ADEPT: Optimising psychological treatment for Anxiety DisordErs in Pregnancy: a feasibility study for a Trial of time-intensive CBT versus weekly CBT

The aim of this research is to investigate if a shorter format of a well-established psychological therapy for anxiety disorders can be used with pregnant women. It will establish if pregnant women find this format acceptable and useful, and if this way of delivering the treatment can later be tested in a large trial. Cognitive behaviour therapy (CBT) is known to be an effective treatment for anxiety disorders. Many women prefer psychological treatments to medication during pregnancy and so this is often a good fit for women with these disorders. CBT is usually delivered over a period of three months. Recently, good results have been demonstrated with CBT delivered in fewer but longer sessions over two to three weeks for OCD, PTSD, panic disorder and social anxiety. However, this format has not yet been tested with pregnant women. This research will first develop a protocol for the delivery of time-intensive CBT (IN-CBT) for OCD, PTSD, panic disorder and social anxiety disorder. This will be tested with a small number of pregnant women with anxiety disorders and feedback will be sought from participants on outcome questionnaires and assessments for the study. The next part of the research will be a small trial (known as a feasibility study). Women taking part will receive either IN-CBT or standard CBT for their anxiety disorder. This will establish if IN-CBT is acceptable for women, the best way to reach potential participants and if enough women will take part in a trial and will complete postnatal outcome measures. Detailed interviews with women undertaking the treatments will investigate views of both versions of CBT and if the study assessments are acceptable and useful. If found feasible in this study, a larger trial would then examine whether IN-CBT for antenatal anxiety disorders is more effective in reducing negative outcomes for mother and child than standard weekly CBT. Ultimately, if the intensive format of delivery was found to be better in terms of benefits for both mother and child, this research would influence practice regarding treatment of antenatal anxiety disorders across the UK.

DAWN: Depression: an exploratory parallel-group randomised controlled trial of Antenatal guided self-help for WomeN

DAWN is a randomised controlled trial in which there is a 50:50 chance of women receiving Guided Self Help rather than care as usual. Guided Self-Help is a brief treatment shown to be effective in non-pregnant groups: we will modify it for pregnant women, aiming to provide an economical and effective way of providing prompt treatment not involving the risks of medication. For the trial we are looking for women who are: pregnant and aged 16+; currently experiencing depression; not in psychological therapy; not taking antidepressants; recruitment is now closed. To request an electronic copy of the Guided Self-Help workbook, please email admin-swmh@kcl.ac.uk. This study is now complete.

DAWN: study protocol for a randomised controlled trial

An exploratory parallel-group randomised controlled trial of antenatal Guided Self-Help (plus usual care) versus usual care alone for pregnant women with depression: DAWN trial

Depression: an exploratory parallel-group randomised controlled trial of Antenatal guided self-help for WomeN (DAWN): study protocol for a randomised controlled trial

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

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, recently there has been an increased drive to address this and embed preconception care into services. This project is a collaboration between the Section of Women’s Mental Health King’s College London, Tommy’s, Public Health England and NHS England & NHS Improvement to develop a suite of preconception advice resources to support women with SMI of childbearing age and the health professionals working with them. Details on the outputs of the collaboration could be found by accessing the links below. (An evidence review of existing literature and services for pregnancy planning for women with SMI launching on PHE website soon).

An online tool to assist with pregnancy planning for women with SMI

A comprehensive web hub covering all the topics they might need to know about if they are in this position

A guide for health professionals to help deliver preconception care to women with SMI

A short ‘5 tips’ animation for social with key messages for women from the project

eLIXIR: Early Lifecourse data Cross-LInkage in Research; a Multidisciplinary Partnership

The developing embryo, fetus and new-born child are very sensitive to change in the surrounding environment, whether this arises from problems with the mother's health, the placenta not working properly, complications during birth, or as consequence of being born too early. Adversity in these periods of developmental vulnerability can have persistent effects on the long-term health of the child, including physical and mental health disorders. We also know that if a mother has complications in pregnancy, that she may suffer from increased risk of ill-heath in later life, for example cardiovascular disease, diabetes or mental health problems. To reduce the risk of these diseases in the child and in the mother, we need to know more about the processes leading up to them. One approach is to capture the information from hospital and general practice health care records as the child grows up, or as the mother gets older, and through the study of this data and routinely collected blood samples, work out when and why the disorders happen. When we know this, we shall be able to work out how to prevent them. In England routine health records are held in different computer systems and are not easy to assemble. Our partnership, the eLIXIR partnership of doctors, scientists and IT specialists has developed a way to put all this data together and to collect it continuously. We shall start doing this in a large population from a deprived area of South London, where health is poor compared to other areas of England. When we have shown this system works, we plan to extend the study to a much bigger population in London and elsewhere. This new and important research resource will help us explore the 'life course' of some of the most common diseases and help scientists and doctors to work out how we may prevent them.

Find out more about the eLIXIR Project

ESMI MBU: Effectiveness and cost-effectiveness of mother and baby units

ESMI MBU investigates the effectiveness and cost-effectiveness of psychiatric Mother and Baby Units (MBUs) compared with general psychiatric wards or care from intensive Crisis Resolution Teams (CRTs) for acute severe postnatal disorders for women in the year post birth. We will compare the effectiveness of these services in preventing further admissions, addressing health and social care needs and supporting mothers in their relationships with their infants. We will also investigate impacts on partners/significant others’ mental health, worries, finances and ability to cope. We have no language or diagnostic restrictions. We are recruiting women: admitted to MBUs, general wards or CRTs for acute severe postnatal disorders in the first year post-delivery; who are not under these services “prophylactically” (i.e. for close monitoring in high risk cases or for statutory parenting assessments (i.e. not for acute illness); whose baby has not been permanently removed from their care before admission. This study is now complete.

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

ESMI-II (Effectiveness of Services for Mothers with Mental Illness) Research Programme

The ESMI-II (Effectiveness of Services for Mothers with Mental Illness) programme aims to evaluate the effectiveness and cost-effectiveness of Community Perinatal Mental Health Teams (CPMHTs). This project is supported by NIHR Health Services & Delivery Research funding, jointly led by Prof Louise Howard (KCL) and Dr Heather O’Mahen (University of Exeter). Work package 1: This first work package involves the development of a typology matrix of the variations of CPMHTs, including team skill mix and interventions provided from historic and current data. This will inform an NHS data linkage before-and-after analysis (work package 4), to examine how access to CPMHT care and outcomes have changed over time, and sampling of services for work package 3. Work package 2: The aim of this work package is to create a valid and acceptable measure of mother-infant interaction that can be feasibly delivered in busy CPMHTs. We are using two widely used systems and testing the predictive validity of each code against a high quality longitudinal database of mothers and their infants. The aim is to choose the best predictive codes to create a brief measure. Work package 3: The third work package involves a realist evaluation of 10 purposively selected services across England. We will be conducting remote interviews of 100 women accessing CPMHTs, 100 significant sources of support and 50 CPMHT staff. We received ethical approval of an amendment to expand the interview guide to also examine how service delivery has changed during the COVID-19 pandemic and how this has impacted the mental health of participants. We will also gather service level data on number of referrals, sessions attended and routine outcomes to understand which CPMHT configurations work most effectively for whom, in what circumstances, why, how and to what extent. Work package 4: We will be using NHS Digital linked data to examine the impact of the introduction of CPMHTs on access to services, birth outcomes, and relapse of mental illness.

For Baby's Sake

For Baby’s Sake is a new domestic abuse and infant parenting programme for mothers and fathers. It is a trauma-informed, whole-family intervention that works with parents from pregnancy to two years postpartum to break cycles of domestic abuse and improve outcomes for children. The programme is being delivered by the Stefanou Foundation. It launched in 2015 across two pilot sites and this first phase of implementation is being evaluated by the Section of Women’s Mental Health.

Find out more about the For Baby's Sake Project

Implementing a pilot intervention for perinatal mental health and intimate partner violence in rural Ethiopia

World Health Organization (WHO) guidelines recognise that intimate partner (domestic) violence (IPV) adversely affects health, and recommend identification, training and woman-centred support. In Ethiopia, IPV is commonest in pregnancy, making antenatal care an important intervention opportunity. Integrating WHO IPV guidelines within perinatal psychosocial interventions could improve physical and mental health, but evidence from rural Africa is lacking. Roxanne Keynejad's PhD project is funded by King's College London and a King's IoPPN Clinical Investigator Scholarship and supervised by Dr Charlotte Hanlon and Professor Louise Howard. It aims to test the hypothesis that IPV moderates women's responses to psychosocial interventions for mental health problems, and to pilot and evaluate a perinatal psychosocial intervention adapted to integrated WHO IPV guidelines, in rural Ethiopia.

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

LARA-VP is funded by the Medical Research Council and King’s Health Partners and aims to improve the identification and response to domestic violence and abuse (DVA) within mental health services. People with pre-existing mental disorders are at increased risk of experiencing DVA, and there is some evidence to suggest that there may also be an association between psychiatric diagnoses and the perpetration of physical abuse against a partner. Research conducted in this project will inform a future trial of our piloted intervention study (“LARA” – “Linking Abuse and Recovery through Advocacy”) that involved reciprocal training between mental health professionals and DVA specialists, and integrated DVA advisors into community mental health teams to improve the identification and care of DVA among mental health service users. This intervention includes the provision of an educational manual on DVA for mental health professionals; this will be updated to reflect recent research and guidance. Natural Language Processing (NLP) methods will also be exercised on pseudo-anonymised clinical records from the Case Register Interactive System (CRIS) to derive the best possible measure of mental health professionals’ ability to identify DVA victimisation and perpetration.

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

Maternal near misses in perinatal mental illness

In order to identify near miss events among women with perinatal mental illness there is a need for a national framework that includes both physical and psychiatric indicators of clinical complications. A two-phase study is being undertaken to develop and pilot a framework for identifying near miss events in women with perinatal mental illness. Qualitative interviews and focus groups will be conducted with key stakeholders (patients and clinicians) to guide the development of the framework. A mixed methods study of electric health records of women who have had contact with secondary mental health services will then be undertaken to test its feasibility and determine rates of near miss events in a population of women with severe mental illness. A qualitative study of patients’ notes be undertaken to explore the contextual influence on detection and response to maternal near misses and deaths among women with severe perinatal mental illness. In the future, we aim to test the framework at a national level and to develop an implementation toolkit to aid identification and response to clinical deterioration among women with perinatal mental illness. For more information please contact abigail.easter@kcl.ac.uk

Mental health and relationship difficulties: the experiences of mental health service users who have perpetrated domestic violence and abuse

Reviews have shown that people with mental health problems are at increased risk of experiencing and perpetrating DVA compared to the general population. Research has also found that mental health professionals face challenges in identifying and managing the risk of DVA perpetration among their service users. This study aims to investigate the experiences of mental health service users who are, or have been, perpetrators of DVA. Individual semi-structured interviews will be conducted with mental health service users to explore their experiences of relationship difficulties, including DVA perpetration, and of talking about these problems with mental health professionals. Participants will be recruited with help from staff at mental health teams and through a computer system that allows researchers to contact service users who have agreed to be contacted for the purposes of research. People will be eligible to take part if they are receiving care and treatment from the South London and Maudsley NHS Foundation Trust, aged 18 or above, of any gender, who are able to communicate in English, and have experienced difficulties in their relationships with intimate partners or adult family members, including perpetration of DVA. The interviews will be audio recorded, transcribed and analysed by the researcher using qualitative methods. Findings may be used to develop interventions to improve mental health services' responses to DVA perpetration.

MiMOS: The Effectiveness of Sexual Assault Referral Centres with regard to Mental Health and Substance Use: A National Mixed Method Study

The MiMOS study is a mixed-methods study funded by the National Institute of Health Research (NIHR). It aims to examine how sexual assault referral centres (SARCs) identify mental health and substance use problems (both pre-existing and emerging problems) and how SARCs work with other agencies to ensure that service users get the right help, at the right time, in the right place. MiMOS comprises several studies, as follows: Literature Review: A literature review of all the currently available published work on how SARCs assess and address mental health and substance use problems among attendees. National Survey: A national survey of SARCs which asks questions about mental health assessment, support, and working with other agencies. Prevalence Study: A survey of people attending six different SARCs to identify the types of mental health and substance use problems that they are experiencing, as well as asking about what help they currently receive, whether they get the care they need at the right time, how satisfied they feel about their treatment, and how often and what services they have used. Case Studies: Case studies of six SARCs including in-depth interviews and focus groups with staff and people who use the services and their significant others. The focus will be to understand how they work with mental health and substance use needs, how they work across other services, workforce training needs, and any gaps and blocks people may experience in getting their needs met. Comparison of SARCs and other NHS mental health services: Comparison of an anonymised clinical database from a SARC service (which has its own psychological therapy service) with data from a mental health trust to see whether there are differences in mental health outcomes for people who have experienced sexual assault. We will use our findings to create a range of resources to help improve the mental health and substance use outcomes for people who have experienced sexual assault. These will be created for a range of people including survivors, SARC commissioners and staff, and wider health and social care staff. We will use press, social media and face to face events to promote our findings. Throughout all this work we will be working in partnership with people with lived experience to develop reports designed for users, carers and staff who work in relevant services so that services can be improved or adapted depending on what we find.

Find out more about the MiMOS Study

PRIMH: Promoting Recovery in Mental Health

PRIMH (Promoting Recovery in Mental Health) is an evaluation of an intervention developed and delivered by the non-governmental organisation AVA (Against Violence and Abuse) to improve service responses to domestic and sexual violence at two mental health trusts: Camden and Islington NHS Foundation Trust and Sussex Partnership NHS Foundation Trust.

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

PROTECT is a mixed methods research programme on the health needs of trafficked people in England. It aimed to develop evidence to inform the NHS response to human trafficking. It provides evidence about the healthcare needs and experiences of trafficked adults and children; documents NHS experience, knowledge and gaps about trafficked people’s healthcare needs; and will provide recommendations on the content and format of training materials to support NHS staff to identify, refer and care for trafficked people.

Read the PROECT Final Report for the Department of Health Policy Research Programme (PDF 2MB)

Find out more about the PROTECT Project

PROTECT-II: Improving outcomes for survivors of human trafficking.

This project aims to evaluate the effectiveness of community-based advocacy interventions in improving mental health and wellbeing among people who have been identified as trafficked and have elected to receive NGO support. This aim will be attained through: Study 1: a survey of the service managers of NGOs providing advocacy interventions to survivors of trafficking in England. Data will be used to populate a brief categorical taxonomy, which describes the structural and service characteristics of organisations which provide advocacy interventions to survivors of trafficking. Study 2: a cohort study of survivors of trafficking who have elected to receive advocacy support from a participating NGO. Selection of NGOs will be based on study 1 findings. Assessments will be conducted before the start of advocacy support (T1), post-intervention (T2) and follow-up at 3-months (T3). The primary outcome is reduced psychological distress (measured using the CORE-OM) at 3-month follow-up (T3) compared with baseline (T1). Study 3: a mixed methods realist evaluation comprising three phases: (1) developing a graphical representation of the theory of change for advocacy support interventions; (2) testing the validity of the assumptions of the programme theory using empirical data; (3) refining the initial programme theory. A triangulation protocol will be developed and implemented to integrate findings from across the three studies.

Risk of Domestic Violence Perpetration in Mental Health Service Users

Mental illness is a known risk factor for behaving violently towards others. However, there is currently limited evidence exploring the link between mental illness and violence in a domestic setting (DV), for example towards partners or family members. This project will assess the risk, prevalence, and risk factors involved in DV perpetration among individuals with mental illness. A systematic review of the existing literature will be conducted, and if the sufficient high quality studies are available a meta-analysis will also be performed, estimating the odds and risk of DV perpetration in individuals with mental illness. This will provide an update to Oram et al’s (2014) systematic review and meta-analysis. An individual participant data meta-analysis will also be conducted on data collected from national surveys and datasets collected directly from researchers. This will allow further exploration into associations, confounders and moderators. A particularly detailed analysis will be conducted using the 2014 England and Wales Adult Psychiatric Co-morbidity Survey (APMS), as questions on DV perpetration were added to the 2014 questionnaire. This survey provides data on the prevalence of psychiatric disorders in the UK. It uses a stratified, multi-stage probability sample of UK households of individuals aged between 16 and 74. This provides a unique and novel opportunity to allow analysis into the relationship between mental illness and different types of DV perpetration. Associations between DV and mental illness variables will be calculated, and logistic regressions will enable the influence of multiple factors to be examined. As well as addressing gaps in the literature, this research will aid in identifying risk factors that can guide identification of at-risk victims and perpetrators, and guide the development of appropriate DV interventions. This PhD is being carried out by Katherine Saunders, under the supervision of Professor Louise Howard, Professor in Women’s Mental Health, Consultant Perinatal Psychiatrist and Head of the Section of Women’s Mental Health, Professor Sabine Landau, Professor of Biostatistics, and Dr Sian Oram, Lecturer in Women’s Mental Health. The project is funded by a NIHR Maudsley BRC PhD Studentship. For more information on this project, contact katherine.saunders@kcl.ac.uk.

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Self-Harm in the Perinatal Period

Suicide is a significant cause of maternal deaths and frequently preceded by self-harm during the perinatal period (pregnancy and the year post-birth). However, little is known about the prevalence, risk factors and consequences of perinatal self-harm (PSH) itself. We therefore aim to investigate, in (a) the general population, and (b) secondary mental-healthcare service-users, the prevalence and risk factors for PSH and estimate the extent to which PSH is associated with later suicide. We will carry out a systematic review and two cohort studies. The first cohort study is of women with hospital deliveries >24 weeks gestation (1996–2011) and ICD coded PSH contacts with outpatient, inpatient and A&E departments of medical/psychiatric hospitals, using national registry data from the National Centre for Register-Based Research in Denmark. The second Cohort study uses secondary mental-healthcare data of service users with hospital deliveries >24 weeks gestation (2007–2014), and ICD-coded/free-text PSH events, using clinical informatics (using comprehensive de-identified mental-healthcare records of South London and Maudsley NHS Foundation Trust service-users) For more information on this project, contact karyn.k.ayre@kcl.ac.uk

The effects of the asylum process on mental health in Iranians and Afghan asylum seekers

Sohail Jannesari's PhD project investigates the impact of the UK asylum process on mental health, with a particular focus on Iranian and Afghan asylum seekers. The project uses participatory action research, and the initial part of the project looks at how researchers can work with asylum seekers in a non-exploitative, more equitable manner.

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

Research has shown that depression in pregnancy can be associated with problems in mother-infant interaction. Such difficulties may lead to adverse emotional and behavioural outcomes in children. However, other than depression, there has been little work on mental disorders such as anxiety disorders or personality dysfunction during pregnancy. This has been highlighted as a research area needing attention and perinatal mental health services are currently being prioritised by NHS England. The aim of this project is to examine mother-infant interactions in women with anxiety disorders and personality dysfunction in pregnancy compared with a cohort of women with no mental disorder. The study population will be recruited from a representative cohort of pregnant women taking part in the 3 month postnatal follow of the WENDY study. We plan to measure a 5-minute mother-infant free-play session; thus we will be able to investigate whether anxiety and personality are associated with mother-infant interaction difficulties, adjusting for other potential risk factors already collected through pregnancy. If we find that anxiety disorders and/or personality difficulties are associated with mother-infant interaction problems at 3 months postnatal, antenatal identification of these problems could enable earlier interventions to be put in place during pregnancy by health and social care. This could support more positive mother-infant interaction and improve long-term child outcomes. Existing mother-child interventions suitable for the antenatal period could be adapted for these risk groups if we provide evidence for the nature of interaction difficulties.

Read the Nuffield Foundation Main Public Report [PDF,465kB]

Understanding the pregnancy, birth, and early motherhood experiences of survivors of adulthood sexual violence and abuse

The study forms part of Siofra Peeren’s PhD research. It seeks to understand experiences of pregnancy, birth, early motherhood, and maternity care among women who have experienced sexual violence or abuse since the age of 16. The study is including women who have had a miscarriage or termination. The research will investigate what aspects of care and support are helpful and unhelpful for women with these experiences, with the aim of improving maternity care. Siofra would like to speak to around 15 women who have experienced sexual violence and abuse after the age of 16 about their experience of pregnancy, birth, early motherhood, and maternity care. There is no time limit on how long ago the experience of sexual violence or abuse was, or how long ago an experience of pregnancy, birth, early motherhood, or maternity care was.

Please click here (PDF 161 KB) for further information about what participation involves

A flyer for the study can be found here

Find out more about the project

VAMHN: Violence, Abuse and Mental Health Network

Violence, Abuse and Mental Health Network (VAMHN) aims to reduce the prevalence of mental health problems among children, adults, and the elderly, by bringing together experts with different ways of thinking about violence, abuse and mental health - some with personal experience of these issues, others with expertise from the work that they do, and survivor researchers with both. We hope to understand, prevent and reduce the impact of violence and abuse on mental health. The activities of this network will address these challenges through: (i) Working with people who have personal experience of violence, abuse, and mental health problems to learn from different perspectives, and generate fresh ideas and research questions, with a focus on the commonest types of violence- domestic and sexual violence and abuse; (ii) Answering research questions through small grant competitions, workshops, conferences, and other events; some of these will lead to larger grant applications; (iii) Sharing measurement approaches, including how to ethically and safely research this area, which will help data collection and analysis by health services, the criminal justice system, family courts, social care, charities, and researchers. We will also develop an online resource providing information about datasets that can be used in research in the future.

Find out more about the VAMHN Project

WENDY: Well-being in pregnancy in an inner city maternity service

WENDY investigates the best ways of identifying disorders and treating depression in pregnant women seeing midwives. We will compare how well the two questions currently used by midwives to assess depression during antenatal booking appointment really do identify depression by comparing them with more detailed assessment methods. We will measure the frequency in pregnancy of depression and other disorders such as anxiety and eating disorders. This study is now complete.

Accuracy of the Whooley questions and the Edinburgh Postnatal Depression Scale in identifying depression and other mental disorders in early pregnancy

A qualitative study of women's views on the acceptability of being asked about mental health problems at antenatal booking appointments