Excerpt

This guideline has been developed to advise on the clinical management of and service provision for antenatal and postnatal mental health. The guideline recommendations have been developed after careful consideration of the best available evidence by a multidisciplinary team of healthcare professionals, women who have experienced mental health problems in the antenatal or postnatal period and guideline methodologists. It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high-quality care for women with antenatal and postnatal mental health problems while also emphasising the importance of the experience of care for women and their families and carers.

Contents

• GUIDELINE DEVELOPMENT GROUP MEMBERSHIP
• ACKNOWLEDGEMENTS
• 1. EXECUTIVE SUMMARY
  • KEY PRIORITIES FOR IMPLEMENTATION
  • 1.1 PRINCIPLES OF CARE FOR ALL WOMEN WITH MENTAL DISORDERS DURING PREGNANCY AND THE POSTNATAL PERIOD
  • 1.2 PREDICTION, DETECTION AND INITIAL MANAGEMENT OF MENTAL DISORDERS
  • 1.3 PREVENTION OF MENTAL DISORDERS
  • 1.4 CARE OF WOMEN WITH A MENTAL DISORDER DURING PREGNANCY AND THE POSTNATAL PERIOD
  • 1.5 THE ORGANISATION OF SERVICES
  • 1.6 RESEARCH RECOMMENDATIONS
• 2. INTRODUCTION
  • 2.1 NATIONAL GUIDELINES
  • 2.2 THE NATIONAL ANTENATAL AND POSTNATAL MENTAL HEALTH GUIDELINE
  • 2.3 THE STRUCTURE OF THIS GUIDELINE
• 3. METHODS USED TO DEVELOP THIS GUIDELINE
  • 3.1 OVERVIEW
  • 3.2 THE SCOPE
  • 3.3 THE GUIDELINE DEVELOPMENT GROUP
  • 3.4 CLINICAL QUESTIONS
  • 3.5 SYSTEMATIC CLINICAL LITERATURE REVIEW
  • 3.6 HEALTH ECONOMICS REVIEW STRATEGIES
  • 3.7 STAKEHOLDER CONTRIBUTIONS
  • 3.8 TESTIMONIES FROM WOMEN WITH MENTAL DISORDERS IN THE ANTENATAL AND POSTNATAL PERIOD
  • 3.9 VALIDATION OF THIS GUIDELINE
• 4. ANTENATAL AND POSTNATAL MENTAL HEALTH: POPULATION, DISORDERS AND SERVICES
  • 4.1 SCOPE OF THE GUIDELINE
  • 4.2 MENTAL DISORDERS DURING PREGNANCY AND THE POSTNATAL PERIOD
  • 4.3 INCIDENCE AND PREVALENCE OF PERINATAL DISORDERS
  • 4.4 AETIOLOGY OF ANTENATAL AND POSTNATAL MENTAL DISORDERS
  • 4.5 CONSEQUENCES OF MENTAL DISORDER DURING PREGNANCY AND THE POSTNATAL PERIOD
  • 4.6 TREATMENT IN THE NHS
  • 4.7 THE ECONOMIC BURDEN OF MENTAL DISORDERS IN THE ANTENATAL AND POSTNATAL PERIOD
  • 4.8 EXPLAINING RISK TO WOMEN: HELPING PATIENTS TO MAKE DECISIONS ABOUT TREATMENT
• 5. THE PREDICTION AND DETECTION OF MENTAL ILLNESS DURING PREGNANCY AND THE POSTNATAL PERIOD
  • 5.1 INTRODUCTION
  • 5.2 PREDICTION – RISK FACTORS FOR THE ONSET OF MENTAL DISORDER DURING PREGNANCY AND THE POSTNATAL PERIOD
  • 5.3 METHODS FOR PREDICTING MENTAL DISORDER DURING PREGNANCY AND THE POSTNATAL PERIOD
  • 5.4 METHODS FOR DETECTING MENTAL DISORDER DURING PREGNANCY AND THE POSTNATAL PERIOD
  • 5.5 REFERRAL PATHWAYS
• 6. PSYCHOLOGICAL AND PSYCHOSOCIAL INTERVENTIONS
  • 6.1 INTRODUCTION
  • 6.2 ISSUES IN RESEARCH INTO PSYCHOLOGICAL TREATMENTS
  • 6.3 DEFINITIONS OF PSYCHOLOGICAL AND PSYCHOSOCIAL INTERVENTIONS
  • 6.4 OVERVIEW OF CLINICAL REVIEW
  • 6.5 REVIEW OF TREATMENTS AIMED AT PREVENTING THE DEVELOPMENT OF MENTAL DISORDERS DURING THE ANTENATAL AND POSTNATAL PERIODS FOR WOMEN WITH EXISTING RISK FACTORS
  • 6.6 HEALTH ECONOMICS EVIDENCE ON PSYCHOLOGICAL AND PSYCHOSOCIAL INTERVENTIONS AIMED AT PREVENTING THE DEVELOPMENT OF DEPRESSION DURING THE ANTENATAL AND POSTNATAL PERIODS IN WOMEN WITH IDENTIFIED PSYCHOSOCIAL RISK FACTORS AND/OR SUBTHRESHOLD DEPRESSIVE SYMPTOMS
  • 6.7 CLINICAL PRACTICE AND RESEARCH RECOMMENDATIONS
  • 6.8 REVIEW OF TREATMENTS AIMED AT PREVENTING THE DEVELOPMENT OF MENTAL DISORDERS DURING THE ANTENATAL AND POSTNATAL PERIODS FOR WOMEN WITH NO IDENTIFIED RISK FACTORS
  • 6.9 REVIEW OF NON-PHARMACOLOGICAL TREATMENTS FOR DEPRESSION IN THE POSTNATAL PERIOD
  • 6.10 HEALTH ECONOMICS EVIDENCE ON PSYCHOSOCIAL INTERVENTIONS FOR TREATMENT OF DEPRESSION IN THE POSTNATAL PERIOD
  • 6.11 FOCUSING ON THE INFANT: INTERVENING IN THE MOTHER-INFANT INTERACTION OR MEASURING CHILD-RELATED OUTCOMES
  • 6.12 BROADER PSYCHOSOCIAL INTERVENTIONS AND OTHER TREATMENTS
  • 6.13 PSYCHOLOGICAL AND PSYCHOSOCIAL TREATMENTS FOR WOMEN WITH DISORDERS OTHER THAN DEPRESSION
• 7. THE PHARMACOLOGICAL TREATMENT OF MENTAL DISORDERS IN PREGNANT AND BREASTFEEDING WOMEN
  • 7.1 INTRODUCTION
  • 7.2 RISK ASSOCIATED WITH SPECIFIC DRUGS IN PREGNANCY AND THE POSTNATAL PERIOD
  • 7.3 THE PHARMACOLOGICAL TREATMENT OF MENTAL DISORDER DURING PREGNANCY AND THE POSTNATAL PERIOD – REVIEW OF AVAILABLE STUDIES
  • 7.4 PRESCRIBING PSYCHOTROPIC MEDICATION TO PREGNANT AND BREASTFEEDING WOMEN
  • 7.5 THE PHARMACOLOGICAL TREATMENT OF SPECIFIC MENTAL DISORDERS DURING PREGNANCY AND THE POSTNATAL PERIOD – ADAPTATION OF EXISTING GUIDELINES
• 8. THE ORGANISATION OF PERINATAL MENTAL HEALTH SERVICES
  • 8.1 INTRODUCTION
  • 8.2 THE CURRENT STRUCTURE OF SERVICES
  • 8.3 ESTIMATING THE NEED FOR SERVICES
  • 8.4 THE FUNCTIONS OF SERVICES FOR WOMEN, THEIR PARTNERS AND CARERS IN THE ANTENATAL AND POSTNATAL PERIOD
  • 8.5 THE STRUCTURE OF PERINATAL MENTAL HEALTH SERVICES
  • 8.6 IMPLEMENTING THE MANAGED NETWORK MODEL: SERVICE RECOMMENDATIONS
  • 8.7 RESEARCH RECOMMENDATION
• 9. APPENDICES
  • APPENDIX 1 SCOPE FOR THE DEVELOPMENT OF A CLINICAL GUIDELINE ON THE MANAGEMENT AND SERVICE GUIDANCE OF ANTENATAL AND POSTNATAL MENTAL HEALTH
  • APPENDIX 1A REFERRAL FROM THE DEPARTMENT OF HEALTH AND WELSH ASSEMBLY GOVERNMENT
  • APPENDIX 2 ADVISORS TO THE GUIDELINE DEVELOPMENT GROUP
  • APPENDIX 3 STAKEHOLDERS WHO RESPONDED TO EARLY REQUESTS FOR EVIDENCE
  • APPENDIX 4 STAKEHOLDERS AND EXPERTS WHO SUBMITTED COMMENTS IN RESPONSE TO THE CONSULTATION DRAFT OF THE GUIDELINE
  • APPENDIX 5 CLINICAL QUESTIONS
  • APPENDIX 6 SEARCH STRATEGIES FOR THE IDENTIFICATION OF STUDIES
  • APPENDIX 7 CLINICAL STUDY ELIGIBILITY CHECKLIST
  • APPENDIX 8 RCT METHODOLOGICAL QUALITY CHECKLIST
  • APPENDIX 9 CLINICAL STUDY DATA EXTRACTION FORMS
  • APPENDIX 10 RCT DATA EXTRACTION FORM
  • APPENDIX 11 FORMULAE FOR CALCULATING STANDARD DEVIATIONS
  • APPENDIX 12 QUALITY CHECKLIST FOR FULL ECONOMICS EVALUATIONS
  • APPENDIX 13 DATA EXTRACTION FORM FOR ECONOMICS STUDIES
  • APPENDIX 14 HEALTH ECONOMICS EVIDENCE ON MOTHER AND BABY UNITS
  • APPENDIX 15 SURVEY OF ANTENATAL AND POSTNATAL MENTAL HEALTH PRIMARY CARE SERVICES IN ENGLAND AND WALES – QUESTIONNAIRE
  • APPENDIX 16 RESULTS OF SURVEY OF ANTENATAL AND POSTNATAL MENTAL HEALTH PRIMARY CARE SERVICES IN ENGLAND AND WALES
  • APPENDIX 17 DECLARATIONS OF INTERESTS BY GDG MEMBERS
  • APPENDIX 18 CHARACTERISTICS OF REVIEWED STUDIES
  • APPENDIX 19 EVIDENCE PROFILES
  • APPENDIX 20 CLINICAL EVIDENCE FOREST PLOTS
• 10. REFERENCES
• 11. ABBREVIATIONS

The views presented in this book do not necessarily reflect those of the British Psychological Society, and the publishers are not responsible for any error of omission or fact. The British Psychological Society is a registered charity (no. 229642).