Melbourne School of Population and Global Health - Research Publications
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ItemTreatment of maternal mood disorder and infant behaviour disturbance in an Australian private mothercraft unit: a follow-up study( 2003)Australia has a system of residential parentcraft services which offer brief admissions to mothers experiencing difficulties with infant care and postnatal mood disturbance. Most of these are state-funded public access services. In 1996 a comparable but differentiated service was opened in the private sector. Masada Private Hospital Mother Baby Unit accommodates five mother-infant pairs who are admitted to a five night structured residential program. Care is provided by a multidisciplinary team comprising a paediatrician, general practitioner, clinical psychologist and specialist nurses. Complex maternal mood disorders as measured on standardised psychometric instruments include depression, anxiety and severe occupational fatigue. Their babies are unsettled, cry for prolonged periods, wake frequently at night and do not sleep well during the day. Many have feeding difficulties. The treatment program comprises both individualised training in infant care and settling strategies and psycho-educational groups offered in a supportive non-judgemental setting. One month post-discharge maternal mood is significantly improved and infant behaviour more manageable compared with functioning on admission.
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ItemTemperament and behaviour of infants aged 4-12 months on admission to a private mother-baby unit and at one- and six-month follow-up( 2004)While infant behaviour is influenced by maternal care, infant crying and dysregulated sleep can reciprocally affect maternal mood. The temperament and behaviour of two 4 – 12-months-old infant cohorts admitted with their mothers to a residential parenting program were examined using behaviour charts and the Short Infant Temperament Questionnaire (SITQ). One group was re-assessed one and six months later. Infant temperament was significantly more difficult than population norms and most had dysregulated sleep. One month after treatment, total infant crying and fussing, frequency of night-time waking,and sleep and feeding dysregulation were significantly (p5<.001) reduced, with change sustained at six months. Easy-Difficult scores (SITQ) were stable and significantly worse than population norms. The contribution of a ‘‘difficult’’ infant temperament to maternal mood disorder warrants further investigation.
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ItemEarly parenting difficulties: implications for health services policy( 2005)Australia’s residential early parenting centres are unique internationally and provide a highly valued service to parents and their very young children. Clinical practice in these services has been based on extensive experience, but now needs to be derived from an evidence base. In response to this need, Tweddle Child and Family Health Service (TCFHS) in Melbourne - a public access early parenting service - commissioned a review of literature relating to its practice and a prospective longitudinal survey of a consecutive group of mothers admitted with infants aged up to one year. This article summarises the main findings of both the literature review and the survey. Australia’s public access residential early parenting centres are a unique national resource and were established initially for the care of abandoned, relinquished or mistreated young children. Over time their purpose and function has altered to reflect social change associated with reduction in relinquishment of children for adoption, and policies that have sought to minimise removal of children from parental care. Now they focus on assisting parents to improve caretaking capacity. There are no equivalent services in any other country in the world. In general, services for parents experiencing difficulty caring for their infants in industrialised countries are based in primary health care of outreach home visiting services. Consumer satisfaction surveys indicate that parents value early parenting services highly, but as yet there is a limited evidence base to their clinical practice.
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ItemAre pregnant Australian women well informed about prenatal genetic screening?: A systematic investigation using the Multidimensional Measure of Informed Choice( 2006)Background: Ethical practice requires that decisions to participate in medical care be well informed. Investigations into prenatal genetic screening for Down syndrome have assessed women’s knowledge but have not examined whether being well informed about the potential consequences of screening, such as subsequent diagnostic testing, diagnosis and termination, is associated with psychological distress for women. Aims: To assess informed choice to participate in second trimester maternal serum screening (2MSS) in pregnant women using a validated measure and to compare anxiety levels in women who were well informed versus poorly informed. Methods: A prospective cohort study where pregnant women completed the Multidimensional Measure of Informed Choice and the Hospital Anxiety and Depression Scale immediately prior to the offer of 2MSS. Follow-up questionnaires assessing psychological symptomatology were completed at 20 and 30 weeks gestation. Results: Only 37% of decisions were informed; those who participated in screening were more likely to have made an informed decision than those who did not (P=0.01); 31% did not know that miscarriage was a possible consequence of diagnostic testing subsequent to an increased risk screening result and only 62% correctly identified that termination of pregnancy would be offered if Down syndrome were to be diagnosed. Short-term anxiety levels in those who were well informed were not significantly different from those who were poorly informed (P=0.14). Conclusions: Health promotion strategies, which are readily applicable in clinical settings and address diverse learning needs and attitudes of pregnant women, are needed. The impact of antenatal screening on other dimensions of pregnancy psychology remains to be investigated.