1
|
Adhikary S, Gillespie K, Kimball H, Healey L, Webb O, Balram A, Branjerdporn G. A systematic review of research examining mothers, infants, family and staff in psychiatric mother-baby units. Acta Psychiatr Scand 2024. [PMID: 38958035 DOI: 10.1111/acps.13727] [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: 05/31/2023] [Revised: 06/07/2024] [Accepted: 06/22/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE This systematic review aimed to summarise and synthesise research conducted in psychiatric mother-baby units (MBUs) in relation to patients, their families, or staff, published from 1st January 2016 to 1st May 2024. METHOD Quantitative, qualitative, and mixed-method studies were included for review if they were published in peer-review journals in English and reported research on MBUs between January 2016 and May 2024. From the initial yield of 10,007 unique studies, 53 studies were included for review. RESULTS MBU research was found to more frequently investigate maternal characteristics rather than the benefits of MBU treatment compared to studies conducted prior to 2016. Most studies that did investigate impact of admission showed favourable results, however few follow-up studies and studies comparing MBU outcomes to other clinical settings were undertaken. Little research has been conducted to investigate the differential impacts of MBU admission on different diagnoses and long-term (>1 year) patient outcomes. There was a dearth of research investigating partners of women in MBUs and few studies conducted on infant outcomes. CONCLUSIONS MBUs were consistently found to improve mental health systems and mother-infant attachment in patients after admission. More research investigating patient support networks and child health, impact of diagnosis on outcomes, and studies with adequate follow-up are required.
Collapse
Affiliation(s)
- Sam Adhikary
- Mater Young Adult Health Centre, Catherine's House for Mothers, Babies and Families, Mater Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Kerri Gillespie
- Mater Young Adult Health Centre, Catherine's House for Mothers, Babies and Families, Mater Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Hayley Kimball
- Mater Young Adult Health Centre, Catherine's House for Mothers, Babies and Families, Mater Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lyndall Healey
- Mental Health and Specialist Services, Gold Coast University Hospital, Gold Coast Hospital and Health Service, Queensland Health, Gold Coast, Queensland, Australia
| | - Olivia Webb
- Mental Health and Specialist Services, Gold Coast University Hospital, Gold Coast Hospital and Health Service, Queensland Health, Gold Coast, Queensland, Australia
| | - Abha Balram
- Mental Health and Specialist Services, Gold Coast University Hospital, Gold Coast Hospital and Health Service, Queensland Health, Gold Coast, Queensland, Australia
| | - Grace Branjerdporn
- Mater Young Adult Health Centre, Catherine's House for Mothers, Babies and Families, Mater Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Mental Health and Specialist Services, Gold Coast University Hospital, Gold Coast Hospital and Health Service, Queensland Health, Gold Coast, Queensland, Australia
- Faculty of Health Sciences & Medicine, Bond University, Robina, Australia
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Maconick L, Ikhtabi S, Broeckelmann E, Pitman A, Barnicot K, Billings J, Osborn D, Johnson S. Crisis and acute mental health care for people who have been given a diagnosis of a 'personality disorder': a systematic review. BMC Psychiatry 2023; 23:720. [PMID: 37798701 PMCID: PMC10552436 DOI: 10.1186/s12888-023-05119-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/18/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND People who have been given a diagnosis of a 'personality disorder' need access to good quality mental healthcare when in crisis, but the evidence underpinning crisis services for this group is limited. We synthesised quantitative studies reporting outcomes for people with a 'personality disorder' diagnosis using crisis and acute mental health services. METHODS We searched OVID Medline, PsycInfo, PsycExtra, Web of Science, HMIC, CINAHL Plus, Clinical Trials and Cochrane CENTRAL for randomised controlled trials (RCTs) and observational studies that reported at least one clinical or social outcome following use of crisis and acute care for people given a 'personality disorder' diagnosis. We performed a narrative synthesis of evidence for each model of care found. RESULTS We screened 16,953 records resulting in 35 studies included in the review. Studies were published between 1987-2022 and conducted in 13 countries. Six studies were RCTs, the remainder were non randomised controlled studies or cohort studies reporting change over time. Studies were found reporting outcomes for crisis teams, acute hospital admission, acute day units, brief admission, crisis-focused psychotherapies in a number of settings, Mother and Baby units, an early intervention service and joint crisis planning. The evidence for all models of care except brief admission and outpatient-based psychotherapies was assessed as low or very low certainty. CONCLUSION The literature found was sparse and of low quality. There were no high-quality studies that investigated outcomes following use of crisis team or hospital admission for this group. Studies investigating crisis-focused psychological interventions showed potentially promising results.
Collapse
Affiliation(s)
- Lucy Maconick
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK.
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK.
| | - Sarah Ikhtabi
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
| | - Eva Broeckelmann
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
| | - Alexandra Pitman
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK
| | - Kirsten Barnicot
- Department of Health Services Research & Management, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Jo Billings
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
| | - David Osborn
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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]
|
6
|
Taylor BL, Sweeney A, Potts LC, Trevillion K, Howard LM. Factors associated with re-admission in the year after acute postpartum psychiatric treatment. Arch Womens Ment Health 2022; 25:975-983. [PMID: 36006457 PMCID: PMC9492555 DOI: 10.1007/s00737-022-01255-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/03/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To examine factors associated with being re-admitted in the year after discharge from acute postpartum psychiatric treatment. METHODS Secondary data analysis of information collected from mothers who were admitted to acute psychiatric services in the year after childbirth between 2013 and 2017. We carried out univariable analyses and multivariable hierarchical logistic regression to examine risk factors for women's re-admission to acute psychiatric care (inpatient or community crisis care) in the year following discharge. RESULTS Sixty-seven (24.1%) of 278 women were re-admitted in the year after discharge from acute care; the median number of days to re-admission was 86 (IQR 35-214), and women who were re-admitted accessed a median of two further acute services (IQR 1-3). In adjusted analyses, reporting a history of childhood trauma (aOR 1.02; 95% CI 1.00- 1.03, p = 0.036), a higher level of difficulties in the mother-infant bond (aOR 1.03; 95% CI 1.01-1.06, p = 0.009) and younger age (aOR 0.95; 95% CI 0.90-1.00, p = 0.066) were associated with re-admission. CONCLUSION This study confirms that the role of childhood adverse experiences on mental health is relevant for outcomes in women experiencing acute postpartum psychiatric episodes. Ongoing parent-infant bonding difficulties are also independently associated with re-admission. Perinatal mental health services therefore need to offer evidence-based interventions to address histories of trauma and to support parent-infant bonding to optimise mental health in women following discharge from acute psychiatric services. However, further research is needed to explore what other factors, not measured in our study, are also influential to re-admission.
Collapse
Affiliation(s)
- Billie Lever Taylor
- Section of Women's Mental Health, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.
| | - Angela Sweeney
- grid.13097.3c0000 0001 2322 6764Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Laura C. Potts
- grid.13097.3c0000 0001 2322 6764Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Kylee Trevillion
- grid.13097.3c0000 0001 2322 6764Section of Women’s Mental Health, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Louise M. Howard
- grid.13097.3c0000 0001 2322 6764Section of Women’s Mental Health, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| |
Collapse
|