Mental health in women experiencing preterm birth

Background: The aim of the study was to explore the degree of psychological distress, anxiety, and trauma related stress reactions in mothers who experience preterm birth. Secondarily, we wanted to identify possible predictors of maternal mental health problems. Methods: Twenty-nine mothers of 35 premature children born before 33rd week of pregnancy were assessed within two weeks after given birth. The standardized psychometric methods; Impact of Event Scale (IES), General Health Questionnaire (GHQ) and State Anxiety Inventory (STAI) assessed mental health problems. The predictors for maternal distress, anxiety, and trauma related stress reactions were pregnancy variables, preterm delivery, Gestation Age, maternal trait anxiety and parity. In addition, maternal prevalence of mental health problems was assessed by clinical diagnoses. Results Our study revealed a high prevalence (52%) of posttraumatic stress responses in the mothers. Conclusions: Our results suggest an early examination of mothers’ psychological reactions to preterm birth at the maternity ward. An early intervention should be considered while the child still is in the neonatal intensive care unit

Patterns of Distress in African American Mothers of Preterm Infants

Objective: To examine inter-relationships among stress due to infant appearance and behavior in the NICU, parental role alteration stress in the NICU, depressive symptoms, state anxiety, posttraumatic stress symptoms, and daily hassles exhibited by African American mothers of preterm infants and to determine whether there were sub-groups of mothers based on patterns of psychological distress. Method: 177 African American mothers completed questionnaires on their psychological distress at enrollment during infant hospitalization and 2, 6, 12, 18, and 24 months after term. Results: Psychological distress measures were inter-correlated. There were four latent classes of mothers: the low distress class with low scores on all measures; the high NICU-related stress class with high infant appearance and parental role stress and moderate scores on other measures; the high depressive symptoms class with high depressive symptoms and state anxiety and moderately elevated scores on NICU-related stress and post-traumatic stress symptoms; the extreme distress class with the highest means on all measures. Infants in the high stress class were sicker than infants in the other classes. The extreme distress class mothers averaged the lowest educational level. The classes differed on distress measures, worry about the child, and parenting stress through 24 months with the extreme distress class having the highest values. Conclusion: Although different types of maternal psychological distress were substantially related, there were distinct sub-groups of mothers that were identifiable in the NICU. Moreover, these sub-groups continued to differ on trajectories of distress and on their perceptions of the infants and parenting through 24 months after term. Originally published Journal of Developmental and Behavioral Pediatrics, Vol. 30, No. 3, June 200

Improving Maternal Mental Health Following Preterm Birth Using an Expressive Writing Intervention: A Randomized Controlled Trial.

Evaluations of evidence-based, easily accessible, psychological interventions to improve maternal mental health following very preterm birth are scarce. This study investigated the efficacy and acceptability of the expressive writing paradigm for mothers of very preterm infants. The level of maternal posttraumatic stress and depressive symptoms was the primary outcome. Participants were 67 mothers of very preterm babies who were randomly allocated into the intervention (expressive writing; n = 33) or control group (treatment-as-usual; n = 32) when their infant was aged 3 months (corrected age, CA). Measurements were taken at 3 months (pre-intervention), 4 months (post-intervention), and 6 months CA (follow-up). Results showed reduced maternal posttraumatic stress (d = 0.42), depressive symptoms (d = 0.67), and an improved mental health status (d = 1.20) in the intervention group, which were maintained at follow-up. Expressive writing is a brief, cost-effective, and acceptable therapeutic approach that could be offered as part of the NICU care

Quality of life among parents of preterm infants: a scoping review

Purpose: To synthesize the body of knowledge on the factors influencing the QoL of mothers and fathers of preterm infants. Methods: A scoping review was performed. Publications indexed in PubMed®, Web of Science™, CINAHL® and PsycINFO® were searched, targeting studies presenting original empirical data that examined parental perception on QoL after a preterm delivery. Eligibility and data extraction were conducted by two independent researchers. The main quantitative findings were synthesized and qualitative data were explored by content analysis. Results: The studies, 11 quantitative and 1 mixed methods, were derived mainly from the USA (n = 6). Heterogeneity across the studies was observed regarding the operationalization of QoL and the use of units of analysis (mothers, parents, families and caregivers). In a context where 40 out of 45 covariates were analysed by only one or two studies, results suggested that parental QoL after a preterm delivery is influenced by factors related with mother’s characteristics, family issues and health care environment rather than infants’ variables. Factors regarding fathers’ characteristics and structural levels were not addressed. Conclusions: Standardizing the operationalization of the QoL when analysing mothers and fathers of preterm infants calls for a structured questionnaire adapted to their specific needs. Further research should include both mothers and fathers, invest in mixed methods approaches and be performed in different countries and settings for allowing integration and comparison of findings.This work was supported by FEDER funding from the Operational Programme Factors of Competitiveness—COMPETE and by national funding from the Foundation for Science and Technology—FCT (Portuguese Ministry of Science, Technology and Higher Education) under the project “Parenting roles and knowledge in Neonatal Intensive Care Units” (FCOMP-01-0124-FEDER-019902; Ref. FCT PTDC/CS-ECS/120750/2010) and the Unidade de Investigação em Epidemiologia—Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013); the grants PD/BD/105830/2014 (to MA), SFRH/BPD/103562/2014 (to EA), co-funded by the FCT and the POPH/FSE Program and the FCT Investigator contract IF/01674/2015 (to SS)

Parental Uncertainty in Illness of an Infant and Perinatal Post-traumatic Stress Disorder in the NICU

Varying and conflicting risk factors for perinatal post-traumatic stress disorder (PPTSD) have been reported in the literature in parents after having an infant in the neonatal intensive care unit (NICU). Furthermore, relationships between feelings of parental uncertainty in illness of an infant in the NICU and PPTSD in parents have not been established. The purpose of this study was to (a) investigate the factor structure underlying parental perception of uncertainty scale (PPUS) in a sample of parents in the NICU; (b) describe how parental uncertainty in illness changes throughout the NICU course and after discharge; (c) evaluate if infant illness severity correlates with higher scores of perceptions of uncertainty in illness at three points in time; (d) assess if parental and/or infant clinical characteristics correlate with screening positive for PPTSD three months after NICU discharge; and (e) explore if more parents who experience high levels of uncertainty about their infant’s illness screen positive for PPTSD. The Uncertainty in Illness Theory guided this research. A sample of 176 parent-infant dyads participated in this prospective, longitudinal, correlational study. The confirmatory factor analysis of the PPUS demonstrated that the four-factor structure and a shorter, two factor model, fits in the sample. Parental uncertainty in illness decreased over time for most parents, though less decrease was associated with social determinants of health and gestational age of infant. Screening positive for PPTSD was associated with both parental and infant characteristics. In the final regression, history of mental health illness (p = 0.015; 95% CI 0.05-0.45), elevated postpartum depression screening scores (p = 0.003; 95% CI 0.096-0.436), and uncertainty after discharge (p = 0.05; 95% CI 0.00-0.13), were associated with screening positive for PPTSD. Healthcare providers in the NICU need to assess parental mental health and assist in development of healthy coping strategies

The experiences of parents with infants in Neonatal Intensive Care Unit

Background: In recent years significant medical science advances have been made in the field midwifery and infant care. The premature, low birth weight and ill infants are admitted to the technologically advanced NICU for care and they often require long‑term stay. This study addresses parental experiences with the infant care in NICU, explores their concerns regarding nursing supports for parents and offers nurses’ perspectives on performing duties. Materials and Methods: A qualitative inductive content analysis method was applied in 2011 that included a purposely selected group of parents, nurses and physicians from neonatal unit at the Medical Science University of Isfahan. Participants were surveyed and interviewed according to the institutional ethics committee approval and signed informed consents. Results: The content analysis identified two main categories: 1) the definition of stress, which consisted of misgivings, nervous pressure, imbalance, separation and 2) the parents’ reaction to stress, which revealed emotional, psychotic and behavioral reactions as subcategories. Discussion: The medical team awareness of NICU parent experiences is essential to the quality of care. Recognizing the type of parents’ reaction to the whole process by the healthcare team seems essential to the optimum outcome

Posttraumatski rast kod majki novorođenčadi primljene u neonatalnu jedinicu intenzivnog liječenja

This descriptive and cross-sectional study investigated social support and posttraumatic growth in 210 mothers whose newborns were hospitalized at neonatal intensive care unit. The study population consisted of all mothers living in the Niğde provincial center whose babies were admitted to the Level 1 Neonatal Intensive Care Unit between December 2007 and November 2008. The Posttraumatic Growth Inventory, the Impact of Event Scale and the Multidimensional Scale of Perceived Social Support were administered in the mothers’ homes. Posttraumatic growth was reported in 75.70% (n=210) mothers. The impact of event and perceived social support were highly (97.40%) predictive of posttraumatic growth. Traumatic events are frequently experienced within the healthcare system. Current research fi ndings are therefore extremely valuable for preventing the negative impact of traumatic events on individuals and for transforming the experience into an opportunity for growth.Ova deskriptivna poprečna studija ispitivala je društvenu potporu i posttraumatski rast u 210 majki čija je novorođenčad hospitalizirana u neonatalnoj jedinici intenzivnog liječenja. Ispitivana populacija obuhvatila je sve majke koje žive u pokrajini Niğde, a čija je novorođenčad primljena na 1. razinu neonatalne jedinice intenzivnog liječenja u razdoblju od prosinca 2007. do studenoga 2008. godine. Majkama su kući dostavljeni upitnici Posttraumatic Growth Inventory, Impact of Event Scale i Multidimensional Scale of Perceived Social Support. Posttraumatski rast je opisalo 75,70% od 210 majki. Utjecaj događaja i doživljena društvena potpora u visokoj su mjeri (97,40%) pretkazivali posttraumatski rast. Kako se traumatski događaji često doživljavaju unutar zdravstvenog sustava, nalazi dobiveni ovim istraživanjem veoma su vrijedni za sprječavanje negativnog utjecaja traumatskih događaja na pojedinca te za pretvaranje takvog iskustva u priliku za rast

Minimizing Parental Posttraumatic Stress Disorder in the NICU: An Efficacy Analysis of Trauma Counseling

abstract: The birth of a new baby is known to be a joyful time for families. However, such a treasured experience can quickly reroute in a matter of moments which leaves the family feeling helpless, frightened, and guilty. The innate process of bonding and attachment is interrupted by the resuscitative course following a traumatic birth. Separation, grief, anger, and fear promote what’s being deemed more and more frequently as parental posttraumatic stress disorder (PTSD). Rates of parental PTSD associated with separation at birth are equivalating those of post-partum depression and post-partum psychosis. Emotionally unstable parents are unable to adequately care for their newborn for both short and long term needs. Facilitation and support of the parental role in an altered environment, such as a neonatal intensive care unit (NICU), is thought to create opportunities for relationship security. Establishment of an emotionally invested caregiver has been proven to minimize sequelae of the NICU patient, reduce length of stay, cut readmission rates, and lower the incidence of failure to thrive post-discharge. A parental psychosocial program was instituted in a 32-bed NICU within a southwest children’s hospital. The program efficacy was analyzed several months after implementation. Results are concurrent with the thought that individual counseling for NICU families reduces stress scores and improves patient satisfaction at discharge

Ethnic/racial diversity, maternal stress, lactation and very low birthweight infants.

OBJECTIVE: (1) To compare maternal characteristics and psychological stress profile among African-American, Caucasian and Hispanic mothers who delivered very low birthweight infants. (2) To investigate associations between psychosocial factors, frequency of milk expression, skin-to-skin holding (STS), and lactation performance, defined as maternal drive to express milk and milk volume. STUDY DESIGN: Self-reported psychological questionnaires were given every 2 weeks after delivery over 10 weeks. Milk expression frequency, STS, and socioeconomic variables were collected. RESULT: Infant birthweight, education, and milk expression frequency differed between groups. Trait anxiety, depression and parental stress in a neonatal intensive care unit (PSS:NICU) were similar. African-American and Caucasian mothers reported the lowest scores in state anxiety and social desirability, respectively. Maternal drive to express milk, measured by maintenance of milk expression, correlated negatively with parental role alteration (subset of PSS:NICU) and positively with infant birthweight and STS. Milk volume correlated negatively with depression and positively with milk expression frequency and STS. CONCLUSION: Differences between groups were observed for certain psychosocial factors. The response bias to self-reported questionnaires between groups may not provide an accurate profile of maternal psychosocial profile. With different factors correlating with maintenance of milk expression and milk volume, lactation performance can be best enhanced with a multi-faceted intervention program, incorporating parental involvement in infant care, close awareness and management of maternal mental health, and encouragement for frequent milk expression and STS