Archives of Women's Mental Health

, Volume 18, Issue 6, pp 805–816 | Cite as

Clinical profile and outcomes of women admitted to a psychiatric mother-baby unit

  • Bettina Christl
  • Nicole Reilly
  • Carolyn Yin
  • Marie-Paule AustinEmail author
Original Article


This study examines the clinical profile of women admitted to a psychiatric mother-baby unit as well as change in their clinical, parenting, attachment and quality of life outcomes. Data was collected from 191 mothers through self-report measures at admission and discharge. Change was analysed in terms of Edinburgh Postnatal Depression Scale (EPDS) score, parenting confidence, maternal attachment to the infant and overall functioning. Psychosocial factors impacting on symptom severity and recovery were examined. Most women (64.8 %) were admitted in the first 3 months after birth with an ICD-10 unipolar depressive episode (52.3 %) or anxiety disorder (25.7 %), and 47.6 % had comorbid diagnoses. Improvement from admission to discharge was seen with large effect sizes (≥one standard deviation, i.e. μ) in terms of clinical symptoms (EPDS, μ = 1.7), parenting confidence (Karitane Parenting Confidence Scale (KPCS), μ = 1.1) and attachment to their infant (Maternal Postpartum Attachment Scale (MPAS), μ = 0.9) as well as overall level of functioning (SF-14, μ = 1.9). The majority (73.3 %) recovered symptomatically, and this was associated with increasing maternal age (odds ratio (OR) = 1.129, p = 0.002) and lower levels of psychosocial risk at admission (OR = 0.963, p = 0.008). Improvement in parenting confidence was associated with increasing maternal age (OR = 1.17, p = 0.003). No predictive factors were found for improvement in maternal attachment after controlling for admission scores. In the short term, joint admission of mothers with their infants is highly beneficial in terms of clinical, functional and parenting outcomes, but follow up studies are needed to assess the longer term benefits for mother–infant dyads. The use of an observational tool to enhance our assessment of maternal–infant interaction and some measure of maternal emotional dysregulation—both important mediators of development of secure infant attachment—would also enhance our ability to tailor therapeutic interventions.


Mother-baby unit Psychosocial risk Maternal clinical outcomes 



We gratefully acknowledge Dr Alice Dwyer’s assistance in defining diagnosis by means of file audit, as well as the infrastructure support from the St John of God Health Care, the nurses at the Burwood Hospital Mother-Baby unit and the women and their families who gave their time to participate in this study.

Conflict of interest

The authors have no conflicts of interest to declare.


  1. Appleby L, Friedman T (1996) The Marcé Clinical Checklist: the basis of multicentre audit and research in severe postnatal illness Proc International Marcé Society Biennial ConferenceGoogle Scholar
  2. Austin M-P, Colton J, Priest S, Reilly N, Hadzi-Pavlovic D (2011) The antenatal risk questionnaire (ANRQ): acceptability and use for psychosocial risk assessment in the maternity setting Women BirthGoogle Scholar
  3. Bauer A, Pawlby S, Plant DT, King D, Pariante CM, Knapp M (2014) Perinatal depression and child development: exploring the economic consequences from a South London cohort Psychological Medicine FirstView:1–11 doi: 10.1017/S0033291714001044
  4. Biringen Z (2008) The emotional availability (EA) Scales., 4th edn., Boulder, Colorado 80307Google Scholar
  5. Brockington IF, Fraser C, Wilson D (2006) The Postpartum Bonding Questionnaire: a validation. Arch Womens Ment Health 9:233–242. doi: 10.1007/s00737-006-0132-1 CrossRefPubMedGoogle Scholar
  6. Bryanton J, Gagnon AJ, Hatem M, Johnston C (2008) Predictors of early parenting self-efficacy: results of a prospective cohort study. Nurs Res 57:252–259. doi: 10.1097/ CrossRefPubMedGoogle Scholar
  7. Buist A (1998) Childhood abuse, parenting and postpartum depression. Aust N Z J Psychiatry 32:479–487. doi: 10.1046/j.1440-1614.1998.00436.x CrossRefPubMedGoogle Scholar
  8. Buist A, Barnett B (1995) Childhood sexual abuse: a risk factor for postpartum depression? Aust N Z J Psychiatry 29:604–608CrossRefPubMedGoogle Scholar
  9. Buist A, Janson H (2001) Childhood sexual abuse, parenting and postpartum depression—a 3-year follow-up study. Child Abuse Negl 25:909–921. doi: 10.1016/S0145-2134(01)00246-0 CrossRefPubMedGoogle Scholar
  10. Buist A, Dennerstein L, Burrows GD (1990) Review of a mother-baby unit in a psychiatric hospital. Aust N Z J Psychiatry 24:103–108CrossRefPubMedGoogle Scholar
  11. Buist A, Minto B, Szego K, Samhuel M, Shawyer L, O’Connor L (2004) Mother-baby psychiatric units in Australia—the Victorian experience. Arch Women’s Ment Health 7:81–87CrossRefGoogle Scholar
  12. Campbell S, Cohn J, Meyers T (1995) Depression in first-time mothers: mother-infant interaction and depression chronicity. Dev Psychol 31:340–357CrossRefGoogle Scholar
  13. Carter A, Garritty-Roukas F, Chazan-Cohen R, Little C, Briggs-Gowan M (2001) Maternal depression and co-morbidity: predicting early parenting, attachment security and toddler social-emotional problems and competencies. J Am Acad Child Adolesc Psychiatry 40:18–26CrossRefPubMedGoogle Scholar
  14. Christl B, Reilly N, Smith M, Sims D, Chavasse F, Austin M-P (2013) The mental health of mothers of unsettled infants: is there value in routine psychosocial assessment in this context? Arch Women’s Ment Health 16:391–399. doi: 10.1007/s00737-013-0360-0 CrossRefGoogle Scholar
  15. Cohen MM, Schei B, Ansara D, Gallop R, Stuckless N, Stewart DE (2002) A history of personal violence and postpartum depression: is there a link? Arch Women’s Ment Health 4:83–92. doi: 10.1007/s007370200004 CrossRefGoogle Scholar
  16. Condon JT, Corkindale CJ (1998) The assessment of parent-to-infant attachment: development of a self-report questionnaire instrument. J Reprod Infant Psychol 16:57–76. doi: 10.1080/02646839808404558 CrossRefGoogle Scholar
  17. Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry 150:782–786. doi: 10.1192/bjp.150.6.782 CrossRefPubMedGoogle Scholar
  18. Črnčec R, Barnett B, Matthey S (2008) Development of an instrument to assess perceived self-efficacy in the parents of infants. Res Nurs Health 31:442–453CrossRefPubMedGoogle Scholar
  19. Douglas AR (2000) Reported anxieties concerning intimate parenting in women sexually abused as children. Child Abuse Negl 24:425–434. doi: 10.1016/S0145-2134(99)00154-4 CrossRefPubMedGoogle Scholar
  20. Fisher JRW, Feekery CJ, Rowe-Murray HJ (2002) Nature, severity and correlates of psychological distress in women admitted to a private mother-baby unit. J Paediatr Child Health 38:140–145CrossRefPubMedGoogle Scholar
  21. Forman DR, O’hara MW, Stuart S, Gorman LL, Larsen KE, Coy KC (2007) Effective treatment for postpartum depression is not sufficient to improve the developing mother–child relationship. Dev Psychopathol 19:585–602. doi: 10.1017/S0954579407070289 CrossRefPubMedGoogle Scholar
  22. Glangeaud-Freudenthal NMC (2004) Mother-baby psychiatric units (MBUs): national data collection in France and in Belgium (1999–2000). Arch Women’s Ment Health 7:59–64CrossRefGoogle Scholar
  23. Glangeaud-Freudenthal NMC, Barnett BEW (2004) Mother-baby inpatient psychiatric care in different countries: data collection and issues—introduction. Arch Women’s Ment Health 7:49–51CrossRefGoogle Scholar
  24. Glangeaud-Freudenthal NMC et al (2011) Inpatient mother-and-child postpartum psychiatric care: factors associated with improvement in maternal mental health. Eur Psychiatry 26:215–223CrossRefPubMedGoogle Scholar
  25. Grant KA, Bautovich A, Reilly N, McMahon C, Austin MP (2012) Parental care and control during childhood: associations with maternal perinatal mood disturbance and parenting stress. Arch Women’s Ment Health 15:297–305. doi: 10.1007/s00737-012-0292-0 CrossRefGoogle Scholar
  26. IBM Corp (2012) IBM SPSS Statistics for Windows, Version 21.0. IBM Corp, ArmonkGoogle Scholar
  27. Irving CB, Saylan M (2007) Mother and baby units for schizophrenia. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD006333 Google Scholar
  28. Kagan J, Snidman N, Zentner M, Peterson E (1999) Infant temperament and anxious symptoms in school age children. Dev Psychopathol 11:209–224CrossRefPubMedGoogle Scholar
  29. Kwako LE, Noll JG, Putnam FW, Trickett PK (2010) Childhood sexual abuse and attachment: an intergenerational perspective. Clin Child Psychol Psychiatry 15:407–422. doi: 10.1177/1359104510367590 PubMedCentralCrossRefPubMedGoogle Scholar
  30. Lovejoy MC, Graczyk PA, O’Hare E, Neuman G (2000) Maternal depression and parenting behavior: a meta-analytic review. Clin Psychol Rev 20:561–592CrossRefPubMedGoogle Scholar
  31. Maizel S, Kandel Katzenelson S, Fainstein V (2005) The Jerusalem psychiatric mother-baby unit. Arch Women’s Ment Health 8:200–202CrossRefGoogle Scholar
  32. Martin T, Dayan J, Dutordoit A (2003) Les unités d’hospitalisation conjointe mère-bébé en psychiatrie, état des lieux en France. Ann Med Psychol 161:504–509Google Scholar
  33. Matthey S (2004) Calculating clinically significant change in postnatal depression studies using the Edinburgh postnatal depression scale. J Affect Disord 78:269–272CrossRefPubMedGoogle Scholar
  34. McMahon CA, Barnett B, Kowalenko NM, Tennant CC (2006) Maternal attachment state of mind moderates the impact of postnatal depression on infant attachment. J Child Psychol Psychiatry 47:660–669. doi: 10.1111/j.1469-7610.2005.01547.x CrossRefPubMedGoogle Scholar
  35. Meltzer-Brody S, Brandon AR, Pearson B, Burns L, Raines C, Bullard E, Rubinow D (2014) Evaluating the clinical effectiveness of a specialized perinatal psychiatry inpatient unit. Arch Womens Ment Health 17:107–113. doi: 10.1007/s00737-013-0390-7 PubMedCentralCrossRefPubMedGoogle Scholar
  36. Milan S, Lewis J, Ethier K, Kershaw T, Ickovics JR (2004) The impact of physical maltreatment history on the adolescent mother–infant relationship: mediating and moderating effects during the transition to early parenthood. J Abnorm Child Psychol 32:249–261CrossRefPubMedGoogle Scholar
  37. Milgrom J, Burrows GD, Snellen M, Stamboulakis W, Burrows K (1998) Psychiatric illness in women: a review of the function of a specialist mother-baby unit. Aust N Z J Psychiatry 32:680–686CrossRefPubMedGoogle Scholar
  38. Morris-Yates A, The Strategic Planning Group for Private Psychiatric Services Data Collection and Analysis Group (2000) The SPGPPS national model for data collection and analysis of a minimum data set with outcome measures for private, hospital-based, psychiatric servicesGoogle Scholar
  39. Mullen PE, Martin JL, Anderson JC, Romans SE, Herbison GP (1993) Childhood sexual abuse and mental health in adult life. Br J Psychiatry 163:721–732. doi: 10.1192/bjp.163.6.721 CrossRefPubMedGoogle Scholar
  40. Murray L, Cooper PJ (1997) Effects of postnatal depression on infant development. Arch Dis Child 77:99–101. doi: 10.1136/adc.77.2.99 PubMedCentralCrossRefPubMedGoogle Scholar
  41. Nair R, Bilszta J, Shafira N, Salam N, Buist A (2010) Review of patients admitted to a specialist inpatient parent-infant psychiatric service. Australas Psychiatry 18:567–572. doi: 10.3109/10398562.2010.525641 CrossRefPubMedGoogle Scholar
  42. Newcombe R (2012a) Confidence intervals for proportions and related measures of effect size. CRC Press, Boca RatonCrossRefGoogle Scholar
  43. Newcombe R (2012b) Confidence intervals for proportions and related quantities. Institute for Primary Care & Public Health,. Accessed 24 March 2014
  44. Nezelof S, Cazas O, Sutter-Dallay AL, Glangeaud N (2005) Joint admission to psychiatric mother-baby unit. Ann Med Psychol Rev Psychiatrique 163:529–534Google Scholar
  45. NICHD Early Child Care Research Network (1999) Chronicity of maternal depressive symptoms, maternal sensitivity, and child functioning at 36 months. Dev Psychol 35:1297–1310CrossRefGoogle Scholar
  46. Poinso F, Gay MP, Glangeaud-Freudenthal NMC, Rufo M (2002) Care in a mother-baby psychiatric unit: analysis of separation at discharge. Arch Women’s Ment Health 5:49–58CrossRefGoogle Scholar
  47. Poobalan AS, Aucott LS, Ross L, Smith WCS, Helms PJ, Williams JHG (2007) Effects of treating postnatal depression on mother–infant interaction and child development: systematic review. Br J Psychiatry 191:378–386. doi: 10.1192/bjp.bp.106.032789 CrossRefPubMedGoogle Scholar
  48. Prior M, Smart D, Sanson A, Oberklaid F (2001) Longitudinal predictors of behavioural adjustment in pre-adolescent children. Aust N Z J Psychiatry 35:297–307. doi: 10.1046/j.1440-1614.2001.00903.x CrossRefPubMedGoogle Scholar
  49. Salmon M, Abel K, Cordingley L, Friedman T, Appleby L (2003) Clinical and parenting skills outcomes following joint mother-baby psychiatric admission. Aust N Z J Psychiatr 37:556–562CrossRefGoogle Scholar
  50. Salmon MP, Abel K, Webb R, Warburton AL, Appleby L (2004) A national audit of joint mother and baby admissions to UK psychiatric hospitals: an overview of findings. Arch Women’s Ment Health 7:65–70CrossRefGoogle Scholar
  51. Salonen AH, Kaunonen M, Åstedt-Kurki P, Järvenpää A-L, Isoaho H, Tarkka M-T (2009) Parenting self-efficacy after childbirth. J Adv Nurs 65:2324–2336. doi: 10.1111/j.1365-2648.2009.05113.x CrossRefPubMedGoogle Scholar
  52. Schechter D, Willheim E (2009) Disturbances of attachment and parental psychopathology in early childhood. Child Adolesc Psychiatr Clin N Am 18:665–687PubMedCentralCrossRefPubMedGoogle Scholar
  53. Schore A (2003) Affect dysregulation and disorders of the self. Norton, New YorkGoogle Scholar
  54. Scott KM, Smith DR, Ellis PM (2010) Prospectively ascertained child maltreatment and its association with DSM-IV mental disorders in young adults. Arch Gen Psychiatry 67:712–719. doi: 10.1001/archgenpsychiatry.2010.71 CrossRefPubMedGoogle Scholar
  55. Silverman ME, Loudon H (2010) Antenatal reports of pre-pregnancy abuse is associated with symptoms of depression in the postpartum period. Arch Womens Ment Health 13:411–415. doi: 10.1007/s00737-010-0161-7 CrossRefPubMedGoogle Scholar
  56. Ware JE, Gandek B, IQOLA Project Group (1994) The SF-36 health survey: development and use in mental health research and the IQOLA project. Int J Ment Health Syst 23Google Scholar

Copyright information

© Springer-Verlag Wien 2015

Authors and Affiliations

  • Bettina Christl
    • 1
  • Nicole Reilly
    • 1
  • Carolyn Yin
    • 1
  • Marie-Paule Austin
    • 1
    • 2
    • 3
    Email author
  1. 1.Perinatal & Women’s Mental Health UnitSt John of God Health Care & School of Psychiatry, University of New South WalesSydneyAustralia
  2. 2.The Black Dog InstituteSydneyAustralia
  3. 3.The Royal Women’s HospitalRandwickAustralia

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