What Predicts Better Infant Outcomes for those with Mothers with Serious Mental Illness?

Student thesis: Doctoral ThesisDoctor of Philosophy


Background: Serious mental illness (SMI) during the perinatal period can have a significant impact on a mother’s general health, child development and their ability to form a healthy bond with their infant. However, despite adversities such as SMI or having a history of childhood trauma, a significant number of mothers are able to form a healthy mother-infant relationship. The existing literature has identified a number of factors which can influence directly or indirectly the mother-infant relationship. Despite this, little is known about the impact SMI and/or a history of childhood trauma in mothers has on a mother’s perception of the mother-infant bond using the postpartum bonding questionnaire, the observed mother- infant relationship using the dyadic synchrony from the CARE-Index and an infant’s developmental outcomes using the Bayley Scales of Infant Development. A fuller understanding of these factors could help target treatments and help facilitate resilience.

Method: This was a secondary analysis of the ESMI (Effectiveness of perinatal mental health services) dataset. Mothers with SMI were recruited from psychiatric mother and baby units (MBU), general acute inpatient wards and crisis resolution teams (CRT) at the point of, or within one month of, discharge. Maternal mental health severity was assessed concurrently using information from both the case records obtained at admission and at the one-month post-discharge interview. Self-reported Maternal Childhood Trauma was collected during an interview at one-month post-discharge. Maternal perceptions of bonding, dyadic synchrony in the observed mother-infant interactions using the CARE-Index and infant developmental outcomes were assessed at around one month following discharge.

Results: Our sample population had overall low dyadic synchrony scores on the CARE-Index (mean 4.51 with a standard deviation of 1.84), with 12.95% categorised as having ‘adequate’ or ‘sensitive’ dyadic synchrony. The normal distrubution ranges from 0-14 with 0 being dangerously insensitive, 7 being normally sensitive and 14 being outstandingly sensitive. 93.54%, 79.12% and 84.09% of infants had scores in the ‘normal or above’ categories for cognitive composite, language composite and motor composite scores respectively. Neither maternal childhood trauma nor severity of maternal mental illness were associated with dyadic synchrony on the CARE-Index or any of the cognitive, language or motor composites scores on the Bayley Scales of Infant Development subscales, even after adjusting for possible confounders. After adjusting for confounders (maternal age, education level, presence of a personality disorder and social support) maternal childhood trauma was no longer associated with self-reported perceived bonding with their infant, (Coef = -0.05, 95% CI -0.13-0.03, p=0.207). The severity of maternal mental illness at the start of the admission was associated with higher self-reported perceived bonding difficulties with their infant one-month following discharge, even after adjusting for social support and type of care the mother received (Coef = 0.46, 95% CI 0.22-0.70, p < 0.001).

Conclusion: In mothers with SMI, severity of maternal mental illness appears to contribute to perceived bonding difficulties, but not observed mother-infant interactions or child developmental outcomes. This may be the result of mothers experiencing negative cognitions and/or negatively misinterpreting information, features which are common to many mental health disorders. Further research is warranted, but interventions such as CBT that encompass effective treatment for severe symptoms and maternal perceptions of the bond may be beneficial for both mother and infant. Additionally, further exploring the positive pathways for recovery and/or resilience will be imperative for developing appropriate strategies and interventions in perinatal mental health services.
Date of Award1 Oct 2022
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorFiona Challacombe (Supervisor) & Susan Pawlby (Supervisor)

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