Margaret P. Salmon

What predicts poor mother-infant interaction in schizophrenia?

BACKGROUND Poor clinician-rated parenting outcome and observed interactive deficits in mothers with schizophrenia admitted to a psychiatric mother and baby unit (MBU) reflect continuing concerns over the parenting capacity of this group. However, little is known about whether interaction deficits are accounted for by severity of illness or adverse social circumstances typically experienced by these mothers. METHOD Thirty-eight women with severe perinatal illness (schizophrenia n=13; affective disorders n=25) and their infants were observed in play interaction a week prior to MBU discharge. Clinical and sociodemographic data were also obtained. RESULTS Mothers with schizophrenia and their infants were rated to have poorer interactive behaviour than the affective disorders group. Infant avoidance of the mother was associated with a lack of maternal sensitivity and responsiveness. The deficits in mother-infant interaction found in the schizophrenia group could not be accounted for by our measures of illness severity or factors relating to adverse social circumstances. CONCLUSIONS The results replicate and extend previous findings showing poor interactive behaviours in mothers with schizophrenia, their infants, and in the dyad, in a range of areas following clinical recovery. The findings suggest that factors other than illness duration, dose of medication, marital status and occupational status are explanatory for the interactive deficits associated with maternal schizophrenia. Parenting interventions that aim to improve maternal sensitivity need to be developed specifically for this group.

Clinical and parenting skills outcomes following joint mother–baby psychiatric admission

Objective: To examine maternal clinical and parenting outcomes as a function of diagnosis following joint mother–baby admission; to identify the associations of poor outcome. Method: Demographic and clinical information was collected on 1081 joint mother–baby admissions, including 224 women with schizophrenia, 155 with bipolar disorder and 409 with non-psychotic depression. Information was based on clinical judgements of senior staff in participating units using the Marcé checklist. Predictors of poor maternal clinical outcome, practical problems in baby care, poor emotional responsiveness to infant and perceived risk of harm to baby were identified by logistic regression. Results: Good clinical outcome was reported in 848 (78%) cases. On each parenting outcome, good outcome was reported in at least 80%. The predictors of poor outcome were similar for all four outcomes. These were a diagnosis of schizophrenia, behavioural disturbance, low social class and either psychiatric illness in the womans partner or a poor relationship with the partner. Of those with poor outcome on all four variables, 66% suffered with schizophrenia. Women with schizophrenia showed more behavioural disturbance, were more likely to experience hallucinations and delusions, and were more likely to be of low social class. They were also less likely to have a partner and more likely to have a partner with a psychiatric illness. Conclusions: Clinical and parenting outcomes, as reported by clinical staff, are usually good following joint mother–baby admission. Women with schizophrenia may need particular measures to improve their parenting. A marital approach to treatment, directed at the womans relationship with her partner or the latters own mental health may improve outcome.

Predictors of parenting outcome in women with psychotic disorders discharged from mother and baby units.

Objective:  To compare the social and clinical characteristics of mothers with psychotic disorders with parenting difficulties, with mothers with no significant parenting problems.

Predictors of social services supervision of babies of mothers with mental illness after admission to a psychiatric mother and baby unit

Abstract.Background: There is insufficient information on the predictors of parenting difficulties in mothers with severe mental illness. Using data from mother and baby units in the UK we aimed to examine the social and clinical characteristics of mothers whose babies were supervised by social services on discharge. Method: A case-control study was carried out using data from mother and baby units and facilities entered onto the Marce database. Results: Of 1197 mothers, 23% were discharged with their babies under some form of social services supervision. Factors independently associated with an increased risk of supervision included social class (OR 3.16, 95% CI 1.99–5.03), single marital status (OR 2.10, 95% CI 1.38–3.20), behavioural disturbance (OR 1.69, 95% CI 1.08–2.65) and psychiatric illness in the partner (OR 2.67, 95% CI 1.59–4.49). The diagnostic groups independently associated with the highest risk of having a supervised baby were schizophrenia (OR 5.16, 95% CI 2.61–10.21) and personality disorder (OR 9.29, 95% CI 3.46–24.91). Conclusions: Mothers with schizophrenia are at particularly high risk of having their baby supervised by social services. Preventative interventions should be targeted at socio-economic difficulties, early detection of psychiatric disorders postpartum and treatment of perinatal mental illness in the context of the whole family.

A national audit of joint mother and baby admissions to UK psychiatric hospitals: an overview of findings.

SummaryThe Marcé Clinical Audit is an ongoing data collection exercise that gathers socio-demographic and clinical information about mothers and their infants, admitted jointly to specialist units in UK psychiatric hospitals. The maternal and parenting outcomes, in particular of mothers with schizophrenia and mothers who harm themselves and/or their infants, were determined and analysed. The majority of women had a primary diagnosis of either depression (43%) or schizophrenia (21%). Mothers with schizophrenia were three times more likely to experience a poor outcome than non-schizophrenic mothers, were more likely to be separated from their infant at discharge and were perceived, by staff, to be at greater risk of harming their infant. They were, however, shown to be no more likely to cause actual harm to their infant, or themselves, than non-schizophrenic mothers.