Obstetric near misses among women with serious mental illness: data linkage cohort study.

BACKGROUND: Investigating obstetric near misses (life-threatening obstetric complications) provides crucial information to prevent maternal mortality and morbidity. AIMS: To investigate the rate and type of obstetric near misses among women with serious mental illness (SMI). METHOD: We conducted a historical cohort study, using de-identified electronic mental health records linked with maternity data from Hospital Episode Statistics. The English Maternal Morbidity Outcome Indicator was used to identify obstetric near misses at the time of delivery in two cohorts: (1) exposed cohort - all women with a live or still birth in 2007-2016, and a history of secondary mental healthcare before delivery in south-east London (n = 13 570); (2) unexposed cohort - all women with a live or still birth in 2007-2016, resident within south-east London, with no history of mental healthcare before delivery (n = 223 274). RESULTS: The rate of obstetric near misses was 884.3/100 000 (95% CI 733.2-1057.4) maternities in the exposed group compared with 575.1/100 000 (95% CI 544.0-607.4) maternities in the unexposed group (adjusted odds ratio 1.6, 95% CI 1.3-2.0, P < 0.001). Highest risks were for acute renal failure (adjusted odds ratio 2.1, 95% CI 1.1-3.8, P = 0.022); cardiac arrest, failure or infarction (adjusted odds ratio 2.3, 95% CI 1.1-4.8, P = 0.028); and obstetric embolism (adjusted odds ratio 3.1, 95% CI 1.6-5.8, P < 0.001). CONCLUSIONS: Findings emphasise the importance of integrated physical and mental healthcare before and during pregnancy for women with SMI

Obesity, antenatal depression, diet and gestational weight gain in a population cohort study

PURPOSE: The aims of this paper are to examine: (1) the relationship between high pre-pregnancy BMI and antenatal depression; (2) whether BMI and antenatal depression interact to predict diet and gestational weight gain (GWG). METHODS: Data came from the Avon Longitudinal Study of Parents and Children (ALSPAC). Underweight women were excluded. Pre-pregnancy BMI was self-reported and antenatal depression was assessed using the Edinburgh Postnatal Depression Scale at 18 and 32 weeks' gestation to identify persistently elevated depressive symptoms (EPDS>12). Dietary patterns were calculated from food frequency questionnaires at 32 weeks' gestation. GWG was categorised using the USA Institute of Medicine guidelines. RESULTS: This study included 13,314 pregnant women. Obese women had significantly higher odds of antenatal depression than normal weight controls after adjusting for socio-demographics and health behaviours (aOR 1.39, 95%CI 1.05-1.84). Every unit increase in pre-pregnancy BMI was associated with approximately 3% higher odds of antenatal depression (aOR 1.03, 95%CI 1.01-1.05). Antenatal depression was not meaningfully associated with dietary patterns after adjusting for confounders and was not associated with inadequate or excessive GWG. There was no evidence for an interaction of depression and BMI on either diet or GWG. CONCLUSIONS: Healthcare professionals should be aware of the dose-response relationship between high pre-pregnancy BMI and antenatal depression

Recent physical and sexual violence against adults with severe mental illness: a systematic review and meta-analysis

People with severe mental illness (SMI) have high prevalence of lifetime victimization, but little is known about the extent and risk of recent domestic/sexual violence. The objective was to synthesize evidence on prevalence, odds, and risk factors for recent violence against people with SMI, with a focus on domestic and sexual violence. Relevant studies were identified through literature searches in Medline, Psychinf, Embase (for studies published in 2010–2015), and through existing systematic reviews (for studies published in 2000–2014). The review included 30 studies (with 16 140 SMI participants), including six on domestic violence and 11 on sexual violence. Prevalence of recent domestic violence ranged from 15–22% among women and from 4–10% among men/mixed samples; with little evidence on risk compared with the general population. Median prevalence of sexual violence was 9.9% (IQR = 5.9–18.1%) in women and 3.1% (IQR = 2.5–6.7%) in men; with 6-fold higher odds of victimization compared with the general population. There was little evidence on risk factors for domestic or sexual violence. In conclusion, people with SMI have a high prevalence of recent domestic and sexual violence, but little is known about risk factors for these violence types, or extent of domestic violence victimization compared to the general population

Fear of childbirth during pregnancy: associations with observed mother-infant interactions and perceived bonding.

Fear of childbirth (FOC) is a common phenomenon that can impair functioning in pregnancy but potential longer term implications for the mother-infant relationship are little understood. This study was aimed at investigating postpartum implications of FOC on the mother-infant relationship. A UK sample of 341 women in a community setting provided data on anxiety, mood and FOC in mid-pregnancy and subsequently completed self-report measures of postnatal bonding in a longitudinal cohort study. Postnatal observations of mother-infant interactions were collected and rated for a subset of 141 women. FOC was associated with maternal perception of impaired bonding, even after controlling for sociodemographic factors, concurrent depression and the presence of anxiety disorders (Coef = 0.10, 95% CI 0.07-0.14, p < 0.001). Observed mother-infant interactions were not associated with FOC (Coef = -0.01-0.03 CI - 0.02 to 0.02, p = 0.46), weakly with concurrent depression (Coef = - 0.10, CI - 0.19 to 0.00, p = 0.06) and not associated with anxiety disorders. The self-efficacy component of FOC was most strongly associated with lower reported bonding (Coef 0.37, 95% CI 0.25-0.49, p < 0.001) FOC makes a distinct contribution to perceived postpartum bonding difficulties but observed mother-infant interaction quality was not affected. This may be due to low self-efficacy impacting psychological adjustment during pregnancy. Targeted interventions during pregnancy focusing both on treatment of key childbirth fears and bonding could help women adjust earlier

Bilingualism in the family and child well-being: A scoping review

© The Author(s) 2020. Aims and objectives: The aim of this scoping review is to investigate the association between bilingualism in the family and child subjective well-being, by reviewing the literature to identify key themes to date and remaining questions for future research. Methodology: Scopus, Web of Knowledge, ERIC, Psych Articles and PsychInfo were searched systematically between September and October 2018, and after title, abstract and full-text screening, 17 of the initial 1433 articles were included in this review. Data and analysis: Each study was coded for the discipline from which it emerged, the language combination studied, the measures of well-being and language proficiency it used, the geographical location of the study and the number of participants. Data on the link between bilingualism and well-being was extracted from each study. Findings and conclusion: Two main themes were identified: ‘The effect of language proficiency on family relationships’ and ‘The acculturation of parents and children as mediated by language’. Across studies, there was significant heterogeneity in definition of concepts and a diverse range of measures employed. In addition, the studies identified suggest a positive link between minority language maintenance and child well-being, and a positive influence of bilingualism, rather than knowledge of only the home or the majority language. However, the directionality of these relationships will need to be investigated in future research. Originality: This is the first scoping review conducted systematically to explore the link between bilingualism in the family and child well-being internationally. It builds on previous work such as a narrative review which examined this association in the European context.The idea for this review emerged from a series of stakeholder workshops which were supported by an ESRC Impact Acceleration Account grant entitled “Multilingualism for wellbeing: defining routes to impact among community language learners” (GNAG/064) and the production of this review was supported by a grant from the Cambridge University Language Sciences Incubator Fund entitled “Multilingualism and subjective wellbeing in the family: a systematic review” (U.GN.GNDB.AHAO.ERKZ)

Receiving threatening or obscene messages from a partner and mental health, self-harm and suicidality: results from the Adult Psychiatric Morbidity Survey

PURPOSE: Threatening or obscene messaging is repeated, unwanted texts, emails, letters or cards experienced by the recipient as threatening or obscene, and causing fear, alarm or distress. It is rarely examined as an aspect of intimate partner violence. We describe the prevalence of exposure to threatening/obscene messaging from a current or ex-partner; characteristics of victims; and associations with other forms of violence and abuse, mental disorder, self-harm, and suicidality. METHODS: Cross-sectional probability-sample survey of the general population in England aged 16 + . Multivariable regression modelling tested associations between receipt of threatening/obscene messaging and current common mental disorder, past-year self-harm and suicidality. RESULTS: Threatening/obscene messages were received from a current/ex-partner by 6.6% (95%CI: 5.9-7.3) of adults who had been in a relationship; 1.7% received these in the past year. Victims were more likely to be female, under 35, single or divorced, socioeconomically disadvantaged, and to have experienced other forms of sexual and partner violence and abuse. Those who received threatening/obscene messages in the past year were more likely to experience common mental disorder (adjusted odds ratio 1.89; 1.01-3.55), self-harm (2.31; 1.00-5.33), and suicidal thoughts (2.00; 1.06-3.78). CONCLUSION: Threatening/obscene messaging commonly occurs in the context of intimate partner violence. While often occurring alongside sexual and physical violence, messaging has an additional association with mental disorder and suicidality. Routine enquiry in service settings concerning safety, including those working with people who have escaped domestic violence, should ask about ongoing contact from previous as well as current partners. This should include asking about messaging, as well as other forms of potentially technology-enabled abuse which may become increasingly common

Factors Affecting Infant Feeding Practices Among Women With Severe Mental Illness

Background: The health benefits of breastfeeding are well-established but for mothers with severe mental illness (SMI), the decision to breastfeed can be complex. Very few prior studies have investigated the infant feeding choices of women with SMI, or the factors associated with this. Our aims were to examine antenatal infant feeding intentions and infant feeding outcomes in a cohort of women admitted for acute psychiatric care in the first postpartum year. We also aimed to examine whether demographic and clinical characteristics associated with breastfeeding were similar to those found in previous studies in the general population, including age, employment, education, BMI, mode of delivery, smoking status, and social support. Methods: This study was a mixed-methods secondary analysis of a national cohort study, ESMI-MBU (Examining the effectiveness and cost-effectiveness of perinatal mental health services). Participants had been admitted to acute care with SMI in the first postpartum year. Infant feeding outcomes were retrospectively self-reported by women during a 1-month post-discharge interview. Free-text responses to questions relating to infant feeding and experience of psychiatric services were also explored using thematic analysis. Results: 144 (66.1%) of 218 women reported breastfeeding (mix feeding and exclusive breastfeeding). Eighty five percentage of the cohort had intended to breastfeed and of these, 76.5% did so. Factors associated with breastfeeding included infant feeding intentions, employment and non-Caucasian ethnicity. Although very few women were taking psychotropic medication contraindicated for breastfeeding, over a quarter (n = 57, 26.15%) reported being advised against breastfeeding because of their medication. Women were given this advice by psychiatry practitioners (40% n = 22), maternity practitioners (32.73% n = 18) and postnatal primary care (27.27% n = 15). Most women stopped breastfeeding earlier than they had planned to as a result (81.1% n = 43). Twenty five women provided free text responses, most felt unsupported with infant feeding due to inconsistent information about medication when breastfeeding and that breastfeeding intentions were de-prioritized for mental health care. Conclusion: Women with SMI intend to breastfeed and for the majority, this intention is fulfilled. Contradictory and insufficient advice relating to breastfeeding and psychotropic medication indicates that further training is required for professionals caring for women at risk of perinatal SMI about how to manage infant feeding in this population. Further research is required to develop a more in-depth understanding of the unique infant feeding support needs of women with perinatal SMI

Experiences of Improving Access to Psychological Therapy Services for Perinatal Mental Health Difficulties: a Qualitative Study of Women's and Therapists' Views

BACKGROUND: Perinatal mental health difficulties are highly prevalent. In England, the Improving Access to Psychological Therapy (IAPT) programme provides evidence-based psychological treatment, predominantly in the form of brief manualized cognitive behavioural therapy (CBT), to people with mild to moderate depression or anxiety. Yet little is known about the experiences of women referred to IAPT with perinatal mental health difficulties. AIMS: The aim of this qualitative study was to investigate how women view IAPT support for perinatal mental health. We also gained the perspective of IAPT therapists. METHOD: Semi-structured interviews were conducted with twelve women who had been referred to and/or received therapy from IAPT during the perinatal period. Additionally, fourteen IAPT therapists participated in two focus groups. Thematic analysis was used. RESULTS: Key themes centred on barriers to access and the need to tailor support to (expectant) mothers. Women and therapists suggested that experiences could be improved by supporting healthcare professionals to provide women with more help with referrals, better tailoring support to the perinatal context, improving perinatal-specific training, supervision and resources, and offering a more individualized treatment environment. CONCLUSIONS: Overall, women reported positive experiences of support offered by IAPT for perinatal mental health difficulties. However, services should seek to facilitate access to support and to enable therapists to better tailor treatment

Maternal personality traits, antenatal depressive symptoms and the postpartum mother-infant relationship: a prospective observational study

PURPOSE: Maternal depression has been associated with bonding difficulties and lower maternal sensitivity in observed mother-infant interactions. However, little research has examined the impact of disordered personality traits in mothers on these outcomes. We investigated the association between disordered personality traits in mothers measured during pregnancy and postnatal (a) self-reported bonding with infant; (b) observational mother-infant interactions. // METHODS: Five hundred fifty-six women were recruited during early pregnancy and subsequently followed up at mid-pregnancy (approximately 28 weeks' gestation) and when infants were aged approximately 3 months (n = 459). During early pregnancy, data were collected on disordered personality traits (using the Standardised Assessment of Personality Abbreviated Scale) and depressive symptoms (using the Edinburgh Postnatal Depression Scale). At 3 months postpartum, self-reported perceived bonding (using the Postpartum Bonding Questionnaire) were collected. A sub-sample of women additionally provided observational mother-infant interaction data (n = 206) (coded using the Child-Adult Relationship Experimental Index). // RESULTS: Higher disordered personality traits was not associated with maternal perceptions of bonding impairment, but was associated with reduced maternal sensitivity during observational mother-infant interactions [adjusted for age, education, having older children, substance misuse prior to pregnancy, infant sex and gestational age: coefficient = - 0.28, 95% CI = - 0.56 to - 0.00, p < 0.05]. After adjusting for depressive symptoms, the association was attenuated [coefficient = - 0.19, 95% CI = - 0.48 to 0.11, p = 0.217]. // CONCLUSIONS: Mothers with disordered personality traits did not perceive themselves as having bonding impairments with their infants but were less sensitive during observed interactions, though depressive symptoms attenuated this relationship. Both depression and disordered personality traits need to be addressed to optimize mother-infant interactions