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 woman's 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 woman's relationship with her partner or the latter's own mental health may improve outcome.