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Barnicot K, Stevens E, Robinson F, Labovitch S, Ballman R, Miele M, Lawn T, Sundaresh S, Iles J. Video feedback for young babies and maternal perinatal mental illness: intervention adaptation, feasibility and acceptability. J Reprod Infant Psychol 2024:1-17. [PMID: 38441072 DOI: 10.1080/02646838.2024.2322636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 02/18/2024] [Indexed: 03/06/2024]
Abstract
AIMS/BACKGROUND We aimed to adapt, pilot and explore experiences of receiving and delivering the video feedback intervention for positive parenting (VIPP) for 2 to 6 month old babies, mothers experiencing moderate to severe perinatal mental health difficulties and perinatal mental health clinicians. DESIGN/METHODS The VIPP intervention was adapted to include developmentally appropriate activities and developmental psychoeducation for 2 to 6 month olds, alongside psychoeducation on emotion regulation, and then piloted in 14 mothers experiencing moderate to severe perinatal mental health difficulties (registration ISRCTN64237883). Observational and self-reported pre-post outcome data on parenting and parent-infant mental health was collected, and post-intervention qualitative interviews were conducted with participating mothers and clinicians. RESULTS Consent (67%), intervention completion (79%) and follow-up rates (93%) were high. Effect sizes on pre-post outcome measures indicated large improvements in parenting confidence and perceptions of the parent-infant relationship, and a medium-size improvement in maternal sensitivity. In qualitative interviews, clinicians and mothers described how mothers' initial anxieties about being filmed were allayed through receiving positive and strengths-focussed feedback, boosting their self-confidence, and that the video feedback facilitated identification of young babies' subtle behavioural cues and moments of mother-infant connection. Streamlining the information provided on maternal emotion regulation, and allowing increased use of clinical judgement to tailor intervention delivery, were suggested to optimise intervention feasibility and acceptability. CONCLUSION It is feasible and acceptable to implement VIPP with very young babies and their mothers experiencing perinatal mental health difficulties. A fully powered randomised controlled trial is required to establish intervention efficacy.
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Affiliation(s)
- Kirsten Barnicot
- Department of Health Services Research and Management, City University of London, London, UK
- Perinatal Mental Health Service, Central & North West London NHS Foundation Trust, London, UK
| | - Eloise Stevens
- Department of Health Services Research and Management, City University of London, London, UK
| | - Fiona Robinson
- Department of Health Services Research and Management, City University of London, London, UK
| | - Sarah Labovitch
- Department of Health Services Research and Management, City University of London, London, UK
- Research and Development, West London NHS Trust, London, UK
| | - Rajinder Ballman
- Perinatal Mental Health Service, Central & North West London NHS Foundation Trust, London, UK
| | - Maddalena Miele
- 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
| | - Sushma Sundaresh
- Perinatal Mental Health Service, Oxleas NHS Foundation Trust, London, UK
| | - Jane Iles
- Department of Psychological Interventions, University of Surrey, Guildford, UK
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Vamvakas A, Lawn T, Veronese M, Williams S, Tsougos I, Howard M. CORRELATION OF ASL-MRI WITH PET AND MRNA EXPRESSIONS CAN REVEAL MOLECULAR SUBSTRATES OF CEREBRAL BLOOD FLOW IN CLINICAL ONGOING PAIN. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)03119-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Vamvakas A, Lawn T, Veronese M, Williams S, Tsougos I, Howard M. CORRELATION OF ASL-MRI WITH PET AND MRNA EXPRESSIONS CAN REVEAL MOLECULAR SUBSTRATES OF CEREBRAL BLOOD FLOW IN CLINICAL ONGOING PAIN. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)03028-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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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. Br J Clin Psychol 2022; 61:1188-1210. [PMID: 36018275 DOI: 10.1111/bjc.12388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Sexual harassment and assault on psychiatric wards is an ongoing concern. A number of incidents have been reported in the media. This paper focuses on a policy drafted to deal with allegations of sexual assault or rape on an in-patient psychiatric ward. We aimed to produce a practical, easy-to-follow guide for junior doctors and ward staff who may face complex and possibly contentious issues surrounding consent, capacity to consent and police involvement.
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Devasahayam A, Lawn T, Murphy M, White PD. Alternative diagnoses to chronic fatigue syndrome in referrals to a specialist service: service evaluation survey. JRSM Short Rep 2012; 3:4. [PMID: 22299071 PMCID: PMC3269106 DOI: 10.1258/shorts.2011.011127] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective To assess the accuracy of diagnoses made by referrers to a chronic fatigue syndrome (CFS) service. Design Retrospective service evaluation surveys of both rejected referral letters and medical case-notes after full clinical assessment. Setting A specialist CFS clinic in London, UK. Participants In the first survey, we assessed rejected referral letters between March 2007 and September 2008. In the second survey, we ascertained the primary diagnosis made in case-notes of 250 consecutive new patients assessed between April 2007 and November 2008. Main outcome measures Reasons for rejection of referrals and primary diagnosis in those assessed. Results In the first survey, 154 out of 418 referrals (37%) were rejected. Of these, 77 out of the available 127 referrals (61%) had a likely alternative diagnosis. In the second survey of clinically assessed patients, 107 (43%) had alternative medical/psychiatric diagnoses, while 137 out of 250 (54%) patients received a diagnosis of CFS. The commonest alternative medical diagnoses of those assessed were sleep disorders and the commonest alternative psychiatric diagnosis was depressive illness. Altogether 184 of 377 (49%) patients had alternative diagnoses to CFS. Conclusions Half of all the referred patients to a specialist CFS clinic had alternative medical and psychiatric diagnoses. Specialist medical assessment for patients with unexplained, disabling, chronic fatigue needs to incorporate both medical and psychiatric assessments.
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Abstract
OBJECTIVES The aim of this study was to examine the accuracy of doctors at diagnosing co-morbid psychiatric disorders in patients with chronic fatigue syndrome (CFS). DESIGN Case series comparing clinical diagnoses with a standardized structured psychiatric interview. SETTING Secondary care specialist chronic fatigue syndrome clinic. PARTICIPANTS One hundred and thirty-five participants of a randomized controlled trial of non-pharmacological treatments at one centre in the PACE trial. MAIN OUTCOME MEASURES Current psychiatric diagnoses made by CFS specialist doctors, compared with current psychiatric diagnoses made independently using a structured psychiatric interview. RESULTS Clinicians identified 59 (44%, 95% CI 39-56%) of patients as suffering from a co-morbid psychiatric disorder compared to 76 (56%, CI 53-69%) by structured interview. Depressive and anxiety disorders were most common. Clinicians were twice as likely to miss diagnoses (30 patients, 22%) than misdiagnose them (13, 10%). Psychiatrists were less likely to miss diagnoses than other clinicians, but were as likely to misdiagnose them. CONCLUSIONS Doctors assessing patients in a chronic fatigue syndrome clinic miss psychiatric diagnoses more often than misdiagnosing them. Missed diagnoses are common. CFS clinic doctors should be trained to diagnose psychiatric disorders.
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Affiliation(s)
- Tara Lawn
- East London Foundation Trust , St Bartholomew's Hospital , London EC1A 7BE , UK
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