Publications by authors named "Anja Wittkowski"

67 Publications

Neurodevelopmental outcomes in children exposed to newer antiseizure medications: A systematic review.

Epilepsia 2021 Jun 14. Epub 2021 Jun 14.

Division of Evolution and Genomic Science, University of Manchester, Manchester, UK.

As prenatal exposure to certain older antiseizure medications (ASMs) has been linked with poorer neurodevelopmental outcomes in children, the use of newer ASMs throughout pregnancy has increased. The current review aimed to delineate the impact of in utero exposure to these newer ASMs on child neurodevelopment. A systematic search of MEDLINE, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature Plus, and PsycINFO was conducted, limiting results to articles available in English and published after the year 2000. Studies investigating neurodevelopmental outcomes following in utero exposure to the following ASMs were eligible for inclusion in the review: eslicarbazepine, gabapentin, lacosamide, lamotrigine, levetiracetam, oxcarbazepine, perampanel, topiramate, and zonisamide. Thirty-five publications were identified, and a narrative synthesis was undertaken. Methodological quality was variable, with distinct patterns of strengths/weaknesses attributable to design. Most studies examined lamotrigine exposure and reported nonsignificant effects on child neurodevelopment. Comparatively fewer high-quality studies were available for levetiracetam, limiting conclusions regarding findings to date. Data for topiramate, gabapentin, and oxcarbazepine were so limited that firm conclusions could not be drawn. Concerningly, no studies investigated eslicarbazepine, lacosamide, perampanel, or zonisamide. Exposure to certain newer ASMs, such as lamotrigine and levetiracetam, does not thus far appear to impact certain aspects of neurodevelopment, but further delineation across the different neurodevelopmental domains and dosage levels is required. A lack of data cannot be inferred to represent safety of newer ASMs, which are yet to be investigated.
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http://dx.doi.org/10.1111/epi.16953DOI Listing
June 2021

Risk factors for self-harm repetition in adolescents: A systematic review.

Clin Psychol Rev 2021 May 29;88:102048. Epub 2021 May 29.

School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK. Electronic address:

Self-harm behavior can begin in early adolescence, with the highest rates of self-harm, between 1990 and 2000 in England, being among adolescents aged 16 to 24 years and there being considerable risk of fatal and non-fatal repetition. Previous systematic reviews have identified risk factors for self-harm in adolescents, but not for the repetition of this behavior. The aim of this review was to synthesise the psychological, psychosocial and sociodemographic risk factors for self-harm repetition in adolescents. By searching four databases, 27 studies were identified and included in the review. Several psychological (e.g., psychiatric morbidity, features of previous self-harm, psychological distress), psychosocial (e.g., alcohol misuse, poor family and peer relationships) and sociodemographic (e.g., age, gender and ethnicity) risk factors were identified for self-harm repetition in adolescents. Several risk factors across all categories for self-harm overlapped with that of self-harm repetition, such as depression, alcohol misuse and female gender. The clinical implications of these findings for practitioners were discussed. As was the case with prior reviews in this area, comparability between studies was limited and a meta-analysis was not possible due to considerable heterogeneity in outcome definitions, measures and methodologies.
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http://dx.doi.org/10.1016/j.cpr.2021.102048DOI Listing
May 2021

The implementation of family-focused practice in adult mental health services: A systematic review exploring the influence of practitioner and workplace factors.

Int J Ment Health Nurs 2021 Aug 1;30(4):885-906. Epub 2021 Apr 1.

University of Manchester, Manchester, UK.

There is increased recognition of the need for greater and more appropriate support to be offered to families in which a parent experiences mental illness and has dependent children. One way of meeting this need is for adult mental health services to take a more family-focused approach. However, there are recognized difficulties in facilitating family-focused practice (FFP). The current review systematically synthesized quantitative and qualitative literature of practitioner perspectives and experiences of FFP in adult mental health settings to identify modifiable factors associated with its successful implementation. Five databases were searched systematically leading to the inclusion and quality assessment of 19 papers, ten of which were quantitative and nine qualitative. Analysis was guided by a narrative synthesis approach. Factors shown to influence FFP functioned at both practitioner and workplace levels and included personal attitudes, beliefs about job role, and perceptions of workplace support. Practitioners who felt that a family-focussed approach was inappropriate or detrimental to service users or outside of their remit as mental health professionals were less likely to adopt this approach. For those who saw the potential benefits of FFP, lack of confidence in their ability to deliver such an approach and lack of training can be barriers, as can lack of support and resources within services. This review highlights the need for actions to boost the awareness of adult mental health practitioners working with parents and to increase their confidence. It also makes the case for broader organizational support if family-focussed practice is to be implemented successfully.
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http://dx.doi.org/10.1111/inm.12837DOI Listing
August 2021

Women's experiences of receiving a diagnosis of premenstrual dysphoric disorder: a qualitative investigation.

BMC Womens Health 2020 10 28;20(1):242. Epub 2020 Oct 28.

Emeritus Professor, School of Medicine, Keele University, Staffordshire, UK.

Background: Premenstrual dysphoric disorder (PMDD) is a complex and disabling condition that affects women of reproductive age, characterised by severe physical and psychological symptoms that occur cyclically and remit following the onset of menses. As the psychological nature and consequences of PMDD often seem indistinguishable from symptoms of other mental health difficulties, this condition presents distinct diagnostic challenges for healthcare professionals. Therefore, this study aimed to explore women's experiences of both having PMDD and of receiving this diagnosis.

Methods: Participant recruitment took place in the United Kingdom during 2018. Seventeen women who had been diagnosed with PMDD by a medical specialist and met the clinical criteria for PMDD on the premenstrual symptoms screening tool were interviewed. The data from these semi-structured interviews were audio-recorded, transcribed and inductively analysed using reflexive thematic analysis.

Results: Twelve subthemes were identified and organised around four main themes: (1) A broken woman, (2) Misdiagnosis and the lost decades, (3) A life transformed and (4) Negotiating the aftermath.

Conclusions: The findings of this study highlight the critical importance of the accurate and timely detection of PMDD, with the aim of preventing women from experiencing severe and prolonged psychological distress. In order to achieve this, there needs to be a greater understanding and awareness of PMDD within both the medical and lay communities, alongside training for healthcare practitioners in PMDD assessment.
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http://dx.doi.org/10.1186/s12905-020-01100-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594422PMC
October 2020

Psychosocial support for male partners of women admitted to Mother and Baby Units.

J Reprod Infant Psychol 2020 09 4;38(4):378-394. Epub 2019 Dec 4.

Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester , Manchester, UK.

Objective: This study explored what support male partners of women admitted to Mother and Baby Units (MBUs) wanted.

Background: Although research has highlighted the need to support male partners of women admitted to specialist MBUs, little is known about the type of support men want and how they wish support to be delivered.

Methods: Ten men whose partner was admitted to a MBU in the United Kingdom or Australia participated in semi-structured interviews. Data were analysed using Thematic Analysis.

Results: Five themes were identified: (1) , (2) , (3) , (4) and (5) .

Conclusion: This is the first qualitative study to specifically explore the type of support male partners of MBU patients would like in terms of content, delivery and timing. Participants expressed the need to be involved in care decisions regarding their spouse and infant and to be offered advice from professionals. They highlighted barriers to accessing support and offered solutions to minimise those. In terms of clinical implications, we recommend a support package, which could be developed for MBUs to improve outcomes for male partners and their family.
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http://dx.doi.org/10.1080/02646838.2019.1698018DOI Listing
September 2020

Correction to: Trial of healthy relationship initiatives for the very early years (THRIVE), evaluating Enhanced Triple P for Baby and Mellow Bumps for those with additional social and care needs during pregnancy and their infants who are at higher risk of maltreatment: study protocol for a randomised controlled trial.

Trials 2019 Sep 10;20(1):557. Epub 2019 Sep 10.

Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Top Floor 200 Renfield Street, Glasgow, G2 3AX, Scotland.

Following publication of the original article [1], it has been brought to our attention that an error was slipped into the article's title.
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http://dx.doi.org/10.1186/s13063-019-3674-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6737664PMC
September 2019

Adult mental health practitioner beliefs about psychosis, parenting, and the role of the practitioner: A Q methodological investigation.

Psychol Psychother 2020 12 26;93(4):657-673. Epub 2019 Aug 26.

School of Health Sciences, University of Manchester, UK.

Objectives: There is a lack of research into parenting interventions for families which include a parent experiencing psychosis or other serious mental illness (SMI). Preliminary findings highlight the potential benefits of adult mental health practitioners supporting parents experiencing SMI by using self-directed parenting interventions. This study explored beliefs relating to parenting and psychosis held by practitioners working in adult mental health settings, specifically examining their beliefs about the parenting needs of adults experiencing psychosis who have dependent children, as well as their role as adult mental health practitioners.

Design: This study used Q methodology to explore the beliefs of mental health practitioners on psychosis and parenting.

Methods: Twenty-one adult mental health practitioners ranked 58 items according to how much they agreed with the belief statement presented. Participants also provided additional written information and interviews to contextualize the Q methodology data.

Results: Three factors emerged representing three groups of practitioners with similar beliefs around psychosis and parenting. Factors were labelled: 'Parenting interventions are worthwhile, and I'd deliver them', 'Parenting interventions are worthwhile, but I'm not confident to deliver them', and 'Parenting interventions might be worthwhile, but it's not my responsibility'.

Conclusion: Using parenting interventions as part of their clinical work was acceptable to most practitioners; however, some lacked confidence in their ability to work in a family-focused way. Efforts now need to focus on enhancing practitioners' skill, knowledge, and confidence in family-focused approaches to provide increased and improved support to families which include a parent experiencing psychosis or other SMI.

Practitioner Points: Parenting interventions need to be made more available and accessible to parents experiencing serious mental illness (SMI), such as psychosis. Adult mental health practitioners are willing to incorporate parenting interventions into their work with parents accessing their services, but some lack confidence to do this. These results highlight the importance of equipping practitioners with the skill, knowledge, and confidence to engage in family-focused approaches. Further research needs to involve parents experiencing SMI as well practitioners working in adult mental health services.
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http://dx.doi.org/10.1111/papt.12249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7687147PMC
December 2020

Trial of healthy relationship initiatives for the very early years (THRIVE), evaluating Enhanced Triple P for Baby and Mellow Bumps additional social and care needs during pregnancy and their infants who are at higher risk of maltreatment: study protocol for a randomised controlled trial.

Trials 2019 Aug 14;20(1):499. Epub 2019 Aug 14.

Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Top Floor 200 Renfield Street, Glasgow, G2 3AX, Scotland.

Background: Growing evidence suggests that experiences in the early years play a major role in children's development in terms of health, wellbeing and educational attainment. The Trial of healthy relationship initiatives for the very early years (THRIVE) aims to evaluate two antenatal group interventions, Enhanced Triple P for Baby and Mellow Bumps, designed for those with additional health or social care needs in pregnancy. As both interventions aim to improve maternal mental health and parenting skills, we hypothesise that in the longer term, participation may lead to an improvement in children's life trajectories.

Methods: THRIVE is a three-arm, longitudinal, randomised controlled trial aiming to recruit 500 pregnant women with additional health or social care needs. Participants will be referred by health and social care professionals, predominately midwives. Consenting participants will be block randomised to one of the three arms: Enhanced Triple P for Baby plus care as usual, Mellow Bumps plus care as usual or care as usual. Groups will commence when participants are between 20 and 34 weeks pregnant.

Discussion: The population we aim to recruit are traditionally referred to as "hard to reach", therefore we will monitor referrals received from maternity and social care pathways and will be open to innovation to boost referral rates. We will set geographically acceptable group locations for participants, to limit challenges we foresee for group participation and retention. We anticipate the results of the trial will help inform policy and practice in supporting women with additional health and social care needs during antenatal and early postnatal periods. This is currently a high priority for the Scottish and UK Governments.

Trial Registration: International Standard Randomised Controlled Trials Number (ISRCTN) Registry, ISRCTN:21656568 . Registered on 28 February 2014 (registered retrospectively (by 3 months)).
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http://dx.doi.org/10.1186/s13063-019-3571-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6694522PMC
August 2019

Parental decision-making following a prenatal diagnosis that is lethal, life-limiting, or has long term implications for the future child and family: a meta-synthesis of qualitative literature.

BMC Med Ethics 2019 08 8;20(1):56. Epub 2019 Aug 8.

The University of Manchester, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, 2nd Floor, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.

Background: Information on the factors influencing parents' decision-making process following a lethal, life-limiting or severely debilitating prenatal diagnosis remains deficient. A comprehensive systematic review and meta-synthesis was conducted to explore the influencing factors for parents considering termination or continuation of pregnancy following identification of lethal, life-limiting or severely debilitating fetal abnormalities.

Methods: Electronic searches of 13 databases were conducted. These searches were supplemented by hand-searching Google Scholar and bibliographies and citation tracing. Thomas and Harden's (2008) thematic synthesis method was used to synthesise data from identified studies.

Results: Twenty-four papers were identified and reviewed, but two papers were removed following quality assessment. Three main themes were identified through systematic synthesis. Theme 1, entitled 'all life is precious', described parents' perception of the importance of the fetus' life, a fatalistic view of their situation alongside moral implications as well as the implications decisions would have on their own life, in consideration of previous life experiences. Theme 2 ('hope for a positive outcome') contained two sub-themes which considered the parent's own imagined future and the influence of other people's experiences. Finally, Theme 3 ('a life worth living') presented three sub-themes which may influence their parental decision-making: These described parental consideration of the quality of life for their unborn child, the possibility of waiting to try for another pregnancy, and their own responsibilities and commitments.

Conclusion: The first review to fully explore parental decision-making process following lethal, life-limiting, or severely debilitating prenatal diagnosis provided novel findings and insight into which factors influenced parents' decision-making process. This comprehensive and systematic review provides greater understanding of the factors influential on decision-making, such as hope, morality and potential implications on their own and other's quality of life, will enable professionals to facilitate supported decision-making, including greater knowledge of the variables likely to influence parental choices.
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http://dx.doi.org/10.1186/s12910-019-0393-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688313PMC
August 2019

Women's lived experiences of a prenatal diagnosis of fetal growth restriction at the limits of viability: An interpretative phenomenological study.

Midwifery 2019 Sep 29;76:110-117. Epub 2019 May 29.

University of Manchester, Manchester, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, United Kingdom. Electronic address:

Objectives: The research team aimed to understand women's lived experiences during pregnancies with poor prognosis following prenatal detection of Fetal Growth Restriction at the limits of viability (FGRLV).

Methods: Qualitative interviews with six women who had attended a specialist service following a prenatal diagnosis of FGRLV were conducted. The interview data were analysed using interpretative phenomenological analysis.

Findings: Three superordinate themes alongside thirteen subthemes were identified. Theme 1 described 'a fine line between supportive and unhelpful' care experiences. A second theme of 'understanding the situation and decisions to be made' described how women faced many uncertainties. The final theme of 'parental responsibility' reflected how women imagined their futures to have been, exploring their embodied parental role and connection to their unborn or young child.

Key Conclusions And Implications For Practice: Women highlighted the importance of maternal healthcare teams providing clear information and reassurance to them. They also reported that prior experiences were important to them in influencing their perception of that pregnancy. Furthermore, women reflected on their desperation for a positive outcome. Understanding these factors can enable maternal healthcare teams to facilitate informed decision-making and provide individualised emotional support for women. Our findings will enable maternal care teams to better support women in similar clinical situations.
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http://dx.doi.org/10.1016/j.midw.2019.05.015DOI Listing
September 2019

Using the repertory grid technique to explore the experience of compassion by mothers in a mother and baby unit.

Midwifery 2019 Aug 8;75:24-32. Epub 2019 Apr 8.

School of Psychological Sciences, University of Manchester, Manchester, UK.

Despite differences between Mother and Baby Units (MBUs) and other inpatient psychiatric settings, research has not yet explored the nature and value of compassionate care offered by MBU staff despite the increasing importance of compassion in healthcare. This novel study investigated the experience of compassionate care by fifteen mothers admitted to a MBU in England using the Repertory Grid Technique. Our findings indicated that these women perceived their MBU care as compassionate. Compassion was central to nursing care and clearly implicated in women's recovery from mental illness. Additionally, other staff characteristics were important to mothers, including how effectively MBU staff coped with stressful situations, staff flexibility in their care approach and how they adhered to professional boundaries. It is important to facilitate the expression of compassion which partially depends on the personalities and training of staff and the cooperation of service managers in fostering compassionate care.
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http://dx.doi.org/10.1016/j.midw.2019.04.003DOI Listing
August 2019

Emotional development in eating disorders: A qualitative metasynthesis.

Clin Psychol Psychother 2019 Jul 25;26(4):440-457. Epub 2019 Apr 25.

Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK.

Emotions are considered to be an important feature in eating disorders. The present study aimed to conduct a systematic review and metasynthesis of qualitative studies, which considered the role of emotions in eating disorders in order to gain further insight on how these individuals experience various emotions and the strategies they use to manage them. Databases including Web of Science, PsychInfo, EMBASE, Medline, and the Cochrane library were searched for qualitative studies. The search identified 16 relevant studies. Meta-ethnography was used to synthesize the data, which involved identifying the key findings and concepts of the studies and creating metaphors. The synthesis involved reciprocal translations and lines of argument approaches being applied to the present data. Results of the synthesis identified four second-order themes and one third-order theme relating to the emotional experiences of such individuals. The second-order themes were (a) negative emotional environments, (b) interpersonal vulnerability, (c) the experience of negative emotions in social contexts, and (d) the management of emotions. The third-order theme was the emotional self within a social environment. This is the first metasynthesis on emotions and eating disorders, and our synthesis highlights the important role that emotions play in the development and maintenance of eating disorders. Our model demonstrates how poor emotional development whilst growing up results in development of poor socioemotional bonds and the inability to handle negative emotions. The most significant finding of the review is that individuals use their eating disorder to manage negative emotions.
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http://dx.doi.org/10.1002/cpp.2365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6766861PMC
July 2019

Correction to: Enhancing maternal and infant wellbeing: study protocol for a feasibility trial of the Baby Triple P Positive Parenting programme for mothers with severe mental health difficulties (the IMAGINE study).

Trials 2018 09 21;19(1):516. Epub 2018 Sep 21.

Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.

Following publication of the original article [1], the authors reported that Elizabeth Camacho was omitted from the author name list.
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http://dx.doi.org/10.1186/s13063-018-2918-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6151026PMC
September 2018

Enhancing maternal and infant wellbeing: study protocol for a feasibility trial of the Baby Triple P Positive Parenting programme for mothers with severe mental health difficulties (the IMAGINE study).

Trials 2018 Sep 10;19(1):479. Epub 2018 Sep 10.

Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.

Background: There is a strong evidence base for the benefits of parenting interventions for parents without severe mental illness (SMI). As the impact of maternal SMI can be significant on child development, mothers need support to maximise outcomes for themselves and their children. Some mothers with SMI require admission jointly with their baby to a Mother and Baby Unit (MBU), a psychiatric inpatient ward, for assessment and treatment. However, MBUs do not yet offer formally evaluated, evidence-based parenting interventions as a matter of routine. This paper describes a study to investigate the feasibility and acceptability of conducting a randomised controlled trial (RCT) to evaluate a parenting and psychological intervention targeting the mother's and infant's wellbeing for mothers admitted to a MBU.

Methods/design: This study is a multisite, single-blind feasibility trial with half the participants randomised to the Baby Triple P Positive Parenting Programme plus treatment as usual (TAU) and the other half randomised to TAU alone. Self-report and observer-rated assessments are collected at baseline, 10 weeks post-baseline and 6 months post-baseline. Participants are mothers admitted to a MBU in the Northwest of England or the Midlands. Participants are included if they are fluent in English to provide informed, written consent. Our objective is to determine whether we can recruit 66 women, randomise 60, and retain them in the intervention and study, and whether the intervention and study procedures are acceptable. As part of a nested process evaluation, qualitative interview data from trial participants and MBU staff will inform feasibility and acceptability. The feasibility of collecting data required to conduct an economic evaluation of the intervention will also be explored.

Discussion: Although research has been conducted in relation to mothers with severe mental illness and MBUs, to our knowledge, this is the first controlled trial to test the feasibility, acceptability, uptake and retention alongside the potential efficacy of a parenting intervention for this population. This study is essential to examine the contextual challenges involved in this setting with this population and to identify any refinements required.

Trial Registration: ISRCTN12765736 . Date of first registration: 2 February 2017.
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http://dx.doi.org/10.1186/s13063-018-2869-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6131761PMC
September 2018

'Just an extra pair of hands'? A qualitative study of obstetric service users' and professionals' views towards 24/7 consultant presence on a single UK tertiary maternity unit.

BMJ Open 2018 03 6;8(3):e019977. Epub 2018 Mar 6.

Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St. Mary's Hospital, Manchester, UK.

Objectives: To explore the views of maternity service users and professionals towards obstetric consultant presence 24 hours a day, 7 days a week.

Design: Semistructured interviews conducted face to face with maternity service users and professionals in March and April 2016. All responses were analysed together (ie, both service users' and professionals' responses) using an inductive thematic analysis.

Setting: A large tertiary maternity unit in the North West of England that has implemented 24/7 obstetric consultant presence.

Participants: Antenatal and postnatal inpatient service users (n=10), midwives, obstetrics and gynaecology specialty trainees and consultant obstetricians (n=10).

Results: Five themes were developed: (1) '' , (2) , (3) , (4) a (5) . Respondents acknowledged that obstetrics is an acute specialty, and consultants resolve intrapartum complications. However, variability in consultant experience and behaviour altered perception of its impact. Service users were generally positive towards 24/7 consultant presence but were not aware that it was not standard practice across the UK. Professionals were more pragmatic and discussed how the implementation of 24/7 working had affected their work, development of trainees and potential impacts on future consultants.

Conclusions: The findings raised several issues that should be considered by practitioners and policymakers when making decisions about the implementation of 24/7 consultant presence in other maternity units, including attributes of the consultants, the needs of maternity units, the team hierarchy, trainee development, consultants' other duties and consultant absences.
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http://dx.doi.org/10.1136/bmjopen-2017-019977DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855205PMC
March 2018

Parenting a Child with Phenylketonuria (PKU): an Interpretative Phenomenological Analysis (IPA) of the Experience of Parents.

J Genet Couns 2018 09 21;27(5):1074-1086. Epub 2018 Feb 21.

Division of Psychology and Mental Health, University of Manchester, Manchester, UK.

Phenylketonuria (PKU) is a rare inherited metabolic disorder which can cause neurological damage if left untreated. PKU is identified through newborn screening in developed countries, and treatment begins immediately to prevent these severe consequences. When a child is diagnosed, parents must assume immediate responsibility for the management of PKU and prevention of neurological damage. Quantitative studies have identified significant psychosocial stressors for parents, but little is known about how the parents experience this process. This study aimed to explore the experiences of parents of children with PKU under the age of two. It is the first study to examine these experiences in this way. Seven parents were interviewed about their experiences, and interpretative phenomenological analysis was used to analyse the data. Three main themes were identified: control, striving for normality and acceptance of PKU as a continuum. Links between the themes and processes underpinning the results were explored with relation to existing literature and theories from a clinical psychology perspective. The role of acceptance of PKU was central to the parent's experiences. Clinical implications and suggestions for further research are discussed.
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http://dx.doi.org/10.1007/s10897-018-0227-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132571PMC
September 2018

Women's Experiences of Seeking and Receiving Psychological and Psychosocial Interventions for Postpartum Depression: A Systematic Review and Thematic Synthesis of the Qualitative Literature.

J Midwifery Womens Health 2017 Nov 6;62(6):723-736. Epub 2017 Dec 6.

Introduction: Postpartum depression (PPD) is a serious maternal disorder that can have adverse effects on maternal and infant health. The importance of offering effective and acceptable treatments is well recognized, particularly given the numerous barriers women in many settings face in accessing interventions for PPD. The aim of this systematic review was to synthesize qualitative research exploring women's experiences of professional psychological and psychosocial support for PPD.

Methods: A systematic review of the literature was conducted in April 2017 by searching 5 electronic databases (CINAHL, MEDLINE, PubMed, Ovid, and Web of Science). Qualitative research studies published in English that explored women's experiences of professional psychosocial support for PPD were included, whereas studies exploring women's experiences of antidepressant medication only were excluded. Seventeen articles met inclusion criteria and were appraised for methodologic quality. Data were synthesized using the interpretive thematic synthesis method.

Results: Four main themes were identified: the process of help-seeking, barriers to seeking and accepting support, valued aspects of support, and outcomes. Women found the process of seeking help difficult, with several barriers preventing them from both seeking and accepting professional support. Despite this, women described the support received as beneficial and particularly valued the therapeutic relationship. Women reported 1) feeling more positive and confident after receiving a psychological and/or psychosocial intervention and 2) experiencing better relationships with their infant and other family members.

Discussion: Although seeking and accepting professional support for PPD was a difficult process, women highly valued mental health care support and perceived it as beneficial. Clinical services should aim to address the barriers women face in accessing mental health care and empower women to feel in control throughout the process, offering interventions appropriate to each woman's personal circumstance.
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http://dx.doi.org/10.1111/jmwh.12669DOI Listing
November 2017

Self-Report Measures of Parental Self-Efficacy: A Systematic Review of the Current Literature.

J Child Fam Stud 2017 6;26(11):2960-2978. Epub 2017 Jul 6.

School of Health Sciences, Division of Psychology and Mental Health, The University of Manchester, Manchester, UK.

Parenting self-efficacy (PSE) describes a parent's belief in their ability to perform the parenting role successfully. Higher levels of PSE have consistently been shown to be correlated with a wide range of parenting and child outcomes. Consequently, many parenting interventions aim to improve PSE. PSE measurement has typically been via self-report measures. However, the wide range of available measures has resulted in their limited use, inconsistent terminology and ambiguous theoretical grounding. The purpose of this systematic review was to examine the psychometric and administrative qualities of the available PSE measures and offer clarity to the terminology and the theory underpinning their use so that the future use of PSE measures can be appropriate. Eleven electronic databases were searched. Articles were included if they introduced a new measure or were psychometric evaluations of an available measure of PSE for parents of children (from infancy until 18 years of age). Thirty-four measures were identified and their psychometric and administrative qualities were examined. Overall, the quality of the available measures was varied. Whilst this review makes recommendations regarding PSE measures for parents of infants through to adolescents, some caution should be applied when choosing the most appropriate measure. The theoretical grounding of each measure was clarified so that appropriate measures can be chosen under the relevant circumstances. The implications of refinement of the available measures are discussed and further research into improving PSE measurement is identified.
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http://dx.doi.org/10.1007/s10826-017-0830-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5646137PMC
July 2017

Demographic and Psychosocial Influences on Treatment Adherence for Children and Adolescents with PKU: A Systematic Review.

JIMD Rep 2018 25;39:107-116. Epub 2017 Aug 25.

School of Health Sciences, University of Manchester, Manchester, UK.

Phenylketonuria (PKU) is a rare genetic disorder in which the amino acid phenylalanine cannot be sufficiently metabolised. Although a build-up of phenylalanine causes irreversible cognitive impairment, this can be prevented through a strict, lifelong diet restricted in natural protein. Despite the severe consequences of poor metabolic control, many children and adolescents have phenylalanine levels above their recommended limits. This systematic review was the first to examine studies reporting demographic and/or psychosocial influences on blood phenylalanine levels, with the aim to identify factors that were robustly linked with metabolic control. Four electronic databases were searched, yielding 1,808 articles. Articles were included if they reported a statistical examination of the association between one or more demographic or psychosocial factor(s) and metabolic control (as measured by blood phenylalanine concentration) for children and adolescents with PKU. Twenty-nine studies were selected for inclusion, which examined a range of child, parent and family factors related to blood phenylalanine levels. The most reproducible association was with child age, with metabolic control worsening with increasing age. This suggests that interventions promoting treatment adherence would be particularly beneficial for adolescents. There was a paucity of studies in some areas, and the quality of included studies varied; therefore, the conclusions of this review are preliminary. Research recommendations focus on promoting the growth of the evidence-base to support clinical practice.
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http://dx.doi.org/10.1007/8904_2017_52DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5953888PMC
August 2017

Social cognition and metacognition in social anxiety: A systematic review.

Clin Psychol Psychother 2018 Jan 24;25(1):10-30. Epub 2017 Aug 24.

The University of Manchester, Manchester, UK.

Cognitive-behavioural and metacognitive approaches to emotional disorder implicate beliefs in social anxiety, but the types of beliefs differ across these perspectives. Cognitive models suggest that social beliefs about the self (i.e., high standards and conditional and unconditional beliefs) are central. In contrast, the metacognitive model gives centre stage to metacognitive beliefs (i.e., positive and negative beliefs about thinking) as main contributors to the maintenance of the disorder. Despite an expanding research interest in this area, the evidence for such contributions has not yet been reviewed. This study set out to systematically review relevant cross-sectional, longitudinal, and experimental investigations of the direct and indirect (through cognitive processes, such as anticipatory processing, self-focused attention, the post-mortem, and avoidance) relationships of social and metacognitive beliefs with social anxiety. Clinical and nonclinical samples were included, and correlation and regression coefficients as well as results from group comparisons (e.g., t tests and analyses of variance) were extracted. Overall, 23 papers were located, through PsycINFO, PubMed, and Web of Science, and reviewed using narrative synthesis. The results showed a robust positive relationship between social beliefs and social anxiety that appeared to be mediated by cognitive processes. Specific metacognitive beliefs were found to positively contribute to social anxiety both directly and indirectly, through cognitive processes. The study's findings are limited to 2 models of social anxiety and other minor limitations (e.g., grey literature was excluded). With these accounted for, the results are discussed in terms of the conceptualization and treatment of social anxiety and suggestions for future research are made.
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http://dx.doi.org/10.1002/cpp.2127DOI Listing
January 2018

Authors' reply re: The effect of senior obstetric presence on maternal and neonatal outcomes in UK NHS maternity units: a systematic review and meta-analysis.

BJOG 2017 11 9;124(12):1910-1911. Epub 2017 Aug 9.

Division of Developmental Biology and Medicine, Faculty of Biology, Medicine and Health, Maternal and Fetal Health Research Centre, School of Medical Sciences, University of Manchester, Manchester, UK.

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http://dx.doi.org/10.1111/1471-0528.14800DOI Listing
November 2017

Treatment Adherence and Psychological Wellbeing in Maternal Carers of Children with Phenylketonuria (PKU).

JIMD Rep 2017 6;37:107-114. Epub 2017 Apr 6.

Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK.

Phenylketonuria (PKU), a rare metabolic disorder, causes cognitive impairment unless treated with a strict, protein-restricted diet, but few studies have examined the relationship between treatment compliance and parental wellbeing. In the present study, 46 primary caregivers of children with PKU completed measures of psychological distress, parenting stress (related to caring for a child with an illness), resilience, perceived social support and child dependency. Treatment adherence was assessed using the proportion of blood phenylalanine concentrations within target range in the preceding year. Results indicated that 59% of caregivers showed clinical levels of psychological distress, which was predicted by their parenting stress and resilience. Whilst the proportion of blood phenylalanine concentrations in range was not associated with parental distress, it was predicted by child age and caregiver's perceived support from family. Despite experiencing high levels of distress, the results indicated that caregivers' ability to adhere to treatment was not affected. Interventions to reduce parenting stress and boost caregiver resilience may have a positive effect on parental wellbeing. Additionally, interventions to promote treatment adherence benefit parents of older children, with a focus on promoting support from family members. Further research with larger sample sizes and longitudinal designs is needed to further establish causal mechanisms.
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http://dx.doi.org/10.1007/8904_2017_23DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5740045PMC
April 2017

"I just feel like I am broken. I am the worst pregnant woman ever": A qualitative exploration of the "at odds" experience of women's antenatal distress.

Health Care Women Int 2017 06 21;38(6):658-686. Epub 2017 Feb 21.

c Division of Clinical Psychology, Department of Psychology , University of Manchester , Manchester , UK.

Advances in perinatal mental health research have provided valuable insights around risk factors for the overall development of maternal distress. However, there is still a limited understanding of the experience of women struggling emotionally during pregnancy. We explored how women view, experience, and interpret psychological distress antenatally. Eighteen Australian women participated in in-depth interviews that were analyzed thematically within a critical realist theoretical framework. We present and situate the current findings within the dominant discourse of the good mother, which arguably promotes guilt and stigma and results in women self-labeling as bad mothers.
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http://dx.doi.org/10.1080/07399332.2017.1297448DOI Listing
June 2017

Acceptability of a Positive Parenting Programme on a Mother and Baby Unit: Q-Methodology with Staff.

J Child Fam Stud 2017 6;26(2):623-632. Epub 2016 Oct 6.

School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL UK.

The Baby Triple P Positive Parenting Programme, a new addition to the established Triple P programmes, is currently being considered for a trial in a Mother and Baby Unit with the aim of exploring its benefits to mothers presenting with severe mental illness. The aim of the current study was to investigate staff views of the acceptability and feasibility of a parenting programme such as the Baby Triple P Positive Parenting Programme in a Mother and Baby Unit. Q-methodology, using an 88-item Q-sort, was employed to explore the opinions of 16 staff working in a Mother and Baby Unit in the North West of England. Results obtained from the Q-sort analysis identified two distinct factors: (1) and (2) . Preliminary findings indicate that staff perceived Baby Triple P to be an acceptable and feasible intervention for the Mother and Baby Unit setting and that mothers on the unit would be open and receptive to the programme. Further research is required to expand these findings and assess the potential for this type of intervention to be used more widely across a number of Mother and Baby Unit settings.
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http://dx.doi.org/10.1007/s10826-016-0564-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5272891PMC
October 2016

A qualitative investigation in the role of the baby in recovery from postpartum psychosis.

Clin Psychol Psychother 2017 Sep 31;24(5):1099-1108. Epub 2017 Jan 31.

School of Health Sciences, University of Manchester, UK.

Psychosis after childbirth is a rare but severe type of mental health difficulty experienced by perinatal women. Research has explored mothers' experiences of onset and recovery from psychosis after childbirth. This study explored the role of the baby in 12 mothers' experiences of recovery. A thematic analysis of the data identified three core themes that described the role of the baby in the mothers' recovery from psychosis after childbirth. Findings revealed that the baby was central to recovery, experienced by mothers as both helpful and unhelpful. The baby interacted with the mother, increasing self-efficacy, and reducing emotional distress. Findings also showed that the baby could act as a barrier to recovery by increasing the women's emotional distress and hindering access to help and self-care. The findings of the study add to the existing evidence based on recovery from psychosis after childbirth. The research and clinical implications of these findings are discussed with reference to the existing literature.

Key Practitioner Message: The baby has an important role in recovery from psychosis after childbirth. The baby can be perceived by mothers to both hinder and help their recovery. Interacting with the baby can be helpful for the mothers' recovery by improving their self-efficacy and reducing emotional distress. Specialist interventions offered by a mother and baby unit can provide practical support that facilitates mother-baby interactions, which helps move women forward in the recovery process.
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http://dx.doi.org/10.1002/cpp.2074DOI Listing
September 2017

Maternal psychological distress during pregnancy does not increase the risk for adverse birth outcomes.

Women Health 2018 01 17;58(1):92-111. Epub 2017 Jan 17.

c Department of Psychology , University of Manchester , Manchester , UK.

Maternal psychological distress during pregnancy is a potential risk factor for various birth complications. This study aimed to explore psychological factors associated with adverse birth outcomes. Symptoms of psychological distress, individual characteristics, and medical complications were assessed at two time points antenatally in 285 women from Australia and New Zealand; birth outcomes were assessed postpartum, between January 2014 and September 2015. Hierarchical multiple regression analyses were conducted to examine the relation of psychological distress to adverse birth outcomes. Medical complications during pregnancy, such as serious infections, placental problems and preeclampsia, and antenatal cannabis use, were the factors most strongly associated with adverse birth outcomes, accounting for 22 percent of the total variance (p < .001). Symptoms of depression and/or anxiety, low social support, and low sense of coherence were not associated with birth complications. In unadjusted analyses, self-reported diagnosis of anxiety disorder during pregnancy and an orientation toward a Regulator mothering style were associated with adverse birth outcomes; however, after controlling for medical complications, these were no longer associated. Our study results indicate that antenatal depressive and/or anxiety symptoms were not independently associated with adverse birth outcomes, a reassuring finding for women who are already psychologically vulnerable during pregnancy.
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http://dx.doi.org/10.1080/03630242.2017.1282395DOI Listing
January 2018

The attitudes of pregnant women and midwives towards raised BMI in a maternity setting: A discussion of two repertory grid studies.

Midwifery 2017 Feb 6;45:14-20. Epub 2016 Dec 6.

South Wales DCLinPsy Programme, Cardiff University, United Kingdom; Manchester Mental Health and Social Care Trust, Manchester, United Kingdom. Electronic address:

Objectives: Weight-related stereotypes may have a detrimental impact on interactions between midwives and pregnant women with a body mass index (BMI) outside the recommended range of 18-30kg/m. This paper explores the reciprocal construal of midwives and pregnant women with a raised BMI and considers the clinical implications of these constructs.

Participants: Ten pregnant women with a BMI≥30kg/m and 11 midwives and from an inner city maternity service were recruited.

Intervention: Participants provided information that allowed for the creation of a repertory grid; generating psychological constructs (perceptions or attitudes) identifying similarities and differences between pregnant women and midwives across a BMI range.

Findings: Midwives were extremely conscious of being perceived as judgemental. They construed all pregnant women as anxious and vulnerable, but attributed characteristics such as "less health-conscious" and "complacent" to those with a raised BMI. The ideal pregnant woman and ideal midwife were typically construed as more likely to have a BMI of 18-30kg/m. Pregnant women with a BMI≤18kg/m were construed as lacking warmth. While midwives differentiated between the elements based on role, the pregnant women construed the elements according to their BMI. Similarly, they construed those with a BMI≤18kg/m as having an undesirable personality, and acknowledged weight-related stereotypes for those with a raised BMI.

Clinical Implications: It is possible these constructs impact on the way midwives care for and interact with women. Midwives may be supported through reflective clinical supervision and communication skills training to reduce the perceptions of stigma experienced by women with a raised BMI. It may be beneficial to involve pregnant women with a raised BMI in service development to ensure services meet their needs.
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http://dx.doi.org/10.1016/j.midw.2016.12.004DOI Listing
February 2017

The Experiences of Fathers When Their Partners are Admitted with Their Infants to a Psychiatric Mother and Baby Unit.

Clin Psychol Psychother 2017 Jul 2;24(4):919-931. Epub 2016 Dec 2.

Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.

Mothers with severe post-natal mental illness can be admitted with their infant to a psychiatric mother and baby unit (MBU) in the UK. MBUs provide specialist assessment, management and support. Partners of women admitted to MBUs are integral to their recovery but may show reduced wellbeing themselves, yet their support needs have not been investigated. This study aimed to identify how fathers experience the MBU and how they felt supported. A qualitative design was adopted by using a purposive sample of 17 fathers, recruited from a MBU during their partner's admission. Semi-structured interviews were used, and responses were analysed using an inductive thematic analysis. Four main themes were developed: (1) 'double whammy', (2) understanding the admission and illness, (3) support for fathers, and (4) personal stressors and coping. We identified the emotional struggle that fathers experienced when coping simultaneously with the arrival of a baby and their partner's illness. Furthermore, fathers sought support from many sources, but their knowledge of psychiatric services and mental illness was limited. Fathers felt uncertain about their partners' progression and when their partner would return home with their baby. The provision of an information pack and regular one-to-one meetings between fathers and MBU staff are recommended. Copyright © 2016 John Wiley & Sons, Ltd.

Key Practitioner Message: Partners of mothers admitted to a psychiatric mother and baby unit have shown increased vulnerability to mental illness themselves; however, little is known about the support that these fathers need and receive during this time. Using interviews, this study sought to understand a) how fathers experienced the mental illness of their partner and the unit's services and b) how fathers could be better supported. Fathers face many emotional and practical challenges during their partner's admission and seek support from numerous sources, including the mother and baby unit. Fathers require more information from the mother and baby unit with regard to mental illness and the unit's services. Furthermore, the introduction of regular one-to-one updates between staff and fathers would provide an opportunity for fathers to understand how their partner is progressing and for staff to informally assess the father's wellbeing and outstanding support needs.
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http://dx.doi.org/10.1002/cpp.2056DOI Listing
July 2017

Does Engaging in a Group-Based Intervention Increase Parental Self-efficacy in Parents of Preschool Children? A Systematic Review of the Current Literature.

J Child Fam Stud 2016 13;25(11):3173-3191. Epub 2016 Jun 13.

School of Psychological Sciences, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL UK.

As the preschool years are a formative period for long-term physical and mental health, this period is recognised as an important window for early effective intervention. Parenting behaviour is a key factor to target in order to optimise child development. Group-based interventions for parents are considered efficient and cost effective methods of early intervention and have been found to improve child behaviour and adjustment. Self-efficacy is key to behaviour change and as such parental self-efficacy should be a consideration in interventions aimed at influencing parenting behaviour. Therefore, the purpose of this systematic review was to examine the impact of group-based early interventions for parents of preschool children on parental self-efficacy. Nine databases were searched (ASSIA, CINAHL, EMBASE, Maternity and Infant Care, Ovid Medline, PsycINFO, Pubmed, Science Direct and Web of Science). Studies were included if they were a randomised controlled trial of a group-based intervention for parents of preschool children and measured change in parental self-efficacy. Fifteen studies were identified. Although changes in parental self-efficacy following a group-based intervention were noted in the majority of studies reviewed, the methodological quality of the studies included in the review means these findings have to be interpreted with caution; only seven studies were rated to be methodologically adequate. Further research is needed to understand the mechanisms by which these interventions may improve parental self-efficacy. Studies specifically examining the impact of such interventions on paternal self-efficacy are also warranted.
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http://dx.doi.org/10.1007/s10826-016-0464-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5061830PMC
June 2016

Baby Steps - An Online Program Promoting the Well-Being of New Mothers and Fathers: A Study Protocol.

JMIR Res Protoc 2016 Jul 1;5(3):e140. Epub 2016 Jul 1.

Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.

Background: Parental well-being can be seriously impacted during the challenging perinatal period. Most research and support services focus on perinatal psychopathology, leaving a need for programs that recognize and enhance the strengths and well-being of parents. Furthermore, fathers have received minimal attention and support relative to mothers, despite experiencing perinatal distress. New parents have limited time and energy to invest in program attendance, and web-based programs provide an ideal platform for delivering perinatal well-being programs. Such programs are globally accessible, available at any time, and can be accessed anywhere with an Internet connection.

Objective: This paper describes the protocol of a randomized controlled trial investigating the effects on first-time parents' perinatal well-being, comparing two versions of the online program Baby Steps.

Methods: The clinical trial will randomize 240 primiparous mother-father couples to either (1) Babycare, an online information-only program providing tips on selected childcare issues, or (2) Well-being, an online interactive program including all content from the Babycare program, plus parental well-being-focused content with tools for goal-setting and problem solving. Both programs will be supported by short message service (SMS) texts at two, four, seven, and ten weeks to encourage continued use of the program. Primary outcomes will be measures of perinatal distress and quality of life. Secondary outcomes will be couple relationship satisfaction, parent self-efficacy, and social support. Cost-effectiveness will also be measured for each Baby Steps program.

Results: Participant recruitment commenced March, 2015 and continued until October, 2015. Follow-up data collection has commenced and will be completed May, 2016 with results expected in July, 2016.

Conclusions: Perinatal distress has substantial impacts on parents and their infants, with potential to affect later childhood adjustment, relationships, and development. This study aims to test the impact of a highly accessible online program to support parental coping, and maximize the well-being of both parents. By including fathers in the program, Baby Steps has the potential to engage and support this often neglected group who can make a substantial contribution to familial well-being.

Clinicaltrial: Australian & New Zealand Clinical Trials Registry: ANZCTR12614001256662; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=367277 (Archived by WebCite at http://www.webcitation.org/6ibUsjFIL).
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http://dx.doi.org/10.2196/resprot.5706DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4963015PMC
July 2016