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Cited by 37Maternal Mental Health During Pregnancy and PostpartumMaternal and Neonatal HealthcarePersonality Disorders and Psychopathology

Pilot early intervention antenatal group program for pregnant women with anxiety and depression

Open access
Thomas, Naomi, Komiti, Angela, Judd, Fiona·2014·Archives of Women's Mental Health
DOI 10.1007/s00737-014-0447-2
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Abstract

This study aims to examine the acceptability and effectiveness of an antenatal group intervention designed to reduce the severity of depression and anxiety symptoms and improve maternal attachment in pregnant women with current or emerging depression and anxiety. Women who participated in the program completed pre- and posttreatment measures of depression (Centre of Epidemiological Studies Depression Scale) and Edinburgh Postnatal Depression Scale), anxiety (State-Trait Anxiety Inventory) and maternal attachment (Condon Maternal Antenatal Attachment Scale). Participants also completed a satisfaction questionnaire and provided general feedback about the group intervention and experience. A total of 48 women (M = 26 weeks of gestation) commenced and 37 (77 %) completed at least 80 % of the six session group intervention. Significant improvements with moderate to large effect sizes were observed for depression as measured on the Centre of Epidemiological Studies Depression Scale (CES-D) (p < 0.001), Edinburgh Postnatal Depression Scale (EPDS) (p < 0.001), state anxiety (p < 0.001) and maternal attachment (p = 0.006). Improvements in posttreatment depression scores on the EPDS were maintained at 2 months postpartum. Participants reported that the program had met their expectations. Partners (n = 21) who completed evaluation forms indicated that their attendance had improved their awareness of their partner’s mental health issues and resources available to their family and would recommend the program to other fathers. These preliminary findings suggest that our antenatal group program is an effective and acceptable intervention for a clinical sample of women and partners. It is a feasible addition or alternative treatment option to perinatal mental health care. Future directions could involve more comprehensive randomised controlled trials (RCT) to examine the effectiveness of the group intervention. © 2014, Springer-Verlag Wien.

AI snapshot

Written from the paper’s full text.

TL;DR

This pilot examined an antenatal group program for pregnant women with current or emerging anxiety and depression, including sessions for partners. It found high acceptability and significant pre-post improvements in depression, state anxiety, and maternal attachment, with postpartum EPDS gains maintained, but the uncontrolled design limits causal conclusions.

Key findings

  • Of 112 women referred, 55 confirmed interest and 48 started; 37 (77%) attended at least 80% of sessions, and 30 completers provided both pre- and post-treatment outcome data.
  • Significant improvements occurred from pre to post intervention on the CES-D (p<.001), EPDS (p<.001), STAI state anxiety (p<.001), and Condon maternal attachment (p=.006), with moderate-to-large effect sizes (e.g., EPDS d=1.1, CES-D d=0.8, STAI-S d=0.7, attachment d=0.5).
  • EPDS improvements were maintained at two months postpartum; the figure note reports significant changes from T1 to T2, T1 to T3, and T2 to T3.
  • Satisfaction was high: CSQ-8 mean 30.4 (range 24–32); all women reported their expectations were met, 83% rated service quality as excellent, and 79% were very satisfied. Among 21 partners returning forms, all said expectations were met, 81% reported better understanding of mental health issues, and 67% would recommend the program to other fathers.

Methods

  • Uncontrolled pilot pre-post design in a real-life antenatal setting at the Royal Women’s Hospital, Melbourne; participants were in the second or third trimester with current or emerging depression/anxiety or risk based on psychiatric history, excluding those with limited English, inability to commit, illicit drug or excessive alcohol use, psychosis, or acute suicide risk.
  • The intervention was six 2-hour fortnightly group sessions, two of which included partners; it was manualized and facilitated by the same clinical psychologist with co-facilitators, covering behavioural self-care, psychoeducation and mood monitoring, interpersonal therapy, and parent-infant relationship content.
  • Measures included the CES-D, EPDS, STAI-S, and Condon Maternal Antenatal Attachment Scale at pre and post, plus EPDS at about two months postpartum, CSQ-8, and evaluation forms; paired t-tests were used for the 30 completers with both pre and post questionnaires.

Limitations

  • The paper states that the English-only sample limits generalizability, that specialist facilitators may restrict where the program can be delivered, and that because women in individual psychiatry/psychology care or on medication were not excluded, improvements cannot be attributed solely to the group rather than other treatment or time; an RCT against waitlist is needed.
  • The paper also notes the small pilot sample and absence of a formal fidelity measure; evident from the text, only 30 of 37 completers had paired outcome data, and non-completers were significantly younger than completers (M=29.7 vs 34.5 years, p=.004).
  • The uncontrolled design and self-report measures are evident limitations; postpartum maternal attachment was not assessed because of practical constraints in calling new mothers.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1007/s00737-014-0447-2

Cites

26 of 26 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 11 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    83% of participants rated the quality of service as 'excellent'.

    “The quality of service was rated as 'excellent' by 83%”
    Quote in the paperNot a substantial claim
  • Findingown data

    79% of participants were 'very satisfied' with the service provided.

    “79% were 'very satisfied' with the service provided.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Depression scores on the CES-D significantly improved from pre-treatment (T1) to post-treatment (T2).

    “there were significant reductions in participants' level of depression as measured on the CES-D (p<.001)”
    • Also stated in: § Abstract · plain
      “Significant improvements with moderate to large effect sizes were observed for depression as measured on the CES-D Scale (p<.001)”
    Quote in the paperSubstantial claim
  • Findingown data

    Participants reported that the program had met their expectations.

    “Participants reported that the program had met their expectations.”
    • Also stated in: § Participants · plain
      “All participants reported that the program had met their expectations”
    Quote in the paperSubstantial claim
  • Findingown data

    90% of participants indicated that they 'definitely' (69%) or 'generally' received the desired service.

    “with 90% indicating that they 'definitely' (69%) or 'generally' received the desired service.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 12
  • May combine two claims. 14
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Of the 28 partners who attended the sessions, 21 (75%) returned their feedback forms.

    “Of the 28 partners who attended the sessions, 21 (75%) returned their feedback forms.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    A total of 48 women commenced the antenatal group program and 37 (77%) completed at least 80% of the six-session group intervention.

    “A total of 48 women (M=26 weeks gestation) commenced and 37 (77%) completed at least 80 percent of the six session group intervention.”
    • Also stated in: § Referral outcomes and study participation · plain
      “A total of 48 women started the group and 37 (77%) attended at least 80% of the program.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    A total of 112 women were referred to the group program over the three year period, and 55 (49%) confirmed their intention to participate.

    “A total of 112 women were referred to the group program over the three year period, and 55 (49%) confirmed their intention to participate.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    100% of partners indicated that the sessions had met their expectations.

    “Of these, 100% indicated that the sessions had met their expectations”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    Of the 37 completers, 30 women returned both T1 and T2 questionnaires.

    “Of the 37 completers, 30 women returned both T1 and T2 questionnaires.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The total mean score on the CSQ-8 was 30.4 (range 24 to 32), suggestive of high satisfaction with the intervention received.

    “The total mean score on the CSQ-8 was 30.4 (range 24 to 32), suggestive of high satisfaction with the intervention received.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The majority of participants (98%) were currently engaged in either psychiatry or individual psychology care through the hospital's mental health service.

    “The majority of participants (98%) were currently engaged in either psychiatry or individual psychology care through the hospital's mental health service.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The majority of participants (83%) had a current diagnosis or symptoms of depression or anxiety, 80% were experiencing a relapse of a past psychiatric diagnosis, and 21 (44%) were taking psychotropic medication.

    “The majority of participants (83%) had a current diagnosis or symptoms of depression or anxiety, 80% were experiencing a relapse of a past psychiatric diagnosis, and 21 (44%) were taking psychotropic medication.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the context of a busy clinical environment, determining the suitability and motivation to attend of the women referred to the program was time consuming with only half of the referrals translating to confirmed attendees.

    “In the context of a busy clinical environment, determining the suitability and motivation to attend of the women referred to the program was time consuming with only half of the referrals translating to confirmed attendees.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Twenty-eight partners attended at least one of the partner sessions offered.

    “Twenty-eight partners attended at least one of the partner sessions offered.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The antenatal group program is an effective and acceptable intervention for a clinical sample of women and partners.

    “These preliminary findings suggest that our antenatal group program is an effective and acceptable intervention for a clinical sample of women and partners.”
    • Also stated in: § Discussion · plain
      “The antenatal group program was found to be acceptable to the expectant mothers and fathers.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Partners may recognise that the mother is struggling but may not know how to support them or what community services are available for their family.
    • Rests on an assumption: Partners can act as protective factors in the early adjustment period if they are well informed of mental health warning signs and know the contingency coping plan to assist their family seek help.
    • Rests on an assumption: Partners are at greater risk of mental health problems themselves if their partner has depression or anxiety.
    • Rests on an assumption: The father-infant relationship is important to the infant's development and later trajectory.
    • Rests on an assumption: The family unit is more than the mother-infant dyad and there is a need to support couples during this early adjustment phase of parenthood.

  • May combine two claims.

    Study design and conductown data

    In the current study, the EPDS was significantly correlated (p<.001) with the CES-D at T1 (r=.72) and T2 (r=.78) and demonstrated good internal reliability with Cronbach's alpha values ranging from 0.75-0.81 at T1, T2 and at two months postpartum follow-up (T3).

    “In the current study, the scale was significantly correlated (p<.001) with the CES-D at T1 (r=.72) and T2 (r=.78) and demonstrated good internal reliability with Cronbach's alpha values ranging from 0.75-0.81at T1, T2 and at two months postpartum follow-up (T3).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    The distribution of scores on T1 and T2 outcome measures were normal so parametric tests were used.

    “The distribution of scores on T1 and T2 outcome measures were normal so parametric tests were used.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Maternal depression and anxiety are two of the highest reported complications of pregnancy.

    “Maternal depression and anxiety are two of the highest reported complications of pregnancy (Lattimore et al. 2005)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Lattimore et al. 2005 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    To ensure consistency across group programs, the intervention was manualized and all programs were facilitated by the same Clinical Psychologist who had experience in both CBT and IPT and parent-infant intervention.

    “To ensure consistency across group programs, the intervention was manualized and all programs were facilitated by the same Clinical Psychologist who had experience in both CBT and IPT and parent-infant intervention.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    The acceptability of the program to participants was mirrored in the high retention rate that was better than previous psycho-educational antenatal group interventions and similar to other IPT programs.

    “The acceptability of the program to participants was mirrored in the high retention rate that was better than previous psycho-educational antenatal group interventions (Lara et al. 2010;Stamp et al. 1995) and similar to other IPT programs (Crockett et al. 2008;Zlotnick et al. 2001).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Lara et al. 2010 source
    • cites Stamp et al. 1995 source
    • cites Crockett et al. 2008 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the current study, the STAI-S showed high internal reliability with Cronbach's alpha ranging from 0.93-0.94 across T1 and T2.

    “In the current study, the STAI-S showed high internal reliability with Cronbach's alpha ranging from 0.93-0.94across T1 and T2.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The program was facilitated by an experienced clinical psychologist and an infant mental health clinician, potentially limiting the healthcare settings in which the program could be conducted.

    “The program was facilitated by an experienced clinical psychologist and an infant mental health clinician potentially limiting the healthcare settings in which the program could be conducted.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Over 10 percent of fathers experience depression between the first trimester and one year postpartum.

    “over 10 percent of fathers also experience depression between the first trimester and one year postpartum (Paulson and Bazemore 2010)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Paulson and Bazemore 2010 source

  • May combine two claims.

    Interpretationown data

    The group format was a feasible and cost effective treatment that could be provided in addition to, or as an alternative option, to regular individual psychiatric or psychological intervention.

    “given its low attrition rate, the group format was a feasible and cost effective treatment that could be provided in addition to, or as an alternative option, to regular individual psychiatric or psychological intervention”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the current study, the CSQ-8 demonstrated an acceptable level of internal reliability (Cronbach's alpha = 0.79).

    “In the current study, the scale demonstrated an acceptable level of internal reliability (Cronbach's alpha = 0.79).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Perinatal anxiety and depression have adverse effects on the mother's emotional well-being, experience of pregnancy, transition to motherhood, and relationships with her infant, partner, other children and larger family system.

    “Perinatal anxiety and depression have adverse effects not only on the mother's emotional well-being, but also on her experience of pregnancy, transition to motherhood and her relationship with her infant, partner, other children and larger family system (Letourneau et al. 2012;Lovestone and Kumar 1993;Stewart 2005).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Letourneau et al. 2012 source
    • cites Lovestone and Kumar 1993 source
    • cites Stewart 2005

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    No formal measure of fidelity was used, but after each group session the facilitators discussed whether all of the manualized content of the session was covered.

    “No formal measure of fidelity was used.However after each group session the facilitators discussed whether all of the manualized content of the session was covered.”
    Quote in the paperNot a substantial claim
23 of 23

  • The paper relies on this without support.

    Partners may recognise that the mother is struggling but may not know how to support them or what community services are available for their family.

    “(1) partners may recognise that the mother is struggling but may not know how to support them or what community services are available for their family;”

  • The paper relies on this without support.

    Partners can act as protective factors in the early adjustment period if they are well informed of mental health warning signs and know the contingency coping plan to assist their family seek help.

    “(2) partners can act as protective factors in the early adjustment period if they are well informed of mental health warning signs and know the contingency coping plan to assist their family seek help;”

  • The paper relies on this without support.

    Partners are at greater risk of mental health problems themselves if their partner has depression or anxiety.

    “(3) partners are at greater risk of mental health problems themselves if their partner has depression or anxiety;”

  • The paper relies on this without support.

    The father-infant relationship is important to the infant's development and later trajectory.

    “(4) recognition of the importance of the father-infant relationship to the infant's development and later trajectory;”

  • The paper relies on this without support.

    The family unit is more than the mother-infant dyad and there is a need to support couples during this early adjustment phase of parenthood.

    “(5) recognition that the family unit is more than the mother-infant dyad and there is a need to support couples during this early adjustment phase of parenthood.”
5 of 5

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Maternal attachment analysis has fewer pairs than the stated 30

    Minor

    The text says the paired tests for all four primary outcomes used 30 women. The maternal attachment result reports 24 degrees of freedom, which corresponds to 25 paired observations, not 30.

  • Completion is described as applying to a six-session program, although some groups had five sessions

    Minor

    The abstract describes the 37 completers in terms of a six-session intervention, but the first four groups were offered only five sessions. The completion figure therefore includes women assessed against different program lengths.

2 of 2

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Related

Authors
Thomas, N., Komiti, A., & Judd, F.
Affiliations
Royal Women's Hospital (AU)
Corresponding author
Judd, Fiona
ORCID
Komiti, Angela
Venue
Archives of Women's Mental Health
Publisher
Springer Science and Business Media LLC
Published
2014-07-30
Volume
17
Issue
6
Pages
503-509
ISSN
  • 1434-1816 (ISSN-L)
  • 1435-1102
DOI
10.1007/s00737-014-0447-2
OpenAlex
W2090568421
Cited by
37
References
24
Citations by year
2026: 1 · 2025: 1 · 2024: 1 · 2022: 4 · 2021: 4 · 2020: 4 · 2019: 1 · 2018: 6 · 2017: 6 · 2016: 3 · 2015: 5 · 2014: 1
FWCI
4.95
Type
journal article
Language
en
Update notices
correction (2014-09-04)
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Archives of Women s Mental Health (publishedVersion)
  • PubMed (publishedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion)
Funders
Pratt Foundation
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
perinatal depression, perinatal anxiety, maternal attachment, pregnant women, early intervention, treatment acceptability, partner involvement, postpartum depression, perinatal mental health care
MeSH terms
Adult, Anxiety, Depression, Feasibility Studies, Female, Gestational Age, Humans, Middle Aged, Patient Acceptance of Health Care, Personality Inventory, Pregnancy, Pregnancy Complications, Prenatal Care, Psychiatric Status Rating Scales, Psychotherapy, Group, Surveys and Questionnaires, Risk Factors, Severity of Illness Index, Program Evaluation, Treatment Outcome, Depression, Postpartum

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