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


Dr Louise Michele Howard, Health Services Research Department, Institute of Psychiatry, PO No. 29, De Crespigny Park, London SE5 8AF, UK.


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

Method:  Descriptive and case–control study.

Results:  Over half of the women with psychotic disorders admitted to psychiatric mother and baby units had a good outcome at the time of discharge – 70% did not need social services supervision, and had no significant parenting problem as judged by clinical staff. Diagnosis was independently associated with all measures of poor parenting; compared with a diagnosis of psychotic depression, a diagnosis of schizophrenia was highly significantly associated with social services supervision [adjusted odds ratio (OR) 25.7; 95% CI 5.97, 111.05], and staff rated problems with emotional responsiveness (adjusted OR 3.39;95% CI 1.42, 8.08), practical baby care (adjusted OR 6.07; 95% CI 2.12, 17.39), and perceived risk of harm to baby (adjusted OR 7.81; 95% CI. 2, 30.53). Low social class and psychiatric illness in the partner were also significantly associated with poor parenting outcomes, including social services supervision (adjusted OR 3.88; 95% CI 2.07, 7.25 and 4.23; 95% CI 2.1, 8.55, respectively).

Conclusions:  Although these associations do not demonstrate causality, these findings suggest preventative interventions targeting socio-economic difficulties, early treatment of psychosis, and detection and treatment of psychiatric problems in the partner may be helpful in improving parenting outcomes in these vulnerable families.