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Trial registered on ANZCTR
Registration number
ACTRN12612001110875
Ethics application status
Approved
Date submitted
16/10/2012
Date registered
17/10/2012
Date last updated
17/10/2012
Type of registration
Retrospectively registered
Titles & IDs
Public title
Early intervention to protect the mother-infant relationship following postnatal depression - A randomised controlled trial
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Scientific title
A randomised controlled trial evaluating the 'Happiness, Understanding, Giving and Sharing' (HUGS) program for improving mother-infant relationships among women with postnatal depression and their infants
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Secondary ID [1]
281376
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nil
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Universal Trial Number (UTN)
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Trial acronym
HUGS
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Postnatal Depression
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Condition category
Condition code
Mental Health
287935
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0
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Depression
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Reproductive Health and Childbirth
287984
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0
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Childbirth and postnatal care
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Public Health
287985
287985
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0
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Health promotion/education
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Happiness, Understanding, Giving and Sharing ('HUGS'). Participants in this condition receive treatment for postnatal depression in a 9-week manualised postnatal depression group program ('Getting Ahead of Postnatal Depression') followed by four weekly sessions (1.5 hours each) of HUGS mother-infant group treatment. The 9-week postnatal depression program consists of 9 weekly sessions for mothers only and 3 evening couple sessions held on different days to the mother-only session (12 sessions in total, 1.5 hours per session). The 9-week program addresses maternal mood, behavioural activation, cognitive strategies, self-esteeem, ways to "relax on the run", the couple relationship, getting support, practical issues, problem-solving and self-care from a cognitive-behavioural framework. The HUGS program includes psychoeducation and direct intervention in the mother-infant relationship as follows:
Session 1. Play and physical contact: This allows interactional oportunities, assessment of interactional deficits and modelling of alternative responses.
Session 2. Observing and understanding baby's signals: Essential elements of a 'good enough' interaction are taught.
Session 3. Parental responses to infant cues: Building on cognitive strategies learnt, distorted cognitions are challenged.
Session 4. Consolidating gains: Reinforcing positive interactional behaviours and cognitions about the infant.
The group is facilitated by a psychologist.
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Intervention code [1]
285845
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Treatment: Other
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Intervention code [2]
285894
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Behaviour
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Intervention code [3]
285895
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Lifestyle
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Comparator / control treatment
Attention placebo playgroup ('Playtime'). Participants in this condition receive the same treatment for postnatal depression in the 9-week manualised postnatal depression group program described above ('Getting Ahead of Postnatal Depression'). This is then followed by four weekly non-directive Playtime playgroup meetings (1.5 hours each) of mothers, infants and a facilitator in the same surroundings as HUGS but with no therapeutic work to control for the possible effects of group membership, additional sessions, and the presence of a facilitator. The Playtime playgroup has been developed to be consistent with what is currently provided in community playgroups. A facilitator will host the four non-directive sessions and provide an opportunity for informal discussion between mothers as well as time to play with the babies. Toys will be available for use. The facilitator will adhere to manualised guidelines to ensure the sessions are non-directive.
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Control group
Placebo
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Outcomes
Primary outcome [1]
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Mean scores on the Parent-Child Early Relational Assessment
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Assessment method [1]
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Timepoint [1]
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1. Baseline
2. Post-Getting Ahead of Postnatal Depression program
3. Post-HUGS/Playtime playgroup
4. 6-month follow-up
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Primary outcome [2]
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Mean scores on the Parenting Stress Index
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Assessment method [2]
288145
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Timepoint [2]
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1. Baseline
2. Post-Getting Ahead of Postnatal Depression program
3. Post-HUGS/Playtime playgroup
4. 6-month follow-up
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Secondary outcome [1]
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z-scores on the Ages and Stages Questionnaire
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Assessment method [1]
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Timepoint [1]
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1. Baseline
2. Post-Getting Ahead of Postnatal Depression program
3. Post-HUGS/Playtime playgroup
4. 6-month follow-up
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Eligibility
Key inclusion criteria
1. women 18 years of age or older
2. infant aged 3-9 months
3. clinical diagnosis of current major or minor depressive episode
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1. currently receiving treatment for depression (medication or therapy)
2. significant difficulty with English
3. medium to high suicide risk
4. current substance abuse, manic/hypomanic symptoms, or depression with psychotic features
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Centralised administration of a coded, pre-generated allocation schedule by an independent person blind to coding. Allocation is concealed from researchers, psychologists and participants until the point of allocation.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
A variable-length permuted blocks, computer-generated random sequence.
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
1/02/2012
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
100
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
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Funding & Sponsors
Funding source category [1]
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Charities/Societies/Foundations
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Name [1]
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beyondblue
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Address [1]
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PO Box 6100
Hawthorn West VIC 3122
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Country [1]
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Australia
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Primary sponsor type
Individual
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Name
Professor Jeannette Milgrom
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Address
Parent-Infant Research Institute
Level 1, South Wing, Centaur Building
Heidelberg Repatriation Hospital
300 Waterdale Rd
Heidelberg Heights VIC 3081
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
284942
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Country [1]
284942
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
288178
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Austin Health Human Research Ethics Committee
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Ethics committee address [1]
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Austin Hospital 145 Studley Rd Heidelberg VIC 3084
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
288178
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Approval date [1]
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10/09/2012
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Ethics approval number [1]
288178
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H2012/04745
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Summary
Brief summary
Approximately 40,000 Australian women annually experience postnatal depression. Postnatal depression interferes with mother-infant relationships, which can influence brain development and long-term cognitive and behavioural outcomes for the child. Current best practice treatment for postnatal depression generally involves treating only maternal mood. However, treatment focusing on maternal mood alone does not improve the mother-infant relationship. Therefore, it is important to directly target mother-infant difficulties as part of the routine care of postnatally depressed women. Existing mother-infant interventions targeted at women with postnatal depression are scarce, poorly-evaluated, of long duration, and have not been adapted for Australian use. This study aims to evaluate the effectiveness of a brief, cost-effective 4-week early intervention program that we developed to improve the mother-infant relationship (Happiness, Understanding, Giving & Sharing "HUGS"). This intervention is added to a 9-week evaluated program we previously developed for treatment of maternal postnatal depression. Treating existing depression first increases the emotional availability needed for optimal mother-infant interaction. The HUGS intervention has shown promising results in two pilot studies. In a randomised controlled trial comparing HUGS to an attention placebo playgroup (control group), the quality of the mother-infant relationship and developmental milestones will be assessed in 100 mother-infant dyads. It is hypothesised that women undergoing the combined postnatal depression treatment and HUGS program will show greater improvement compared to the control group who receive postnatal depression treatment followed by the attention placebo playgroup in: 1. The observed quality of the mother-infant interaction; and 2. Maternal reports of parenting stress, including feelings of attachment to their infant. It is also hypothesised that infants undergoing the HUGS program will show greater improvement compared to infants in the attention placebo playgroup, in terms of: 1. Difficult infant behaviour; and 2. Early developmental milestones.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Address
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Country
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Phone
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Fax
34816
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Email
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Contact person for public queries
Name
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Dr Charlene Schembri
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Address
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Parent-Infant Research Institute
Level 1, South Wing, Centaur Building
Heidelberg Repatriation Hospital
330 Waterdale Rd
Heidelberg Heights VIC 3081
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Country
18063
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Australia
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Phone
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+61 3 9496 4496
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Fax
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+61 3 9496 4148
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Email
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[email protected]
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Contact person for scientific queries
Name
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Dr Charlene Schembri
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Address
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Parent-Infant Research Institute
Level 1, South Wing, Centaur Building
Heidelberg Repatriation Hospital
330 Waterdale Rd
Heidelberg Heights VIC 3081
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Country
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Australia
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Phone
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+61 3 9496 4496
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Fax
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+61 3 9496 4148
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
Source
Title
Year of Publication
DOI
Embase
Improving the mother-infant relationship following postnatal depression: a randomised controlled trial of a brief intervention (HUGS).
2021
https://dx.doi.org/10.1007/s00737-021-01116-5
N.B. These documents automatically identified may not have been verified by the study sponsor.
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