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Baans NEU, Janßen M, Müller JM. Parent-child relationship measures and pre-post treatment changes for a clinical preschool sample using DC:0-3R. Child Adolesc Psychiatry Ment Health 2024; 18:56. [PMID: 38755711 PMCID: PMC11100244 DOI: 10.1186/s13034-024-00746-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 05/01/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND To reduce psychopathologies in children, various treatment approaches focus on the parent-child relationship. Disruptions in the parent-child relationship are outlined in the most recently revised versions of the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-3R/DC:0-5). The measures used to assess the parent-child relationship include the Parent-Infant Relationship Global Assessment Scale (PIRGAS) and the Relationship Problems Checklist (RPCL), which cover, e.g., essential concepts like over- or underinvolvement of the caregiver. However, not much is known about the cross-sectional and predictive value of PIRGAS and RPCL scores at admission to discharge, namely whether changes in these scores are correlated with child and maternal psychopathologies and changes through treatment. METHODS Based on clinical records of 174 preschool-aged children of the Family Day Hospital, we report related basic descriptive data and changes from admission to discharge for the parent-child relationship, child behaviour, and maternal psychopathology. We used a Pearson correlation or a point-biserial correlation to describe the associations and performed a paired t-test to examine differences before and after measurement. RESULTS Our results show overall improvements in our parent-child relationship measures and in child and maternal psychopathology. However, we observed little or no correlation between the parent-child relationship measures and child or maternal psychopathology. CONCLUSIONS We highlight potential drawbacks and limitations of the two relationship measures used that may explain the results of this study on the associations between the variables assessed. The discussion emphasizes the assessment of DC:0-3R/DC:0-5, which are popular in clinical practice for economic reasons.
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Affiliation(s)
- Nicole Elli Ursula Baans
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Schmeddingstrasse 50, 48149, Münster, Germany
| | - Marius Janßen
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Schmeddingstrasse 50, 48149, Münster, Germany
| | - Jörg Michael Müller
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Schmeddingstrasse 50, 48149, Münster, Germany.
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Roca-Lecumberri A, Torres A, Andrés S, López C, Naranjo C, Roda E, Garcia-Esteve L, Gelabert E. Treating postpartum affective and/or anxiety disorders in a mother-baby day hospital: preliminary results. Int J Psychiatry Clin Pract 2023; 27:344-350. [PMID: 37530780 DOI: 10.1080/13651501.2023.2236169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/28/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION Women experiencing perinatal mental-health illness have unique needs. The present study analyzes preliminary data about the effectiveness of MBDH in treating postpartum women with affective and anxiety disorders. METHODS We analysed 33 mothers with affective and/or anxiety disorders treated at the MBDH with their babies between March 2018 and December 2019. All women were assessed at admission, discharge and three months after discharge. Outcomes included symptoms of depression (EPDS) and anxiety (STAI-S), mother-infant bonding (PBQ) and functional impairment (HoNOs). We also assessed the clinical significance of changes in patients' scores on these scales and patient satisfaction. RESULTS At discharge, no patients still met the full criteria for the main diagnosis. Between admission and discharge, symptoms of depression and anxiety, mother-infant bonding, functional impairment and autonomy in caring for babies improved significantly. These gains were maintained at three months follow-up. Patient satisfaction was high. CONCLUSIONS These preliminary results suggest that multidisciplinary intervention for postpartum women with affective or anxiety disorders at the MBDH improves maternal psychopathology, mother-infant bonding and mothers' ability to care for their babies. MBDHs are a promising approach for delivering specialised perinatal mental-health care for mother-baby dyads.
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Affiliation(s)
- Alba Roca-Lecumberri
- Perinatal Mental Health Unit, Hospital Clínic Barcelona, Barcelona, Spain
- Psychiatry and Clinical Psychology Department, Institute of Neuroscience Hospital Clínic Barcelona, Barcelona, Spain
| | - Anna Torres
- Perinatal Mental Health Unit, Hospital Clínic Barcelona, Barcelona, Spain
- Psychiatry and Clinical Psychology Department, Institute of Neuroscience Hospital Clínic Barcelona, Barcelona, Spain
| | - Susana Andrés
- Perinatal Mental Health Unit, Hospital Clínic Barcelona, Barcelona, Spain
- Child and Adolescent Psychiatry and Psychology Department, Institute of Neuroscience Hospital Clínic Barcelona, Barcelona, Spain
| | - Cristina López
- Perinatal Mental Health Unit, Hospital Clínic Barcelona, Barcelona, Spain
- Psychiatry and Clinical Psychology Department, Institute of Neuroscience Hospital Clínic Barcelona, Barcelona, Spain
| | - Carmen Naranjo
- Perinatal Mental Health Unit, Hospital Clínic Barcelona, Barcelona, Spain
- Psychiatry and Clinical Psychology Department, Institute of Neuroscience Hospital Clínic Barcelona, Barcelona, Spain
| | - Ester Roda
- Perinatal Mental Health Unit, Hospital Clínic Barcelona, Barcelona, Spain
- Psychiatry and Clinical Psychology Department, Institute of Neuroscience Hospital Clínic Barcelona, Barcelona, Spain
| | - Lluïsa Garcia-Esteve
- Perinatal Mental Health Unit, Hospital Clínic Barcelona, Barcelona, Spain
- Psychiatry and Clinical Psychology Department, Institute of Neuroscience Hospital Clínic Barcelona, Barcelona, Spain
| | - Estel Gelabert
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
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Moureau A, Cordemans L, Gregoire C, Benoît P, Delvenne V. A 5 years' experience of a parent-baby day unit: impact on baby's development. Front Psychiatry 2023; 14:1121894. [PMID: 37398587 PMCID: PMC10308312 DOI: 10.3389/fpsyt.2023.1121894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/12/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Psychiatric Mother-Baby Units are well established in France, United Kingdom, and Australia, mostly in full-time hospitalization. Inpatient units are considered as best practice for improving outcomes for mothers and babies when the mother is experiencing severe mental illness and many studies have showed the effectiveness of care for the mother or the mother-infant relationship. Only a limited number of studies have focused on the day care setting or on the development of the baby. Our parent-baby day unit is the first day care unit in child psychiatry in Belgium. It offers specialized evaluation and therapeutic interventions focused on the baby and involves parents with mild or moderate psychiatric symptoms. The advantages of day care unit is to reduce the rupture with social and family living. Aims The objective of this study is to evaluate the effectiveness of parent-baby day unit in prevention of babies' developmental problems. First, we present the clinical characteristics of the population treated in the day-unit in comparison to the features presented in the literature review about mother-baby units, which usually receive full-time treatment. Then, we will identify the factors that might contribute to a positive evolution of the baby's development. Materials and methods In this study, we retrospectively analyze data of patients admitted between 2015 and 2020 in the day unit. Upon admission, the 3 pillars of perinatal care - babies, parents, and dyadic relationships - have systematically been investigated. All the families have received a standard perinatal medico-psycho-social anamnesis, including data on the pregnancy period. In this unit, all the babies are assessed at entry and at discharge using the diagnostic 0 to 5 scale, a clinical withdrawal risk, and a developmental assessment (Bayley). Parental psychopathology is assessed with the DSM5 diagnostic scale and the Edinburgh scale for depression. Parent-child interactions are categorized according to Axis II of the 0 to 5 scale. We have evaluated the improvement of children symptomatology, the child development and the mother-child relation between the entrance (T1) and the discharge (T2) and we have compared two groups of clinical situations: a group of patients with a successful evolution (considering baby's development and the alliance with the parents) and a group of unsuccessful evolution during hospitalization. Statistical analysis We use descriptive statistics to characterize our population. To compare the different groups of our cohort, we use the T-test and non-parametric tests for continue variables. For discrete variables, we used the Chi2 test of Pearson. Discussion The clinical population of the day unit is comparable to the mother-baby units in terms of psychosocial fragility but the psychopathological profile of the parents entering the day unit shows more anxiety disorder and less post-partum psychosis. The babies' development quotient is in the average range at T1 and is maintained at T2. In the day unit, the number of symptoms as well as the relational withdrawal of the babies is reduced between T1 and T2. The quality of parent-child relationship is improved between T1 and T2. The children of the group of pejorative evolution had a lower developmental quotient at the T1 and an overrepresentation of traumatic life events. Conclusion These results indicate that parent-baby day unit lead to positive outcomes in clinical situations with anxio-depressive parents, relational withdrawal of the babies, functional problems of the babies but not when a significant impact on the development of the baby already exists. The results of this study can guide therapeutic approaches for the benefit of care in parent-baby day units, and improve the development of the child and of the dyadic relationships.
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Affiliation(s)
- Audrey Moureau
- Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
- Child and Adolescent Psychiatry Department, Queen Fabiola Children’s University Hospital, Brussels, Belgium
| | - Louise Cordemans
- Child and Adolescent Psychiatry Department, Queen Fabiola Children’s University Hospital, Brussels, Belgium
- Faculty of Psychology, Université Libre de Bruxelles, Brussels, Belgium
| | - Caroline Gregoire
- Child and Adolescent Psychiatry Department, Queen Fabiola Children’s University Hospital, Brussels, Belgium
- Faculty of Psychology, Université Libre de Bruxelles, Brussels, Belgium
| | - Pirmez Benoît
- Faculty of Statistics, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Veronique Delvenne
- Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
- Child and Adolescent Psychiatry Department, Queen Fabiola Children’s University Hospital, Brussels, Belgium
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Narayan S, Kishore MT, Satyanarayana V, Bhaskarapillai B, Desai G, Chandra P. Bonding and Infants' Development and Quality of Life: A Study Among Mothers with Severe Mental Illnesses in Remission. Indian J Psychol Med 2023; 45:250-256. [PMID: 37152397 PMCID: PMC10159554 DOI: 10.1177/02537176231164732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Background Maternal mental health has specific implications for bonding and infants' mental health. However, most of the evidence comes from mothers who are either symptomatic or did not have adequate mental health support. In this context, our objective was to explore if symptom status in mothers and bonding share any significant association with the infants' development and quality of life (QOL), in case of mothers with severe mental illnesses in remission. Methods The study included 41 mother-infant dyads from the outpatient perinatal psychiatry services and the mother-baby unit of the current study center. Symptom status, self-reported bonding, mother-infant interactions, and infants' development and QOL were assessed with Clinical Global Impressions, Postpartum Bonding Questionnaire, Pediatric Infant-Parent Exam, Developmental Assessment Scales for Indian Infants, and Pediatric Quality of Life Scale, respectively. Results Most mothers had a complete recovery or minimal symptoms. Nine (22%) infants had a significant developmental delay. Atypical play-based interactions were observed in nine (22%) mothers. Self-reported bonding and bonding as evinced over play-based interactions did not significantly correlate with the QOL or development of the infants. Mothers who have recovered and are functioning well reported good bonding with their infants, though objective assessment revealed specific difficulties. Symptom severity correlated with poor physical QOL in infants. Conclusion The association between mothers' bonding and infants' mental health is domain-specific and differential than linear and robust. Infants of mothers with severe mental illnesses postpartum should be routinely monitored for mother-infant bonding, development, and quality of life.
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Affiliation(s)
- Shweta Narayan
- Dept. of Clinical Psychology, NIMHANS,
Bangalore, Karnataka, India
| | - M. Thomas Kishore
- Dept. of Clinical Psychology, NIMHANS,
Bangalore, Karnataka, India
- M. Thomas Kishore, Dept. of Clinical
Psychology, Dr MV Govindaswamy Centre, NIMHANS, Bangalore, Karnataka 560029,
India. E-mail:
| | | | | | - Geetha Desai
- Dept. of Psychiatry, NIMHANS,
Bangalore, Karnataka, India
| | - Prabha Chandra
- Dept. of Psychiatry, NIMHANS,
Bangalore, Karnataka, India
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Osofsky JD, Fields-Olivieri MA, Frazer AL, Graham RA, McCurdy BH, Weems CF. What to Look for in Relationships: Development, inter-rater reliability, and initial validity estimates for a young child-caregiver relationship assessment. Front Psychol 2023; 14:1157665. [PMID: 37057146 PMCID: PMC10086182 DOI: 10.3389/fpsyg.2023.1157665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/08/2023] [Indexed: 03/30/2023] Open
Abstract
IntroductionObservational assessments are important for understanding a range of behaviors and emotions in the young child-caregiver relationship. This paper provides initial data on a multidimensional assessment for professionals who work with young children and their caregivers, the What to Look for in Relationships (WLR). The WLR was designed to assist providers in evaluating strengths and areas for improvement in five areas of young child-caregiver relationship dimensions. This paper reports on the development, interrater reliability, initial convergent and discriminant validity, and incremental utility of the scales.MethodsData were collected from caregiver-child dyads, who participated in a semi-structured observational caregiver-child interaction session as part of a clinic evaluation for relationship-based therapeutic services for young children in child protection. Recorded interactions were coded using the WLR scales with 146 interactions coded by at least two independent observers for interrater reliability analyses.ResultsThe scales showed adequate internal consistency, good inter-rater reliability, strong convergent associations with a single dimension measure (i.e., the Parent-Infant Relationship Global Assessment Scale; PIR-GAS) and discriminated those in the clinical range from those with adaptive functioning on the PIR-GAS.DiscussionThis study provides initial support for the usefulness of the WLR scales for assessing dimensions of caregiver-child relationships during early childhood that may be useful targets of intervention.
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Affiliation(s)
- Joy D. Osofsky
- Louisiana State University Health Sciences Center, New Orleans, LA, United States
- *Correspondence: Joy D. Osofsky,
| | | | - Andrew L. Frazer
- Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Rebecca A. Graham
- Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Bethany H. McCurdy
- Human Development and Family Studies, Iowa State University, Ames, IA, United States
| | - Carl F. Weems
- Human Development and Family Studies, Iowa State University, Ames, IA, United States
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Arefadib N, Shafiei T, Cooklin A. Barriers and facilitators to supporting women with postnatal depression and anxiety: A qualitative study of maternal and child health nurses' experiences. J Clin Nurs 2023; 32:397-408. [PMID: 35156748 PMCID: PMC10078709 DOI: 10.1111/jocn.16252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/24/2022] [Accepted: 01/31/2022] [Indexed: 01/17/2023]
Abstract
AIMS AND OBJECTIVES To explore maternal and child health nurses' experiences of supporting women with postnatal depression and anxiety and the factors which impact these. BACKGROUND Maternal and child health nurses play a key role in identifying women with postnatal depression and anxiety and facilitating their access to appropriate supports. Understanding how nurses carryout this work, and the conditions which impact their ability to do so, is critical to the development of service delivery frameworks that can facilitate optimal outcomes for women and their families. Despite this, little is known about this subject. DESIGN A qualitative descriptive study. METHODS Participants were maternal and child health nurses practicing for at least six months and regularly seeing new mothers in Victoria, Australia. Twelve nurses were interviewed. Thematic analysis was conducted to identify patterns across our data. Qualitative content analysis was used to identify issues which were most emphasised by nurses. Reporting complies with the COREQ checklist. FINDINGS Three overarching themes were identified. Theme one pertained to steps taken by nurses following the identification of depression or anxiety symptoms and the shared challenges they encountered. Theme two concerned nurses' experiences of supporting women who required acute mental health interventions and the systemic barriers they faced. Finally, theme three related to how the existing service delivery model could be improved to better support nurses in their work. CONCLUSIONS The complex system within which nurses operate presents barriers that can impede their ability to respond to women with postnatal mental health issues. There is a need for service delivery frameworks that better support nurses and facilitates equitable access to mental healthcare. RELEVANCE TO CLINICAL PRACTICE Facilitating equitable access to all perinatal mental health services and interventions must be at the heart of all future policy, funding and service delivery frameworks.
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Affiliation(s)
- Noushin Arefadib
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Touran Shafiei
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Amanda Cooklin
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
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Artmann M, Smeha LN, Lima SBSD. Percepção da Equipe de Saúde sobre a Implantação de Alojamento Conjunto Mãe-Bebê em Unidade Psiquiátrica. REVISTA PSICOLOGIA E SAÚDE 2022. [DOI: 10.20435/pssa.v14i2.1670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
O alojamento conjunto mãe/bebê em unidade psiquiátrica é uma alternativa para proteger o vínculo e manter os cuidados parentais. O objetivo deste estudo foi conhecer o posicionamento, as sugestões e as necessidades dos profissionais diante da implantação de um alojamento conjunto mãe-bebê. Trata-se de uma pesquisa qualitativa, com 28 profissionais da equipe de saúde de uma unidade psiquiátrica, localizada em hospital geral público. Os participantes responderam a um instrumento com questões fechadas e abertas. Os resultados evidenciaram sensibilidade, empatia e motivação dos profissionais para contribuir na efetivação do projeto. Para isso, eles pontuaram a necessidade de mudanças na estrutura física, na gestão da unidade e na capacitação da equipe. Os participantes consideram que a implementação poderá auxiliar na recuperação da mãe e evitar o comprometimento no vínculo dela com o bebê, contudo sugerem a sistematização na modalidade intermitente. Assim, os resultados/sugestões da equipe constituem subsídios para as próximas etapas de implantação do alojamento.
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Roca-Lecumberri A, Torres A, Andrés S, Naranjo C, Roda E, Lopez C, Sureda B, Solé E, Imaz ML, Lera S, Mallorquí A, García-Esteve L. New units for perinatal mental health disorders: Description of the first 150 dyads attended at Mother Baby Day Hospital CLINIC-BCN. REVISTA DE PSIQUIATRÍA Y SALUD MENTAL 2022. [DOI: 10.1016/j.rpsm.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lasica PA, Glangeaud-Freudenthal NMC, Falissard B, Sutter-Dallay AL, Gressier F. Bipolar disorder in the postpartum period: the impact of a prenatal mood episode on maternal improvement at postpartum discharge after joint inpatient hospitalization. Arch Womens Ment Health 2022; 25:399-409. [PMID: 34661738 DOI: 10.1007/s00737-021-01188-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Abstract
Bipolar disorder (BD) is linked to a high risk of relapse in the year postpartum. The aim of this study was to search for an association of a mood episode during pregnancy with a lack of maternal improvement after a post-partum episode requiring joint hospitalization. In an observational, naturalist, and multicentric study, 261 women suffering from a BD and jointly hospitalized with their child in a Mother-Baby Unit (MBU) were assessed for risk factors associated with a lack of maternal improvement at discharge. A directed acyclic graph (DAG)-based approach was used to identify confounders to be included in a multiple regression model. In bivariate analyses, a lack of improvement (16.9%) was associated with pregnancy specificities (decompensation, psychotropic treatment, antipsychotics, and benzodiazepines intake), as well as maternal smoking during pregnancy and baby's neonatal hospitalization. In a multivariate analysis based on DAG, a lack of improvement was linked to psychiatric decompensation during pregnancy (OR = 3.31, 95%CI [1.55-7.35], p = 0.002), independently from maternal age, mother's maltreatment during childhood, low level of education, single status, low familial social support, and diagnosis of personality disorder. This study shows the critical importance of mental health during pregnancy in women with BD. Clinical screening and evaluation of the benefit/risk balance of psychotropics during pregnancy are essential.
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Affiliation(s)
- Pierre-Alexandre Lasica
- Department of Psychiatry, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, CHU de Bicêtre (AP-HP, GH Paris Saclay), 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France
| | - Nine M C Glangeaud-Freudenthal
- INSERM Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics (U1153), Paris Descartes University, Paris, France
| | - Bruno Falissard
- Department of Biostatistics, Maison de Solenn, Université Paris-Saclay, UVSQ, CESP, INSERM U1018, 97 Bld de Port-Royal, 75679, Paris Cedex 14, France
| | - Anne-Laure Sutter-Dallay
- Charles Perrens Hospital, Perinatal Psychiatry Network, University Department of Child and Adolescent Psychiatry, Univ. Bordeaux, INSERM U1219, F-33000, Bordeaux, France
| | - Florence Gressier
- Department of Psychiatry, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, CHU de Bicêtre (AP-HP, GH Paris Saclay), 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France. .,CESP, INSERM U1018, Université Paris-Saclay, Faculté de Médecine Paris Saclay, 94275, Le Kremlin Bicêtre, France.
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Soni N, Roberts S, Branjerdporn G. Exploring Discharge Outcomes and Readmission Rates of Mothers Admitted to a Psychiatric Mother and Baby Unit. Psychiatr Q 2022; 93:393-407. [PMID: 34606066 DOI: 10.1007/s11126-021-09956-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
To evaluate change in Health of the Nation Outcome Scale (HoNOS) scores from admission to discharge, readmission rates after 28-day and six months post-discharge, and factors associated with readmission in a Mother and Baby Unit (MBU). An exploratory cohort study was completed of mother-infant dyads admitted to a public psychiatric MBU in Australia between March 2017 and August 2018 (18 months). Admission and discharge scores on the clinician-rated Health of the Nation Outcome Scale (HoNOS) were compared using dependent samples t-tests. The frequency of readmission to any psychiatric inpatient unit within six months of discharge was determined from medical records. Characteristics of mothers who were and were not readmitted were evaluated. Of the 82 mother-infant dyads admissions, 12 (14.63%) women were readmitted within six months, and six (7.31%) were readmitted within 28-days. Total HoNOS scores significantly improved between admission and discharge (t(81)=9.45, p<.000). Descriptive statistics for demographics, diagnoses, Mental Health Act status and discharge supports were computed for women readmitted and not readmitted. While these readmission rates and HONOS scores reflect a successful MBU admission, further research is required with larger sample sizes and more specific maternal and infant mental health outcome measures.
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Affiliation(s)
- Nayan Soni
- Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Susan Roberts
- Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia.
| | - Grace Branjerdporn
- Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
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Gressier F, Glangeaud-Freudenthal NM, Falissard B, Sutter-Dallay AL. Comorbid borderline personality disorders in women with post-partum depression admitted to mother-baby units. J Psychiatr Res 2022; 146:149-155. [PMID: 34982970 DOI: 10.1016/j.jpsychires.2021.12.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 12/05/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
Borderline personality disorder (BPD) is associated with perinatal depression and parenting difficulties. However, little is known about the characteristics and specific effects of BPD in women with postpartum depression. This study aimed to explore 1) the sociodemographic, mental health characteristics, and motherhood difficulties in women with a major depressive postpartum episode (MDPE) and a comorbid diagnosis of BPD, compared to those with other personality disorders (other PD) or no PD and 2) whether BPD itself may be an independent risk factor for infant neglect in women with a MDPE. 412 women admitted to a Mother and Baby Unit (2001-2010) with a MDPE were involved in this study. Our study showed that women with MDPE-BPD (n = 64) more frequently reported a history of childhood maltreatment, single status, low social support, a history of depression, smoking during pregnancy and suicide attempt during the perinatal period compared to women with other PDs (n = 88) or no PD (n = 260). Women with comorbid BPD had a greater length of stay. Regarding infant care, neglect, abuse, and separation at discharge were more frequent in women with comorbid BPD. Logistic regression was performed to specifically examine whether BPD in women with a MDPE was an independent risk factor for infant neglect during the postpartum period. Comorbid BPD was independently associated with infant neglect (OR = 2.21; CI95% [1.02-4.81]). Our results underline the importance of screening for BPD in women with perinatal depression. Further studies are needed to explore the links between MDPE, BPD, and infant development.
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Affiliation(s)
- Florence Gressier
- CESP, Inserm U1018, University Paris-Saclay, Faculté de Médecine Paris Saclay, Department of Psychiatry, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.
| | - Nine Mc Glangeaud-Freudenthal
- INSERM Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics (U1153), Paris Descartes University, Paris, France
| | - Bruno Falissard
- Department of Biostatistics, Maison de Solenn, Université Paris Saclay, UVSQ, CESP, Inserm U1018, 97 Bld de Port-Royal, 75679, Paris, Cedex 14, France
| | - Anne-Laure Sutter-Dallay
- Charles Perrens Hospital, Perinatal Psychiatry Network, University Department of Child and Adolescent Psychiatry, Univ. Bordeaux, INSERM, BPH, U1219, F-33000, Bordeaux, France
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12
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Anke TMS, Slinning K, Moe V, Brunborg C, Siqveland TS, Skjelstad DV. Bipolar offspring and mothers: interactional challenges at infant age 3 and 12 months-a developmental pathway to enhanced risk? Int J Bipolar Disord 2020; 8:27. [PMID: 32869152 PMCID: PMC7459000 DOI: 10.1186/s40345-020-00192-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/04/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Bipolar offspring are considered a high-risk group for developing mental disorders. Developmental outcomes result from additive and interactive effects of biological vulnerability and environmental influences. Mother-infant interactions represent important early environmental influences that may modify infants' risk of mental disorders. The aim of the current prospective study was to investigate the patterns and development of mother-infant interactions in the first year of life in dyads in which the mothers have bipolar disorder (BD). METHODS Twenty-six dyads in which the mothers had BD and 28 dyads in which the mothers had no mental disorder were video-taped in a free play interaction. The Parent-Child Early Relational Assessment (PCERA) was used to assess the quality of the interactions on three domains (maternal behaviour, infant behaviour and dyadic coordination) at 3 and 12 months of infant age. First, we compared the mother-infant interaction patterns between the two groups at 12 months. Second, we investigated how the patterns developed within and between the groups from infant ages 3 to 12 months. RESULTS BD dyads demonstrated significantly more challenges in all three interaction domains at infant age 12 months compared to the healthy dyads. This observation was in line with the findings at infant age 3 months. Subdued expression of positive affect and mutual underinvolvement represented core challenges in maternal and infant behaviours in the BD dyads. Continuous difficulties with dyadic coordination and reciprocity were the most concerning interaction behaviours at 3 and 12 months. On the positive side, there was little expression of negative affect or tension in maternal, infant and dyadic behaviour, and some positive changes in infant behaviour from 3 to 12 months. CONCLUSIONS The current results suggest that challenges in mother-infant interaction patterns in the first year of life may enhance the developmental risk for bipolar offspring. Clinical interventions should address both the BD mothers' needs in relation to postpartum mood deviations and mother-infant interactions. We suggest interaction interventions to promote dyadic coordination and reciprocity, such as helping mothers being more sensitive to their infant's cues and to provide attuned contingent responses.
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Affiliation(s)
- Teija M S Anke
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, 3004, Drammen, Norway.
| | - Kari Slinning
- The Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Vibeke Moe
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Ullevål, Oslo, Norway
| | | | - Dag Vegard Skjelstad
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, 3004, Drammen, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
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Wright T, Stevens S, Reed PW, Wouldes TA. Post-discharge outcomes for mothers and the mother-infant relationship following admission to a psychiatric Mother-Baby Unit. Infant Ment Health J 2020; 41:770-782. [PMID: 32573014 DOI: 10.1002/imhj.21870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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 (r² = 0.29, p = 0.07) but this was lost post-discharge (r² = 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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Affiliation(s)
- Tanya Wright
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Suzanne Stevens
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Peter W Reed
- Starship Child Health, Auckland District Health Board, Auckland, New Zealand
| | - Trecia A Wouldes
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Wright T, Young K, Darragh M, Corter A, Soosay I, Goodyear-Smith F. Perinatal e-screening and clinical decision support: the Maternity Case-finding Help Assessment Tool (MatCHAT). J Prim Health Care 2020; 12:265-271. [DOI: 10.1071/hc20029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/28/2020] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
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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Trevillion K, Shallcross R, Ryan E, Heslin M, Pickles A, Byford S, Jones I, Johnson S, Pawlby S, Stanley N, Rose D, Seneviratne G, Wieck A, Jennings S, Potts L, Abel KM, Howard LM. 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. BMJ Open 2019; 9:e025906. [PMID: 30904867 PMCID: PMC6475160 DOI: 10.1136/bmjopen-2018-025906] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Research 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 ANALYSIS Quasi-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 DISSEMINATION The 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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Affiliation(s)
- Kylee Trevillion
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Rebekah Shallcross
- Centre for Academic Primary Care, University of Bristol Medical School, Bristol, UK
| | - Elizabeth Ryan
- Biostatistics Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Margaret Heslin
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Andrew Pickles
- Biostatistics Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Sarah Byford
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Ian Jones
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Susan Pawlby
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Nicky Stanley
- School of Social Work, Care and Community, University of Central Lancashire, Preston, UK
| | - Diana Rose
- Service User Research Enterprise, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Gertrude Seneviratne
- Psychological Medicine and Integrated Care Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
| | - Angelika Wieck
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Stacey Jennings
- Addictions, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Laura Potts
- Biostatistics Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Kathryn M Abel
- Medical and Human Sciences, Institute of Brain Behaviour and Mental Health, Manchester, UK
- Manchester Mental Health & Social Care Trust, Manchester, UK
| | - Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
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