Mothers and Their Infants Co‐admitted to a Newly Developed Mother–baby Unit: Characteristics and Outcomes

Wright, Tanya; Stevens, Suzanne; Wouldes, Trecia

doi:10.1002/imhj.21742

Cited by 19 publications

(18 citation statements)

References 28 publications

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“…All women were referred by community-based, maternal mental health (MMH) teams and had infants under 1 year of age. Comprehensive description of the service and therapeutic interventions has been previously reported (Wright et al, 2018). Consent to participate in this study was sought by research assistants when the clinical team had determined that the maternal mental state was sufficient to enable competent informed consent.…”

Section: Participants and Proceduresmentioning

confidence: 99%

“…The GAF was determined by the treating psychiatrist at admission, discharge, and follow-up. We have previously reported the positive correlation between GAF and routine outcome collection using the Health of the Nation Outcome scale (Wright et al, 2018) and our preference to employ GAF because it allows greater recognition of the relationship with the infant and maternal caregiving within functioning.…”

Section: Maternal Psychopathology and Functioningmentioning

confidence: 99%

“…Greater improvement was associated with longer duration of admission and having no history of recent, illicit substance use. Co‐admitted infants were observed to be experiencing high rates of infant mental health difficulties (51%), lagging behind developmentally (51%), and showing features of, or meeting criteria for, a disordered mother–infant relationship in 67% and 29% of cases respectively (Wright, Stevens, & Wouldes, 2018).…”

Section: Introductionmentioning

confidence: 99%

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Post‐discharge outcomes for mothers and the mother–infant relationship following admission to a psychiatric Mother–Baby Unit

Wright

Stevens

Reed

et al. 2020

Infant Mental Health Journal

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Mother-Baby Unit research has focussed on maternal psychopathology over the course of an admission. Less is known about the baby's well-being, the shared relationship, or the mother's recovery. In an initial sample of 45 women, we describe discharge and post-discharge outcomes for maternal psychopathology (using maternal report and the Global Assessment of Function, GAF) and the mother-infant relationship (using the Child and Adult Relational Experimental Index, CARE Index). Three months post-discharge, one third of women described themselves as "completely recovered," one third were experiencing significant deterioration and 17% were readmitted to inpatient care. Poorer GAF scores were associated with a clinical diagnosis of comorbid personality disorder, antenatal presence of the index illness, partner illicit substance use, maternal perception of her bond, infant social withdrawal, and child protection concern. Post-discharge, the mother-infant relationship results were concerning. Only 17% were regarded as adequate. Improvement was observed across this period in 56% but relational deterioration occurred for 35%. Maternal and relational outcomes were weakly correlated at discharge (rš = 0.29, p = 0.07) but this was lost post-discharge (rš = 0.03, p = 0.89). The shared relationship and infant mental health should both be targets for intervention; both during MBU admission, and post-discharge.

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Section: Participants and Proceduresmentioning

confidence: 99%

Section: Maternal Psychopathology and Functioningmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Post‐discharge outcomes for mothers and the mother–infant relationship following admission to a psychiatric Mother–Baby Unit

Wright

Stevens

Reed

et al. 2020

Infant Mental Health Journal

Self Cite

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“…This is surprising given that electronic screening facilitates disclosure in perinatal settings and in one study, 69% reported they were glad to be asked and 87% took it as evidence their provider cared about them. 16 Other perinatal studies in New Zealand with participants with higher burdens of psychopathology have had considerably higher participation, 17 suggesting that MatCHAT may not have been a sufficiently relational approach to facilitate participation. Alternatively, the timing (over the holiday period, which is renowned for lower staffing) and short duration of this study likely contributed to poor uptake by both midwife and perinatal participants.…”

Section: Discussionmentioning

confidence: 99%

Perinatal e-screening and clinical decision support: the Maternity Case-finding Help Assessment Tool (MatCHAT)

et al. 2020

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INTRODUCTIONScreening tools assist primary care clinicians to identify mental health, addiction and family violence problems. Electronic tools have many advantages, but there are none yet available in the perinatal context. AIMTo assess the acceptability and feasibility of the Maternity Case-finding Help Assessment Tool (MatCHAT), a tool designed to provide e-screening and clinical decision support for depression, anxiety, cigarette smoking, use of alcohol or illicit substances, and family violence among pre- and post-partum women under the care of midwives. METHODSA co-design approach and an extensive consultation process was used to tailor a pre-existing electronic case-finding help assessment tool (eCHAT) to a maternity context. Quantitative MatCHAT data and qualitative data from interviews with midwives were analysed following implementation. RESULTSFive midwives participated in the study. They reported that MatCHAT was useful and acceptable and among the 20 mothers screened, eight reported substance use, one depression and five anxiety. Interviews highlighted extensive contextual barriers of importance to the implementation of maternity-specific screening. DISCUSSIONMatCHAT has potential to optimise e-screening and decision support in maternity settings, but in this study, use was impeded by multiple contextual barriers. The information from this study is relevant to policymakers and future researchers when considering how to improve early identification of common mental health, substance use and family violence problems.

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“…These disorders may also be associated with deficits in caring for the newborn baby and disruptions in the mother–baby relationship 1–3. Over the longer term, the children of mothers admitted to inpatient psychiatric services may develop a range of health, developmental and mental health concerns 4. A recent examination of the costs of perinatal mental health problems indicates that the greatest costs relate to adverse child outcomes 5…”

Section: Introductionmentioning

confidence: 99%

Protocol for a quasi-experimental study of the effectiveness and cost-effectiveness of mother and baby units compared with general psychiatric inpatient wards and crisis resolution team services (The ESMI study) in the provision of care for women in the postpartum period

et al. 2019

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IntroductionResearch into what constitutes the best and most effective care for women with an acute severe postpartum mental disorder is lacking. The effectiveness and cost-effectiveness of psychiatric mother and baby units (MBUs) has not been investigated systematically and there has been no direct comparison of the outcomes of mothers and infants admitted to these units, compared with those accessing generic acute psychiatric wards or crisis resolution teams (CRTs). Our primary hypothesis is that women with an acute psychiatric disorder, in the first year after giving birth, admitted to MBUs are significantly less likely to be readmitted to acute care (an MBU, CRTs or generic acute ward) in the year following discharge than women admitted to generic acute wards or cared for by CRTs.Methods and analysisQuasi-experimental study of women accessing different types of acute psychiatric services in the first year after childbirth. Analysis of the primary outcome will be compared across the three service types, at 1-year postdischarge. Cost-effectiveness will be compared across the three service types, at 1-month and 1-year postdischarge; explored in terms of quality-adjusted life years. Secondary outcomes include unmet needs, service satisfaction, maternal adjustment, quality of mother–infant interaction. Outcomes will be analysed using propensity scoring to account for systematic differences between MBU and non-MBU participants. Analyses will take place separately within strata, defined by the propensity score, and estimates pooled to produce an average treatment effect with weights to account for cohort attrition.Ethics and disseminationThe study has National Health Service (NHS) Ethics Approval and NHS Trust Research and Development approvals. The study has produced protocols on safeguarding maternal/child welfare. With input from our lived experience group, we have developed a dissemination strategy for academics/policy-makers/public.

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Mothers and Their Infants Co‐admitted to a Newly Developed Mother–baby Unit: Characteristics and Outcomes

Cited by 19 publications

References 28 publications

Post‐discharge outcomes for mothers and the mother–infant relationship following admission to a psychiatric Mother–Baby Unit

Post‐discharge outcomes for mothers and the mother–infant relationship following admission to a psychiatric Mother–Baby Unit

Perinatal e-screening and clinical decision support: the Maternity Case-finding Help Assessment Tool (MatCHAT)

Protocol for a quasi-experimental study of the effectiveness and cost-effectiveness of mother and baby units compared with general psychiatric inpatient wards and crisis resolution team services (The ESMI study) in the provision of care for women in the postpartum period

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