On this page

You can find out more about research studies supported by APP. These are being updated, so check back regularly:

MBU vs General Unit care, 2010

Why this topic

There has been little research to compare the different types of care for PP (for example admission to Mother and Baby Unit or admission without baby to a mixed-sex general adult ward).

What we did

We conducted a survey of APP members in 2010 - receiving back 218 completed questionnaires.

What we found out

We found that women who had been admitted to Mother and Baby Units were much more satisfied with the care they received. They felt safer, more informed about their illness, more confident with their baby on discharge, and had quicker recovery times than women admitted to other types of unit.

Obstetric factors associated with postpartum psychosis, 2006

Why this topic

Some women with PP experience illness after some pregnancies, but remain well after others. We don't know why.

What we did

We compared deliveries that were affected and unaffected by PP.

What we found out

We found that being a first-time mother and experiencing a medical complication during delivery were significant risk factors for PP.

What's next?

The next step is to design studies that can explore what biological and psychological mechanisms could account for these findings. View the research report here.

Early symptoms of postpartum psychosis, 2008

Why this topic

Understanding more about the timing and nature of very early symptoms of PP can help us understand the potential triggers involved in the illness and help us train health professionals to recognise symptoms earlier.

What we did

We examined the earliest symptoms reported by women in their episode of PP.

What we found out

Before this study it was believed that symptoms began on day 3-4 following delivery after a ‘latent period’. Most women in our sample felt that looking back, they could notice some mild symptoms beginning on day one, and 10% felt that they began to feel more ‘elated or strong and important' over the last trimester of pregnancy.

The most commonly recalled early symptoms were feeling ‘excited, elated or high’, feeling ‘more active and energetic, ‘talking more or feeling chatty’, ‘not being able to, or needing to sleep’ and other symptoms such as ‘feeling anxious or fearful’ or ‘confused, unreal and in a dream world.’

Health professionals rarely ask about these kinds of symptoms, even in women at very high risk of PP episodes. Indeed, they are likely to consider that such women are coping ‘ultra well’ with pregnancy and the demands of new motherhood.

What's next?

The team has published a paper describing the early symptoms, and will use the information in our awareness-raising and health professional training. View the research report here.

Partner support study, 2011

Why this topic

In previous research, women have told us that there needs to be more support for their partners during their episode of postpartum psychosis (PP).

What we did

We conducted two studies to investigate the experience of partners during an episode of PP, and the type of support they would find acceptable. Working with Dr Jess Heron, medical student, Sarah Sandell, sent out a postal survey to the partners of APP members. Medical student, Alice Blackwell, conducted twenty in-depth telephone interviews with women's partners.

What we found out

81 partners returned questionnaires. We found that only 30% of partners were satisfied with the level of information and support provided to them by the NHS. Requested services included web-based information for partners, dedicated time with health professionals, and - in the long term - counselling and conversations with other partners who had been through similar situations. In-depth interviews showed that partners described PP as the most traumatic event of their lives. They received little support or information and some suffered long term symptoms, like flashbacks when considering having another baby. Men agreed that although they felt that more support was needed, there are many practical and emotional barriers to accepting support. Online, practical information written by other men would be valued.

What's next?

We are developing web advice for partners, and will trial some of the support suggestions made in APP and in the Mother and Baby Unit in Birmingham.

Risk of postpartum and non-postpartum recurrence of illness, 2005

What we did

We conducted a study of the risk of further illness in women who have suffered PP. This is the largest study to date into risk of recurrence.

What we found out

We found that after experiencing an episode of PP, women had a significant risk (around 57%) of becoming ill following a subsequent delivery but we also found a high risk of experiencing an episode of illness unrelated to childbirth. Some women are advised to avoid future pregnancies if they wish to avoid further episodes of illness. This advice might not be appropriate. Women should be informed about risk of relapse following future pregnancy alongside lifetime risk, and be informed about strategies to manage long term mental wellbeing and relapse.

What's next?

Work is underway to try to understand the factors involved in why some women have further episodes of illness while others just have one postpartum episode. This work will be important in advising people on their individual risks and on ways of reducing the risk of recurrence. View the research report here.

Changes in self identity following an episode of PP

What we did

We supported Rachel O’Brien, a trainee Clinical Psychologist for Surrey and Borders NHS Trust, to conduct a study into changes in role and self identify following an episode of PP. Rachel interviewed seven women and has analysed the data using a qualitative methodology called Interpretative Phenomenological Analysis.

What we found out

She found that women feel isolated, both because their experience is not shared by those around them, and because of the relative lack of knowledge of PP in health professionals, family and friends. Many women describe a sense of survival and achievement after recovering from such an experience.

Postnatal hypomania (‘the highs’), 2009

What we did

In this study we examined how common symptoms of hypomania (and other mild forms of postnatal mood change) are in a general population sample of women from a large maternity hospital. We examined risk factors for postpartum high mood and later postnatal depression.

What we found out

We found that there was a spectrum of severity of ‘bipolar-like’ symptoms in the normal population following childbirth and that these symptoms were much more common in the first week postpartum than during pregnancy or later in the postpartum. The more extreme these high mood symptoms were, the greater the chance the women would suffer a postnatal depression.

As in PP, primiparity (first delivery) was a risk factor, as was a previous history of minor mood disturbance and a family history of bipolarity or depression. View the research report here.

What's next?

Further studies of postnatal hypomania may be able to give insights into risk factors and mechanisms involved in postnatal triggering of more severe mood disorder episodes.

Living with postpartum psychosis, 2003

What we did

We conducted in-depth interviews with 10 women from APP about the experience of postpartum psychosis.

What we found out

A number of key themes arose out of the interviews.

All of the women interviewed viewed childbirth as the precipitant of their illness, predominantly viewing it as biological or hormonal, with traumatic births or stressful pregnancies as further precipitants. Women viewed PP as different from other forms of mental illness, requiring separate and specialised forms of treatment.

Many described a lack of experience in health professionals compounding their fear and sense of isolation. Lack of control over treatment and their lives was discussed by many women, who felt anger that they, and their families, were sidelined from decision-making processes.

Many women talked of the lack of support in place for husbands – who either became responsible for looking after their partner and baby or were separated from them.

A sense of loss and, for some, guilt arose as a key theme at being unable to fulfil the role of a new mother. Women described losing the privilege to feel ‘normal emotions’ without worrying, or others worrying, that this was a sign of illness.

Those interviewed described that relationships with friends and family are often strained following an episode. They felt there was a correlation between friends’ reactions and a previous awareness of psychiatric illness.

For some the use of humour was useful, while in other families the illness was not spoken about and women felt denied the opportunity to discuss worries.

For most, it was described as a ‘life changing experience’, forcing a struggle with self identity, but most felt that they ‘regained their old sense of self’ and gained greater confidence, self awareness and a sense of empathy with others. View the research report here.

Publications and lay summaries

In this section, we share research articles produced by APP or those working with APP. Where possible, we include links to lay summaries for some of the research. A lay summary is a simple summary for people who are not researchers.

Effectiveness and cost-effectiveness of psychiatric mother and baby units: quasi-experimental study. Jessica Heron, Giles Berrisford and Annette Bauer
Letter to the Editor. The British Journal of Psychiatry, Volume 222, Issue 4, April 2023, pp. 176 – 177, DOI: https://doi.org/10.1192/bjp.2022.196

The impact of postpartum psychosis on partners. Holford N et al. BMC Pregnancy Childbirth. 2018 Oct 23;18(1):414. doi: 10.1186/s12884-018-2055-z.

Roberts, L; Heron, J; Jones, L; Jones, I; Dolman, C; Lane, D. 2018. Qualitative exploration of the effect of a television soap opera storyline on women with experience of postpartum psychosis. Bjpsych Open 4(02), pp. 75-82.

Berrisford, G; Lambert, A; Heron J. Understanding Postpartum Psychosis. Community practitioner: the journal of the Community Practitioners' & Health Visitors' Association. Sep 2015

Di Florio A, Jones L, Forty L, Gordon-Smith K, Blackmore ER, Heron J, Craddock N, Jones I. Mood disorders and parity - a clue to the aetiology of the postpartum trigger. J Affect Disord. 2014 Jan;152-154:334-9

Di Florio A, Forty L, Gordon-Smith K, Heron J, Jones L, Craddock N, Jones I. Perinatal episodes across the mood disorder spectrum. JAMA Psychiatry. 2013 Feb;70(2):168-75.

Information and support needs during recovery from postpartum psychosis. J Heron; N Gilbert; C Dolman; S Shah; I Beare; S Dearden; N Muckelroy; I Jones; and J Ives. Arch Womens Ment health. 2012 June; 15(3): 155-85.

Genetic analysis implicates vascular endothelial growth factor receptor pathways in postpartum psychosis. Green EK, Hamshere M, Robertson E, Heron J, Jones L, Forty L, Gordon-Smith K, Holmans P, Craddock N, Jones I. Submitted.

Risk of puerperal and non-puerperal recurrence of illness following bipolar affective puerperal (post-partum) psychosis. Robertson E, Jones I, Haque S, Holder R, Craddock N, Br J Psychiatry, Volume 186 (March 2005) pp.258-259 Lay Summary

The characteristics of women who increase and decrease in depression in the postpartum period: the importance of considering bipolarity. Maudgil, J. Heron, M.S. Haque, F. Oyebode, I. Jones. Submitted.

Interventions for the prevention and treatment of postpartum psychosis: a systematic review. Doucet S, Jones I, Letourneau N, Dennis CL, Blackmore ER, Arch Women Ment Hlth , Volume 14 , 2 (April 2011) pp.89-98

The management of bipolar disorder in the perinatal period and risk factors for postpartum relapse. K. Doyle, J. Heron, G. Berrisford, L Jones, J Whitmore, G. Wainscott, and F. Oyebode. European Psychiatry 2011 Lay Summary

Differentiation and clinical implications of postpartum depression and postpartum psychosis. Doucet S, Dennis CL, Letourneau N, Blackmore ER. Journal of obstetric, gynaecologic, and neonatal nursing: JOGNN / NAACOG. 2009; 38(3):269-79.

Cognitive style, personality and vulnerability to postnatal depression. Jones L, Scott J, Cooper C, Forty L, Smith KG, Sham P, Farmer A, McGuffin P, Craddock N, Jones I, Br J Psychiatry, Volume 196, 3 (March 2010) pp.200-205

The classification of perinatal mood disorders--suggestions for DSMV and ICD11. Jones I, Cantwell R, Nosology Working Group, Royal College of Psychiatrists, Perinatal Section None, Arch Womens Ment Health, Volume 13, 1 (February 2010) pp.33-36

Postnatal Hypomania: Future perspectives. Heron J & Oyebode F. Neuropsychiatry, February 2011, Vol. 1, No. 1, Pages 55-60.

Management of postnatal depression in primary care: a window of opportunity. Tait L, Heron J. British Journal of General Practice. 2010 Nov;60(580):801-2.

Parenting outcomes following co-joined Mother and Baby Unit admissions over a 10 year period. Whitmore J, Heron J, Wainscott G. International Journal of Social Psychiatry. April 2010.

Jones I, Heron J, Robertson Blackmore E. Book chapter: Puerperal Psychosis. In Oxford Textbook of Women’s Mental Health, Dora Kohen Ed, Oxford University Press, 2010.

Measuring hypomania in the postpartum: a comparison of the Highs Scale and the Altman Mania Rating Scale. S. Smith, J. Heron, S. Haque, P. Clarke, F. Oyebode, I. Jones. Arch Womens Ment Health. May 2009 Lay Summary

A longitudinal study of hypomania and depression in pregnancy and the postpartum. Heron J, Haque S, Oyebode F, Craddock N, Jones I. Bipolar Disorders, Apr 2009; Vol. 11, No. 4., pp. 410-417 Lay Summary

Early postpartum symptoms in puerperal psychosis. Heron J, McGuiness M, Blackmore Robertson E, Craddock N, Jones I. British Journal of Obstetrics and Gynaecology. 2008, Feb, 115 (3): 348-353 Lay Summary

The incidence of hospitalisation for postpartum psychotic and bipolar episodes.Jones I, Heron J, Robertson Blackmore E, Craddock N. Archives of General Psychiatry. March 2008; 65, 3.

No 'latent period' in the onset of bipolar affective puerperal psychosis. Heron J, Robertson Blackmore E, McGuinness M, Craddock N, Jones I. Arch Womens Ment Health. 2007 Apr;10(2):79-81 Lay Summary

Bipolar Affective Puerperal Psychosis – genome-wide significant evidence for linkage to chromosome 16. Jones I, Hamshere M, Nangle JM, Bennett P, Green E, Heron J, Segurado R, Lambert D, Holmans P, Corvin A, Owen M, Jones L, Gill M, Craddock N. Am J Psychiatry. 2007 Jul;164(7):1099-104 Lay Summary

Mood and anxiety disorders in women. Heron J. British Journal of Psychiatry. 2007 191: 271-272.

Postnatal hypomania in the clinical and non-clinical population: prevalence, implications and risk factors. Heron J. PhD Thesis. University of Birmingham. 2006.

Postnatal euphoria: are 'the highs' an indicator of bipolarity? Heron J, Craddock N, Jones I. Bipolar Disord. 2005 Apr;7(2):103-10.

Management of postnatal depression. Musters C, McDonald E, Jones I, Brit Med J, Volume 337 , 7666 (August 2008)

Eileithyla's mischief: The organic psychoses of pregnancy, parturition and the puerperium. Jones I, Brit J Psychiat , Volume 193 , 1 (July 2008) pp.84-84

Is the perimenopause a time of increased risk of recurrence in women with a history of bipolar affective postpartum psychosis? A case series. Blackmore ER, Craddock N, Walters J, Jones I, Arch Women Ment Hlth , Volume 11 , 1 (February 2008) pp.75-78 Lay Summary

Clinical presentation of postnatal and non-postnatal depressive episodes. Cooper C, Jones L, Dunn E, Forty L, Haque S, Oyebode F, Craddock N, Jones I, Psychol Med , Volume 37 , 9 (September 2007) pp.1273-1280

Psychiatric disorders and pregnancy. Jones I, Brit J Psychiat, Volume 190 (February 2007) pp.184-185

Familiarity of postpartum depression in unipolar disorder: results of a family study. Forty L, Jones L, Macgregor S, Caesar S, Cooper C, Hough A, Dean L, Dave S, Farmer A, McGuffin P, Brewster S, Craddock N, Jones I, Am J Psychiatry, Volume 163, 9 (September 2006) pp.1549-1553

Associations among postpartum depression, eating disorders, and perfectionism in a population-based sample of adult women. Mazzeo SE, Landt MCTSO, Jones I, Mitchell K, Kendler KS, Neale MC, Aggen SH, Bulik CM, Int J Eat Disorder, Volume 39, 3 (April 2006)

Obstetric variables associated with bipolar affective puerperal psychosis. Blackmore ER, Jones I, Doshi M, Haque S, Holder R, Brockington I, Craddock N, Br J Psychiatry, Volume 188 (January 2006) pp.32-36pp.202-211 Lay Summary

Recurrence of post-partum and non-post-partum psychosis. Jones I, Robertson-Blackmore E, Craddock N, Brit J Psychiat, Volume 187 (September 2005) pp.289-289

Bipolar disorder and childbirth: the importance of recognising risk. Jones I, Craddock N, Br J Psychiatry, Volume 186 (June 2005) pp.453-454 Lay Summary

Risk of puerperal and non-puerperal recurrence of illness following bipolar affective puerperal (post-partum) psychosis. Robertson E, Jones I, Haque S, Holder R, Craddock N, Br J Psychiatry , Volume 186 (March 2005) pp.258-259

Variation in the coding sequence and flanking splice junctions of the estrogen receptor alpha (ERalpha) gene does not play an important role in genetic susceptibility to bipolar disorder or bipolar affective puerperal psychosis. Middle F, Jones I, Robertson E, Morey J, Lendon C, Craddock N, Am J Med Genet B Neuropsychiatr Genet , Volume 118B , 1 (April 2003) pp.72-75

Do puerperal psychotic episodes identify a more familial subtype of bipolar disorder? Results of a family history study. Jones I, Craddock N, Psychiatr Genet, Volume 12, 3 (September 2002) pp.177-180

Is the estrogen regulated expression of the serotonin transporter gene modulated by the VNTR polymorphism: A possible mechanism for increased risk for bipolar affective puerperal psychosis? Coyle NE, Lambert JC, Middle F, Robertson E, Jones I, Craddock N, Lendon C, Am J Med Genet, Volume 105, 7 (October 2001) pp.619-619

Familiarity of the puerperal trigger in bipolar disorder: results of a family study. Jones I, Craddock N, Am J Psychiatry, Volume 158, 6 (June 2001) pp.913-917

Molecular genetic approaches to puerperal psychosis. Jones I, Lendon C, Coyle N, Robertson E, Brockington I, Craddock N, Prog Brain Res, Volume 133 (2001) pp.321-331

Molecular genetic studies of bipolar disorder and puerperal psychosis at two polymorphisms in the estrogen receptor alpha gene (ESR 1). Jones I, Middle F, McCandless F, Coyle N, Robertson E, Brockington I, Lendon C, Craddock N, Am J Med Genet, Volume 96, 6 (December 2000) pp.850-853

Variation at the serotonin transporter gene influences susceptibility to bipolar affective puerperal psychosis. Coyle N, Jones I, Robertson E, Lendon C, Craddock N, Lancet, Volume 356, 9240 (October 2000) pp.1490-1491

Puerperal psychosis: Evidence for familiality of the puerperal trigger. Jones I, Coyle N, Roberstson E, Middle F, Mcandless F, Lendon C, Brockington I, Craddock N, Mol Psychiatr, Volume 4 (September 1999) pp.S26-S26

Molecular genetic approaches to puerperal psychosis. Jones IR, McCandless F, Morey J, Benjamin J, Brockington I, Craddock N, Am J Med Genet, Volume 81, 6 (November 1998) pp.544-544

Motherhood and Mental Health. Brockington I F (1996). Oxford, Oxford University Press.

Eileithyia’s Mischief: the Organic Psychoses of Pregnancy, Parturition and the Puerperium. Brockington I F (2006). Bredenbury, Eyry Press

Menstrual Psychosis and the Catamenial Process. Brockington I F and 15 others (2006) The Birmingham Interview for Maternal Mental Health, Bredenbury, Eyry Press. Brockington I F (2008) Bredenbury, Eyry Press

A guidance on the protection and promotion of mental health in children of persons with severe mental disorders. Brockington I, Chandra P, Dubowitz H, Jones D, Moussa S, Nakku J, Quadros Ferre I (2011). W P. World Psychiatry 10: 93-102.