TY - JOUR
T1 - Effectiveness and cost-effectiveness of psychiatric mother and baby units: quasi-experimental study
AU - Howard, Louise
AU - Trevillion, Kylee
AU - Potts, Laura
AU - Heslin, Margaret
AU - Pickles, Andrew
AU - Byford, Sarah
AU - Carson, Lauren
AU - Dolman, Clare
AU - Jennings, Stacey
AU - Johnson, Sonia
AU - Jones, Ian
AU - McDonald, Rebecca
AU - Pawlby, Susan
AU - Powell, Claire
AU - Seneviratne, Gertrude
AU - Shallcross, Rebekah
AU - Stanley, Nicky
AU - Wieck, Angelika
AU - Abel, Kathryn M.
N1 - Funding Information:
This paper summarises independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (grant reference: RP-PG-1210-12002). The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health and Social Care.
Funding Information:
S.B. declares grants from the NIHR during the conduct of this study. L.M.H. reports grants from UK Research and Innovation (UKRI) and the NIHR and consultancy payment to King's College London from Public Health England. I.J. is a trustee of the Maternal Mental Health Alliance and Action on Postpartum Psychosis. R.M. reports personal and other fees from Improving Opioid Outcomes in the Treatment of Opioid Dependence (IOTOD), grants from Mundipharma Research Ltd and non-financial support from the United Nations Office on Drugs and Crime (UNODC). A.P. reports grants from King's College London. R.S. reports grants from the NIHR, personal fees from Piccolo and Pilates PT, grants from the Wellcome ISSF Return to Work Fellowship. R.S. founded The Feminist Therapy Centre in London, which provides private psychological therapy, including for people in the perinatal period. S.B. and L.M.H. are members of the BJPsych editorial board and did not take part in the review or decision-making process of this paper.
Publisher Copyright:
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.
PY - 2022/10/21
Y1 - 2022/10/21
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85138207520&partnerID=8YFLogxK
U2 - doi:10.1192/bjp.2022.48
DO - doi:10.1192/bjp.2022.48
M3 - Article
SN - 0007-1250
VL - 221
SP - 628
EP - 636
JO - British Journal of Psychiatry
JF - British Journal of Psychiatry
IS - 4
ER -