Louise M. Howard
- Published in print:
- 2014
- Published Online:
- November 2020
- ISBN:
- 9780199676859
- eISBN:
- 9780191918346
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/oso/9780199676859.003.0005
- Subject:
- Clinical Medicine and Allied Health, Psychiatry
In 1996, when I was working with Channi as a psychiatry trainee, we were both struck by how often we were seeing women with psychotic disorders in the outpatient clinic who were seeking advice on ...
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In 1996, when I was working with Channi as a psychiatry trainee, we were both struck by how often we were seeing women with psychotic disorders in the outpatient clinic who were seeking advice on whether or not they should try to conceive and have a family. Although there was a small amount of literature on the parenting difficulties some of these women would experience, there was a very limited evidence base on their risk of adverse obstetric outcomes. We felt we needed to know more about the outcome of pregnancy for women with pre-existing psychotic disorders, and this led to my PhD, funded by a Wellcome Trust Clinical Training Fellowship, with Channi as my primary supervisor. Channi became too ill to continue working on this project, but our work together led to my perinatal mental health research programme, for which I will always be in his debt. This chapter describes this early PhD research, and the research it has led on to, over the subsequent years. We initially thought about collecting detailed clinical outcome data from the women we were seeing locally, who came from a large catchment area. However, to obtain a large enough sample size would take many years and it became clear we needed large epidemiological datasets in order to optimize statistical power and minimize bias. We therefore started to look for such data, with the first dataset available coming from colleagues at the Institute of Psychiatry—the PriSM psychosis study (Thornicroft et al. 1998). The PRiSM psychosis study research team conducted the complete ascertainment of all prevalent cases of psychosis in the two study catchment areas in the index year (1991–1992) providing us with a representative population of mothers with psychotic disorders. We found that 63% of women with psychotic disorders (n = 155) were mothers, and that these women were more likely to be older and live in unsupported accommodation than women who had not had children, although they had similar levels of disability and health and social care needs (Howard et al. 2001).
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In 1996, when I was working with Channi as a psychiatry trainee, we were both struck by how often we were seeing women with psychotic disorders in the outpatient clinic who were seeking advice on whether or not they should try to conceive and have a family. Although there was a small amount of literature on the parenting difficulties some of these women would experience, there was a very limited evidence base on their risk of adverse obstetric outcomes. We felt we needed to know more about the outcome of pregnancy for women with pre-existing psychotic disorders, and this led to my PhD, funded by a Wellcome Trust Clinical Training Fellowship, with Channi as my primary supervisor. Channi became too ill to continue working on this project, but our work together led to my perinatal mental health research programme, for which I will always be in his debt. This chapter describes this early PhD research, and the research it has led on to, over the subsequent years. We initially thought about collecting detailed clinical outcome data from the women we were seeing locally, who came from a large catchment area. However, to obtain a large enough sample size would take many years and it became clear we needed large epidemiological datasets in order to optimize statistical power and minimize bias. We therefore started to look for such data, with the first dataset available coming from colleagues at the Institute of Psychiatry—the PriSM psychosis study (Thornicroft et al. 1998). The PRiSM psychosis study research team conducted the complete ascertainment of all prevalent cases of psychosis in the two study catchment areas in the index year (1991–1992) providing us with a representative population of mothers with psychotic disorders. We found that 63% of women with psychotic disorders (n = 155) were mothers, and that these women were more likely to be older and live in unsupported accommodation than women who had not had children, although they had similar levels of disability and health and social care needs (Howard et al. 2001).
