It is well established that poor perinatal mental health is associated with detrimental outcomes for not only the mother but also for her infant and the family (Halligan, Murray, Martins, & Cooper, 2007; Behrendt, Scharke, Herpetz- Dahlmann, Konrad, & Firk, 2019). Some research suggests that only addressing the mother’s mental illness does not improve infant outcomes (Gunlicks & Weissman 2008; Nylen, Moran, Franklin, & O’Hara, 2006), which has led to increased interest in mother–infant group programs that address maternal mental health, as well as approaches to support infant development (Stein et al, 2014; Toth, Rogosch, Manly, & Cicchetti, 2006).

Together In Mind – A Group Collaborative Intervention

Researchers in Australia are exploring an innovative collaborative group intervention designed to address both perinatal and infant mental health. “Together in Mind” is a group intervention for mothers diagnosed with moderate to severe mental illness and their infants. It is not intended to replace treatment, but rather to address participants’ mental health and the mother-infant relationship through a unique collaboration between three related public health services addressing:

(1) Adult perinatal mental health assessing and supporting the mother’s mental health and wellbeing;

(2) Child and youth mental health (infant services) working with complex families with infants aged 0–4 years; and

(3) Community child health nurses conducting home visiting, parenting support groups and providing strategies for new or struggling parents.

“Together in Mind” is a 6-week collaborative group intervention providing psychoeducation sessions and support for mothers who have a diagnosis of moderate to severe mental illness with an infant under 12 months. It is facilitated collaboratively by trained staff from adult mental health, child and youth mental health, and child health services. The program draws on a biopsychosocial and trauma-informed model that acknowledges the multiple factors with impact on the well-being of the parent, their infant, and family. For this reason, a 2-hour evening psychoeducation session is also offered to participants’ partners by a perinatal facilitator and a male mental health clinician in the program.

A recent study evaluated the “Together in Mind” program using a single group pre and post-test evaluation design. Validated measures of maternal mental health, parenting confidence, maternal–infant relationship, and the infant’s social-emotional wellbeing were all conducted before and after intervention. An exit survey asked participants to rate statements about their experience in the program, including acceptability of the program and perceived impact on emotional and social functioning, as well as parenting confidence.

Mothers were included in the study if they had (1) a moderate to severe mental health diagnosis, (2) an infant under the age of 12 months for which they were the primary caregiver, and (3) were over the age of 18 years. A total of 84 mother–infant dyads participated in small groups which met 5 hours per day, 1 day a week, for 6 weeks with a maximum of 6 mother–infant dyads in each group.

Improvements in Maternal Mental Health and Child Well-Being

The study found significant improvements of a large effect size for improvements in maternal mental health according to clinician-rating, and a medium effect found for the total score on the self-reported Depression Anxiety and Stress Scale (DASS-21). There was a significant reduction across all DASS-21 subscales with small to medium effect sizes found for depression (d = 0.36; p < .001), anxiety (d = 0.42;p < 001), and stress (d = 0.58; p < .001). There were also statistically significant improvements in maternal–infant postnatal attachment scores (d = 0.49; p = < .001), parenting confidence (d=0.63; p=<.001), and emotional social development of the infant (d = 0.83; p=<.001). Participants also provided high ratings of satisfaction with the program and perceptions of improvements in their wellbeing, confidence for caring for their child, and improved enjoyment of spending time with their child.

Considering Group Interventions – Next Steps

There are some limitations to note when interpreting these findings. First, outcomes may have been impacted by other factors such as participants’ engagement in other medical or therapeutic interventions (e.g., medication, therapy). There was not a control group in the study, so it is unclear how much improvements were associated with participation in the program. Furthermore, the program is relatively time and resource intensive, which may impact ability for sustainability and dissemination to other settings. The authors note that a cost-benefit analysis would be valuable in further evaluations. Overall, the authors conclude that this study adds to the evidence (Newman, Sivaratnam, & Komiti, 2015) that interventions focusing on the mother’s mental health, parent–infant relationships, and the development of safe and supportive social connections are likely to lead to better outcomes for the infant.

Rachel Vanderkruik, PhD, MSc

References:

Primary Article: Irvine A, Rawlinson C, Bor W, Hoehn E. Evaluation of a collaborative group intervention for mothers with moderate to severe perinatal mental illness and their infants in Australia. Infant Ment Health J. 2021 Jul;42(4):560-572. doi: 10.1002/imhj.21922. Epub 2021 Jun 25. PMID: 34170035; PMCID: PMC8453701.

Behrendt, H., Scharke, W., Herpetz-Dahlmann, B., Konrad, K., & Firk, C. (2019). Like mother, like child? Maternal determinants of children’s early social-emotional development. Infant Mental Health Journal, 40(2), 234–247. http://doi.org/10.1002/imhj.21765

Halligan, S., Murray, L., Martins, C., & Cooper, P. (2007). Maternal depression and psychiatric outcomes in adolescent offspring: A13-year longitudinal study. Journal of Affective Disorders, 97(1-3), 145-154. http://doi.org/10.1016/j.jad2006.06.010

Gunlicks, M., & Weissman, M. (2008). Change in child psychopathology with improvement in parental depression: A systematic review. Journal of the American Academy of Child & Adolescent Psychiatry, 47(4), 379–389. http://doi.org/10.1097/CHI.

Newman, L., Sivaratnam, C., & Komiti, A. (2015). Attachment and early brain development – neuroprotective interventions in infantcaregiver therapy. Translational Developmental Psychiatry, 3(1),

  1. http://doi.org/10.3402/tdp/v3.28647

Nylen, K., Moran, T., Franklin, C., & O’Hara, M. (2006). Maternal depression: A review of relevant treatment approaches for mothers and infants. Infant Mental Health Journal, 27(4), 327–343. http://doi.org/10.1002/imhj.20095

Stein, A., Person, R. M., Goodman, S. H., Rapa, E., Rahman, A., McCallum, M., … Pariante, C. M. (2014). The effects of perinatal mental disorders on the fetus and child. The Lancet, 384(9956), 1800–1819. http://doi.org/10.1016/S0140-6736(14)61277-0

Toth, S. L., Rogosch, F. A., Manly, J. T., & Cicchetti, D. (2006). The efficacy of toddler-parent psychotherapy to reorganise attachment in the young offspring of mothers with major depressive disorder: A randomised preventive trial. Journal of Consulting and Clinical Psychology, 74(6), 1006–1016. http://doi.org/10.1037/0022-006X.74.6.1006

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