The Stafford Interview

The interview can be conducted in the community or in the clinical setting. It is designed for use worldwide, with mothers of many cultural backgrounds. The interviewer can omit probes that are culturally inappropriate.

The word ‘mother’ refers to the subject or patient throughout. The whole interview can be conducted up to 1 year after childbirth or during pregnancy and the postpartum period in separate prepartum and postpartum sections. It can be conducted in a single setting but (because of its length) more conveniently in two or three sessions.

Unless an audio- or videotape record is kept, the interviewer is instructed to record in narrative the evidence for each rating, so that other raters, not present at the interview, can judge the nature and severity of symptoms or items present; so far as possible, the interviewer should write down the subject’s own words, and there is sufficient space in the schedule for this purpose. The verbatim record allows other ratings to be made, not in the schedule. It allows pairs of raters to rate independently, measure their reliability and, after discussion, agree consensus ratings (Brockington et al. 1992); we believe that this is the correct way to establish reliability, not by borrowing ‘reliability’ from co-trained experts, working under ideal conditions and knowing that their accuracy is under scrutiny (Reid 1970; Taplin and Reid 1973). The verbatim record also allows ratings to be compared between subjects (cross-sectional analysis); in a large sample of mothers, all those with a particular rating can be compared, and adjustments made.

Since the interview makes no attempt comprehensively to explore psychopathology, those who need to focus on one disorder (such as depression) can add additional questions or self-rating scales. Recommendations for add-on scales or interview questions are made at appropriate points.

Compulsory probes are printed in bold type, additional questions in regular type and instructions to interviewers in italics. ‘If’ clauses are provided to shorten the interview.

Coding instructions are given on the page opposite the questions. A rating of ‘8’ indicates that the rating is not applicable to this mother, and ‘9’ that the rating cannot be made, because of inadequate information.

During the interview the mother will, to some extent, follow her own lines of thought, and it will be necessary to move from one section to another. To facilitate this movement, sections are printed on paper of different colours, and recommendations are offered for a simple method of binding.

The prepartum section is in four parts—introduction (white paper), the social, psychological and obstetric background to pregnancy (green paper), the unborn child (yellow paper) and prepartum emotional changes and psychiatric disorders (blue paper).

The interview begins with general enquiries about the circumstances of referral or selection, the most important events in the mother’s life, her psychiatric and obstetric history and the people who will be important to this baby.

The section headed ‘social, psychological and obstetric background’ has the following subsections, with exploratory questions on

Attention is directed to the unborn child—any social and medical concerns, and (if culturally appropriate) interaction with the foetus.

The section on prepartum psychiatric disorders begins with a question about positive mental health and an overview of psychiatric symptoms. The mother’s worries and concerns are rated under nine categories, for example, the fear of parturition. General probes, without a full inventory of symptoms, are used to explore anxiety, obsessive/compulsive symptoms, irritability, depression and other psychiatric disorders, including psychosis. Here, the interview can be augmented by additional schedules or self-rating scales. General ratings are made on onset and duration, treatment and role impairment.

The postpartum section is in five parts—parturition (orange paper), the social, psychological and medical background to the puerperium (green paper), postpartum psychiatric disorders (blue paper), the mother infant relationship (yellow paper) and observations, summary, diagnosis and treatment plan (white paper).

The exploration of parturition covers the obstetric events, mental state during and after labour and condition of the baby at its birth.

The social, psychological and medical background to the puerperium begins with probes about a range of postpartum events such as the mother’s reaction to the newborn, breastfeeding and sleep deprivation. The relationship with the father of the baby and family members is dealt with in the same way as during pregnancy, with the addition of questions that relate to their attitudes to the baby. Cultural issues such as postpartum and pregnancy rituals, and concern about the gender of the infant, have been included.

As in pregnancy, the exploration of postpartum psychiatric disorders begins with a question about positive mental health and an overview of psychiatric symptoms. The mother’s worries and concerns are rated with a different set of ten categories, for example, the pathological fear of cot death. General probes are used to explore anxiety, obsessive/compulsive symptoms, irritability, depression and other psychiatric disorders. Two additional anxiety ratings are concerned with phobic avoidance of the baby and intrusive behaviour. In depressed mothers, there are additional questions with her maternal role and the involvement of the infant in suicidal ideas. A page is devoted to postpartum psychosis, with a caveat that most of the evidence will come from observations about the mother’s behaviour. There are general ratings of postpartum psychiatric disorder, similar to those in pregnancy.

The section on the mother-infant relationship has three pages of probes and ratings; it can be used as a self-standing instrument, together with a self-rating scale such as the PBQ (Brockington et al. 2006c). These pages deal with

The interview concludes with questions about satisfaction with psychiatric treatment and the desire for further children. The interviewer records impressions, including abnormal behaviour. Consideration is given to any particular risks to this mother or the child. On the final page, there is a summary of the main features, and a diagnosis and treatment plan.

Table 1 details the probes and ratings. In total, there are 130 probes and 185 ratings—about ten more than in the 5th edition of the Birmingham Interview.

The interview can be used for training, clinical practice and research. Its value in training has been exploited in Bangalore and Barcelona, where all trainees conduct interviews. Even a single interview can foster awareness of the wide scope of mother-infant psychiatry and demonstrate the tactful exploration of all areas.

In clinical practice, a 2-h interview is well tolerated by mothers, who appreciate the thorough exploration of their problems. Mothers are able to talk openly, freely in a relaxed way about sensitive issues like foetal abuse, child maltreatment, filicidal ideas, intimate partner violence and suicide. It is often a relief to speak in detail about their suffering, and find understanding of areas, which, in oppressive cultures, arouse obloquy, shame and guilt. The interviews are often positive and therapeutic in themselves. They allow complex clinical presentations to be broken down to their specific components, each with an optimal treatment. The interview provides an in-depth account of the transition to parenthood and pays attention to all areas of the childbearing process, including some, such as the planning of and acceptance of pregnancy, parturition, and the mother-infant relationship, which are rarely explored by mental health professionals.

With its self-standing prepartum and postpartum stages, it is ideal for the cohort studies that are so badly needed to determine the predictors of postpartum disorders and provide a platform for prevention.

There are plans to hold a conference in Stafford in May 2018 to review research conducted with the Stafford Interview and give preliminary thoughts to improvements.