Research report Towards parenthood: An antenatal intervention to reduce depression, anxiety and parenting difficulties Jeannette Milgrom a,b, ⁎, Charlene Schembri b , Jennifer Ericksen b , Jessica Ross b , Alan W. Gemmill b a Psychological Sciences, University of Melbourne, Australia b Parent–Infant Research Institute, Department of Clinical & Health Psychology, Austin Health, Melbourne, Australia article info abstract Article history: Received 17 May 2010 Received in revised form 25 October 2010 Accepted 25 October 2010 Available online 26 November 2010 Background: There have been few antenatal interventions aimed at preparing women for the transition to parenthood and previous attempts to intervene antenatally to prevent postnatal depression and anxiety have had limited impact. Methods: We evaluated the effectiveness of an antenatal intervention which targeted risk factors for poor postnatal adjustment, with the dual aim of reducing both postnatal symptoms of depression/anxiety and parenting difficulties (a nine-unit self-guided workbook with weekly telephone support). Based on an initial feasibility study (n = 200) which confirmed a low level of help-seeking among distressed women during pregnancy, an additional community networking component was developed aimed at increasing social support and access to health professionals to facilitate treatment of current antenatal depression/anxiety, if present. In the evaluation of a second version of the intervention, pregnant women (n = 143) were randomly allocated to receive either the intervention or routine care. Results: Following the antenatal intervention there were significantly fewer cases scoring above threshold for mild-to-severe depression/anxiety symptoms postnatally compared to routine care, along with a trend towards reduced parenting stress. The community networking component appeared helpful and women with higher baseline depression scores showed higher levels of help-seeking in both intervention and routine care groups. Limitations: It was not possible to evaluate the efficacy of individual program components separately. Conclusions: The findings provide support for the effectiveness of the Towards Parenthood intervention both as a preparation for parenthood program and in reducing symptoms of postnatal depression/anxiety. © 2010 Elsevier B.V. All rights reserved. Keywords: Postnatal depression Antenatal depression Anxiety Early intervention Parenting preparation Randomised controlled trial 1. Introduction Throughout pregnancy approximately 9% of expectant mothers are depressed at any one time (according to the best meta-analytic estimates: Gavin et al., 2005). Similarly, among newly-delivered mothers 12.9% will be depressed at 3 months postpartum (Gavin et al., 2005). The impact on women's lives is profound. Depression and associated feelings of despair and hopelessness are frequently accompanied by co-morbid anxi- ety and consequences include poor partner relationships (Hickey et al., 2005). Furthermore, antenatal depression (AND) and anxiety have been associated not only with poor self-care and poor obstetric outcomes (Chung et al., 2001; Dayan et al., 2006; Zuckerman et al., 1989) but also with suboptimal infant outcomes (Talge et al., 2007). Postnatal depression (PND) in turn is often accompanied by an impaired mother–infant relationship linked to poor child cognitive, behavioural and social development (Milgrom et al., 2006, 2004; Murray et al., 2003). The development and validation of effective early interventions and, if possible, preventative programs are therefore highly desirable. Journal of Affective Disorders 130 (2011) 385–394 ⁎ Corresponding author. Clinical & Health Psychology, Heidelberg Repatriation Hospital, PO Box 5444, Heidelberg West, Victoria 3081, Australia. Tel.: + 61 3 9496 4009; fax: +61 3 9496 4148. E-mail address: jeannette.milgrom@austin.org.au (J. Milgrom). 0165-0327/$ – see front matter © 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2010.10.045 Contents lists available at ScienceDirect Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad