Antenatal mindfulness intervention to reduce depression, anxiety and stress: a pilot randomised controlled trial of the MindBabyBody program in an Australian tertiary maternity hospital.

BACKGROUND: Mindfulness interventions to reduce psychological distress are well-suited to pregnancy, due to their brief and non-pharmacological nature, but there is a need for more robust evidence determining their usefulness. This pilot study was designed to explore the feasibility of a randomised controlled trial of a mindfulness intervention to reduce antenatal depression, anxiety and stress. METHODS: The study was designed in two parts 1) a non-randomised trial targeting women at risk of mental health problems (a selected population) and 2) a randomised controlled trial (RCT) of a universal population. Process evaluation focused on feasibility of recruitment pathways, participant retention, acceptability of study measures, and engagement with mindfulness practices. Measurement of psychological distress was taken pre and post intervention through the Centre for Epidemiologic Studies Depression Scale Revised, the Depression Anxiety and Stress Scale-21, the State-Trait Anxiety Inventory, and the Perceived Stress Scale. RESULTS: 20 women were recruited to the non-randomised trial, and 32 to the RCT. Recruitment through a mailed study brochure at the time of booking-in to the hospital resulted in the largest number of participants in the RCT (16/32; 50%), and resulted in considerably earlier recruitment (50% in first trimester, 50% second trimester) compared to recruitment through the antenatal clinic waiting room (86% in second trimester, 14% third trimester). Over a third of women in the universal population scored above clinical cut-offs for depression and anxiety, indicating a sample with more symptomology than the general population. The most common reason for loss to follow-up was delivery of baby prior to follow-up (n = 9). In the non-randomised study, significant within group improvements to depression and anxiety were observed. In the intervention arm of the RCT there were significant within group improvements to anxiety and mindfulness. No between group differences for the intervention and 'care as usual' control group were observed. CONCLUSIONS: This small pilot study provides evidence on the feasibility of an antenatal mindfulness intervention to reduce psychological distress. Major challenges include: finding ways to facilitate recruitment in early pregnancy and engaging younger women and other vulnerable populations. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12613000742774 (31/10/2012).

Consultation-liaison psychiatry in a maternity hospital.

OBJECTIVE: The aim of the study was to describe referral patterns of maternity inpatients to the consultation-liaison psychiatry (CLP) service at a large women's hospital in metropolitan Melbourne, Australia. METHOD: Clinicians recorded socio-demographic data, referring unit, consultee's reason for referral, psychiatric diagnosis made, and treatment provided for all maternity inpatients referred from 2004 to 2008. RESULTS: Main reasons for referral were detection of depression, past psychiatric history, and concern regarding a woman's coping. Most common diagnoses were depression, substance use disorders and anxiety disorders. Many women referred for assessment while inpatients were initially seen in the antenatal period. CONCLUSIONS: Pregnant women referred to a CLP service present with a range of mental health problems, most often depression, anxiety and substance use disorders. Many of these problems are evident in and require intervention during the antenatal period as well as at the time of confinement. CLP services to maternity hospitals should be provided in the antenatal as well as the inpatient setting.