Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK.
Centre for Academic Primary Care, University of Bristol Medical School, Bristol, UK.
BMJ Open. 2019 Mar 23;9(3):e025906. doi: 10.1136/bmjopen-2018-025906.
Research into what constitutes the best and most effective care for women with an acute severe postpartum mental disorder is lacking. The effectiveness and cost-effectiveness of psychiatric mother and baby units (MBUs) has not been investigated systematically and there has been no direct comparison of the outcomes of mothers and infants admitted to these units, compared with those accessing generic acute psychiatric wards or crisis resolution teams (CRTs). Our primary hypothesis is that women with an acute psychiatric disorder, in the first year after giving birth, admitted to MBUs are significantly less likely to be readmitted to acute care (an MBU, CRTs or generic acute ward) in the year following discharge than women admitted to generic acute wards or cared for by CRTs.
Quasi-experimental study of women accessing different types of acute psychiatric services in the first year after childbirth. Analysis of the primary outcome will be compared across the three service types, at 1-year postdischarge. Cost-effectiveness will be compared across the three service types, at 1-month and 1-year postdischarge; explored in terms of quality-adjusted life years. Secondary outcomes include unmet needs, service satisfaction, maternal adjustment, quality of mother-infant interaction. Outcomes will be analysed using propensity scoring to account for systematic differences between MBU and non-MBU participants. Analyses will take place separately within strata, defined by the propensity score, and estimates pooled to produce an average treatment effect with weights to account for cohort attrition.
The study has National Health Service (NHS) Ethics Approval and NHS Trust Research and Development approvals. The study has produced protocols on safeguarding maternal/child welfare. With input from our lived experience group, we have developed a dissemination strategy for academics/policy-makers/public.
对于患有急性严重产后精神障碍的女性，缺乏最佳和最有效的护理研究。精神病母婴单位（MBU）的有效性和成本效益尚未系统调查，也没有直接比较入住这些单位的母亲和婴儿的结果，与入住普通急性精神病病房或危机解决小组（CRT）的结果相比。我们的主要假设是，在分娩后第一年患有急性精神障碍的女性，与入住普通急性病房或接受 CRT 治疗的女性相比，入住 MBU 的女性在出院后一年内再次入住急性护理（MBU、CRTs 或普通急性病房）的可能性显著降低。
在分娩后第一年，对不同类型的急性精神科服务的女性进行准实验研究。将在出院后 1 年对主要结局在三种服务类型之间进行分析。将在出院后 1 个月和 1 年对三种服务类型的成本效益进行比较；从质量调整生命年的角度进行探讨。次要结局包括未满足的需求、服务满意度、产妇调整、母婴互动质量。将使用倾向评分来分析结局，以解释 MBU 和非 MBU 参与者之间的系统差异。分析将在根据倾向评分定义的层内分别进行，并对估计值进行汇总，以产生加权平均治疗效果，以说明队列流失。
该研究已获得国家卫生服务（NHS）伦理批准和 NHS 信托研究和开发批准。该研究制定了保障母婴福利的方案。在我们的生活体验小组的参与下，我们为学术界/政策制定者/公众制定了传播策略。
