Mother and baby units for schizophrenia

 

Abstract

Background

Mother and baby units (MBUs) are recommended, in the UK, as an optimal site for treating post partum psychoses. Naturalistic studies suggest poor outcomes for mothers and their children if admission is needed during the first year after birth, but the evidence for the effectiveness of MBUs in addressing the problems faced by both mothers with mental illness and their babies is unclear.

Objectives

To review the effects of mother and baby units for mothers with schizophrenia or psychoses needing admission during the first year after giving birth, and their children, in comparison to standard care on a ward without a mother and baby unit.

Search methods

We undertook electronic searches of the Cochrane Schizophrenia Group's Register (June 2006).

Selection criteria

We included all randomised clinical trials comparing placement on a mother and baby unit compared to any other standard care without attachment to such a unit.

Data collection and analysis

If data were available we would have independently extracted data and analysed on an intention-to treat basis; calculated the relative risk (RR) and 95% confidence intervals (CI) of homogeneous dichotomous data using a random effects model, and where possible calculated the number needed to treat (NNT); calculated weighted mean differences (WMD) for continuous data.

Main results

Unfortunately, we did not find any relevant studies to include. One non-randomised trial, published in 1961, suggested beneficial effects for those admitted to mother and baby units. For the experimental group, more women were able to care for their baby on their own and experienced fewer early relapses on their return home compared with standard care. Care practices for people with schizophrenia have changed dramatically over the past 40 years and a sensitively designed pragmatic trial is possible and justified.

Authors' conclusions

Mother and bay units are reportedly common in the UK but less common in other countries and rare or non-existent in the developing world. However, there does not appear to be any trial-based evidence for the effectiveness of these units. This lack of data is of concern as descriptive studies have found poor outcomes such as anxious attachment and poor development for children of mothers with schizophrenia and a greater risk of the children being placed under supervised or foster care. Effective care of both mothers and babies during this critical time may be crucial to prevent poor clinical and parenting outcomes. Good, relevant research is urgently needed.

 

Plain language summary

Mother and baby units for schizophrenia

Post-partum psychosis is a consistent source of new episodes of severe mental illness and its worldwide prevalence has remained unchanged at 1 in 1000 live births over the past 150 years. For some women, admission to hospital is necessary. In the UK special mother and baby units (MBUs) are available in some areas to allow mothers to remain with their babies during treatment. This can help avoid the potential detrimental effects of separation from the mother on the baby and the effect this separation would have on the mother's confidence and capability as a future carer.

While surveys have reported that many women strongly prefer admission to MBUs, there are concerns that admitting a baby to a psychiatric unit for long periods of time may be harmful in terms of institutionalisation of the baby, and the rarer potential risk of physical harm from severely ill mothers. Although MBUs are recommended as the optimal site for treating a perinatal psychosis in the UK, outside of some parts of Australia, Europe, Canada, and New Zealand, they are either virtually non existent or very limited. There is no real clarity in the literature to explain the reasons why there is such a difference in the treatment of women with mental illness around the world.

To assess the efficacy of MBUs we systematically searched for any randomised trials of MBUs compared to standard care. We found no trials involving either mothers suffering from post partum psychosis or severe post natal depression. Anecdotal results from a 1961 trial did suggest a beneficial effect, but non-randomised data from over 40 years ago is difficult to apply to today's care. Such lack of data is of concern as MBUs are expensive to set up and run. If they are to be the 'gold standard' of care for mothers and their babies, their effectiveness needs to validated. Good quality, relevant research is urgently needed.

 

摘要

背景

精神分裂症患者的母嬰同室

在英國，母嬰同室(MBUs)被建議為治療產後精神病的最佳場所。自然的研究顯示如果在產後的第一年需要入院的話，母親與小孩的預後是不佳的。然而MBU在處理精神疾病的母親與其嬰兒所面臨的問題的效果，其證據是不清楚的。

目標

回顧母嬰同室對於在產後第一年需要住院的精神分裂症或精神病母親與其孩子的效果，與接受標準照護而沒有母嬰同室者相比較。

搜尋策略

我們搜尋the Cochrane Schizophrenia Group's Register 的電子資料庫(至2006年6月)。

選擇標準

我們納入所有的隨機臨床試驗，比較有母嬰同室的安置，與其他任何沒有母嬰同室的標準照護。

資料收集與分析

如果有資料，我們會獨立地擷取資料，並以治療意向為基礎去分析，使用隨機效果模式來對同質的二分變項計算相對風險(RR)與95%信賴區間(CI)，可能的話就計算益一需治數(NNT)。對於連續變項則計算加權的平均差異(WMD)。

主要結論

不幸地，我們並沒有找到任何相關的研究。1個非隨機試驗，發表於1961年，顯示對於接受母嬰同室的患者來說有助益的效果。實驗組與標準照護組相比較，有更多女性可以自行照顧她們的嬰兒，在返家後也比較少人在早期就復發。對於精神分裂症患者的照護標準在過去的40年間已有戲劇性地改變，而一個靈敏地設計的實用試驗是可能的，也是可提供證據的。

作者結論

母嬰同室在英國是普遍的，但在其他國家並沒有那麼常見，在發展中國家甚至是很少或根本沒有的。然而，並沒有任何試驗為基礎的證據顯示這種單位的效果。缺乏資料是令人擔憂的，因為質性研究發現精神分裂症母親的小孩有較差的結果如焦慮的依附與較差的發展，這些小孩也有較高的機率會被安置在寄養機構。在這段關鍵期對於母親與嬰兒兩者的有效照護可能對預防較差的臨床與教養結果是重要的。現在迫切地需要好的、相關的研究。

翻譯人

本摘要由彰化基督教醫院陳美雀翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

產後精神病一直是嚴重精神疾病的一個新來源，過去150年來全球的盛行率也一直維持在每1000個活產有1個案例。對一些婦女來說，住院是必須的。在英國的某些地方，有母嬰同室的特殊單位，讓母親在住院治療期間仍然可以跟她們的嬰兒在一起。這可以協助避免嬰兒與母親分開所導致的潛在有害影響，以及這樣的分離對於母親將來作為一個照顧者的信心與能力的影響。雖然調查結果發現許多婦女強烈傾向選擇住院時有母嬰同室，有人擔心一個嬰兒長期住在精神科病房對於這個嬰兒會有有害的機構化效果，以及嚴重生病的母親可能會對嬰兒有身體傷害的微小潛在風險。雖然在英國母嬰同室被建議為治療產後精神病的最佳場所，在澳洲、歐洲、加拿大與紐西蘭以外的一些地區，不是幾乎沒有母嬰同室，就是非常少見。文獻中並沒有清楚地解釋為何全球各國在治療精神疾病的婦女上有這些差異。為了評估MBU的成效，我們系統性地搜尋任何比較MBU與標準照護的隨機試驗。我們沒有發現任何試驗是關於產後精神病或產後嚴重憂鬱的母親。1個1961年的試驗顯示可能有助益的效果，但40年以前非隨機的資料要應用到當代的照護是有困難的。資料的缺乏是值得關注的，因為MBU的設置與運作是昂貴的。如果要把它當作對母親與嬰兒的標準照護，那麼它的效益需要被驗證。現在迫切地需要良好品質、相關的研究。