An effect of antenatal and postnatal maternal support programs on attachment and resilience for mums and infants: A Randomised Controlled Trial.

INTERVENTION: The population of interest for this study are expectant women booked to deliver at the Royal Women's Hospital who are referred to the mental health services.This will be a randomised controlled trial (RCT) with four arms. Participants in three arms will receive an intervention. The fourth arm will be the control group. Progress through the different phases of the trial will be based on the Consolidated Standards of Reporting Trials (CONSORT) recommendations for RCTs. During pregnancy (antenatal period) one‐half (n=250) of participants (Groups 1 and 3) will receive a mindfulness‐based intervention in addition to treatment as usual (TAU) and the other half (n=250) will receive TAU only (Groups 2 and 4). Two months following birth (postnatal period), participants in Groups 1 and 2 with receive an attachment‐based intervention in addition to TAU and Groups 3 and 4 will receive TAU only. The interventions are: 1. Antenatal mindfulness intervention aimed at addressing maternal anxiety, depression and stress. The intervention comprises of five weekly sessions, with each session of 2hrs and 15mins duration. The intervention will be delivered by mental health and health professionals (e.g., psychologists, midwives and maternal and child health care nurses) who have been trained and supervised by Dr Mercuri. 2. Postnatal attachment‐focused intervention focused on infant‐parent interactional coaching and improving parental reflective capacity. The intervention comprises of 10 weekly sessions, with each session of 1.5‐2 hours duration. The first session will take place approximately 2 months post delivery. The intervention will be delivered by mental health and health professionals (e.g., psychologists, maternal and child health care nurses) who have been trained and supervised by Prof. Newman. Adherence to the interventions will be monitored via an attendance registry. CONDITION: Anxiety Depression Personality Disorders Psychosis Substance Dependence PRIMARY OUTCOME: 1. Maternal mental health and psychosocial functioning, as measured by the following questionnaires: ; ; ‐ Pregnancy Related Anxiety Questionnaire‐ Revised ; ‐ Spielberger State‐Trait Inventory ; ‐ Centre for Epidemiological Depression Scale ; ; ; 2. Maternal parenting, attachment and mother‐infant interaction, as measured by the following; ; ; ‐Emotional Availability Scale ; ‐Strange Situation Procedure ; Infant Development, as measured by the following: ; ; ‐ Fetal heart rate (CTG) ; ‐ Bayley Scales of Infant Development ; ‐ Psychoeducational Profile (3rd ed.) ; SECONDARY OUTCOME: Parental Knowledge of Infant Development, as measured by the Newborn Developmental Knowledge Questionnaire. INCLUSION CRITERIA: *Have basic English literacy and communication skills to enable them to participate in the assessment and intervention processes; *Receiving antenatal care and booked to deliver at the Royal Women's Hospital *Up to 2nd trimester *Considered ‘at risk’, where 'at risk' includes women who have a current or past personal or family (first degree relatives only) history of any mental illness including symptoms of anxiety and depression, and/or have current psychosocial stressors (e.g., poor social support, unstable accommodation, intimate partner violence, contact with Department of Human Services Protective Services).