Pregnancy and parenthood projects

ADEPT: Optimising psychological treatment for anxiety disorders in pregnancy (feasibility trial)

Lead: Dr Fiona Challacombe. Outline: The research showed pregnant women with anxiety disorders found time-intensive CBT acceptable and useful.  Intensive CBT may reduce anxiety quickly for this group and should be tested in a confirmatory trial examining longer-term outcomes.

Developing pre-conception advice resources to support women with serious mental illness and the health professionals working with them

Lead: Prof Louise Howard. Outline: Women with serious mental illness (SMI) may experience specific social, physical, and mental health needs which may impact on their pregnancies. This population may also encounter conflicting or stigmatising information around their desire for motherhood. We collaborated with Tommy’s, Public Health England and NHS England & NHS Improvement to develop the following resources: 1. An online tool to assist with pregnancy planning for women with SMI. 2. An online information hub. 3. A guide for health professionals to help deliver preconception care to women with SMI. 4. Animation sharing key messages for women.

ESMI: Effectiveness of services for mother with mental illness (research programme)

Lead: Prof Louise Howard. Funder: NIHR HSDR. Outline: The programme consisted of four main research programmes: 1. The wellbeing in pregnancy study (WENDY), which found the two-item Whooley questions are a useful tool for case identification and reported that around one in four participants had a mental illness in early pregnancy. The study also found that stigma and fears around losing custody of children were significant barriers to disclosure of mental health problems. 2. An exploratory parallel-group randomised controlled trial (DAWN), which showed guided self-help could be successfully delivered to pregnant women with depression. The workbook is free to download. 3. A qualitative study of stakeholders’ views and experiences of perinatal mental health care and services (STACEY). 4. The effectiveness and cost-effectiveness of perinatal mental health services mother and baby unit study (ESMI-MBU), which found no short-term clinical or cost-effectiveness advantage to MBUs versus non-MBU care but found that MBU care was preferred by women. A summary of the entire research programme is available here.

ESMI-II: Effectiveness of services for mothers with mental illness (research programme)

Leads: Prof Louise Howard and Prof Heather O’Mahen (University of Exeter). Funder: NIHR. Outline: The programme aimed to evaluate the effectiveness and cost-effectiveness of community perinatal mental health teams.

Gestational diabetes and maternal and infant mental health (PhD project)

Lead: Dr Claire Wilson. Supervisors: Prof Louise Howard, Prof Khalida Ismail, Prof Emily Simonoff.  Outline: The project synthesised evidence to show that while most preconception mental disorders were not associated with a significant risk of gestational diabetes (GDM), women with psychotic disorders were uniquely vulnerable to GDM. Early detection and management of GDM could improve physical and mental health outcomes for these women and their children. The project also used data from the Born in Bradford cohort to demonstrate that women with common mental disorders were not at an increased risk of type 2 diabetes following gestational diabetes.  

Impact of anxiety disorders and personality dysfunction in pregnancy on mother-infant interactions

Lead: Prof Louise Howard. Funder: Nuffield Foundation. Outline: This cohort study found that anxiety disorders may lead to women having distorted perceptions of their relationship with their baby, even though their interactions are of similar quality to those of women without anxiety disorders. Conversely, mothers with high levels of personality difficulties are not more likely to perceive they have a problem with bonding but independently observed interactions are more likely to be impaired; this appears to be partly related to comorbid depression. 

Obstetric near misses among women with severe mental illness

Leads: Dr Abigail Easter, Prof Louise Howard. Outline: This historical cohort study used electronic medical records data to demonstrate a higher rate of obstetric near misses for women with severe mental illness versus women with no history of mental healthcare prior to delivery, including acute renal failure, cardiac arrest, failure, or infarction, and obstetric embolism.  

Self-harm in the perinatal period (PhD project)

Lead: Dr Karyn Ayres. Supervisors: Prof Louise Howard, Dr Rina Dutta. Outline: This project used Danish registry data to identify the prevalence and risk factors for self-harm during pregnancy, reporting that perinatal self-harm was more common in women with pre-existing psychiatric history.  The project also developed a natural language processing application to identify perinatal self-harm in electronic medical records, estimating the prevalence among secondary mental service users in London.

Violence and abuse projects

For Baby’s Sake: an evaluation of a domestic abuse and infant parenting programme for mothers and fathers

Lead: Dr Kylee Trevillion. Outline: This evaluation found that the For Baby’s Sake programme prototype had been successful in receiving appropriate referrals and engaging families who met intervention criteria. Families who remained engaged reported a positive experience of the programme. Some potential change mechanisms and outcomes were indicated but further evidence from larger samples is needed to confirm this. Evidence of cost-savings generated were uncertain, as is often the case in the early stages of newly developed service, with further research needed.

Implementing a pilot intervention for perinatal mental health and intimate partner violence (IPV) in rural Ethiopia (PhD project)

Lead: Dr Roxanne Keynejad. Supervisors: Prof Louise Howard, Prof Charlotte Hanlon. Outline: This project conducted a randomised controlled feasibility study of a brief problem-solving therapy (PST) intervention adapted for pregnant women experiencing IPV in rural Ethiopia. Recruitment was feasible and the intervention and trial were acceptable. Recommended adjustments for a future, fully powered, randomised controlled trial were identified, including more training on the types of IPV and how to discuss them, automating randomisation and conducting post-intervention outcome assessments immediately and three months postpartum. 

LARA (Linking Abuse and Recovery through Advocacy)

Lead: Prof Louise Howard. Funder: NIHR RfPB. Outline: This project piloted a domestic violence intervention for community mental health teams, comprising domestic violence training and referral pathways into domestic violence advocacy. Clinician knowledge improved significantly, and service users reported significant reductions in violence and unmet needs. Low identification rates in control teams suggested future trials using service user outcomes may not be feasible.

LARA-VP: Linking Abuse and Recovery through Advocacy for Victims and Perpetrators

Lead: Prof Louise Howard. Funder: MRC and King’s Health Partners. Outline: This project developed an educational manual for mental health professionals on identifying and responding to domestic abuse victimisation and perpetration and undertook work to develop a natural language processing application to identify recorded domestic abuse in electronic medical records.

Mental health and domestic abuse perpetration: the response of mental health professionals (MDRes Project)

Lead: Dr Marilia Calcia. Supervisors: Dr Sian Oram, Prof Gail Gilchrist, Prof Heidi Lempp. Outline: This project identified barriers and facilitators to identification of domestic abuse perpetration in healthcare settings, found that mental health professionals typically become aware of patients’ perpetration of domestic abuse through information given by families and partner agencies, described patterns of mental health service use among perpetrators of domestic homicide, and demonstrated how mental health service responses to these patients are affected by a lack of knowledge about domestic abuse and by gaps in communication with other agencies and with patients’ families.

MiMOS: the effectiveness of sexual assault referral centres with regards to mental health and substance use: a national mixed-methods study

KCL Lead: Dr Kylee Trevillion. Funder: NIHR

Promoting Recovery in Mental Health (PRIMH)

Leads: Dr Sian Oram, Dr Kylee Trevillion. Funder: Department of Health. Outline: This project evaluated an intervention developed and delivered by the charity AVA (Against Violence and Abuse) to develop whole mental health trust responses to domestic abuse. The evaluation identified significant increases in staff knowledge about domestic and sexual violence, how to identify potential new cases of domestic and sexual violence, and confidence in using referral pathways.

Risk of intimate partner violence perpetration in mental health service users (PhD project)

Lead: Dr Katherine Saunders. Supervisors: Dr Sian Oram, Prof Sabine Landau. Outline: This project conducted a systematic review and individual participant data meta-mediation analysis of general population surveys from high-income settings which measured mental disorder and past year IPV perpetration, reporting that depression was associated with increased risk of IPV perpetration among both men and women. Among women, much of the effect was mediated by IPV victimisation.

Understanding the pregnancy, birth, and early motherhood experiences of survivors of adulthood sexual violence and abuse (PhD project)

Lead: Dr Siofra Peeren. Supervisors: Dr Sian Oram, Dr Elsa Montgomery, Dr Angela Sweeney. Outline: This project synthesised evidence on the healthcare experiences of adult survivors of sexual violence, and conducted qualitative interviews with adult survivors about their experiences of pregnancy, birth, and maternity care, as well as with maternity care professionals. Findings showed that pregnancy, birth and motherhood presented survivors with opportunities for embodied and relational healing, but care could also mirror abuse. Providers needed system-level support in order to be able to deliver care that met survivors’ needs. 

Migration and modern slavery projects

The effects of the asylum process on mental health in Iranians and Afghan asylum seekers (PhD project)

Lead: Dr Sohail Jannesari. Supervisors: Dr Sian Oram, Prof Stephani Hatch. Outline: This research provided a framework for considering post-migration influences on asylum seeker mental health and a review of available evidence, and analysed how the mental health of Iranian and Afghan asylum seekers was impacted by the process of claiming asylum. It also considered whether and how participatory action research could reduce the risk of exploitation for migrants participating in research.

Modern Slavery Core Outcome Set

Lead: Dr Sian Oram. Funder: Modern Slavery Policy Evidence Centre & AHRC. Outline: The MSCOS presents a set of core outcomes that should, as a minimum standard, form the basis for interventions for adult survivor recovery and reintegration, as well as providing a framework for policy and service design and evaluation. The seven core outcomes are: secure and suitable housing; long-term, consistent support; finding purpose in life and self-actualisation; safety from any trafficker or other abuser; access to medical treatment; access to education; and trauma-informed services.

PROTECT: Provider Responses, Treatment, and Care for Trafficked People

Leads: Prof Louise Howard and Dr Sian Oram. Funder: Department of Health Policy Research Programme. Outline: PROTECT demonstrated the high levels of violence and psychological distress experienced by trafficked people and reported that a minority of trafficked people were able to access health services while being exploited. The programme also demonstrated that NHS professionals lacked the knowledge and confidence to respond to trafficking but wanted to receive training to do so. Findings informed the development of NHS training and awareness raising materials. The full programme report is available here.

PROTECT-II: Improving outcomes for survivors of human trafficking

Lead: Dr Sian Oram. Funder: NIHR. Outline: The project aimed to evaluate the effectiveness of community-based advocacy interventions in improving mental health and wellbeing among trafficked people in contact with NGO services in England. The evaluation was unable to proceed due to the COVID-19 pandemic and a national embargo on the use of Modern Slavery Victim Care Contract data for the purposes of the research. More information can be found here.