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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

Research output: Contribution to journalArticle

Kylee Trevillion, Rebekah Shallcross, Elizabeth Ryan, Margaret Heslin, Andrew Pickles, Sarah Byford, Ian Jones, Sonia Johnson, Susan Pawlby, Nicky Stanley, Diana Rose, Gertrude Seneviratne, Angelika Wieck, Stacey Jennings, Laura Potts, Kathryn M. Abel, Louise M. Howard

Original languageEnglish
Article numbere025906
Pages (from-to)1-13
JournalBMJ Open
Issue number3
Early online date23 Mar 2019
Accepted/In press13 Feb 2019
E-pub ahead of print23 Mar 2019
Published23 Mar 2019


King's Authors


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.

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