full report: antenatal parenting support: an exploratory randomised contol trail of psychosocial

SCPHRP

Final report

form for SCPHRP grants

SCPHRP reference number: SCPH/13

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Project title:

Antenatal parenting support: an exploratory randomised controlled trial of psychosocial antenatal programmes.

Start date: January 2012 Finish date: June 2013

Investigators:

Philip Wilson Angus MacBeth

Christine Puckering Sharon McAlees

Lucy Thompson Marion Henderson

Anne Clarke 1. SUMMARY

Social adversity and poor maternal mental health during pregnancy have long-term adverse effects on childrens health, social, educational and economic outcomes. Depression, anxiety and stress in pregnancy may have direct physiological effects on the fetus as well as impairing development of maternal sensitivity to the child. There is a need for improved antenatal support and more effective engagement with high risk mothers-to-be.

Consecutive women meeting high risk criteria were invited to participate in trial. Participants (n=35) were randomly allocated in clusters of six, to either a Mellow Bumps group, an active comparison group (Chill-out in Pregnancy) or care-as-usual. Mellow Bumps is a six-week group based antenatal parenting programme which aims to decrease maternal antenatal stress levels and emphasise the importance of early interaction in enhancing brain development and attachment. Chill-out in Pregnancy is a six-week group based stress reduction programme.

Results suggest that taking part in either a Mellow Bumps group or Chill-out in Pregnancy may contribute to modest improvements in mental health and wellbeing when measured eight to twelve weeks post-birth compared to care-as-usual.

2. ORIGINAL AIMS The original aim of this study was to compare the impact of participation in a Mellow Bumps intervention with that of a control intervention, as well as care-as-usual, on the mental health of pregnant women with additional health and social care needs.

3. METHODOLOGY 3.1. Study Design

This was an exploratory study for a three-arm parallel randomised open-label blinded end- point (PROBE) clinical trial design. Referrals to specialist midwifery services of women in Inverclyde and Ayrshire meeting the Special Needs in Pregnancy (SNiP) criteria used in NHS Greater Glasgow and Clyde were invited to participate. SNiP protocols are largely based on

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maternal and family factors, so can be readily detected early in pregnancy, making early intervention feasible. It includes women who have previous or current mental health issues, substance misuse, have had previous children who are looked after or accommodated in local authority or kinship care or are involved in the criminal justice system (see appendix 1). These women may have had previous negative experiences with health and/or social services. Consented participants were randomly allocated, in groups of six, to either Mellow Bumps, an active comparison condition Chill-out in Pregnancy, or Care-as-usual. Participants were offered a 20 shopping voucher at the last data collection point.

3.2. Interventions: The two active interventions were offered in addition to participants routine maternity care (Care-as-usual).

Mellow Bumps (MB)

MB is a six week group-based antenatal programme designed to support families with additional health and social care needs. MB is intended to decrease maternal antenatal stress levels, increase expectant mothers understanding of neonates capacity for social interaction and emphasise the importance of early interaction in enhancing brain development and attachment. It is delivered non-didactically to maximise participant engagement and rapport. Each week there is one activity focused on the woman and another on a baby-related topic. The programme is designed to be offered between twenty to thirty weeks gestation, to capture the period when the risk of miscarriage is low and fetal movement felt, but before major preoccupation with the delivery.

Chill-out in Pregnancy (ChIP) CHiP is a relaxation programme that includes all the mother-centred components of Mellow Bumps but none of the baby or mother-baby relationship components. Like MB, it runs for six weeks at two hours per week. It aims to decrease maternal stress levels.

Care-as-usual (CAU) Participants in NHS Greater Glasgow & Clyde received care in line with local Special Needs in Pregnancy protocol. Participants in NHS Ayrshire & Arran received care in line with local Vulnerable Families guidelines. If indicated, a pre-birth case conference was arranged, between weeks 28-32 of the pregnancy, which was followed by either a child protection case conference post-birth or a post-birth planning meeting when necessary.

3.3. Outcome measures Information from participants was collected at three collection time points: pre-intervention (majority within two weeks of the intervention starting), post-intervention (majority within two weeks of the intervention finishing) and 8-12 weeks post-birth. Apart from the infant saliva samples, which community midwives were asked to collect on the fifth postnatal day, the measures were administered face-to-face by the researcher in the participants home.

Pre-intervention The Adult Wellbeing scale (AWS): generates scores in four domains depression, anxiety, outward-directed irritability and inward-directed irritability. The dimensions have different cut- off scores that indicate a possible problem in that area (Table 1).

Edinburgh Postnatal Depression Scale (EPDS): generates a single score. The cut-off points that suggest that a woman may have depression are detailed in Table 1.

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Domain Normal score Borderline score

Probable problem score

AWS-depression 0-3 4-6 7-15 AWS-anxiety 0-5 6-8 9-15 AWS-outward irritability 0-4 5-7 8-12 AWS-inward irritability 0-3 4-6 7-12 EPDS 0-9 10-12 13-30

Table 1: Cut-off scores Participants were also asked to provide saliva samples, by drooling or spitting into provided receptacles, for cortisol assays. Samples were to be collected on three occasions each day repeated on two days:

(i) Time 1: on waking in the morning

(ii) Time 2: 45 minutes after time 1

(iii)Time 3: when retiring to bed for the night Post-intervention

AWS, EPDS, saliva samples for cortisol assays

5 days post-birth

Saliva samples from infant pre- and post-new born heelprick blood sampling (Guthrie test) for cortisol assays.

8-12 weeks post-birth AWS, EPDS, saliva samples for cortisol assays, mother-baby video, semi-structured interview.

3.4. Ethics

The study was reviewed and approved by the NHS West of Scotland Research Ethics Committee (12/WS/0024, 4th April 2012).

3.5. Trial Registration

This trial is registered with ClinicalTrials.gov (ID NCT01590212).

4. RESULTS

4.1. Recruitment

Pregnant women who met the inclusion criteria were approached by community midwives in one area in NHS Greater Glasgow & Clyde and in NHS Ayrshire & Arran. If potential participants were agreeable their details were passed on to the researcher who arranged to visit them at home to discuss the project further. Originally, it was planned to run two MB groups, two CHiP groups and two CAU groups; one of each in each area with eight women in each group, n=48. Recruitment was slower than anticipated for a number of reasons:

(i) The period available for recruitment was substantially shortened because of a prolonged dispute between Disclosure Scotland and NHS R&D: Disclosure Scotland would only provide Basic Disclosure whereas NHS R&D required Enhanced Disclosure for access to the sites. Ultimately the researchers Enhanced Disclosure for another post was accepted by NHS R&D as valid evidence.

(ii) The rate of referral was slower than hoped. As a consequence, the target geographic area in NHS Ayrshire & Arran was extended.

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Eventually, 35 women were recruited to the project. In order to ensure that there were sufficient women at the right stage of pregnancy to make running a group intervention viable, participants were randomly allocated in groups of six to MB, CHiP or CAU. For the final group, randomisation was abandoned to ensure that two CHiP groups would run. Of 31 participants who completed the questionnaires at baseline, 68% (n=21) completed the information at all three time points. Of the remainder two participants completed baseline and post-intervention questionnaires and two completed baseline and 8-12 weeks post-birth measures (see Figure 1: Participant flow diagram. From consent to the final data collection point, 23 participants were retained in the project for between 19 and 34 weeks (mean 27.13, SD 4.495).

Referred n=50

Declined n=11 Failed contact n=4

Recruited n=35

Withdrew n=2

Failed contact n=2

Baseline data n=31

Post-intervention data

Withdrew n=2 No contact on advice of health

professional n=1 Failed contact n=5

Contact attempted including failed contacts at post-intervention

Failed contact n=2 Withdrew n=2

No contact on advice of health professional n=1

8-12 week post-birth data n=23

Figure 1: Participant flow diagram

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Num

ber

4.2. Participants

14

12

10

8

6

4

2

0 19 years or 20-24 years 25-29 years 30-34 years 35-39 years 40+ years

less Age group

Figure 2: Participant age groups Age: Participants were aged between 17 and 42 years (mean 27.14, SD 7.49), see Figure 2.

Parity: 29% (n=10) participants were first time parents, 51% (n=18) had one or two children and 20% (n=7) had three or more children. Of those who had children, six (24%) had children who were being looked after by the local authority or in kinship care.

Social circumstances: 66% (n=23) participants lived in an area that was measured, by the Scottish Index of Multiple Deprivation (SIMD), as one of the 20% most deprived areas. 26% (n=9) lived in the second most deprived quintile. The remainder (8%, n=3) lived in the second least deprived area quintile.

Primary referral criteria: The majority of participants had mental health issues (48%, n=17) or there were child protection concerns (23%, n=8), see Figure 3.

Even though this was the participants primary referral criterion, many had complex issues. For example, one had previous child protection concerns as well as a history of substance misuse and involvement with the criminal justice system.

5

Nu

mb

er

18

16

14

12

10

8

6

4

2

0 Mental

Child

Criminal

Substance

Care leaver Domestic

Young

health issue protection concerns

justice (self or partner)

misuse abuse person complex

Primary SNiP criteria

Figure 3: Primary SNiP criteria Infants: Gender (n=23): 11 boys, 12 girls

Gestation (n=27): 34-41 weeks (mean 39.30, SD 1.81)

Birth weight (n=23): 2.21-4.41kg (mean 3.39, SD 0.57)

Group differences at baseline

There were no statistically significant differences between the groups at baseline in the geographical area deprivation of their home address (2=2.026, df 4, p0.731), age group (2=6.808, df 10, p=0.743), or primary reason (2=10.73, df 12, p=0.552) for referral to the project (Table 2). Similar comparisons were made between those completing baseline data only and those who were followed up. No significant differences were found (see appendix 2).

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Group allocation Total

Mellow Bumps

CHiP

Care-as- usual

SIMD Quintile 1 = most deprived, 5 = least deprived

1 N %

8 5 7 20 80.0% 55.6% 58.3% 64.5%

2 N %

1 3 4 8 10.0% 33.3% 33.3% 25.8%

4 N %

1 1 1 3 10.0% 11.1% 8.3% 9.7%

Age groups 19 years or less N %

1 1 1 3 10.0% 11.1% 8.3% 9.7%

20-24 years N %

4 3 4 11 40.0% 33.3% 33.3% 35.5%

25-29 years N %

3 1 2 6 30.0% 11.1% 16.7% 19.4%

30-34 years N %

2 1 1 4 20.0% 11.1% 8.3% 12.9%

35-39 years N %

0 1 3 4 0% 11.1% 25.0% 12.9%

40+ years N %

0 2 1 3 0% 22.2% 8.3% 9.7%


Mental health N issue %

5 4 7 16 50.0% 44.4% 58.3% 51.6%

Child protection N concerns %

2 3 2 7 20.0% 33.3% 16.7% 22.6%

criminal justice N self or partner %

1 1 1 3 10.0% 11.1% 8.3% 9.7%

substance misuse N %

2 0 0 2 20.0% 0% 0% 6.5%

care leaver N %

0 1 0 1 0% 11.1% 0% 3.2%

domestic abuse N %

0 0 1 1 0% 0% 8.3% 3.2%

young person N complex %

0 0 1 1 0% 0% 8.3% 3.2%

Total N 10 9 12 31

Table 2: Geographic deprivation, age groups and primary SNiP criteria by group allocation Analysis by independent samples t-test suggested that there was no statistical significant difference between the mean age of the participants in each group and the length of time they were retained in the project (see appendix 2). However, participants who were allocated to a MB group seemed more likely to be a first time parent compared to those allocated to CHiP or CAU (Table 3).

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Group allocation Total

Mellow Bumps

CHiP

Care-as- usual

First time parent Count % within Group allocation

4 2 2 8 40.0% 22.2% 16.7% 25.8%

Experienced parent Count % within Group allocation

6 7 10 23 60.0% 77.8% 83.3% 74.2%

Total Count 10 9 12 31

Table 3: First-time parent by group allocation Also, those allocated to an intervention group were more likely to have had a previous child in local authority or kinship care (2 5.087, df 2, p

Figure 4: Baseline measures likely problems Change over time

Figure 5: EPDS scores by group allocation

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Figure 6: AWS-depression scores by group allocation

Figure 7: AWS-anxiety scores by group allocation

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Figure 8: AWS-outward irritability scores by group allocation

Figure 9: AWS-inward irritability scores by group allocation

In Figure 5 -Figure 9, it appears that participants in the intervention groups showed improvements in the EPDS and some of the AWS subscale scores that were not replicated in the CAU group (see also appendix 2). In order to adjust for the effect of pre-intervention scores, which appeared to differ between the groups although this was not statistically

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significant, an analysis of covariance (ANCOVA) was undertaken. No statistically significant differences (p 0.05) between the groups were found when post-intervention scores and scores at 8-12 weeks post-birth were compared to pre-intervention scores (see appendix 2).

Cortisol Assays Maternal The saliva samples were unpopular with participants. Feedback suggested that they suspected that the samples might be tested for illicit drugs. As a result, only twelve participants supplied saliva samples at baseline.

Figure 10: Mean cortisol level pre-intervention The number of saliva samples provided by participants declined at each data collection point; five participants supplied samples post-intervention and only four at the 8-12 week post-birth data collection point (see appendix 2 for descriptive data). The small sample numbers meant that it was not possible to analyse any potential differences in cortisol levels between the groups.

Infant Samples of saliva were received from seven infants (a total of 14 samples); it was possible to conduct cortisol assays on six. Only two infants had samples with sufficient saliva at both collection points (pre-and post-Guthrie tests. Feedback from community midwives suggested that collecting the saliva by the laboratorys preferred method (small plastic pipette) had been extremely difficult and seemed to distress the infants. The lack of samples precluded further data analysis.

N

Minimum

Maximum

Mean

Std. Deviation

Baby pre-Guthrie cortisol (nmol/l)) baby post-Gurthrie cortisol (nmol/l))

3 3

2 2

54 18

23.33 9.67

27.227 8.021

Table 6: Baby cortisol assays

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Mother-baby interaction video Eighteen participants agreed to the researcher filming them whilst they cared for their infant, for example, during feeding or nappy changing. The videos were examined using the Mellow Parenting Observation System (MPOS). Low positive and high negative rates are indicative of possible problems in the relationship1,2. No statistically significant differences were found between the groups (see appendix 2).

MB

CHiP

CAU

-0.1 -0.05 0 0.05 0.1 0.15 0.2 Negative interactions (rate per sec.) Positive interactions (rate per sec.)

Qualitative feedback

Figure 11: Mother-infant interactions

At the 8-12 week post-birth data collection point, participants were asked about their antenatal, delivery and postnatal experiences of support, their experiences of the group intervention if they took part and their feelings about taking part in a research project in semi- structured interview. Interviews were audio-recorded and transcribed verbatim. The transcripts have just been completed. As a result, there was insufficient time to carry out a rigorous thematic analysis for this report. It is planned that this will be carried out in the near future and written up for publication in a peer-reviewed journal.

Preliminary qualitative analysis suggests that, for the majority of the participants it was an unplanned pregnancy. Participants were concerned about how they would cope. For a few, there was a worry about the reaction of social services,

I was worried in case I wasnt going to get to keep him because of what happened before (PID 107, MB).

In general, those that had attended an intervention group viewed the experience positively. Being able to meet other pregnant women in a non-judgemental environment was valued,

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the ladies (group facilitators) didnae judgeI thoroughly enjoyed itit was funthe ladies were very supportive and I would highly recommend it (CHiP) (PID 118, CHiP)

The activities of the groups had provided opportunities to relax as well as learn,

we done the desert island task thing with the play doughit was calming, it calms you down, it makes you forget about everything else thats all bad, and youre just concentrating on the goodyour minds no thinking about the negatives, youre thinking about the positives and the future, things like that (PID 122, CHiP)

we were watching the DVD and it was abootyou talking to your child and all

that, aboot the brain cellsI found that very, very interestingthat amazed me that DVDIm different wi him (this baby) than I was wi the rest of thaimI spend mair time talking to himIve got four kids and it made me sit and thinkI could spend a wee bit extra time wi thaim in the day, its about all those wee extra brain cells (PID 107, MB)

In addition, for this participant, the CHiP group had provided practical support,

CHiPs (sic) helped me to get a pram and a car seat and different things that I needed and didnt have the money for (PID 123, CHiP).

Furthermore, this participant was continuing to use the relaxation techniques that she had learnt in the group to help her cope with everyday situations,

I panic quite a lot when Im out and now I dont care, Ill stop and Ill breathebreathe the way they taught mejust to calm down (PID 123, CHiP).

It seems that taking part had had short term benefits as well as potential longer term positive outcomes. As a reflection, perhaps, of the value placed on the group, many of the participants mentioned that they felt that a six week period for the programme was too short.

5. DISCUSSION The results presented in this report suggest that taking part in either a Mellow Bumps or Chill- out in Pregnancy group had positive effects on the mental health and wellbeing of women who are vulnerable in pregnancy. Previous research has demonstrated that maternal mental health and wellbeing impacts on child development3. In particular, depression impairs maternal sensitivity and atunement to an infants needs with subsequent potential problems with attachment. Insecure attachment is a risk factor for later emotional behaviour problems4. Even though the size of the sample means that the results should be interpreted with a degree of caution, this study suggests that these group programmes were effective in helping women facing social adversity and their infants. No significant inter-group differences were found in analysis of video interactions at 8-12 postnatal weeks, but numbers were small and no baseline video data were available.

Traditional antenatal education programmes tend to fail to engage with women who face social adversity5. In this study, participants with significant health and social care needs were recruited. Feedback from those that took part in the groups has been positive suggesting that the format of the programmes was acceptable to this population.

Furthermore, this study has served as a useful exploratory study assessing the feasibility of recruiting to a randomised trial of Mellow Bumps. Many of the lessons have informed the development of the Trial of Healthy Relationships in Very-Early years (THRIVE) project.

Limitations

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The findings of this feasibility study should be considered in the light of the following limitations. Firstly, this study was limited to participants living in one health board area and one community health care partnership (CHCP) in the west of Scotland. It is possible that the working practices of community midwives may have differed from other potential settings. Secondly, all the participants were actively engaged with health services when they were recruited to the study. It was not possible to identify individuals who were reluctant to engage with midwives. Thirdly, the method used to recruit participants may have compromised the dependability of the findings. Midwives were asked to identify individuals and refer them to the project. It is possible that the participants approached were only those that were thought to be likely to take part in the group programmes. Lastly, it is possible that participants answered the questionnaires in a way that they felt would be received positively by either the research team or health and social service professionals.

Challenges This project faced a number of challenges from the outset. The delay in gaining access to research sites for the reasons outlined in section 4.1 had repercussions for this study as it was time-limited. The time period available for recruitment and follow-up was reduced significantly. The geographical distance between the two research sites meant that having an nhs.net email account was invaluable to enable personal information to be passed securely between the researcher and practitioners. As this is a hard-to-reach population, considerable perseverance was needed to make contact at the different stages of the project. Text messaging was used to confirm, re-arrange and remind participants of researcher appointments.

6. CONCLUSIONS The aim of this study was to carry out an exploratory randomised controlled trial of a social intervention with a very hard-to-reach population. The results suggest that psychoeducational interventions in pregnancy may benefit women with major psychosocial needs. We have demonstrated that undertaking a randomised trial in this population is feasible.

7. IMPORTANCE TO POLICY & PRACTICE AND POSSIBLE IMPLEMENTATION Providing group-based parenting support in a format acceptable to pregant women with additional health and social care needs may impact on their mental wellbeing in the short and longer term, but a definitive trial is required.

8. FUTURE RESEARCH This project has acted as a feasibility study for the THRIVE project which has been funded by the National Institute for Health Research (1.9M) and is hosted by the MRC/CSO Social Public Health Sciences Unit (SPHSU), University of Glasgow.

9. DISSEMINATION The preliminary results of this study have been presented at conferences such as the Scottish School of Primary Care annual conference in Inverness in April 2013.

A dissemination event is planned for August 2013 to which stakeholders along with practitioners will be invited.

The study will be written up for publication in a peer-reviewed journal. 10. RESEARCH WORKERS

Jane White was employed by the University of Glasgow to work on this project 0.6wte for a period of fifteen months from January 2012. From April 2013, she has been employed by MRC/CSO SPHSU (now University of Glasgow) to work on the THRIVE project. The PI (Dr Marion Henderson) has allowed Jane to complete data collection in conjunction with working on THRIVE.

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The Scottish Mental Health Research Network provided research assistant support to help transcribe the qualitative interviews.

11. ACKNOWLEDGEMENTS

This project would not have been possible without the help and support of numerous people. We would like to thank:

The women who have agreed to take part.

Elaine Moore, Anne Clarke, Karen Bell, Mary Garven, Marion Dodd, Beth Donnelly, Alison Barr, Jean Reid, and the community midwives who have helped to recruit participants, NHS Ayrshire & Arran.

Anne Jamieson, Catriona McLean, Morag McPhail, Rose Sloan, Joanne McGarry, Karen Smith, Halina McIntyre, NHS Greater Glasgow & Clyde.

Rosemary Mackenzie, Harriet Waugh and the Mellow Parenting team who trained the

group facilitators, developed the Chill-out in Pregnancy programme for this study and have provided on-going support.

Leona Cunningham, Mellow Parenting, who helped with the analysis of the qualitative feedback

Elsa Ekevall and Kim Jones, University of Glasgow.

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Caoimhe Clarke, Cat. Nixon, Shona Shinwell, MRC/CSO SPHSU, University of Glasgow

The Scottish Collaboration for Public Health Research and Policy who provided the majority of the funding

12. REFERENCES 1. Wilson, P.; Thompson, L.; Puckering, C.; McConnachie, A.; Holden, C.; Cassidy, C.; Gillberg,

C. (2010) Parent-child relationships: are health visitors judgements reliable? Community Practitioner 83(5), pp22-5.

2. Robertson, J.; Puckering, C.; Parkinson, K.; Corlett, L.; Wright, C. (2011) Motherchild feeding interactions in children with and without weight faltering; nested case control study Appetite 56, pp753759.

3. Clatworthy J (2012) The effectiveness of antenatal interventions to prevent postnatal depression in high risk women. Journal of Affective Disorders 137 (13), pp 2534.

4. OConnor TG, Heron J, Golding J, Beveridge M, Glover V (2002) Maternal antenatal anxiety and childrens behavioural/emotional problems at 4 years. Report from the Avon Longitudinal Study of Parents and Children. British Journal of Psychiatry 180, pp5028.

5. Gagnon AJ, Sandall J (2007) Individual or group antenatal education for childbirth or parenthood, or both. Cochrane Database of Systematic Reviews 2007 (3):CD002869

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APPENDIX 1: Special Needs in Pregnancy (SNiP) criteria

Substance misuse in last 12 months Alcohol misuse in the last 12 months Woman and or partner in criminal justice system HIV positive Child protection issues/concerns for this baby or any previous children whether or not

currently with parent(s) Significant mental health issues such as:

o Previous history of bipolar disorder, or previous admission to hospital for treatment of mental illness

o Family member with history of bipolar disorder (mother/father/brother/sister) o Current mental health problem for example depression or anxiety disorder

Gender based violence Would benefit from social work support Domestic violence with child protection concerns Homeless Living in supported accomodation Young women including those:

o Linked to leaving care services with complex needs o With identified or potential child protection concerns o Receiving considerable social work support for complex needs o In youth criminal justice system o Pregnancy conceived under difficult circumstances o Living in supported accommodation o Lacking social support from family/socially isolated o Experiencing mental health ill health o Accommodated by local authority o Linked into leaving care services

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Those who completed baseline only

Total

2 Baseline only

Two or more times

age groups 19 years or less 20-24 years 25-29 years 30-34 years 35-39 years 40+ years

1 2 3

2 2.955, df 5, p=0.707

0 11 11 2 3 5 2 3 5 0 4 4 1 2 3

SIMD Quintile 1 = 1 most deprived, 5 = least deprived 4

2 19 21 2 5..135, df 2,

p=0.077 3 4 7 1 2 3

Parity First time parent Experienced parent

2 6 8 2 3.296, df 1, p=0.069 4 19 23

Previous children yes LAAC

N/A

1 4 5 2 0.03, df 1, p=0.862

3 15 18 2 6 8


Mental health issue Child protection concerns criminal justice self or partner substance misuse care leaver domestic abuse young person complex

3 13

16

2 5.958, df 6, p=0.428

1 6

7 0 3

3 1 1 2 1 0 1 0 1 1 0 1

1 Total 6 25 31

APPENDIX 2: Data Tables

2

No

Table 7: Participants who completed baseline questionnaires only compared to others: age group, geographical deprivation, parity, previous children looked after or accommodated,

primary SNiP referral reason

N

Mean Std.

Deviation Std. Error Mean

EDPS score pre-intervention Baseline only Two or more times

6 11.00 4.561 1.862 25 11.24 6.666 1.333

AWS depression score pre- Baseline only intervention Two or more times

6 5.50 2.588 1.057 25 5.96 2.541 .508

AWS anxiety score pre- Baseline only intervention Two or more times

6 6.00 4.243 1.732 25 5.92 3.785 .757

AWS outward irritability score Baseline only pre-intervention Two or more times

6 4.17 2.137 .872 25 3.52 2.616 .523

AWS inward irritability score pre- Baseline only intervention Two or more times

6 2.50 1.517 .619 25 2.44 1.917 .383

Table 8: Participants who completed baseline questionnaires only compared to others: outcome measures

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Independent Samples t-Test: Baseline only vs others Levene's

Test for Equality of Variances

t-test for Equality of Means

F

Sig.

t

df

Sig. (2- tailed)

Mean Difference

Std. Error Difference

95% Confidence

Interval of the Difference

Lower Upper EDPS score Equal pre- variances intervention assumed

Equal variances not assumed

3.576 .069 -.083 29 .934 -.240 2.888 -6.147 5.667

-.105 10.848 .918 -.240 2.290 -5.289 4.809

AWS Equal depression variances score pre- assumed intervention Equal

variances not assumed

.023 .880 -.397 29 .694 -.460 1.159 -2.830 1.910

-.392 7.497 .706 -.460 1.173 -3.196 2.276

AWS Equal anxiety variances score pre- assumed intervention Equal


.004 .952 .045 29 .964 .080 1.758 -3.516 3.676

.042 7.039 .967 .080 1.890 -4.385 4.545

AWS Equal outward variances irritability assumed score pre- Equal intervention variances

not assumed

.124 .728 .560 29 .580 .647 1.155 -1.715 3.008

.636 9.001 .541 .647 1.017 -1.655 2.948

AWS inward Equal irritability variances score pre- assumed intervention Equal


1.135 .296 .071 29 .944 .060 .843 -1.664 1.784

.082 9.283 .936 .060 .728 -1.580 1.700

Table 9: Participants who completed baseline questionnaires only compared to others: outcome measures independent samples t-test

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Group allocation

age at group start date

Retention - weeks

Mellow Bumps N Mean Std. Deviation Minimum Maximum

10 9 25.20 27.56 5.391 3.712

18 22 34 34

CHiP N Mean Std. Deviation Minimum Maximum

9 5 28.89 24.80 8.594 4.764

17 21 40 30

Care-as-usual N Mean Std. Deviation Minimum Maximum

12 9 29.00 28.00 7.851 5.099

18 19 42 34

Table 10: Age and retention by group allocation

Independent Samples Test: MB vs CHiP Levene's Test

for Equality of Variances


F

Sig.

t

df

Sig. (2- tailed)

Mean Difference


95% Confidence Interval of the

Difference Lower Upper

age Equal at variances group assumed start Equal date variances

not assumed

4.493 .049 -1.134 17 .273 -3.689 3.254 -10.554 3.176

-1.107 13.199 .288 -3.689 3.334 -10.880 3.502

Reten Equal tion - variances weeks assumed


1.604 .229 1.207 12 .251 2.756 2.283 -2.218 7.730

1.118 6.768 .302 2.756 2.464 -3.111 8.623

Table 11: Independent t-test baseline demographics Mellow Bumps compared to CHiP

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Independent Samples Test: MB vs CAU Levene's Test



F

Sig.

t

df

Sig. (2- tailed)

Mean Difference




age at Equal group variances start assumed date Equal


2.394 .138 -1.295 20 .210 -3.800 2.935 -9.922 2.322

-1.340 19.385 .196 -3.800 2.836 -9.728 2.128

Retenti Equal on - variances weeks assumed


1.615 .222 -.211 16 .835 -.444 2.102 -4.901 4.012

-.211 14.620 .835 -.444 2.102 -4.936 4.047

Table 12: Independent t-test baseline demographics Mellow Bumps compared to Care-as- usual

Independent Samples Test: CHiP vs CAU Levene's Test



F

Sig.

t

df

Sig. (2- tailed)

Mean Difference


95% Confidence


Lower Upper age at Equal group variances start assumed date Equal


.240 .630 -.031 19 .976 -.111 3.604 -7.653 7.431

-.030 16.459 .976 -.111 3.653 -7.837 7.615

Retenti Equal on - variances weeks assumed


.003 .958 -1.150 12 .273 -3.200 2.783 -9.264 2.864

-1.174 8.907 .271 -3.200 2.726 -9.376 2.976

Table 13: Independent t-test baseline demographics CHiP compared to care-as-usual

22

Baseline EDPS score AWS depression

score

AWS anxiety score

AWS outward

irritability score

AWS inward irritablity

score

Mellow N Bumps Mean

Minimum Maximum

Std. Deviation

10 10 10 10 10 14.10 7.00 6.30 4.80 2.80

8 4 3 1 0 21 11 11 10 6

4.358 2.108 2.791 2.821 2.044 CHiP N

Mean Minimum Maximum

Std. Deviation

9 9 9 9 9 11.00 6.00 6.78 3.11 2.33

0 2 0 1 0 20 10 12 7 5

6.595 2.550 3.734 2.315 1.732 Care-as- N

usual Mean Minimum Maximum

Std. Deviation

11 11 11 11 11 9.27 5.00 5.36 3.09 2.27

1 1 0 0 0 20 8 12 6 6

6.987 2.608 4.653 2.343 1.902 Total N

Mean Minimum Maximum

Std. Deviation

31 31 31 31 31 11.19 5.87 5.94 3.65 2.45

0 1 0 0 0 21 11 12 10 6

6.247 2.513 3.803 2.511 1.823

Table 14: Outcome measures at baseline

Post-Intervention EPDS score AWS depression

score

AWS anxiety score

AWS outward

irritability score

AWS inward irritability

score

Mellow N Bumps Mean

Minimum Maximum Std. Deviation

7 7 7 7 7 10.71 6.57 5.29 3.86 2.14

7 4 3 1 0 20 13 10 9 4

4.957 3.309 2.563 2.854 1.574 CHiP N Mean


6 6 6 6 6 4.83 4.67 3.17 2.00 .83

1 1 0 0 0 10 8 8 3 2

3.251 2.658 2.714 1.265 .753 Care-as- N usual Mean


10 10 10 10 10 7.90 5.50 4.60 2.80 1.20

0 2 0 0 0 19 10 11 7 6

6.887 2.915 4.061 2.251 1.814 Total N Mean


23 23 23 23 23 7.96 5.61 4.43 2.91 1.39

0 1 0 0 0 20 13 11 9 6

5.796 2.935 3.300 2.275 1.559

Table 15: Outcome measures post-intervention

23

8-12 weeks post-birth

EPDS score AWS depression

score

AWS anxiety score

AWS outward

irritability score


score

Mellow N Bumps Mean


9 9 9 9 9 5.22 3.44 3.56 2.00 .89

0 0 0 0 0 10 6 6 6 3

2.906 1.878 1.944 1.936 1.269 CHiP N Mean


5 5 5 5 5 2.80 3.00 2.80 1.60 .80

0 1 0 0 0 10 7 10 3 4

4.147 2.345 4.087 1.140 1.789 Care-as- N usual Mean


9 7 9 9 9 5.56 5.14 4.00 2.89 .67

0 1 0 0 0 16 10 11 5 3

6.146 4.259 4.822 2.028 1.118 Total N Mean


23 21 23 23 23 4.83 3.90 3.57 2.26 .78

0 0 0 0 0 16 10 11 6 4

4.599 2.965 3.616 1.839 1.278

Table 16: Outcome measures 8-12 weeks post-birth

Mellow Bumps vs Care- as-usual

Group allocation

N

Mean

Std. Deviation

Std. Error Mean

EDPS score pre- Mellow Bumps 10 14.10 4.358 1.378 intervention Care-as-usual 11 9.27 6.987 2.107 AWS depression score Mellow Bumps 10 7.00 2.108 .667 pre-intervention Care-as-usual 11 5.00 2.608 .786 AWS anxiety score pre- Mellow Bumps 10 6.30 2.791 .883 intervention Care-as-usual 11 5.36 4.653 1.403 AWS outward irritability Mellow Bumps 10 4.80 2.821 .892 score pre-intervention Care-as-usual 11 3.09 2.343 .707 AWS inward irritablity Mellow Bumps 10 2.80 2.044 .646 score pre-intervention Care-as-usual 11 2.27 1.902 .574

Table 17: Baseline outcome measures means: Mellow Bumps group compared to Care-as- usual group

24

Independent Samples Test: MB vs

CAU

Levene's Test for Equality of

Variances


F

Sig.

T

df

Sig. (2- tailed)

Mean Difference




EDPS Equal score pre- variances interventi assumed on Equal


2.920 0.104 1.876 19 0.076 4.827 2.573 -0.559 10.213

1.918 16.942 0.072 4.827 2.517 -0.485 10.140

AWS Equal depressio variances n score assumed pre- Equal interventi variances on not

assumed

.807 0.380 1.920 19 0.070 2.000 1.042 -0.180 4.180

1.940 18.769 0.068 2.000 1.031 -0.159 4.159

AWS Equal anxiety variances score pre- assumed interventi Equal on variances

not assumed

6.587 0.019 0.552 19 0.588 0.936 1.697 -2.616 4.488

0.565 16.593 0.580 0.936 1.658 -2.567 4.440

AWS Equal outward variances irritability assumed score pre- Equal interventi variances on not

assumed

.211 0.651 1.516 19 0.146 1.709 1.127 -.651 4.069

1.502 17.601 0.151 1.709 1.138 -.685 4.104

AWS Equal inward variances irritablity assumed score pre- Equal interventi variances on not

assumed

.025 0.877 0.612 19 0.548 0.527 0.861 -1.275 2.329

0.610 18.455 0.549 0.527 0.864 -1.285 2.340

Table 18: Independent t-test baseline outcome measures: Mellow Bumps compared to Care- as-usual

Chill-out In Pregnancy vs Care-as-usual

Group allocation

N

Mean

Std. Deviation

Std. Error Mean

EDPS score pre- CHiP 9 11.00 6.595 2.198 intervention Care-as-usual 11 9.27 6.987 2.107 AWS depression score CHiP 9 6.00 2.550 .850 pre-intervention Care-as-usual 11 5.00 2.608 .786 AWS anxiety score pre- CHiP 9 6.78 3.734 1.245 intervention Care-as-usual 11 5.36 4.653 1.403 AWS outward irritability CHiP 9 3.11 2.315 .772 score pre-intervention Care-as-usual 11 3.09 2.343 .707 AWS inward irritablity CHiP 9 2.33 1.732 .577 score pre-intervention Care-as-usual 11 2.27 1.902 .574

Table 19: Baseline outcome measure means: Chill-out in Pregnancy compared to Care-as- usual groups

25

Independent Samples

Test: CHiP vs CAU

Levene's Test for Equality of Variances


F

Sig.

T

df

Sig. (2- tailed)

Mean

Differenc e




EDPS score Equal pre- variances intervention assumed


0.093 0.764 0.564 18 0.580 1.727 3.063 -4.709 8.163

0.567 17.579 0.578 1.727 3.045 -4.681 8.135



0.093 0.764 0.862 18 0.400 1.000 1.161 -1.438 3.438

0.864 17.373 0.399 1.000 1.158 -1.439 3.439

AWS anxiety Equal score pre- variances intervention assumed


1.873 0.188 0.737 18 0.471 1.414 1.919 -2.617 5.446

0.754 17.999 0.461 1.414 1.876 -2.526 5.355


not assumed

0.104 0.750 0.019 18 0.985 0.020 1.048 -2.181 2.221

0.019 17.304 0.985 0.020 1.046 -2.184 2.225

AWS inward Equal irritablity variances score pre- assumed intervention Equal


0.155 0.698 0.074 18 0.942 0.061 0.822 -1.666 1.787

0.074 17.751 0.941 0.061 0.814 -1.651 1.772

Table 20: Independent t-test baseline outcome measures: Chill-out in Pregnancy compared to Care-as-usual groups

26

Mellow Bumps vs Chill- out in Pregnancy

Group allocation

N

Mean

Std. Deviation

Std. Error Mean

EDPS score pre- Mellow Bumps 10 14.10 4.358 1.378 intervention CHiP 9 11.00 6.595 2.198 AWS depression score Mellow Bumps 10 7.00 2.108 .667 pre-intervention CHiP 9 6.00 2.550 .850 AWS anxiety score pre- Mellow Bumps 10 6.30 2.791 .883 intervention CHiP 9 6.78 3.734 1.245 AWS outward irritability Mellow Bumps 10 4.80 2.821 .892 score pre-intervention CHiP 9 3.11 2.315 .772 AWS inward irritablity Mellow Bumps 10 2.80 2.044 .646 score pre-intervention CHiP 9 2.33 1.732 .577 Table 21: Baseline outcome measure means: Mellow Bumps compared to Chill-out in

Pregnancy group

Independent Samples

Test: MB vs CHiP

Levene's Test for Equality of Variances


F

Sig.

T

df

Sig. (2-

tailed)

Mean Difference


95% Confidence


Lower Upper EDPS score Equal pre- variances intervention assumed


1.727 0.206 1.221 17 0.239 3.100 2.538 -2.256 8.456

1.195 13.648 0.253 3.100 2.595 -2.478 8.678



0.261 0.616 0.936 17 0.363 1.000 1.069 -1.255 3.255

0.926 15.618 0.369 1.000 1.080 -1.294 3.294

AWS Equal anxiety variances score pre- assumed intervention Equal


0.579 0.457 -0.318 17 0.754 -0.478 1.502 -3.647 2.691

-0.313 14.751 0.759 -0.478 1.526 -3.735 2.779


not assumed

0.457 0.508 1.416 17 0.175 1.689 1.192 -.827 4.205

1.432 16.878 0.170 1.689 1.180 -.801 4.179

AWS inward Equal irritablity variances score pre- assumed intervention Equal


0.258 0.618 0.534 17 0.601 0.467 0.875 -1.379 2.312

0.538 16.951 0.597 0.467 0.867 -1.362 2.296

Table 22: Independent t-test baseline outcome measures: Mellow Bumps compared to Chill- out in Pregnancy groups

27

ANCOVA: Tests of Between-Subjects Effects Dependent Variable: EPDS score post-intervention

Source

Type III Sum of Squares

df

Mean Square

F

Sig.

Corrected Model Intercept

EPDS PRE GROUP ALLOCATION Error

Total Corrected Total

326.389a 24.691 214.594 74.056 412.568 2195.000 738.957

3 1 1 2 19 23 22

108.796 24.691 214.594 37.028 21.714

5.010 1.137 9.883 1.705

.010

.300

.005

.208

a. R Squared = .442 (Adjusted R Squared = .354)

Table 23: EPDS score post-intervention compared to pre-intervention

ANCOVA: Tests of Between-Subjects Effects Dependent Variable: EPDS score @ 8-12 weeks

Source


df

Mean Square

F

Sig.


EPDS PRE GROUP ALLOCATION Error


305.493a 20.956 278.767 50.670 159.811 1001.000 465.304

3 1 1 2 19 23 22

101.831 20.956 278.767 25.335 8.411

12.107 2.491 33.143 3.012

.000

.131

.000

.073


Table 24: EPDS score at 8-12 weeks post-birth compared to pre-intervention

ANCOVA: Tests of Between-Subjects Effects Dependent Variable: AWS depression score post-intervention

Source


df

Mean Square

F

Sig.


AWS-depression PRE GROUP ALLOCATION

Error Total

Corrected Total

82.737a 2.941 70.806 13.037 106.742 913.000 189.478

3 1 1 2 19 23 22

27.579 2.941 70.806 6.518 5.618

4.909 .524

12.603 1.160

.011

.478

.002

.335


Table 25: AWS-depression score post-intervention post-birth compared to pre-intervention

ANCOVA: Tests of Between-Subjects Effects Dependent Variable: AWS depression score @ 8-12 weeks

Source


df

Mean Square

F

Sig.


AWS-depression PRE GROUP ALLOCATION

Error Total

Corrected Total

35.026a 3.157 18.296 23.288 140.784 496.000 175.810

3 1 1 2 17 21 20

11.675 3.157 18.296 11.644 8.281

1.410 .381 2.209 1.406

.274

.545

.155

.272


Table 26: AWS-depression score at 8-12 weeks post-birth compared to pre-intervention

28

ANCOVA: Tests of Between-Subjects Effects Dependent Variable: AWS anxiety score post-intervention

Source


df

Mean Square

F

Sig.

Corrected Model Intercept AWS-

anxiety PRE GROUP ALLOCATION Error


153.667a .336

138.676 24.681 85.986 692.000 239.652

3 1 1 2 19 23 22

51.222 .336

138.676 12.341 4.526

11.318 .074

30.643 2.727

.000

.788

.000

.091


Table 27: AWS-anxiety score post-intervention post-birth compared to pre-intervention

ANCOVA: Tests of Between-Subjects Effects Dependent Variable: AWS anxiety score @ 8-12 weeks

Source


df

Mean Square

F

Sig.

Corrected Model Intercept AWS-

anxiety PRE GROUP ALLOCATION Error


152.915a 4.300

148.285 12.062 134.737 580.000 287.652

3 1 1 2 19 23 22

50.972 4.300

148.285 6.031 7.091

7.188 .606

20.911 .850

.002

.446

.000

.443


Table 28: AWS-anxiety score at 8-12 weeks post-birth compared to pre-intervention

ANCOVA: Tests of Between-Subjects Effects Dependent Variable: AWS outward irritability score post-intervention

Source


df

Mean Square

F

Sig.


AWS-outward irritability

GROUP ALLOCATION Error Total

Corrected Total

83.833a .546

72.464

3.003 29.993 309.000 113.826

3 1 1

2 19 23 22

27.944 .546

72.464

1.502 1.579

17.702 .346

45.905

.951

.000

.563

.000

.404


Table 29: AWS-outward irritability score post-intervention post-birth compared to pre-intervention

ANCOVA: Tests of Between-Subjects Effects Dependent Variable: AWS outward irritability score @ 8-12 weeks

Source


df

Mean Square

F

Sig.

Corrected Model Intercept AWS

outward irritability PRE GROUP ALLOCATION

Error Total

Corrected Total

16.103a 8.625 9.757

9.293 58.332 192.000 74.435

3 1 1

2 19 23 22

5.368 8.625 9.757

4.647 3.070

1.748 2.810 3.178

1.514

.191

.110

.091

.246


Table 30: AWS-outward irritability score at 8-12 weeks post-birth compared to pre-interventio

29

ANCOVA: Tests of Between-Subjects Effects Dependent Variable: AWS inward irritability score post-intervention

Source


df

Mean Square

F

Sig.




Corrected Total

18.978a .938

12.790

2.998 34.500 98.000 53.478

3 1 1

2 19 23 22

6.326 .938

12.790

1.499 1.816

3.484 .517 7.044

.826

.036

.481

.016

.453


Table 31: AWS-inward irritability score post-intervention post-birth compared to pre-intervention

ANCOVA: Tests of Between-Subjects Effects Dependent Variable: AWS inward irritability score @ 8-12 weeks

Source


df

Mean Square

F

Sig.


AWS-inward irritability PRE


Corrected Total

4.870a .235 4.646

.056

31.043 50.000 35.913

3 1 1

2 19 23 22

1.623 .235 4.646

.028 1.634

.994

.144 2.843

.017

.417

.708

.108

.983

a. R Squared = .136 (Adjusted R Squared = -.001)

Table 32: AWS-inward irritability at 8-12 weeks post-birth compared to pre-intervention

30

Group allocation

N

Minimum

Maximum

Mean

Std. Deviation

Mellow cortisol level pre-intervention Bumps day 1, time, 1 (nmol/l))

cortisol level pre-intervention day 1, time 2 (nmol/l)) cortisol level pre-intervention day 1, time 3 (nmol/l)) cortisol level pre-intervention day 2, time 1 (nmol/l)) cortisol level pre-intervention day 2, time 2 (nmol/l)) cortisol level pre-intervention day 2, time 3 (nmol/l))

4 14.1 24.8 20.275 5.0592

4 4.5 36.0 19.850 12.8868

4 3.7 9.0 5.950 2.2428

4 8.5 24.0 15.875 6.9906

4 6.6 24.5 14.550 7.4011

3 1.8 9.4 5.433 3.8109

CHiP cortisol level pre-intervention day 1, time, 1 (nmol/l)) cortisol level pre-intervention day 1, time 2 (nmol/l)) cortisol level pre-intervention day 1, time 3 (nmol/l)) cortisol level pre-intervention day 2, time 1 (nmol/l)) cortisol level pre-intervention day 2, time 2 (nmol/l) cortisol level pre-intervention day 2, time 3 (nmol/l)

1 24.4 24.4 24.400 .

1 12.8 12.8 12.800 .

1 3.9 3.9 3.900 .

1 10.9 10.9 10.900 .

1 19.2 19.2 19.200 .

1 6.5 6.5 6.500 .

Care- cortisol level pre-intervention as- day 1, time, 1 (nmol/l) usual cortisol level pre-intervention

day 1, time 2 (nmol/l) cortisol level pre-intervention day 1, time 3 (nmol/l) cortisol level pre-intervention day 2, time 1 (nmol/l) cortisol level pre-intervention day 2, time 2 (nmol/l) cortisol level pre-intervention day 2, time 3 (nmol/l)

7 9.5 30.1 18.643 7.5875

6 7.1 26.4 13.300 6.7219

7 1.2 15.2 5.686 5.9698

6 7.0 27.6 16.800 7.1685

6 3.7 22.8 12.967 7.7668

6 1.3 7.8 3.400 2.2521

Table 33: Pre-Intervention cortisol assays by group allocation

31

Group allocation

N

Minimum

Maximu m

Mean

Std. Deviation

Mellow Bumps cortisol level post- intervention

Nil Samples

CHiP cortisol level post- intervention day 1, time 1 (nmol/l) cortisol level post- intervention day 1, time 2 (nmol/l) cortisol level post- intervention day 1, time 3 (nmol/l) cortisol level post- intervention day 2, time 1 (nmol/l) cortisol level post- intervention day 2, time 2 (nmol/l) cortisol level post- intervention day 2, time 3 (nmol/l))

3 7.9 12.8 11.100 2.7731

3 8.4 47.6 23.300 21.2233

3 4.6 18.1 9.300 7.6269

2 16.7 24.0 20.350 5.1619

3 18.4 22.6 21.000 2.2716

3 4.5 9.3 6.633 2.4440

Care-as-usual cortisol level post- intervention day 1, time 1 (nmol/l) cortisol level post- intervention day 1, time 2 (nmol/l) cortisol level post- intervention day 1, time 3 (nmol/l) cortisol level post- intervention day 2, time 1 (nmol/l) cortisol level post- intervention day 2, time 2 (nmol/l) cortisol level post- intervention day 2, time 3 (nmol/l)

2 13.3 17.8 15.550 3.1820

2 10.5 11.3 10.900 .5657

2 4.4 5.2 4.800 .5657

2 8.8 13.9 11.350 3.6062

2 9.8 13.4 11.600 2.5456

2 6.0 12.4 9.200 4.5255

Table 34: Post-intervention cortisol assays by group allocation

32

Group allocation

N

Minimum

Maximum

Mean

Std. Deviation

Mellow cortisol @ day 1, time 1 Bumps (nmol/l)

cortisol @ 8-12 weeks day 1, time 2 (nmol/l) cortisol @ 8-12 weeks day 1, time 3 (nmol/l) cortisol @ 8-12 weeks day 2, time 1 (nmol/l) cortisol @ 8-12 weeks day 2, time 2 (nmol/l) cortisol @ 8-12 weeks day 2, time 3 (nmol/l)

2 10.1 11.2 10.650 .7778

2 2.8 3.0 2.900 .1414

1 6.2 6.2 6.200 .

2 8.0 19.8 13.900 8.3439

1 3.1 3.1 3.100 .

2 4.4 9.3 6.850 3.4648

CHiP cortisol @ 8-12 weeks Nil Samples

Care-as- cortisol @ 8-12 weeks usual day 1, time 1 (nmol/l)

cortisol @ 8-12 weeks day 1, time 2 (nmol/l) cortisol @ 8-12 weeks day 1, time 3 (nmol/l) cortisol @ 8-12 weeks day 2, time 1 (nmol/l) cortisol @ 8-12 weeks day 2, time 2 (nmol/l) cortisol @ 8-12 weeks day 2, time 3 (nmol/l)

2 8.7 11.8 10.250 2.1920

2 7.8 10.5 9.150 1.9092

2 8.1 18.4 13.250 7.2832

2 6.7 19.9 13.300 9.3338

2 7.3 10.5 8.900 2.2627

2 7.1 10.1 8.600 2.1213

Table 35: 8-12 week post-birth cortisol assays by group allocation

33

Group allocation

Statistic

Std. Error

Video positive rate per second

22.398, df 2, p=0.302*

Mellow Mean Bumps 95% Confidence Lower Bound

Interval for Mean Upper Bound Median Std. Deviation Minimum Maximum Skewness Kurtosis

.0750 .01763

.0333

.1167

.0850 .04986

.01

.16 .277 .752

-.333 1.481 CHiP Mean

95% Confidence Lower Bound Interval for Mean Upper Bound Median Std. Deviation Minimum Maximum Skewness Kurtosis

.1240 .01860

.0724

.1756

.1400 .04159

.08

.17 -.297 .913

-2.781 2.000 Care-as- Mean usual 95% Confidence Lower Bound


.1060 .01470

.0652

.1468

.1000 .03286

.07

.14 .166 .913

-2.845 2.000 * Kruskal Wallis Test

Table 36: Positive mother-infant interactions (rate per sec) by group allocation

34

Video negative rate per second

21.097, df 2, p=0.578*

Mellow Mean Bumps 95% Confidence Lower Bound


.0175 .00559

.0043

.0307

.0200 .01581

.00

.04 -.036 .752

-1.682 1.481 CHiP Mean

95% Confidence Lower Bound Interval for Mean Upper Bound Median Std. Deviation Minimum Maximum Skewness Kurtosis

.0120 .00800 -.0102 .0342 .0000

.01789 .00 .04

1.258 .913 .313 2.000

Care-as- Mean usual 95% Confidence Lower Bound


.0080 .00374 -.0024 .0184 .0100

.00837 .00 .02

.512 .913 -.612 2.000

* Kruskal Wallis Test

Table 37: Negative mother-infant interactions (rate per sec.) by group allocation

35

full report: antenatal parenting support: an exploratory randomised contol trail of psychosocial

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