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Protocol for a quasi-experimental study of the effectiveness and cost-effectiveness of mother and baby units compared with general psychiatric inpatient wards and crisis resolution team services (The ESMI study) in the provision of care for women in the postpartum period
  1. Kylee Trevillion1,
  2. Rebekah Shallcross2,
  3. Elizabeth Ryan3,
  4. Margaret Heslin4,
  5. Andrew Pickles3,
  6. Sarah Byford4,
  7. Ian Jones5,
  8. Sonia Johnson6,
  9. Susan Pawlby7,
  10. Nicky Stanley8,
  11. Diana Rose9,
  12. Gertrude Seneviratne10,
  13. Angelika Wieck11,
  14. Stacey Jennings12,
  15. Laura Potts3,
  16. Kathryn M Abel13,14,
  17. Louise M Howard1
  1. 1 Section of Women’s Mental Health, Institute of Psychiatry, Psychology & Neuroscience at King’s College London, London, UK
  2. 2 Centre for Academic Primary Care, University of Bristol Medical School, Bristol, UK
  3. 3 Biostatistics Department, Institute of Psychiatry, Psychology & Neuroscience at King’s College London, London, UK
  4. 4 King’s Health Economics, Institute of Psychiatry, Psychology & Neuroscience at King’s College London, London, UK
  5. 5 National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, London, UK
  6. 6 Division of Psychiatry, University College London, London, UK
  7. 7 Institute of Psychiatry, Psychology & Neuroscience at King’s College London, London, UK
  8. 8 School of Social Work, Care and Community, University of Central Lancashire, Preston, UK
  9. 9 Service User Research Enterprise, Institute of Psychiatry, Psychology & Neuroscience at King’s College London, London, UK
  10. 10 Psychological Medicine and Integrated Care Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
  11. 11 Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
  12. 12 Addictions, Institute of Psychiatry, Psychology & Neuroscience at King’s College London, London, UK
  13. 13 Medical and Human Sciences, Institute of Brain Behaviour and Mental Health, Manchester, UK
  14. 14 Manchester Mental Health & Social Care Trust, Manchester, UK
  1. Correspondence to Professor Louise M Howard; louise.howard{at}


Introduction Research into what constitutes the best and most effective care for women with an acute severe postpartum mental disorder is lacking. The effectiveness and cost-effectiveness of psychiatric mother and baby units (MBUs) has not been investigated systematically and there has been no direct comparison of the outcomes of mothers and infants admitted to these units, compared with those accessing generic acute psychiatric wards or crisis resolution teams (CRTs). Our primary hypothesis is that women with an acute psychiatric disorder, in the first year after giving birth, admitted to MBUs are significantly less likely to be readmitted to acute care (an MBU, CRTs or generic acute ward) in the year following discharge than women admitted to generic acute wards or cared for by CRTs.

Methods and analysis Quasi-experimental study of women accessing different types of acute psychiatric services in the first year after childbirth. Analysis of the primary outcome will be compared across the three service types, at 1-year postdischarge. Cost-effectiveness will be compared across the three service types, at 1-month and 1-year postdischarge; explored in terms of quality-adjusted life years. Secondary outcomes include unmet needs, service satisfaction, maternal adjustment, quality of mother–infant interaction. Outcomes will be analysed using propensity scoring to account for systematic differences between MBU and non-MBU participants. Analyses will take place separately within strata, defined by the propensity score, and estimates pooled to produce an average treatment effect with weights to account for cohort attrition.

Ethics and dissemination The study has National Health Service (NHS) Ethics Approval and NHS Trust Research and Development approvals. The study has produced protocols on safeguarding maternal/child welfare. With input from our lived experience group, we have developed a dissemination strategy for academics/policy-makers/public.

  • cohort study
  • perinatal mental disorder
  • propensity scoring
  • cost-effectiveness analysis

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  • Contributors LMH, KMA, AP, SB, IJ, SP, DR, NS and SJo designed the study and are grant holders; KT, RS, MH, KMA and LMH drafted the study protocol manuscript; SJe, ER, LP, AW, SGe and all authors discussed and commented on the study protocol manuscript.

  • Funding This paper summarises independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research (PGfAR) Programme (Grant Reference Number: RP-PG-1210-12002) and the National Institute for Health Research (NIHR) / Wellcome Trust King’s and Manchester Clinical Research Facility. The study team acknowledges the study delivery support given by the national NIHR Clinical Research Networks. This study represents independent research supported by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. LMH is also supported by an NIHR Research Professorship (NIHR-RP-R3-12-011).

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests LMH chaired the NICE CG192 guidelines development group on antenatal and postnatal mental health in 2012-2014. IJ was a member of the NICE CG192 guidelines development group and is a Trustee of the Maternal Mental Health Alliance and Action on Postpartum Psychosis. GS is clinical lead for a psychiatric Mother and Baby Unit.

  • Ethics approval The study has obtained NHS Research Ethics Committee approval from the London-Camberwell St. Giles committee (number: 14/LO/0765).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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