Healthy babies for mothers with serious mental illness: A case management framework for mental health clinicians

Hauck, Yvonne; Röck, Daniel; Jackiewicz, Tanyana A.; Jablensky, Assen

doi:10.1111/j.1447-0349.2008.00573.x

Cited by 34 publications

(25 citation statements)

References 28 publications

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“…Second, personality disorders are not included despite the fact that these disorders are prevalent during pregnancy and are known to worsen health outcomes and complicate treatment in case of comorbid conditions [15]. Third, comorbid conditions such as insufficient social support and substance use are claimed to be strong independent co-predictors for mental disorders [16,17] but are rarely incorporated in screening or triage.…”

Section: Introductionmentioning

confidence: 99%

Successful five-item triage for the broad spectrum of mental disorders in pregnancy – a validation study

Quispel

Schneider

Hoogendijk

et al. 2015

BMC Pregnancy Childbirth

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BackgroundMental disorders are prevalent during pregnancy, affecting 10% of women worldwide. To improve triage of a broad spectrum of mental disorders, we investigated the decision impact validity of: 1) a short set of currently used psychiatric triage items, 2) this set with the inclusion of some more specific psychiatric items (intermediate set), 3) this new set with the addition of the 10-item Edinburgh Depression Scale (extended set), and 4) the final set with the addition of common psychosocial co-predictors (comprehensive set).MethodsThis was a validation study including 330 urban pregnant women. Women completed a questionnaire including 20 psychiatric and 10 psychosocial items. Psychiatric diagnosis (gold standard) was obtained through Structured Clinical Interviews of DSM-IV axis I and II disorders (SCID-I and II). The outcome measure of our analysis was presence (yes/no) of any current mental disorder.The performance of the short, intermediate, extended, and comprehensive triage models was evaluated by multiple logistic regression analysis, by analysis of the area under the ROC curve (AUC) and through associated performance measures, including, for example, sensitivity, specificity and the number of missed cases.ResultsDiagnostic performance of the short triage model (1) was acceptable (Nagelkerke's R2=0.276, AUC=0.740, 48 out of 131 cases were missed). The intermediate model (2) performed better (R2=0.547, AUC=0.883, 22 cases were missed) including the five items: ever experienced a traumatic event, ever had feelings of a depressed mood, ever had a panic attack, current psychiatric symptoms and current severe depressive or anxious symptoms. Addition of the 10-item Edinburgh Depression Scale or the three psychosocial items unplanned pregnancy, alcohol consumption and sexual/physical abuse (models 3 and 4) further increased R2 and AUC (>0.900), with 23 cases missed. Missed cases included pregnant women with a current eating disorder, psychotic disorder and the first onset of anxiety disorders.ConclusionsFor a valid detection of the full spectrum of common mental disorders during pregnancy, at least the intermediate set of five psychiatric items should be implemented in routine obstetric care. For a brief yet comprehensive triage, three high impact psychosocial items should be added as independent contributors.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0480-9) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Successful five-item triage for the broad spectrum of mental disorders in pregnancy – a validation study

Quispel

Schneider

Hoogendijk

et al. 2015

BMC Pregnancy Childbirth

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“…CHWs have long been believed to be central to ensuring adherence to actions promoting health [28, 29]. It has been argued that adherence is closely linked to the quality of interactions with the health worker [28], and when the participant has faith and trust in the messenger [30].…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Relationship and Study Adherence in a Community Health Worker-Led Intervention

et al. 2016

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Community health workers (CHWs) are increasingly utilized to reach low-resource communities. A critical domain influencing success is the CHWs’ ability to create and maintain a therapeutic relationship with the participants they serve. A limited evidence base exists detailing this construct, and evaluating CHW-participant relationships in the context of CHW-led programs. In a longitudinal study design, data on this therapeutic relationship were collected [as captured using The Scale to Assess the Therapeutic Relationship in Community Mental Health Care (STAR)] on 141 participants who had been assigned to a CHW during their perinatal period. Results indicate that therapeutic relationship was associated with the participant’s psychosocial health, and independently predicted study adherence in the longitudinal intervention. Changes in therapeutic relationship over the months following birth were strongly associated with changes in anxiety and depression symptoms. A trustful relationship is critical in ensuring CHWs can effectively reach the population they serve. The findings offer additional psychometric evidence of the uses and benefits of STAR outside of the traditional clinical setting in the context of public health research.

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“…In order to disseminate our findings widely among clinicians, we published them in Directions in Psychiatry (warded "Exemplary Status" by the Accreditation Council for Continuing Medical Education) [11]. We also worked with mental health services to develop a care coordination package for these women in pregnancy, resulting in the implementation of a State care-coordination program for pregnant women with severe mental illness, the first of its kind in Australia [12].…”

Section: Data Typementioning

confidence: 99%

Longitudinal, Whole-population Data Examining Pathways of Risk from Conception to Disease: The Western Australian Schizophrenia High-risk e-Cohort

Morgan

Valuri

Croft

et al. 2014

OHD

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This database has been constructed to support a program of work designed to untangle genetic and environmental contributions to the risk for schizophrenia and other adverse outcomes in the offspring of mothers with schizophrenia and other severe mental illness. To do this, it utilises Western Australian whole-population health and social services databases. Records on the Western Australian psychiatric case register have been linked to Midwives’ Notification of Birth records and to Registrations of Births (for paternal links) as well as to other data sets. Maternal links identify women with psychosis who gave birth in Western Australia between 1980 and 2001. Comparison mothers are those with no record of psychiatric illness who gave birth in Western Australia over the same period. The study database comprises 246,873 mothers and 467,945 children: 889 mothers with schizophrenia (1,672 children); 1,644 mothers with bipolar disorder (3,358 children); 4,200 mothers with unipolar major depression (8,864 children); 775 mothers with other psychoses (1,592 children); and 239,365 comparison mothers (452,459 children). Full psychiatric histories for mothers, fathers and children have been extracted. At the time of the most recent update to the psychiatric data on children, 33,363 children had a history of psychiatric illness; 5,500 of these had had at least one contact with mental health services at which a diagnosis of a psychotic disorder had been recorded. Data have also been collected on obstetric complications and a range of infant and childhood morbidities including birth defects, intellectual disability, educational achievement, childhood abuse, criminal offending.The program aims are to: (i) determine the frequency and distribution of obstetric complications in women with schizophrenia compared to a non-psychiatric comparison group of mothers; (ii) explore the spectrum of outcomes for the children born to women with schizophrenia compared to comparison children, and to assess the specificity of these findings to maternal schizophrenia compared to maternal bipolar disorder, unipolar major depression and other psychotic illness; and (iii) examine the relationship between familial psychiatric status, obstetric complications and mental health outcomes for children.The data sit in an Ingres relational database. A full description of the database and its elements has been published [1]. Numbers in this article differ from previously published numbers as a result of new linkages and updates to the database.

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Healthy babies for mothers with serious mental illness: A case management framework for mental health clinicians

Cited by 34 publications

References 28 publications

Successful five-item triage for the broad spectrum of mental disorders in pregnancy – a validation study

Successful five-item triage for the broad spectrum of mental disorders in pregnancy – a validation study

Therapeutic Relationship and Study Adherence in a Community Health Worker-Led Intervention

Longitudinal, Whole-population Data Examining Pathways of Risk from Conception to Disease: The Western Australian Schizophrenia High-risk e-Cohort

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