Prevalence of anxiety, depression, and stress among parents of neonates admitted to neonatal intensive care unit: a systematic review and meta-analysis

Psychometric Testing of a Scale to Measure Family Resilience Among Parents of Preterm Infants in the NICU

We evaluated the psychometric properties of the French-Canadian Communication, Organization, and Intrafamilial Beliefs in Neonatology (COCINL) NICU family resilience scale. Participants included 88 parents of preterm infants hospitalized for more than 14 days. We administered the COCINL scale and validated questionnaires of psychological distress and of self-reported perception of family resilience. Psychometric testing included internal consistency, interrater reliability among couples, construct, divergent, and exploratory criterion validation. We found high internal consistency for each subscale and the total scale. Interrater reliability among 11 couples demonstrated moderate agreement. Strong correlations between subscales supported the internal structure, however not by exploratory factor analysis. Divergent validation was supported by moderate correlations with psychological distress scores. Exploratory sensitivity and specificity analysis indicated that the COCINL scale aligns with participants' perceptions of family resilience. We found the psychometric properties of the COCINL scale to be adequate for measuring NICU family resilience for research purposes. It provides an assessment of family resilience during the NICU hospitalization that can be used to guide nursing interventions to promote parents' mental health in a family-centered care approach.

Parenting in the Neonatal Intensive Care Unit: A Qualitative Study

BACKGROUND

This qualitative study is aimed at describing parental feelings, their readiness during discharge, and their needs while their infant is in the neonatal intensive care unit.

METHODS

The study was conducted with the parents of infants being monitored in a neonatal intensive care unit. A total of 30 in-depth interviews were conducted with 15 parents. This qualitative study was carried out using the Gadamerian-based research method. After parents were informed about the study, written and verbal consent was obtained from them.

RESULTS

The content analysis of the interview data resulted in six themes: 'sense of trust and cocoon effect, anxiety and conflicting emotions, parent-infant bonding and breastfeeding, fear of providing care, readiness/unreadiness and support needs and recommendations'.

CONCLUSION

Parents often feel anxious and fearful about harming their vulnerable infants, with added stress surrounding their ability to provide care and the discharge process.

Postpartum Depression Screening Practices in the Neonatal Intensive Care Unit: Opportunities for Improvement

PURPOSE

The purpose of this scoping review is to provide an overview of postpartum depression (PPD) screening practices for mothers with infants in the neonatal intensive care unit (NICU), identify gaps in PPD screening, and provide potential solutions for improved screening.

BACKGROUND

The American Academy of Pediatrics (AAP) recommends routine screening for PPD at the first, second, 4th, and 6th months of well-child visits. However, mothers of premature or critically ill infants in the NICU often miss this screening. NICU mothers and parents are at high risk of developing PPD due to the many stressors and traumas experienced during the NICU stay. Missed screening for PPD and delayed diagnosis and treatment lead to poor long-term parental mental health and a defragmented family system.

METHODS

Using the PRISMA model, the authors identified 30 articles that support the need for PPD screenings in the NICU, for all at-risk families. Barriers to implementing PPD screening in the NICU were identified and discussed.

FINDINGS

Several gaps were revealed regarding PPD screening in the NICU, such as cultural barriers, diverse populations, and a need for staff education regarding PPD identification, treatment, and referral. Furthermore, encouraging mothers and non-birthing partners to engage in transparent communication was also identified to improve care.

CONCLUSION

It is crucial for the NICU team to actively involve the mother, father, or non-birthing partners in the process of education, training, and assessment. By doing so, they can empower families with the knowledge and skills necessary to support their infants, aiding in confidence and inclusion and decreasing the risk for PPD during this critical time.

Trajectory of parental health-related quality of life after neonatal hospitalization - a prospective cohort study

BACKGROUND

Health-related quality of life is an important measure of patient-reported outcomes. There is limited evidence on how parental health-related quality of life develops after neonatal hospitalization.

OBJECTIVE

To evaluate parents' health-related quality of life (HRQL) during the year following their infant's treatment in the neonatal intensive care unit (NICU).

METHODS

This prospective cohort study, conducted at a German university hospital between 2020 - 2023, examined HRQL among parents of infants hospitalized in the NICU for ≥ 14 days and parents of infants discharged from the maternity ward according to PedsQL™ Family Impact Module. Multiple linear regression analysis was performed to identify associations between cohort affiliation and differences in parental HRQL. Key secondary outcome was parenting sense of competence (PSOC).

RESULTS

Participants included 131 parents of NICU infants and 122 unexposed parents. HRQL increased over time for NICU mothers (58.7 at 14 days, 70.8 at 6 months, 77.0 at 12 months after birth) and NICU fathers (69.8 at 14 days, 73.9 at 6 months, 75.7 at 12 months). NICU treatment was significantly associated with lower HRQL at 14 days (mothers: -20.26 points; P < .001; fathers: -9.40 points; P = .04), but not at 6 or 12 months after birth. At 12 months postpartum, NICU mothers showed higher PSOC compared to unexposed mothers (mean difference -4.85; P = 0.005).

CONCLUSIONS

Parents and especially mothers of NICU infants reported lower HRQL at 14 days postpartum. At 6 and 12 months, their HRQL improved, aligning with that of unexposed parents.

Maternal Mental Health Spillovers From Child Illness and Disability: A Dynamic Panel Analysis

OBJECTIVES

There is growing recognition of the consequences of a person's health and illness experience for the health and wider welfare of those close to them. However, estimation of these health spillovers is challenging. This study adopts a longitudinal approach to examine maternal mental health spillovers associated with various forms of child illness and disability.

METHODS

Dynamic panel models are used in estimating maternal mental health spillovers related to 7 subcategories of chronic child illness and disability. In particular, we use longitudinal data from the Growing Up in Ireland study and a system generalized method of moments approach. We also consider heterogeneity in these spillovers by the severity of the child's illness/disability and by household deprivation.

RESULTS

We find that a child's experience of chronic nervous system conditions and chronic mental and behavioral disorders are associated with 10.8 and 5.1 percentage point increases in the probability of maternal depression, respectively. Similar associations were not observed for other health conditions. Spillover magnitude is also found to be strongly related to illness/disability severity. Finally, subsample analyses reveal a larger association between severe child illness and maternal depression among deprived households.

CONCLUSIONS

This analysis, in observing health spillovers related to certain disease categories but not others, draws further attention to their context specificity. Our findings also further corroborate calls for inclusion of caregiver and family member outcomes in the economic evaluation of child health services and support consensus guidelines for collection of these outcomes alongside patient outcomes in clinical trials.

Psychological distress in the neonatal intensive care unit: a meta-review

INTRODUCTION

Parental psychological distress (PD) (anxiety, depression, stress and post-traumatic stress syndrome) can adversely affect parents' own physical and mental health as well as their children's long-term health and development. Numerous studies have addressed PD in mothers of infants admitted to NICU, with interventions proposed, but few have addressed the impact on fathers or other family members. The present review examined systematic reviews that addressed PD in NICU and potential interventions.

METHODS

A meta-review was performed by searching various databases between 2000 and May 2024.

RESULTS

Fifty-four studies were included. The incidence of maternal PD varied depending on the screening tool used (13-93%), as did paternal PD (0.08-46%). The incidence of PD in sexual, racial and gender minorities, siblings, grandparents and those in lower-middle income countries is not known. Numerous screening tools were used with a wide variety of cut-off values. Various intervention programmes were evaluated and showed contradictory evidence regarding their effect on PD.

DISCUSSION

Routine screening should be implemented together with a combination of interventional programmes, specifically family-centred interventions. More research is required for PD in siblings, sexual and gender minority parents as well as parents living in low middle income countries.

IMPACT STATEMENT

Psychological distress is high in NICU, affecting parents and siblings. Maternal psychological distress may have long lasting effects on infant health and differs from that of fathers, who require as much attention as mothers Little is known about emotional stress in siblings and sex and gender minority group peoples Few interventions showed conclusive effectiveness in reducing psychological distress with combination interventions showing more effectiveness than single interventions.

Effectiveness of yoga and laughter yoga in improving psychological resilience of mothers with babies hospitalized in neonatal intensive care unit

This randomized controlled study aimed to determine the effectiveness of yoga and laughter yoga approaches in enhancing psychological resilience of mothers with babies hospitalized in the neonatal intensive care unit. The Mothers were randomized into three groups as yoga, laughter yoga, and control groups. The mothers received a total of 10 yoga/laughter yoga sessions for 45 minutes twice a week as home-based exercises. Depression, anxiety, stress, and psychological resilience outcomes were evaluated at baseline and after 5th and 10th sessions. The study was completed with 60 mothers including 20 mothers in the yoga group, 19 mothers in the laughter yoga group, and 21 mothers in the control group. There were statistically significant differences between the groups in terms of depression, anxiety, stress, and psychological resilience after 5th and 10th sessions. Yoga and laughter yoga was effective for increasing psychological resilience and alleviating depression, anxiety, stress.

Association of Very Low Birth Weight Infants With Parental and Sibling Mental Health Care Usage

BACKGROUND AND OBJECTIVES

Parents and siblings of very low birth weight, premature infants are at risk for poor mental health outcomes with increased mental health care usage. Knowledge regarding mental health care use patterns could guide interventions.

METHODS

This retrospective cohort study included US families with commercial insurance coverage from a single carrier. Neonates born at ≤30 weeks' gestational age or with a birth weight <1500 g were identified by insurance claim data between July 1, 2015, and June 30, 2016. Each case neonate family was matched with up to 4 control families.

RESULTS

The study included 1209 case and 1884 control neonates (with 134 deaths among only the case neonates [11.1% of cases]); 2003 case and 3336 control parents (mean [SD] age, 34.6 [5.4] years; 2858 [53.5%] female); and 884 case and 1878 control siblings (mean [SD] age, 6.8 [5.5] years; 1375 [49.8%] female). Compared with controls, more case parents used mental health care over the first year after birth hospitalization discharge. Higher usage was observed for bereaved case parents soon after their child's death. A smaller proportion of bereaved case siblings received mental health care compared with controls. Although nonbereaved case parents returned toward the proportion of use observed in controls, nonbereaved case female siblings, bereaved case female and male siblings, and bereaved male parents experienced continued differences.

CONCLUSIONS

Understanding and meeting the mental health care needs of parents and siblings of very low birth weight premature neonates can be guided by these findings, including elevated and prolonged needs of bereaved parents and siblings.

Parental stress, depression, anxiety and participation in care in neonatal intensive care unit: a cross-sectional study in Italy comparing mothers versus fathers

BACKGROUND

This study aimed at documenting the levels of stress, depression, anxiety and participation in care among mothers versus fathers of newborns hospitalised in a third-level neonatal intensive care unit (NICU) in Northern Italy.

METHODS

Parental stress, depression and anxiety were assessed by the Parental Stressor Scale in NICU (PSS:NICU), the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI). Participation in care was evaluated with the Index of Parental Participation. Differences between mothers and fathers were assessed with the Mood's median test and z-test, respectively for continuous and discrete variables. Multivariate analyses controlling for potential confounders were performed to confirm gender differences.

RESULTS

191 parents (112 mothers and 79 fathers) were enrolled. Mothers reported significantly higher median scores for stress (2.9 vs 2.2, p<0.001) and trait anxiety (37 vs 32, p=0.004) and higher depression rates (EPDS ≥12: 43.8% vs 19.0%, p<0.001). 'High stress' (PSS:NICU ≥3) was reported by 45.5% of mothers compared with 24.1% of fathers (p=0.004). The frequency of the three conditions simultaneously was significantly higher among mothers (20.0% vs 3.8%, p=0.016), with the vast majority of mothers (76.0%) suffering from at least one condition compared with less than half of fathers (45.3%, p<0.001). Participation in care was more frequent in mothers (median score: 19 vs 15, p<0.001), with the exception of activities related to advocacy (median 5 vs 4, p=0.053). In a multivariate analysis, gender differences in mental health outcomes did not change.

CONCLUSIONS

Routine screening of mental distress among parents of infants in NICU is warranted, and gender differences need to be acknowledged in order to deliver tailored support and to promote collaboration with the family of vulnerable newborns. Knowledge and skills on how to prevent and cope with mental distress of parents should be part of the core curriculum of staff working in NICU.

Guilt-and Shame-Proneness, Birth-related Post-traumatic Stress and Post-Traumatic Growth in Women with Preterm Birth

Mothers of premature infants are at high risk of experiencing birth trauma and poor postpartum mental health. However, for some, this experience can lead to personal growth. This study examines Lithuanian women with preterm births, where birth-related PTSD is notably higher despite a lower preterm birth rate. Given the common emotional responses of guilt and shame, we explore whether proneness to these emotions moderates the relationship between birth-related PTSD and post-traumatic growth. A cross-sectional study was conducted using an anonymous e-survey to collect data. Women (N = 79) who experienced a preterm birth during 2020 to 2021 participated in the study at least 2 months postpartum, completing the City Birth Trauma Scale (City BiTS), the Guilt and Shame Proneness Scale (GASP), and the Post Traumatic Growth Inventory (PTGI). The relationship between birth-related post-traumatic stress and post-traumatic growth was assessed using linear regression, while the roles of guilt and shame proneness in this relationship were evaluated using moderated regression. The results showed that higher birth-related post-traumatic stress symptoms were associated with greater post-traumatic growth. However, proneness to shame-related negative self-evaluation weakened this relationship, particularly in women with very preterm births. These findings suggest that trauma models should incorporate the moderating role of shame in recovery outcomes. Women with very preterm births who are prone to shame may require more focused attention from healthcare specialists, with targeted interventions to address these emotional challenges and enhance post-traumatic growth. Additionally, policy initiatives should prioritize support programs tailored to the unique psychological needs of these women.