Louise M Howard1, Kylee Trevillion1, Laura Potts2, Margaret Heslin3, Andrew Pickles2, Sarah Byford3, Lauren E Carson1, Clare Dolman1, Stacey Jennings1, Sonia Johnson4, Ian Jones5, Rebecca McDonald1, Susan Pawlby6, Claire Powell1, Gertrude Seneviratne7, Rebekah Shallcross1, Nicky Stanley8, Angelika Wieck9, Kathryn M Abel10. 1. Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK. 2. Biostatistics and Health Informatics, King's College London, UK. 3. King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK. 4. Division of Psychiatry, UCL, London, UK. 5. National Centre for Mental Health, Division of Psychiatry and Clinical Neuroscience, Cardiff University, UK. 6. Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK. 7. South London and Maudsley NHS Foundation Trust, Beckenham, UK. 8. School of Social Work, Care and Community, University of Central Lancashire, Preston, UK. 9. Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK. 10. Centre for Women's Mental Health, University of Manchester, UK.
Abstract
BACKGROUND: Psychiatric mother and baby units (MBUs) are recommended for severe perinatal mental illness, but effectiveness compared with other forms of acute care remains unknown. AIMS: We hypothesised that women admitted to MBUs would be less likely to be readmitted to acute care in the 12 months following discharge, compared with women admitted to non-MBU acute care (generic psychiatric wards or crisis resolution teams (CRTs)). METHOD: Quasi-experimental cohort study of women accessing acute psychiatric care up to 1 year postpartum in 42 healthcare organisations across England and Wales. Primary outcome was readmission within 12 months post-discharge. Propensity scores were used to account for systematic differences between MBU and non-MBU participants. Secondary outcomes included assessment of cost-effectiveness, experience of services, unmet needs, perceived bonding, observed mother-infant interaction quality and safeguarding outcome. RESULTS: Of 279 women, 108 (39%) received MBU care, 62 (22%) generic ward care and 109 (39%) CRT care only. The MBU group (n = 105) had similar readmission rates to the non-MBU group (n = 158) (aOR = 0.95, 95% CI 0.86-1.04, P = 0.29; an absolute difference of -5%, 95% CI -14 to 4%). Service satisfaction was significantly higher among women accessing MBUs compared with non-MBUs; no significant differences were observed for any other secondary outcomes. CONCLUSIONS: We found no significant differences in rates of readmission, but MBU advantage might have been masked by residual confounders; readmission will also depend on quality of care after discharge and type of illness. Future studies should attempt to identify the effective ingredients of specialist perinatal in-patient and community care to improve outcomes.
BACKGROUND: Psychiatric mother and baby units (MBUs) are recommended for severe perinatal mental illness, but effectiveness compared with other forms of acute care remains unknown. AIMS: We hypothesised that women admitted to MBUs would be less likely to be readmitted to acute care in the 12 months following discharge, compared with women admitted to non-MBU acute care (generic psychiatric wards or crisis resolution teams (CRTs)). METHOD: Quasi-experimental cohort study of women accessing acute psychiatric care up to 1 year postpartum in 42 healthcare organisations across England and Wales. Primary outcome was readmission within 12 months post-discharge. Propensity scores were used to account for systematic differences between MBU and non-MBU participants. Secondary outcomes included assessment of cost-effectiveness, experience of services, unmet needs, perceived bonding, observed mother-infant interaction quality and safeguarding outcome. RESULTS: Of 279 women, 108 (39%) received MBU care, 62 (22%) generic ward care and 109 (39%) CRT care only. The MBU group (n = 105) had similar readmission rates to the non-MBU group (n = 158) (aOR = 0.95, 95% CI 0.86-1.04, P = 0.29; an absolute difference of -5%, 95% CI -14 to 4%). Service satisfaction was significantly higher among women accessing MBUs compared with non-MBUs; no significant differences were observed for any other secondary outcomes. CONCLUSIONS: We found no significant differences in rates of readmission, but MBU advantage might have been masked by residual confounders; readmission will also depend on quality of care after discharge and type of illness. Future studies should attempt to identify the effective ingredients of specialist perinatal in-patient and community care to improve outcomes.
Authors: Billie Lever Taylor; Angela Sweeney; Laura C Potts; Kylee Trevillion; Louise M Howard Journal: Arch Womens Ment Health Date: 2022-08-25 Impact factor: 4.405