Pregnant women with depression are being missed by the two quick screening questions midwives currently use, and this programme will test whether a longer questionnaire catches more cases. The research also tackles a second gap: no one has rigorously tested whether a brief talking therapy—Guided Self Help—works for depression during pregnancy, or whether specialist Mother and Baby Units are worth their higher cost compared to general psychiatric wards or crisis teams. Around one in five women experience a mental disorder during pregnancy or the first year after birth, yet services vary wildly across the UK. The programme will provide the first head-to-head evidence on screening accuracy, treatment effectiveness, and cost-effectiveness for both mild and severe cases. If Guided Self Help proves effective, it could be rolled out cheaply in maternity clinics nationwide. If Mother and Baby Units prevent re-admission and improve mothering outcomes better than general wards, commissioners will have hard data to justify their funding. The qualitative work with women and partners will also reveal what good care actually looks like from the inside—information that currently barely exists.
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Aims and objectives: This research programme plans to: investigate how best to identify depression at antenatal booking, estimate the prevalence of common mental disorders in early pregnancy, develop and evaluate Guided Self Help modified for pregnant women for antenatal depression, evaluate services for women with acute severe postnatal mental disorders i.e. admissions to a psychiatric unit (general wards or psychiatric Mother and Baby Units) or care from Crisis Resolution Teams, investigate women s and partners/significant others experiences of different types of care Background and rationale: There is growing evidence that mental disorders are a significant problem during and after pregnancy. National policy emphasises the importance of early identification and appropriate treatment by perinatal mental health services. Research environment: This bid is led by a multidisciplinary team with an international reputation for clinical and academic excellence in mental health, based at King's Health Partners, one of only five accredited Academic Health Science Centres in the UK. King's Health Partners aims to integrate clinical service delivery, education and research for the benefit of patients in London and worldwide, and is therefore an ideal base for a multidisciplinary perinatal mental health research programme. Co-applicants are also based at other world class universities with expertise in applied research: University College London, University of Manchester, University of Cardiff, UCLAN and the University of Melbourne. Research plan: Workpackage 1 (WP1) Module 1 - cross-sectional survey in maternity service booking clinics to compare the sensitivity, specificity and positive predictive value of the two Whooley questions (currently used by midwives) with the Edinburgh Postnatal Depression Scale, and a gold standard diagnostic interview, for the identification of depression. We will also estimate rates of depression and other commonly occurring disorders. WP1, Module 2 - RCT of Guided Self Help (modified for pregnancy) compared with care as usual. WP2 – Qualitative investigation of the experiences of perinatal mental health care from the perspectives of women with a range of mental disorders (mild to severe, during pregnancy and postnatally) and partners/significant others, and professionals WP3 - Cohort study of women with severe postnatal mental illnesses treated in psychiatric Mother and Baby Units, general wards or under Crisis Resolution Teams to compare how well services prevent re-admission in the following year, address health and social care needs, and help women return to optimal mothering. We will also investigate impacts on partners/significant others mental health, worries, finances and ability to cope. Projected outputs & Dissemination plans: This programme will establish the most effective ways to identify depression in maternity services; provide up to date evidence on the prevalence of common mental disorders during the first trimester and the efficacy of Guided Self Help modified for pregnancy; and provide data on the experience, and effectiveness and cost-effectiveness of different service models including psychiatric Mother and Baby Units. We will publish in high impact peer reviewed international journals; disseminate our results to policy makers, NHS commissioners and NHS providers; summarise findings on a programme website, charities leaflets, newsletters and websites; provide reports for stakeholders, general media and our international networks. Relevant expertise & experience of research team: Our research team includes leading experts in perinatal mental health, health economics, midwifery, service user research,
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