antenatal depression. A pregnant woman with a Diagnostic and Statistical Manual of Mental Disorders diagnosis of depression was allocated to receive seven sessions of cognitive behavioral therapy in a randomized controlled trial. We describe her experiences and mood during treatment, at 12 weeks, 9 months, 2 years, and 7 years postpartum, as well as markers of her child’s development. The woman’s mood symptoms were dramatically improved after treatment and remained in the mild to moderate range until 7 years postpartum. Her child showed overall age-appropriate development, with strengths highlighted in...

Infant mental health journal, 2018

Symptoms of depression negatively impact on mother-infant relationships and child outcomes. We ev... more Symptoms of depression negatively impact on mother-infant relationships and child outcomes. We evaluated a novel, 10-session mother-infant therapeutic playgroup-Community HUGS (CHUGS)-which combines cognitive and experiential components through psychoeducation, play, music, and movement. Participants were mothers experiencing a range of postnatal mental health difficulties, including depression, with infants ≤12 months of age. However, the aim was not to treat maternal depression but to ameliorate associated problems in the mother-infant interaction. In the feasibility study, all participants received CHUGS. In the pilot randomized controlled trial (RCT), participants were randomized between intervention and a wait-list. Outcomes were the Parenting Stress Index (PSI; R.R. Abidin, 1995), Parenting Sense of Competency Scale (Self-Efficacy subscale; J. Gibaud-Wallston & L.P. Wandersman, 1978), and the Depression, Anxiety, Stress Scales (P.F. Lovibond & S.H. Lovibond, 1995). In the feas...

Journal of Medical Internet Research, 2016

There are few published controlled trials examining the efficacy of internet-based treatment for ... more There are few published controlled trials examining the efficacy of internet-based treatment for postnatal depression (PND)" 1a-ii) Non-web-based components or important co-interventions in title Mention non-web-based components or important co-interventions in title, if any (e.g., "with telephone support").

British Journal of Midwifery, 2013

This paper discusses what we know about paternal depression during the perinatal period and if th... more This paper discusses what we know about paternal depression during the perinatal period and if there are any effective interventions for it. Available prevalence estimates suggest that depression experienced by men perinatally may be elevated and specific and/or related to this significant life stage. Currently, there is a paucity of research evaluating how depression during the perinatal period manifests differently in men than women and if men cope with their depression in ways different to women. There is also a lack of studies comparing the risk factors of paternal depression during the perinatal period and the risk factors for general depression in men. Studies showed that paternal perinatal depression not only affects the men, but their children as well. On reviewing the studies on interventions, it is clear that further randomised controlled trials (RCTs) of interventions are needed to establish efficacious and cost-effective treatment protocols for men.

The Australian and New Zealand journal of psychiatry, 2015

Both antidepressant medications and psychological therapy are common treatments for depression in... more Both antidepressant medications and psychological therapy are common treatments for depression in postpartum women. Antidepressant treatment may have a number of practical disadvantages, including a preference by women to avoid medication while breastfeeding. Consequently, more information about the relative benefits of the two modalities in the perinatal period is helpful. In the treatment of depressive disorders there is some evidence that combination therapies (pharmacological plus psychological treatment) may be more efficacious than either form of mono-therapy in isolation. However, in the treatment of postnatal depression, such evidence is limited. Forty five postpartum women with a DSM-IV diagnosis of depression were randomised to receive either: 1) cognitive behavioural therapy (CBT); 2) sertraline, or 3) a combination of both treatment modalities. Psychometric measures were collected weekly for 12 weeks, with a follow-up at 24 weeks. Symptoms of depression and anxiety were ...

Childhood obesity (Print), 2013

The rise of childhood obesity in Western society has focused attention on parental feeding practi... more The rise of childhood obesity in Western society has focused attention on parental feeding practices. Despite evidence that controlled feeding influences child weight, there is a paucity of research examining predictors of controlled feeding. The aim of this study was to determine whether maternal antenatal and/or concurrent anxiety and depressive symptoms, including stress, predicted controlled feeding and whether maternal controlled feeding practices, in turn, predict child BMI. In total, 203 mothers participated in a longitudinal follow-up survey. Mothers' self-reported symptoms of anxiety and depression were measured both in pregnancy and at 2-7 years postpartum. Maternal-reported child BMI and maternal use of restriction, pressure to eat, and monitoring were measured at 2-7 years postpartum. Feeding practices were not uniformly predictive of child BMI. Maternal use of restriction and monitoring were partially positively predicted by concurrent maternal stress and negatively...

BMC public health, Jan 17, 2006

Information on clinical acceptability is needed when making cost-utility decisions about health s... more Information on clinical acceptability is needed when making cost-utility decisions about health screening implementation. Despite being in use for two decades, most data on the clinical acceptability of the Edinburgh Postnatal Depression Scale (EPDS) come from qualitative reports, or include relatively small samples of depressed women. This study aimed to measure acceptability in a survey of a relatively large, community sample with a high representation of clinically depressed women. Using mail, telephone and face-to-face interview, 920 postnatal women were approached to take part in a survey on the acceptability of the EPDS, including 601 women who had screened positive for depression and 245 who had received DSM-IV diagnoses of depression. Acceptability was measured on a 5-point Likert scale of comfort ranging from "Not Comfortable", through "Comfortable" to "Very Comfortable". The response rate was just over half for postal surveys (52%) and was 100...

Women's Health Issues, 2009

Background and Purpose. Sleep quality appears to be an antecedent to depressive symptoms during p... more Background and Purpose. Sleep quality appears to be an antecedent to depressive symptoms during pregnancy. We sought to: (1) examine the psychometrics of the Pittsburgh Sleep Quality Index (PSQI) in pregnancy; (2) examine whether sleep quality predicted increases in depressive symptoms, and (3) compare PSQI scores across three or two levels of depressive symptoms. Methods. Each of the 252 participants completed the Beck Depression Inventory (short form) and a sleep quality measure at mid and late pregnancy. Results. PSQI total scores showed good internal consistency and construct validity. An improved model of the internal structure of the PSQI in pregnancy was found with one factor labelled Sleep Efficiency, a second labelled Night and Daytime Disturbances, and an Overall Sleep Quality component associated with, but separate from, both of these two factors. While PSQI scores showed moderate stability over time, sleep disturbance scores increased in late pregnancy. Importantly, PSQI prospectively predicted increases in depressive symptoms. Conclusions. Findings suggest that the PSQI is useful in pregnancy research. Findings also support the idea that sleep problems are prospective risk factors for increases in depressive symptoms during pregnancy. Practitioners are advised to screen for sleep quality during early pregnancy.

JMIR Research Protocols, 2012

perinatal depression, and the effectiveness of interventions for women screened as high risk for ... more perinatal depression, and the effectiveness of interventions for women screened as high risk for developing perinatal depression. The three key questions (KQs) are: 8

Journal of Women's Health, 2008

Objective: This study had two aims: (1) to examine pregnant women's alcohol consumption across ti... more Objective: This study had two aims: (1) to examine pregnant women's alcohol consumption across time from prepregnancy until childbirth and (2) to explore whether prepregnancy drinking and intention to drink predict prenatal alcohol consumption while controlling for relevant demographic variables. Methods: At 17-21 weeks, 248 pregnant women completed questions about demographics, intention to drink alcohol during the subsequent pregnancy, and retrospective measures of prepregnancy and early pregnancy consumption. After this time, calendars were sent fortnightly assessing daily alcohol consumption until birth. Results: For women who drank both prepregnancy and postpregnancy confirmation, average fortnight alcohol consumption in the first weeks of pregnancy was lower than during prepregnancy, and consumption continued to decrease between gestational weeks 1 and 8, particularly following pregnancy confirmation, after which it remained relatively stable. When predicting whether women drank in late pregnancy, intention accounted for unique variance after controlling for income and prepregnancy drinking. For women who drank after pregnancy confirmation, prepregnancy drinking quantity significantly predicted intention to drink, which in turn predicted fortnight alcohol consumption in later pregnancy, after controlling for prepregnancy drinking and income. Conclusions: Findings highlight the need to measure alcohol consumption at multiple time points across pregnancy, the need for educating and supporting women to reduce consumption when planning pregnancies, and the usefulness of intention to drink as a predictor of drinking during pregnancy.

Journal of Reproductive and Infant Psychology, 2009

An inductive qualitative approach was employed to explore women's experiences of their body and m... more An inductive qualitative approach was employed to explore women's experiences of their body and mood during pregnancy and the postpartum. In-depth interviews were conducted with 20 perinatal women (n at late pregnancy=10; n in the early postpartum period=10). While most of the sample reported adapting positively to body changes experienced during pregnancy, the postpartum period was often associated with body dissatisfaction. Women reported several events unique to pregnancy which helped them cope positively with bodily changes (e.g. increased perceived body functionality, new sense of meaning in life thus placing well-being of developing foetus above body aesthetics, perceptual experiences such as feeling baby kick, increased sense of social connectedness due to pregnancy body shape, and positive social commentary); however, these events no longer protected against body dissatisfaction post-birth. While women reported mood lability throughout the perinatal period, the postpartum was also a time of increased positive affect for most women, and overall most women did not associate body changes with their mood. Clinical implications of these findings included the need for education about normal postpartum body changes and their timing, and the development of more accurate measures of perinatal body image.

Journal of Midwifery & Women's Health, 2009

ABSTRACTThis study aimed to: 1) describe the number, frequency, severity of discomfort and effect... more ABSTRACTThis study aimed to: 1) describe the number, frequency, severity of discomfort and effect of symptoms on life of 29 physical symptoms women experienced at 15 to 25 weeks of gestation; 2) explore whether experiencing this group of physical symptoms more frequently and intensely was associated with a higher score of depressive symptoms and lower self‐esteem; (3) examine whether discomfort and effect ratings aided prediction of well being over and above symptom frequency; and (4) investigate which individual physical symptoms contributed most to predicting depressive symptoms and self‐esteem. Pregnant women (n = 215) completed the Beck Depression Inventory, Rosenberg Self‐Esteem Scale, and a physical symptoms questionnaire. Frequency, discomfort, and the effect of physical symptoms all consistently correlated with higher scores for depressive symptoms, but less consistently with lower self‐esteem. Discomfort and the effect of symptoms predicted variance in depressive symptoms a...

Journal of Health Psychology, 2009

The overall aim of this study was to examine the relationship between depression and body dissati... more The overall aim of this study was to examine the relationship between depression and body dissatisfaction across pregnancy and the first 12 months postpartum. During pregnancy, women's ( N = 116) perceived attractiveness and strength/fitness remained stable, while feeling fat and salience of weight/shape decreased in late pregnancy. During the postpartum, feeling fat and salience of weight/shape increased. Depression and body dissatisfaction scores were correlated with each other concurrently and across multiple time points. However, in baseline-controlled prospective analyses, only a model of greater depression late in pregnancy predicting body dissatisfaction at six weeks postpartum and feeling fat throughout the postpartum was supported.