Admission to psychiatric hospital for mental illnesses 2 years prechildbirth and postchildbirth in Scotland: a health informatics approach to assessing mother and child outcomes

Objective: To identify factors associated with: admission to a specialist mother and baby unit (MBU) and the impact of perinatal mental illness on early childhood development using a data linkage approach in the 2 years prechildbirth and postchildbirth. Methods: Scottish maternity records (SMR02) were linked to psychiatric hospital admissions (SMR04). 3290 pregnancy-related psychiatric admissions for 1730 women were assessed. To investigate factors associated with MBU admission, the group of mothers admitted to an MBU were compared with those admitted to general psychiatric wards. To assess the impact of perinatal mental illness on early child development, a pragmatic indicator for ‘at potential risk of adversity’, defined as a child who was recorded as requiring intensive treatment at any time under the health plan indicators (HPI) and/or who had no record of completing three doses of the 5-in-1 vaccine by 12 months was generated. Logistic regression models were used to describe the association between each variable and the risk of admission between those with a history of prior psychiatric admission and those without. Results Women admitted to an MBU were significantly more likely to be admitted with non-affective psychosis (OR=1.97, 95% CI 1.22 to 3.18), affective psychosis (OR=2.44, 95% CI 1.37 to 4.33) and non-psychotic depressive episodes (OR=1.93, 95% CI 1.42 to 2.63). They were less likely to come from deprived areas (OR=0.68 95% CI 0.49 to 0.93). Women with a previous history of psychiatric admission were significantly more likely to be located in the two most deprived quintiles. Almost one-third (29%) of children born to mothers with a pregnancy-related psychiatric admission were assessed as ‘at potential risk of adversity.’ Conclusions: A health informatics approach has potential for improving understanding of social and clinical factors, which contribute to the outcomes of perinatal mental illness, as well as potential adverse developmental outcomes for offspring

The efficacy of electroconvulsive therapy in a perinatal population : a comparative pilot study

This study aims to investigate the effectiveness of electroconvulsive therapy (ECT) as a treatment for postnatal depression compared with a matched nonpostnatal population. A secondary aim is to compare the number of ECT treatments needed to treat in both groups. As the numbers in this study are small, this would act as a pilot study, allowing a power calculation to determine the numbers needed for a more definitive study. Cases were identified from the local Scottish ECT Accreditation Network database. Twelve patients had received ECT and had complete data from all those admitted to the Glasgow Mother and Baby Unit since its opening. Each case was matched to 2 control subjects who had also received ECT and who were matched for age, sex, and severity of depressive symptoms. It was not possible to find 2 control subjects for each case, and 23 control subjects were allocated. Severity was matched using the Montgomery-Åsberg Depression Rating Scale (MADRS), which is completed for all patients receiving ECT in Scotland, at the beginning and end of their course. As all control subjects were matched for initial severity of symptoms using MADRS, the change in MADRS score between both groups was compared. When comparing the mean change in MADRS scores between both groups, it was seen that the perinatal patients scores dropped by a mean of 10.09 points more than those of the control subjects (95% confidence interval for difference, −0.54 to 20.73, P = 0.062). No difference was seen between the groups when comparing the number of treatments (7.8 vs 8). Further research is required