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Barnicot K, Welsh M, Kalwarowsky S, Stevens E, Iles J, Parker J, Miele M, Lawn T, O'Hanlon L, Sundaresh S, Ajala O, Bassett P, Jones C, Ramchandani P, Crawford M. Video feedback parent-infant intervention for mothers experiencing enduring difficulties in managing emotions and relationships: A randomised controlled feasibility trial. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:1188-1210. [PMID: 36018275 DOI: 10.1111/bjc.12388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 07/26/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Parents experiencing mental health difficulties consistent with "personality disorder", often related to a history of complex trauma, may face increased challenges in parent-child relationships and child socioemotional development. There are no published randomised controlled trials (RCTs) evaluating perinatal parent-child interventions for this population. We evaluated the feasibility and acceptability of undertaking an RCT of the video feedback intervention for positive parenting adapted for perinatal mental health (VIPP-PMH). DESIGN Feasibility study incorporating a pilot RCT. METHODS Mothers with enduring difficulties in managing emotions and relationships, consistent with a "personality disorder", and their 6- to 36-month old infants were randomly allocated to receive six sessions of VIPP-PMH (n = 20) or usual care alone (n = 14). RESULTS 76% of eligible mothers consented to participate. Intervention uptake and completion rates were 95% (≥1 VIPP-PMH session) and 70% (6 sessions), respectively. Follow-up rates were 85% at month 5 and 65% at month 8 post-baseline. Blinded observer-ratings of maternal sensitivity in parent-child interaction favoured the intervention group at month 5 (RR = 1.94, 95% CI 0.67-5.63) and month 8 (RR = 1.91, 95% CI 0.68-5.33). Small changes over time in self-rated parenting confidence and stress favoured the intervention group. There were no clear intervention effects on maternal non-intrusiveness or mental health, or on child behaviour problems, emotional functioning, or self-regulation. CONCLUSIONS An RCT of VIPP-PMH is feasible and acceptable to implement with mothers experiencing difficulties consistent with perinatal "personality disorder". A fully powered definitive RCT should be undertaken.
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Affiliation(s)
- Kirsten Barnicot
- Research and Development/Perinatal Mental Health Service, Central & North West London NHS Foundation Trust, London, UK.,Division of Psychiatry, Imperial College London, London, UK.,Centre for Mental Health Research, City University of London, London, UK
| | - Morgan Welsh
- Department of Psychology, University of Surrey, Guildford, UK
| | - Sarah Kalwarowsky
- Research and Development/Perinatal Mental Health Service, Central & North West London NHS Foundation Trust, London, UK
| | - Eloise Stevens
- Research and Development/Perinatal Mental Health Service, Central & North West London NHS Foundation Trust, London, UK.,Division of Psychiatry, Imperial College London, London, UK
| | - Jane Iles
- Department of Psychology, University of Surrey, Guildford, UK
| | - Jennie Parker
- Research and Development/Perinatal Mental Health Service, Central & North West London NHS Foundation Trust, London, UK
| | - Maddalena Miele
- Research and Development/Perinatal Mental Health Service, Central & North West London NHS Foundation Trust, London, UK
| | - Tara Lawn
- Perinatal Mental Health Service, East London NHS Foundation Trust, London, UK
| | - Laura O'Hanlon
- Perinatal Mental Health Service, East London NHS Foundation Trust, London, UK
| | - Sushma Sundaresh
- Perinatal Mental Health Service, Oxleas NHS Foundation Trust, London, UK
| | - Ola Ajala
- Perinatal Mental Health Service, Camden & Islington NHS Foundation Trust, London, UK
| | | | - Christina Jones
- Department of Psychology, University of Surrey, Guildford, UK
| | | | - Mike Crawford
- Division of Psychiatry, Imperial College London, London, UK
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Ikhtabi S, Pitman A, Toh G, Birken M, Pearce E, Johnson S. The experience of loneliness among people with a "personality disorder" diagnosis or traits: a qualitative meta-synthesis. BMC Psychiatry 2022; 22:130. [PMID: 35177022 PMCID: PMC8855579 DOI: 10.1186/s12888-022-03767-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 02/08/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Loneliness is prevalent among people with a "personality disorder" diagnosis or who have related personality traits, but the experience of loneliness among people with "personality disorder" diagnoses/traits has not been well described. A qualitative approach has potential to help understand the experience of loneliness among people with "personality disorder" diagnoses/traits, and to develop interventions that promote recovery. We therefore aimed to synthesise the qualitative literature relevant to this topic. METHOD We conducted a meta-synthesis of qualitative studies exploring the subjective experience of loneliness as reported by people with "personality disorder" diagnoses/traits. We searched four databases using pre-formulated search terms, selected eligible articles, appraised the quality of each, and analyzed data from eligible studies using thematic synthesis. RESULT We identified 39 articles that described the experience of loneliness in people with "personality disorder" diagnoses/traits. From extracted data, we identified seven themes: (1) disconnection and emptiness: a "haunting alienation", (2) alienation arising from childhood experiences, (3) thwarted desire for closeness and connection, (4) paradox: for both closeness and distance, (5) experiences of existential loneliness, (6) recovery, embedded in a social world, and (7) group therapy: a setback. Our results suggest that for our sample early alienating and traumatic experiences may pave the way for experiences of loneliness, which further exacerbate "personality disorder" symptoms and distress. CONCLUSION Despite describing a need to belong and efforts to cope with unmet social needs, people with "personality disorder" diagnoses/traits (particularly "emotionally unstable personality disorder") report experiencing an intense disconnection from other people. This seems rooted in early adversities, reinforced by later traumatic experiences. Given the apparent salience of loneliness to people with "personality disorder" diagnoses/traits, interventions focused on helping people connect with others, which may include both psychological and social components, have potential to be beneficial in reducing loneliness and promoting recovery.
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Affiliation(s)
| | - Alexandra Pitman
- grid.83440.3b0000000121901201UCL Division of Psychiatry, London, UK ,grid.450564.60000 0000 8609 9937Camden and Islington NHS Foundation Trust, London, UK
| | - Gigi Toh
- grid.83440.3b0000000121901201UCL Division of Psychiatry, London, UK
| | - Mary Birken
- grid.83440.3b0000000121901201UCL Division of Psychiatry, London, UK
| | - Eiluned Pearce
- grid.83440.3b0000000121901201UCL Division of Psychiatry, London, UK
| | - Sonia Johnson
- grid.83440.3b0000000121901201UCL Division of Psychiatry, London, UK ,grid.450564.60000 0000 8609 9937Camden and Islington NHS Foundation Trust, London, UK
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Taylor BL, Howard LM, Jackson K, Johnson S, Mantovani N, Nath S, Sokolova AY, Sweeney A. Mums Alone: Exploring the Role of Isolation and Loneliness in the Narratives of Women Diagnosed with Perinatal Depression. J Clin Med 2021; 10:jcm10112271. [PMID: 34073903 PMCID: PMC8197355 DOI: 10.3390/jcm10112271] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Abstract
In this study, we explore the role that isolation and loneliness play in the narratives of women diagnosed with perinatal depression. Isolation and loneliness are increasingly seen as risk factors for depression, including in the perinatal period, but little is known about whether, and in what ways, women themselves associate isolation or loneliness with perinatal distress. Based on the thematic analysis of semi-structured interviews with fourteen mothers in England, we found that women often connected feelings of depression during and after pregnancy to feeling dislocated from their previous identities and relationships. Women felt lost, confined to their homes, and often unsupported by their partners and families. However, fears of being judged to be inadequate mothers made it difficult for women to make authentic connections with others or to express negative feelings, increasing isolation and depression. We drew on the intersectionality theory to illustrate how the intersect between motherhood and other aspects of women's identities (being young, single, deprived and/or from an ethnic minority) could leave some women particularly isolated and marginalised. Our conclusions emphasise the need to challenge social constructions of the good/bad mother, advocate for social change to lessen pressures on mothers, and develop support that addresses women's interpersonal contexts and social networks.
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Affiliation(s)
- Billie Lever Taylor
- Division of Psychiatry, Faculty of Brain Sciences, University College London, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK;
- Correspondence: (B.L.T.); (A.S.)
| | - Louise M. Howard
- Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK; (L.M.H.); (S.N.)
| | - Katherine Jackson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle NE2 4AX, UK;
| | - Sonia Johnson
- Division of Psychiatry, Faculty of Brain Sciences, University College London, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK;
| | - Nadia Mantovani
- Population Health Research Institute, St George’s, University of London, Cranmer Terrace, London SW17 0RE, UK;
| | - Selina Nath
- Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK; (L.M.H.); (S.N.)
- Population, Policy and Practice Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Antoaneta Y. Sokolova
- Lived Experience Advisory Group, University College London, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK;
| | - Angela Sweeney
- Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK; (L.M.H.); (S.N.)
- Correspondence: (B.L.T.); (A.S.)
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Bright KS, Wajid A, McNeil DA, Stuart S, Kingston D. Profiles of women participating in an internet-based prenatal mental health platform (HOPE – Healthy Outcomes of Prenatal and Postnatal Experiences). JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Rubio L, Lever Taylor B, Morant N, Johnson S. Experiences of intensive home treatment for a mental health crisis during the perinatal period: A UK qualitative study. Int J Ment Health Nurs 2021; 30:208-218. [PMID: 32816376 DOI: 10.1111/inm.12774] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Abstract
Some women with severe perinatal mental health difficulties in England are cared for by acute home treatment services, known as Crisis Resolution Teams (CRTs), which provide short-term home-based treatment for adults experiencing a mental health crisis. Intensive home treatment has been trialed in a number of countries, but it is not known how well suited it is to the needs of perinatal women. This qualitative study aimed to explore how women and practitioners experience the provision of intensive home treatment for perinatal mental health problems. Semi-structured interviews were conducted with women who had received intensive home treatment in the perinatal period (n = 15), and focus groups were held with practitioners working in CRTs or in specialist perinatal mental health services (3 groups, n = 25). Data were analysed thematically. Women commonly found intensive home treatment problematic, experiencing it as intrusive and heavily risk-focused, with poor staff continuity and little tailoring to the perinatal context. However, women valued emotional support when provided, particularly when it had a perinatal focus, sometimes based on practitioners sharing their own experiences. Some women also appreciated avoiding hospital admission, but choice was often limited. Practitioners reported a lack of perinatal training among CRT staff and described difficulties tailoring treatment to perinatal women's needs. Currently, intensive home treatment, as offered by CRTs, may not be well suited to women with perinatal mental health difficulties. Findings suggest a need to develop community crisis responses that are better tailored to the needs of this population.
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Affiliation(s)
- Luisa Rubio
- Division of Psychiatry, University College London, London, UK
| | | | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
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