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Development of a Clinical Rating Scale to Assess Mother-Infant Interaction in a Psychiatric Mother and Baby Unit

  • R. Kumar (a1) and A. E. Hipwell (a2)
Abstract
Background

Psychiatrists are sometimes asked to express an opinion about the competence and motivation of a mentally ill mother to be a consistent, adequate and safe parent of her recently born infant, There are no reliable methods for assessing mother–infant interaction and relationship in a psychiatric context.

Method

The Bethlem Mother–infant Interaction Scale (BMIS) was developed by the staff of a specialised psychiatric mother and baby unit. Of the seven subscales, four measured different aspects of the mother's contribution to the dialogue with her baby, one measured her capacity to organise and maintain routine care, one attempted to rate the perception by staff of risk to the child, and the remaining subscale rated the baby's contribution to their interaction. In normal clinical practice the ratings were made consensually by nurses and they encompassed observations that had been made by them during the previous week.

Results

Despite the simple and global nature of the ratings of the BMIS, moderate to high coefficients of inter-rater reliability were obtained for weekly ratings by nurses as well as for intra-rater reliability of ratings of videotaped interactions between mothers and their infants. Ratings of mothers and babies in day-to-day activity in the unit that were based on one hour's observation only were much less reliable. The internal consistency of the BMIS was high and comparisons with other methods used in non-clinical settings showed good criterion-related validity.

Conclusions

Using the BMIS facilitated attempts to reliably assess disturbances of mother–infant interaction and the scale was acceptable and clinically useful. The nurses' ratings of their perceptions of ‘risk’ to the infant, which are in some ways the most important, were the least reliable. Repeated weekly ratings gave a valuable impression of change or lack of it over time. The predictive validity of the scale has yet to be determined.

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Copyright
Corresponding author
Professor R. Kumar, Institute of Psychiatry, University of London, De Crespigny Park, London SE5 8AF
References
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Ainsworth M. D. S., Bell S. M. V. & Stayton D. J. (1971) Individual differences in the strange situation behaviour of one-year-olds. In The Origins of Human Social Relations (ed. Schaffer H. R.), pp. 1757. London: Academic Press.
Ainsworth M. D. S., Blehar M. C., Waters E., et al (1978) Patterns of Attachment. Hillsdale, NJ: Erlbaum.
Appleby L. & Dickens C. (1993) Mothering skills of women with mental illness. British Medical Journal, 306, 348349.
Bartko J. J. (1966) Intraclass correlation coefficient as a measure of reliability. Psychological Reports, 19, 311.
Bayley N. (1969) The Bayley Scales of Infant Development. New York: The Psychological Corporation.
Bell S. M. & Ainsworth M. D. S. (1972) Infant crying and maternal responsiveness. Child Development, 43, 11711190.
Buist A. E., Dennerstein L. & Burrows G. D. (1990) Review of a mother-and-baby unit in a psychiatric hospital. Australian and New Zealand Journal of Psychiatry, 24, 103108.
Dunn G. (1989) Design and Analysis of Reliability Studies: the Statistical Evaluation of Measurement Errors. London: Edward Arnold.
Dunn G. (1992) Design and analysis of reliability studies. Statistical Methods in Medical Research, 1, 123157.
Endicott J. & Spitzer R. L. (1978) A Diagnostic Interview: The Schedule for Affective Disorders and Schizophrenia. Archives of General Psychiatry, 35, 837844.
Fleiss J. L. (1986) The Design and Analysis of Clinical Experiments. New York: John Wiley.
Kumar R. (1992) Mentally ill mothers and their babies: what are the benefits and risks of joint hospital admission? In Practical Problems in Clinical Psychiatry (eds Hawton K. & Cowen P.), pp. 184197. Oxford: Oxford University Press.
Kumar R., Meltzer E. S., Hepplewhite R., et al (1986) Admitting mentally ill mothers and their babies into psychiatric hospitals. Bulletin of the Royal College of Psychiatrists, 10, 169172.
Kumar R., & Hipwell A. (1994) Implications for the infant of maternal puerperal psychiatric disorders. In Child and Adolescent Psychiatry: Modern Approaches (eds Rutter M., Taylor E. & Hersov L.), pp. 759775. Oxford: Blackwell.
Kumar R., & Hipwell A. & Lawson C. (1994) Prevention of adverse effects of perinatal maternal mental illness on the developing child. In Perinatal Psychiatry: Use and Misuse of the Edinburgh Postnatal Depression Scale (eds Cox J. & Holden J.), pp. 4353. London: Gaskell.
Kumar R., Marks M., Platz C. et al (1995) Clinical survey of a psychiatric Mother and Baby Unit: characteristics of 100 consecutive admissions. Journal of Affective Disorders, 33, 1122.
Margison F. R. & Brockington I. F. (1982) Psychiatric Mother and Baby Units. In Motherhood and Mental Illness 2: Causes and Consequences (eds Kumar R. & Brockington I. F.), pp. 223238. London: Wright.
Meltzer E. S. & Kumar R. (1985). Puerperal mental illness, clinical features and classification: a study of 142 Mother-and-Baby Admissions. British Journal of Psychiatry, 147, 647654.
Spearman C. (1910) Correlation calculated from faulty data. British Journal of Psychology, 3, 271295.
Spitzer R. L., Endicott J. & Robins E. (1978) Research Diagnostic Criteria: rationale and reliability. Archives of General Psychiatry, 36, 773782.
Stewart D. (1989) Psychiatric admission of mentally ill mothers with their infants. Canadian Journal of Psychiatry, 34, 3437.
Thiels C. & Kumar R. (1987) Severe puerperal mental illness and disturbances of maternal behaviour. Journal of Psychosomatic Obstetrics and Gynaecology, 7, 2738.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Development of a Clinical Rating Scale to Assess Mother-Infant Interaction in a Psychiatric Mother and Baby Unit

  • R. Kumar (a1) and A. E. Hipwell (a2)
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