Article

Posttraumatic stress among mothers of very low birthweight infants at 6 months after discharge from the neonatal intensive care unit

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Abstract

This correlational study examined how mother's posttraumatic stress disorder (PTSD) symptoms are related to characteristics of the mother and her infant, as well as to mother-infant interaction and infant development, in 21 mothers of very low birthweight infants. Twenty-three percent of mothers scored in the clinical range on a measure of PTSD. How ill the infant was during the NICU hospitalization was related to mothers' PTSD symptoms. Mothers with greater PTSD symptoms were less sensitive and effective at structuring interaction with their infant.

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... It has been observed that the prevalence of perinatal PTSD is higher in high-risk samples such as premature birth, cesarean section, serious complications during pregnancy or delivery (13,(15)(16)(17)(18)(19). Similarly, it has been shown that mothers with a preterm baby experience more post-traumatic stress symptoms, the symptoms persist until the first years after birth, and are more permanent than mothers of full-term and healthy babies (20)(21)(22)(23)(24). ...
... According to the DSM-IV, the Impact of Event Scale used in the literature to measure perinatal trauma, measures only three clusters among the PTSD symptoms and can be associated with underestimation of PTSD dimension associated with childbirth (45,46). However, studies in the literature show that the psychometric properties of PPQ and PPQ-II, which are facilitated by increasing the response options, are sufficient and frequently used to measure perinatal trauma (22,(36)(37)(38)(47)(48)(49)(50). From this point of view, it was aimed to adapt PPQ-II to Turkish and to examine the psychometric properties of the scale within the scope of this study. ...
... When the studies in which PPQ and PPQ-II are examined in the literature, it is seen that sub-scale scores are used in very few studies (51,67), while the total score was used in many other studies. (22,35,36,38,(48)(49)(50)68). As stated before, when the objective is to evaluate the trauma symptoms related to childbirth, it is stated that it is much more important to be able to make a general measurement of trauma experiences related to birth, rather than which subscale reflects which cluster (35). ...
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Objective: The aim of this study is to adapt the Perinatal Post Traumatic Stress Disorder Questionnaire-II (PPQ-II) and determine the psychometric properties of this scale. Method: The study was conducted with two different samples consisting of mothers who give full-term and preterm birth. To investigate the factor structure and conduct confirmatory factor analysis, the first sample was composed of 194 women between the ages of 18-43 (Mean=30.12, standard deviation [SD]=4.96). The second sample in which confirmatory factor analysis was conducted consisted of 238 women between the ages of 19-43 (Mean=30.33, SD=4.00). Depression Anxiety Stress Scale and Connor-Davidson Resilience Scale were used in this study as well as PPQ-II. Results: The exploratory and confirmatory factor analysis revealed a two-factor structure named "Intrusive Thoughts and Avoidance" and "Hyperarousal and Numbness Responses". The model obtained by confirmatory factor analysis demonstrated acceptable goodness of fit values and the questionnaire was found to have satisfactory reliability and validity values. Conclusion: PPQ-II could be considered as a valid and reliable scale which could be used in maternal mental health studies conducted in Turkey.
... These feelings can be an appropriate and expected response. However, they can also manifest as more significant and persistent mental health disorders such as postpartum depression, acute stress disorder (ASD), and post-traumatic stress disorder (PTSD) [1,[5][6][7][8][9][10]. While postpartum depression has focused on depressive symptoms and maternal mental health only, PTSD has been regarded as a better model for assessing for a severe and prolonged stress response in parents of NICU infants [1]. ...
... In response to a traumatic event, individuals with PTSD may re-experience aspects of the event, avoid trauma-related stimuli, have negative thoughts and feelings, and experience hyperarousal symptoms [6,[11][12][13]. Published studies that have evaluated PTSD symptoms in NICU parents report an incidence of positive PTSD screening in 9-60% of mothers and 8-47% of fathers with variability based on many factors including the population studied, time of assessment, and screening tool utilized [1,7,8,10,14,15]. Previous literature has also reported higher incidence of PTSD in NICU parents compared to healthy term infants [6,8,9,[16][17][18]. ...
... Published studies that have evaluated PTSD symptoms in NICU parents report an incidence of positive PTSD screening in 9-60% of mothers and 8-47% of fathers with variability based on many factors including the population studied, time of assessment, and screening tool utilized [1,7,8,10,14,15]. Previous literature has also reported higher incidence of PTSD in NICU parents compared to healthy term infants [6,8,9,[16][17][18]. Despite increasing evidence supporting PTSD following NICU admission, there is a paucity of research regarding specific risk factors for PTSD development or how to appropriately screen and allocate mental health services during and after the NICU course. ...
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To determine the incidence of mental health symptoms in military families after prolonged NICU admission. Prospective cohort study of military-affiliated NICU parents participating in serial electronic surveys, which included validated screening tools for acute stress (ASD), post-traumatic stress (PTSD), and depression disorders. Among 106 military parents surveyed after NICU admission, 24.5% screened positive for ASD and 28.3% for depression. 77 (72.6%) parents continued participation beyond discharge, with 7.8% screening positive for PTSD and 15.6% for late depression. Positive ASD correlated with later symptoms of PTSD (OR 8.4 [2.4–30]) and early depression with both PTSD symptoms (OR 5.7 [1.7–18.8]) and late depression (OR 8.4 [2.4–30]) after discharge. Secondary analysis determined these findings were independent of deployment and other military related factors. This study highlights the potential mental health burden experienced by military-affiliated NICU parents. Early ASD and depression screening may identify parents at risk for mental health symptoms after discharge.
... A child's illness or disability is a strong stressor for the parents, especially the mother, and a risk factor for many psychological problems and somatic diseases. An existing severe illness or one that occurred in the past have been shown to be associated with an increased incidence of acute stress disorder (ASD), post-traumatic stress disorder (PTSD), increased anxiety, or depression in mothers [1][2][3][4][5][6][7][8][9][10]. Having a child with a disability also has similar consequences. ...
... Disturbed emotional well-being (health) in the group of mothers of both healthy and ill children is linked, in light of scientific research, to the occurrence of depressive symptoms, increased anxiety, acute stress disorder, and posttraumatic stress disorder, as well as peritraumatic distress [1][2][3][4][5][6][7][8][9][10]. While the occurrence of ASD and PTSD symptoms is reported more often in the group of parents with children treated at NICUs, PICUs, and pediatric oncology units [1][2][3][4]6,8], depression and anxiety are frequently a significant problem in parents of children with a chronic disease and those with a disability [7,[9][10][11][12]. ...
... Disturbed emotional well-being (health) in the group of mothers of both healthy and ill children is linked, in light of scientific research, to the occurrence of depressive symptoms, increased anxiety, acute stress disorder, and posttraumatic stress disorder, as well as peritraumatic distress [1][2][3][4][5][6][7][8][9][10]. While the occurrence of ASD and PTSD symptoms is reported more often in the group of parents with children treated at NICUs, PICUs, and pediatric oncology units [1][2][3][4]6,8], depression and anxiety are frequently a significant problem in parents of children with a chronic disease and those with a disability [7,[9][10][11][12]. Although the co-occurrence of poor SRH and symptoms of depression and anxiety is relatively well described in the literature, the number of studies exploring the association of acute stress disorder with posttraumatic stress disorder (PTSD) is limited. ...
Article
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A child’s illness or disability is a considerable stressor for the mother and a risk factor for many psychological problems and somatic diseases. The purpose of the study was to (1) assess the prevalence of poor SRH and pain, (2) compare self-rated health and pain, (3) and identify the determinants of SRH and pain in mothers of healthy children and children requiring ambulatory observation or hospitalization. The study covered 234 mothers of both healthy and unhealthy children who required outpatient observation or treatment at an intensive care unit, neonatal intensive care unit, or oncology department. To analyse the variables obtained, the following tools were used: Self-Rated Health, Numerical Rating, Interpersonal Support Evaluation List, Peritraumatic Distress Inventory, Modified Hospital Anxiety and Depression Scale, and Impact of Effects Scale—Revised. The self-assessment of health in mothers of healthy children and those in need of outpatient observation or hospitalization at units with various specialities differed in a statistically significant way. The severity of the average and maximum pain among mothers of healthy children and those with a history of disease differed statistically significantly. Poor SRH co-occurred with severe maximum pain in all of the examined groups. Both in the control group and the group of mothers of children requiring outpatient observation, poor SRH co-occurred with a high level of anxiety. Only in the control group was a correlation found between the severity of the average and maximum pain and the severity of anxiety and depression symptoms.
... Rates of PMADs are particularly high among parents of infants admitted to the NICU. Compared to parents of well newborns, NICU parents have a 20-30% higher prevalence of PMADs [3][4][5][6][7][8][9][10][11][12]. Unfortunately, epidemiologic studies estimate that 50-70% of PMADs go undiagnosed, and for the minority who are able to receive an appropriate PMAD diagnosis, only 50% are able to access adequate treatment [13]. ...
... With or without an antenatal meeting, NICU mental health support staff should meet with each NICU family in the first 72 hours of a child's admission to (re)establish a working relationship, normalize emotional distress, and identify additional PMAD risk factors [42]. At a minimum, formal parental PMAD screening should then take place during the first week of a child's admission, 1-2 days prior to anticipated NICU discharge for admissions greater than 1-2 weeks, and during NICU developmental follow-up visits in the first year after NICU discharge [3,10,12,42,43]. Additional screening may be necessary for families with more risk factors. ...
Article
Perinatal mood and anxiety disorders (PMADs) are common, particularly among parents of infants requiring admission to the neonatal intensive care unit (NICU), yet remain underdiagnosed and undertreated. Undertreated parental mental health disorders can interfere with healthy infant development, compounding abnormal neurodevelopment and psychosocial development that preterm or ill newborns may already face. Interdisciplinary efforts to increase PMAD awareness, screening, and referral uptake may improve family-infant health and developmental outcomes in high-risk infants requiring NICU admission. Therefore, special emphasis on PMAD screening and treatment in NICU parents aligns with the American Academy of Pediatrics mission and should be a focus in neonatal care and included in education, quality improvement, and outcome-based research initiatives.
... Parental posttraumatic stress can affect the development of parent-child-relationships and child outcome. For example, mothers with more PTSS were less effective in structuring interactions with their preterm children (46). Further, posttraumatic stress after preterm births in parents has been found to lead to disruptions in parenting, specifically more controlling and less sensitive parent-infant interactions, cognitive distortions, and consecutive child attachment and behavior problems (47,48). ...
... Further, posttraumatic stress after preterm births in parents has been found to lead to disruptions in parenting, specifically more controlling and less sensitive parent-infant interactions, cognitive distortions, and consecutive child attachment and behavior problems (47,48). These potential effects have to be taken into account when evaluating parental PTSS (46). Thus, high levels of parental PTSS that become evident in the NICU period may indicate a need for early clinical intervention to prevent later chronification and impaired mental health outcome on the expense of family relations and child development. ...
... 9,10 On the other hand, mothers and their low-risk full-term infants often have shorter hospital stays than preterm infants and are usually discharged within 24 hours of birth, unless the mother had a cesarean birth Evidence from high-income countries also shows that preterm infants require longer hospitalizations than full-term infants and mothers are concerned about the infant's outcome. [11][12][13] Mothers with preterm infants in the United States have also reported emotional distress. 1,14 In US hospitals, mothers also described their preterm infants as small and fragile and lengthy hospitalization increased their financial burdens. ...
... 9,10 Similar concerns also occurred in Canadian and US mothers who reported that they were shocked about their preterm infants' small size. 11 Mothers in our study also disagreed with how hospital staff handled the infants; the mothers felt like they could have done better than the healthcare providers if they had been able to exercise their parental role. ...
Article
Background: Hospitalization of a newborn infant is stressful for all mothers. Hospitals in Malawi have limited nursing staff and support, so mothers are the primary care providers for their hospitalized infants. Few studies have explored the experience of these mothers as both care providers and mothers. Purpose: The purpose of this study was to explore the experiences of mothers during the hospitalization of the infant. The goal was to increase knowledge of their primary concerns about the hospital stay. Methods: This was a descriptive qualitative study conducted at Queen Elizabeth Central Hospital in Malawi. Mothers were interviewed prior to their infant's discharge. We used the directed content analysis approach to analyze our data. Results: Twenty mothers of preterm or full-term infants were interviewed. The primary concerns were perinatal experiences, the infant's condition and care including breastfeeding, support from family members, and support and care from healthcare providers. Additionally, mothers of preterm infants were concerned about the burdens of kangaroo mother care. Implication for Practice: In hospitals that provide limited nursing support to mothers and their infants, it is important to identify a support system for the mother and provide mothers with information on infant care. Implications for Research: Future research should identify specific supports and resources in the community and hospital settings that are associated with positive hospital experiences.
... Parental stress after the birth of a preterm baby is well known. 1,2 The need to keep the infant in the neonatal intensive care unit for prolonged periods and thereby the inability of the mother to take over the role of primary caregiver adds to the stress. Although numerous studies have analyzed parents' feelings and perceptions after having a preterm baby, these are limited mainly by the fact that mothers and fathers were made to answer a predesigned questionnaire. ...
... A very high rate of depression, anxiety, and post-traumatic stress disorders has been reported in mothers of babies born preterm, having a significant impact on the growth and development of infants. 1,2 Being well versed with all the published data, there was a double conflict in my mind, putting undue pressure on oneself to fight the existing or non-existing psychiatric and psychological imbalance. ...
Article
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Parental stress after the birth of a preterm baby is well known. Being an obstetrician who herself had an extremely premature delivery, the author thought of narrating self-experience regarding delivering a preterm baby. The objective is to engage the reader both cognitively and emotionally regarding aspects of preterm birth that obstetricians often disregard. Autoethnography is a unique form of research that examines an interplay between self and cultural norms. The role of narrating self-experience by the author, though well established in mental health issues, has not been explored much in maternal and child health. Mothers of preterm babies go through a mixed bag of feelings. The feelings of happiness and delight are in no time transformed into anxiety, guilt, sufferance, and sometimes even frank depression. Preventing preterm births as far as possible should be the goal of every obstetrician.
... Multiple studies have shown that the birth of a baby with a congenital anomaly and the baby's subsequent hospitalization in a neonatal intensive care unit (NICU) are significant sources of parental distress [26][27][28][29][30][31][32][33]. Moreover, the course of the illness and treatment, as well as infants' physical vulnerability and the uncertainty of prognosis, often produces additional psychological distress in their parents [18,29,[34][35][36]. ...
... Our data highlight several potential risk factors in this specific population: duration of hospital stay, days of mechanical ventilation, presence of associated anomalies, medical devices at discharge, and motor score at Bayley III at six months. Our data are consistent with that reported by Holditch-Davis et al. [29] with mothers of high-risk premature babies, who reported that infant illness was unrelated to maternal PTSD symptoms, and in contrast with few studies reporting that illness severity was related to maternal PTSD symptoms [15,28]. In particular, our findings with regard to the duration of ventilatory time are in line with that reported by Chang and colleagues [48] in mothers of preterm infants. ...
Article
Background Pediatric Medical Traumatic Stress (PMTS) is a psychological and physiological response of children and their families to pain, serious illness, and invasive medical procedures. We aimed to apply the PMTS model to parents of newborns operated at birth for a congenital malformation and to identify clinical and socio-demographic risk factors associated with PMTS symptoms at 6 months. Methods We designed a cross-sectional study to assess PMTS symptoms (avoidance, arousal, reexperiencing) in parents of six months children operated on for a congenital anomaly, with the Italian version of the Impact of Event Scale – Revised (IES-R). Results One-hundred-seventy parents form the object of the study. Eighty-two parents (48,2%) fell over the clinical cut-off. Ventilatory time (p = 0.0001), length of hospital stay (p = 0.0001), associated anomalies (p = 0.0002), medical devices at discharge (p = 0.0001) and Bayley motor scale (p = 0.0002) resulted significantly correlated with IES-R Total and Subscale Scores. Multivariate linear regression showed length of hospital stay and number of associated anomalies as significant predictors of IES-R Scores. Conclusions Regardless the type of anomaly and socio-demographic factors, it is the clinical history of the child which seems to predict the severity of PMTS symptoms in this population of parents. PMTS represents a useful model to describe the psychological reactions of parents of newborns operated at birth for a congenital malformation. NICU and outpatient pediatric staff should be aware of risk factors to identify families who may request early multidisciplinary interventions since the first admission. Level of Evidence. Prognosis Study, Level II.
... Parental posttraumatic stress can affect the development of parent-child-relationships and child outcome. For example, mothers with more PTSS were less effective in structuring interactions with their preterm children (46). Further, posttraumatic stress after preterm births in parents has been found to lead to disruptions in parenting, specifically more controlling and less sensitive parent-infant interactions, cognitive distortions, and consecutive child attachment and behavior problems (47,48). ...
... Further, posttraumatic stress after preterm births in parents has been found to lead to disruptions in parenting, specifically more controlling and less sensitive parent-infant interactions, cognitive distortions, and consecutive child attachment and behavior problems (47,48). These potential effects have to be taken into account when evaluating parental PTSS (46). Thus, high levels of parental PTSS that become evident in the NICU period may indicate a need for early clinical intervention to prevent later chronification and impaired mental health outcome on the expense of family relations and child development. ...
Article
Full-text available
Previous research suggests that the birth of a preterm child with very low birth weight (VLBW; <1,500 g) can be traumatic for both parents and lead to short-term consequences like clinical levels of posttraumatic stress symptoms (PTSS) or even to the development of a Posttraumatic Stress Disorder (PTSD). However, little is known about possible mid- and long-term psychological consequences in affected parents. The purpose of this study were (a) to examine the prevalence of parental birth-related PTSS and PTSD in a group of parents with VLBW preterm infants compared to parents of full-term infants 5 years after birth and (b) to investigate potential associations with risk factors for parental PTSS at 5 years postpartum. Perinatal factors (VLBW preterm or term, perceived stress during birth), psychological factors (perceived social support and PTSS 4–6 weeks postpartum, psychiatric lifetime diagnosis) and sociodemographic characteristics (number of children, singleton or multiple birth, socio-economic status), were included in the analysis. The sample consisted of 144 families (77 VLBW, 67 term birth) who participated in the prospective longitudinal cohort study “Hamburg study of VLBW and full-term infant development” (HaFEn-study) and were initially recruited at three perinatal care centers in Hamburg, Germany. PTSD prevalence and PTSS of mothers and fathers were assessed with the Impact of Event Scale-Revised (IES-R), social support with the Questionnaire of Social Support (SOZU-K-22), and lifetime psychiatric diagnoses with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID-I). Data were analyzed by hierarchic multiple regression analyses. Results showed that 5 years after birth none of the parents fulfilled the criteria for a birth-related PTSD diagnosis. For mothers, postnatal PTSS and a VLBW preterm birth significantly predicted PTSS 5 years postpartum. For fathers, psychiatric lifetime diagnosis and postnatal PTSS significantly predicted PTSS 5 years after birth. Early identification of parents with higher risk of PTSS, especially after VLBW preterm birth, and their clinical needs seems beneficial to reduce the risk of long-term consequences. More research is needed on the paternal perspective and on potential effects of preterm birth on both parents and their children's mental health outcomes.
... From the perspective of the health and functioning of the family unit, however, this approach could be problematic. A mother's inability to help her infant can create feelings of alienation, role conflict, guilt, frustration and depression [24,38,64,67], exacerbating already-high stress levels and impeding emotional connection with her child [23,63,73]. A perception of maternal replacement is unhelpful here. ...
... Preterm infants are very fragile, often fighting for their lives going through painful yet life-saving procedures daily. Parents are desperate and can experience feelings of emotional trauma, displacement, inadequacy, and uselessness while modern specialized medical care and machines try to keep their infants alive [23,24]. Given that, mothers had to be treated sensitively. ...
... The cutoff point for PTSD detection is ≥6. In the study of Feeley (2011) in Canada, its validity has been confirmed and its reliability was confirmed by a reexamination method (r = 0.92). [16] In the study of Soltani et al., its reliability was 0.82 by Cronbach's alpha on ten people. ...
... In the study of Feeley (2011) in Canada, its validity has been confirmed and its reliability was confirmed by a reexamination method (r = 0.92). [16] In the study of Soltani et al., its reliability was 0.82 by Cronbach's alpha on ten people. [7] In the present study, the reliability was α = 0.85, with Cronbach's alpha. ...
Article
Background: Spiritual health in the field of health has a great importance in mental disorders and posttraumatic stress disorders, in treatment process. The present study was done aiming "determine the effect of spiritual care education on the spiritual health of preeclamptic women with postpartum stress disorder." Materials and methods: This randomized clinical trial was done in 2017 on 260 women with preeclampsia in Mashhad. Data collection was done with questionnaires Perinatal Posttraumatic Stress Questionnaire (PPQ), the posttraumatic disorder checklist, Duke University Religion Index, and the Spiritual Well-Being Scale (SWBS). In the intervention group, first, women were educated on spiritual care each day based on Richards and Bergin's pattern, in three sessions, which lasted 45-60 min. The control group also received routine cares. All units completed the questionnaire SWBS at the 8th postpartum period. P < 0.05 was meaningful. Results: After the intervention, this score of spiritual health in the intervention and control groups had a significant difference with independent test (P = 0.004). Spiritual health significantly increased in the interventional group. Conclusions: Providing spiritual care to pregnant mothers with preeclampsia, increase their spiritual health.
... 1 The findings from previous research on maternal mental health including a recent study from Germany indicate that mothers of VLBW infants are at high risk for symptoms of depression, anxiety, and PTSD. 20,45,46 Psychological distress in these mothers has been reported to have a negative impact on maternal sensitivity, attention, and responsiveness in the relationship with their infant, ultimately impairing the quality of these mother-infant relationships. 15,47 NICU HCPs have the unique opportunity to support these mothers postdelivery by encouraging early and graduated involvement in daily infant care in addition to arranging peer support from mothers of hospitalized infants who have stabilized. ...
Article
Full-text available
This qualitative grounded theory pilot study investigated the concerns and coping mechanisms of mothers of very low-birth-weight (VLBW; <1500 g) infants following discharge from the neonatal intensive care unit in Alberta, Canada. In-depth, semistructured, face-to-face, audio-recorded interviews were conducted with women of VLBW infants. Interviews lasting 75 to 90 minutes were transcribed verbatim and coded using grounded theory methodology. Data saturation and theoretical redundancy were achieved in interviews with 6 mothers of VLBW infants. The core variable of "reconstructing normal" emerged from the interview data. Women indicated that mothering a VLBW infant is an unfolding experience that is continuously being revised, creating a new sense of normal. The construct consists of 4 categories; mother-infant relationship, maternal development , maternal caregiving and role-reclaiming strate
... Maternal mental health is another factor that may underlie the unique development of comorbid psychopathology in preterm children (52). Mothers of preterm infants are significantly more likely than mothers of full-term infants to experience postpartum depression (53,54), anxiety, and posttraumatic stress (55)(56)(57). A recent longitudinal study by Priel et al. (58) reported that maternal depression markedly increased the risk for childhood psychopathology at both 6 and 10 years of age in association with heightened oxytocin levels of the child. ...
Article
Full-text available
Preterm birth is associated with a significantly increased risk for childhood and adolescent psychopathology relative to full-term birth, with an inverse relationship between gestational age at birth and later risk for psychopathology. The manifestation of symptomatology and comorbidity profiles of emotional and behavioral adjustment problems in this high-risk group have been shown to be distinct from the broader pediatric population. Acknowledging these differences, a preterm behavioral phenotype has been proposed and increasingly recognized, highlighting the unique, frequent co-occurrence of symptomatology associated with attention-deficit/hyperactivity disorder, autism spectrum disorder, and anxiety disorders. The current state-of-the-art review provides a comprehensive characterization of this phenotype to date and further highlights key knowledge gaps primarily regarding the evolution of symptoms, co-occurrence of disorders and/or symptomatology within the phenotype, and associations of the phenotype with chronological age and degree of prematurity.
... Parents whose babies are being treated in neonatal intensive care find it a profoundly emotional and stressful experience [1][2][3]. For parents facing decisions about the possibility of redirecting intensive care to palliative care, their experience may become particularly traumatic. ...
Objective: To understand the dynamics of conversations between neonatologists and parents concerning limitation of life-sustaining treatments. Design: Formal conversations were recorded, transcribed and analysed according to the conventions and methods of conversation analysis. Setting: Two tertiary neonatal intensive care units. Participants: Consultant neonatal specialists and families. Main outcome measures: We used conversation analysis and developed an inductive coding scheme for conversations based on the introduction of limiting life-sustaining treatments and on the parental responses. Results: From recordings with 51 families, we identified 27 conversations about limiting life support with 20 families and 14 doctors. Neonatologists adopted three broad strategies: (1) 'recommendations', in which one course of action is presented and explicitly endorsed as the best course of action, (2) a 'single-option choice' format (conditional: referring to a choice that should be made, but without specifying or listing options), and (3) options (where the doctor explicitly refers to or lists options). Our conversation analysis-informed coding scheme was based on the opportunities available for parents to ask questions and assert their preference with minimal interactional constraint or pressure for a certain type of response. Response scores for parents presented with conditional formats (n=15, median 5.0) and options (n=10, median 5.0) were significantly higher than for those parents presented with 'recommendations' (n=16, median 3.75; p=0.002) and parents were more likely to express preferences (p=0.005). Conclusion: Encouraging different approaches to conversations about limitation of life-supporting treatment may lead to better parent engagement and less misalignment between the conversational partners.
... Mothers and fathers coping with preterm birth acknowledge the traumatic load of this experience, reporting feelings of powerlessness and shock due to the unpredictability of the event (O'Donovan & Nixon, 2019). Literature indicated that 6 months after childbirth, mothers kept experiencing symptoms of posttraumatic stress, with some evidence showing higher levels of trauma being associated with infants' low birth weight, length of hospitalization, and illness severity (Feeley et al., 2011;Holditch-Davis, Bartlett, Blickman, & Miles, 2003). When not resolved, early maternal childbirth-related posttraumatic stress could significantly affect parenting experience and behavior. ...
Article
The goal of this study was to examine the effects of preterm birth and maternal childbirth-related posttraumatic stress and parenting stress on maternal mind-mindedness (MM). The study also investigated the effects of perceived social support on parenting stress and MM. Sixty-five preterm (N = 32) and full-term (N = 33) mother-infant dyads were observed at 6 months. Measures of maternal MM were obtained from observations of mother-infant interaction. Mothers also provided ratings of their posttraumatic stress disorder (PTSD) symptoms, parenting stress, and perceived social support via an online survey. Experiencing a preterm birth did not affect mothers' use of mental state descriptors during mother-infant interaction. Neither childbirth-related posttraumatic stress nor parenting stress directly affected maternal ability to comment on the child's mental states appropriately. However, at medium and high levels of perceived social support, a negative association between parenting stress and MM was observed. Maternal perception of being emotionally supported by significant others promoted MM in mothers showing low or mild levels of parenting stress, but not in mothers experiencing high stress in parenting their infants. Results suggest that a proclivity to MM might be affected by the interaction between parenting stress and social support, rather than by childbirth-related variables, such as prematurity.
... Parents whose babies are being treated in neonatal intensive care find it a profoundly emotional and stressful experience. [1][2][3] For parents facing decisions about the possibility of redirecting intensive care to palliative care, their experience may become particularly traumatic. Such decisions may arise when a baby is recognised to have a poor prognosis because of brain injury, for example following extremely premature birth or a severe lack of oxygen during labour, or with severe congenital anomalies. ...
Article
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Objective: To investigate whether parent-initiated or doctor-initiated decisions about limiting life-sustaining treatment (LST) in neonatal care has consequences for how possible courses of action are presented. Method: Formal conversations (n = 27) between doctors and parents of critically ill babies from two level 3 neonatal intensive care units were audio or video recorded. Sequences of talk where decisions about limiting LST were presented were analysed using Conversation Analysis and coded using a Conversation Analytic informed coding framework. Relationships between codes were analysed using Fisher's exact test. Results: When parents initiated the decision point, doctors subsequently tended to refer to or list available options. When doctors initiated, they tended to use 'recommendations' or 'single-option' choice (conditional) formats (p=0.017) that did not include multiple treatment options. Parent initiations overwhelmingly concerned withdrawal, as opposed to withholding of LST (p=0.030). Conclusion: Aligning parents to the trajectory of the news about their baby's poor condition may influence how the doctor subsequently presents the decision to limit LST, and thereby the extent to which parents are invited to participate in shared decision-making. Practice implications: Explicitly proposing treatment options may provide parents with opportunities to be involved in decisions for their critically ill babies, thereby fostering shared decision-making.
... T h e s e symptoms are persistent and present in an increased alertness state, with autonomic activation when faced with different situations. [8][9][10][11][12] According to the DSM-IV, when stress symptoms persists after the first 6 months of the traumatic event, it is defined as chronic posttraumatic stress disorder (CPTSD). Several factors are involved in CPTSD associated with prematurity, 12-20 including an unexpected preterm birth, grief over the term birth and the baby that the parents had imagined, a profound anguish over the potential death of the baby, concern about the baby requiring invasive therapies; barriers that hurdle early interactions with the baby at the NICU and inability to breastfeed. ...
Article
Background: The birth of very low birth weight (VLBW) preterm infants causes stress in mothers, which may continue for over 6 months. This is called chronic post-traumatic stress disorder (CPTSD). Objective: To detect CPTSD frequency and symptoms among mothers of VLBW preterm infants born before 32 weeks of gestation. Methods: Cross-sectional cohort study in mothers using a survey based on the Davidson Trauma Scale. Results: A total of 172 surveys were administered but 146 were included; 82 (56 %) did not have stress symptoms, while 64 (44 %) had CPTSD. Mothers with CPTSD accounted for 46.8 % of preterm infants born at ≤ 28 weeks versus 31.7 % in those without CPTSD (p = 0.032). Preterm infants with a birth weight < 1000 g were significantly more frequent among mothers with CPTSD, 53 % versus 34 % among those without stress (p = 0.011). No differences were observed in neonatal morbidity (p = 0.072). Severe morbidity in preterm infants was significantly more common among those with CPTSD, 43.8 % versus 28 % (p ≤ 0.004).Mothers who had a lower education accounted significantly for more cases of CPTSD (p = 0.013). No significant differences were seen in maternal age (p = 0.313), children's age (p = 0.405), and length of stay (p = 0.316). Conclusion: Among the mothers of VLBW preterm infants, 44 % had CPTSD, and this was significantly more common among those who had preterm infants born at ≤28 weeks, a birth weight <1000 g, severe morbidity, and a lower level of education.
... Mothers may be affected by PT birth as well [17]. The neonatal intensive care unit (NICU) experience may expose mothers to high levels of psychological distress and post-traumatic stress [18][19][20][21][22][23][24], as the infants are often surrounded by tubes and medical equipment during their recovery. This may lead mothers to perceive and represent them as too fragile, less competent, and more difficult to care for [4,25]. ...
Article
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The preterm birth of a child is a sudden event that can disturb the overall family system and its functioning. Many studies have been conducted with the aim of exploring how and the degree to which this event affects the early mother-infant dyadic relationship and maternal well-being, with often mixed findings. The present study investigates the combined effect of preterm birth and parenting stress on mind-mindedness, a parenting dimension that captures how parents represent and treat their children as separate individuals with their own mental states and activities. A hundred and ten mothers and their three-month-old infants (preterm = 54; full-term = 56) participated in the study. Mind-mindedness was assessed by coding mothers' comments about infant's mental states during dyadic face-to-face interaction. Parenting stress was evaluated with the Parenting Stress Index Short Form questionnaire. Mothers of preterm infants reported similar levels of appropriate and non-attuned mind-related comments to mothers of full-term infants. The reported parenting stress levels were also comparable. Interestingly, only mothers of preterm infants who reported higher stress in parenting showed more non-attuned comments during the interaction. The results underline the need to address preterm birth as a complex event, going beyond group differences and considering its interplay with other risk or protective factors in shaping children's and parents' adjustments and well-being.
... Additionally, severity of pain, as perceived by the woman, is associated with increased levels of postpartum posttraumatic stress symptoms (Ayers et al. 2016;Bailham et al. 2004). Objective characteristics, which include the medical events that occur during childbirth and neonatal outcomes (e.g., mode of delivery and birth weight), also are predictive of PTSS (Feeley et al. 2011;Zaat et al. 2018). Considering both subjective perceptions and objective characteristics of childbirth is imperative for a comprehensive understanding of the etiology of postpartum PTSS. ...
Article
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Existing research suggests that childbirth may be a significant trigger of posttraumatic stress symptoms (PTSS). The current study examined whether subjective birthing experiences and objective childbirth characteristics mediated the association between predisposing psychosocial factors measured during pregnancy (e.g., fear of childbirth, history of trauma, and social support) and PTSS during the postpartum period. Women were recruited during pregnancy from a large Midwestern hospital. Symptoms of posttraumatic stress, obsessive compulsive disorder (OCD), and depression, as well as PTSS-related risk factors, including social support, lifetime trauma exposure, fear of childbirth, subjective perceptions, and objective characteristics of childbirth, were measured during pregnancy and 4, 8, and 12 weeks postpartum. A path model revealed that subjective perceptions of childbirth mediated the association between fear of childbirth and PTSS at 4 weeks postpartum. Objective childbirth characteristics mediated the association between fear of childbirth and PTSS at 8 weeks postpartum, and there was a direct association between fear of childbirth and PTSS. Subjective perceptions of childbirth also mediated the effect of fear of childbirth on PTSS at 4 weeks postpartum when controlling for OCD symptoms. Further, the direct effect of fear of childbirth on PTSS at 8 weeks postpartum remained significant when controlling for OCD symptoms. The current study emphasizes the importance of fear of childbirth and subjective and objective birthing experiences in predicting postpartum psychopathology. Future research should examine these models in diverse and at-risk samples. Valid assessments and effective interventions for perinatal PTSS should be explored.
... In a study carried out in 2014 on 39 mothers and 27 fathers of children hospitalized in NICU,33% of fathers and 51% of mothers met the criteria for the diagnosis of PTSD (Aftyka et al., 2014). It was also demonstrated that parents suffering from PTSD showed less attitude to take care of their children (Feeley et al., 2011). Parental presence in the NICU is particularly important to achieve a smooth transition from hospital to home. ...
Article
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The present study aims to explore any differences in terms of emotional impact between visiting policies restricted vs. 24h open, among parents of children hospitalized in Neonatal Intensive Care Unit (NICU) and Pediatric Intensive Care Unit (PICU). Methods: Eleven parents of children admitted to NICU and 11 parents of children admitted to PICU compiled the Profile of Mood State (POMS) and the Stait-trait Anxiety Inventory (STAI-Y). Results: Data were analyzed by performing Chi-Square. Results revealed that parents with restricted access reported significantly higher levels of anxiety. Findings underlined that anxiety levels are high in both groups, however, caregivers exposed to restricted visiting, condition showed more emotional dysregulation. Conclusion: The negative effects and the emotional impact of the restricted visiting policies, suggesting the emergence of a risk factor of psychological nature, which can negatively influence treatment outcomes in term of compliance and psychological health. The open access of parents is a relevant research field on humanization on hospital services and healthcare.
... Mothers may be affected by PT birth as well [17]. The neonatal intensive care unit (NICU) experience may expose mothers to high levels of psychological distress and post-traumatic stress [18][19][20][21][22][23][24], as the infants are often surrounded by tubes and medical equipment during their recovery. This may lead mothers to perceive and represent them as too fragile, less competent, and more difficult to care for [4,25]. ...
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The preterm birth of a child is a sudden event that can disturb the overall family system and its functioning. Many studies have been conducted with the aim of exploring how and the degree to which this event affects the early mother-infant dyadic relationship and maternal well-being, with often mixed findings. The present study investigates the combined effect of preterm birth and parenting stress on mind-mindedness, a parenting dimension that captures how parents represent and treat their children as separate individuals with their own mental states and activities. A hundred and ten mothers and their three-month-old infants (preterm = 54; full-term = 56) participated in the study. Mind-mindedness was assessed by coding mothers' comments about infant's mental states during dyadic face-to-face interaction. Parenting stress was evaluated with the Parenting Stress Index Short Form questionnaire. Mothers of preterm infants reported similar levels of appropriate and non-attuned mind-related comments to mothers of full-term infants. The reported parenting stress levels were also comparable. Interestingly, only mothers of preterm infants who reported higher stress in parenting showed more non-attuned comments during the interaction. The results underline the need to address preterm birth as a complex event, going beyond group differences and considering its interplay with other risk or protective factors in shaping children's and parents' adjustments and well-being.
... Mothers and fathers coping with preterm birth acknowledge the traumatic load of this experience, reporting feelings of powerlessness and shock due to the unpredictability of the event (O'Donovan & Nixon, 2019). Literature indicated that 6 months after childbirth, mothers kept experiencing symptoms of posttraumatic stress, with some evidence showing higher levels of trauma being associated with infants' low birth weight, length of hospitalization, and illness severity (Feeley et al., 2011;Holditch-Davis, Bartlett, Blickman, & Miles, 2003). When not resolved, early maternal childbirth-related posttraumatic stress could significantly affect parenting experience and behavior. ...
Article
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The goal of this study was to examine the effects of preterm birth and maternal childbirth-related posttraumatic stress and parenting stress on maternal mind-mindedness (MM). The study also investigated the effects of perceived social support on parenting stress and MM. Sixty-five preterm (N = 32) and full-term (N = 33) mother-infant dyads were observed at 6 months. Measures of maternal MM were obtained from observations of mother-infant interaction. Mothers also provided ratings of their posttraumatic stress disorder (PTSD) symptoms, parenting stress, and perceived social support via an online survey. Experiencing a preterm birth did not affect mothers' use of mental state descriptors during mother-infant interaction. Neither childbirth-related posttraumatic stress nor parenting stress directly affected maternal ability to comment on the child's mental states appropriately. However, at medium and high levels of perceived social support, a negative association between parenting stress and MM was observed. Maternal perception of being emotionally supported by significant others promoted MM in mothers showing low or mild levels of parenting stress, but not in mothers experiencing high stress in parenting their infants. Results suggest that a proclivity to MM might be affected by the interaction between parenting stress and social support, rather than by childbirth-related variables, such as prematu-rity.
... Among the major sources of stress and anxiety for parents are fear for their child's health, alterations in their parental role, the infant's behaviour and appearance and the highly technical NICU environment [12,13]. Not uncommonly, parents in the NICU experience severe enough stress to meet diagnostic criteria for acute stress disorder or posttraumatic stress disorder [14,15]. Other often-reported forms of emotional distress in NICU parents are a sense of loss of control, conflicting feelings of hope and hopelessness and, among mothers, guilt feelings for having been unable to bring their pregnancy to term [6]. ...
Article
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Background: Extremely premature infants (those born before 28 weeks' gestational age) are highly immature, requiring months of care at a neonatal intensive care unit (NICU). For parents, their child's grave medical condition and prolonged hospitalization are stressful and psychologically disruptive. This study aimed at exploring the needs of psychosocial support of parents of extremely premature infants, and how the NICU as an organization and its staff meets or fails to meet these needs. Method: Sixteen open-ended interviews were conducted with 27 parents after their infant's discharge from the NICU. Inductive content analysis was performed. Results: Four themes were identified: Emotional support (with subthemes Empathic treatment by staff, Other parents as a unique source of support, Unclear roles of the various professions); Feeling able to trust the health care provider; Support in balancing time spent with the infant and other responsibilities; Privacy. Parents of extremely premature infants needed various forms of emotional support at the NICU, including support from staff, professional psychological help and/or companionship with other patients' parents. Parents were highly variable in their desire to discuss their emotional state with staff. The respective roles of nursing staff, social workers and psychologists in supporting parents emotionally and identifying particularly vulnerable parents appeared unclear. Parents also needed to be able to maintain a solid sense of trust in the NICU and its staff. Poor communication with and among staff, partly due to staff discontinuity, damaged trust. Parents struggled with perceived pressure from staff to be at the hospital more than they could manage and with the limited privacy of the NICU. Conclusions: The complex and individual psychosocial needs of parents of extremely preterm infants present many challenges for the NICU and its staff. Increasing staffing and improving nurses' competence in addressing psychosocial aspects of neonatal care would help both nurses and families. Clarifying the roles of different professions in supporting parents and developing their teamwork would lessen the burden on nurses. Communicating with parents about their needs and informing them early in their NICU stay about available support would be essential in helping them cope with their infant's hospitalization.
... Besides, being disconnected from participating in daily care means parents do not acquire the relevant knowledge and confidence to perform preterm infant care. Moreover, maternal-infant bonding and attachment are more difficult to establish in prolonged hospitalization scenarios where time with their infants is lost (Feeley et al., 2011;Medina et al., 2018). After discharge, these parents feel stress and uncertainty in their abilities to care for their high-risk infants (Boykova, 2016;Turner, Winefield, & Chur-Hansen, 2013). ...
Article
Purpose: To explore Chinese parents' experiences and expectations of having preterm infants in a Chinese neonatal intensive care unit. Design and methods: A qualitative descriptive design with semi-structured interviews was used to describe the experiences and expectations of parents of preterm infants in a neonatal intensive care unit in the central region of China. Purposive sampling was adopted to recruit parents (n = 15) of preterm infants and data were collected by face-to-face interviews from January to May 2018. Themes were identified by thematic analysis. This study followed the consolidated criteria for reporting qualitative research (COREQ). Results: Five themes emerged from the analysis: (1) mixed emotional experiences; (2) separation from the infants; (3) perceived incompetence in taking care of preterm infants; (4) obtained support through various sources; (5) desired more from healthcare professionals. Conclusions: Parents experienced additional emotional burdens due to separation from their infants as well as a lack of an effective approach to their associated needs. While NICU staff adopted several strategies to help parents cope with their infant hospitalization, these parents still expected to receive more support from healthcare providers to meet their needs. Practice implications: Healthcare providers should be more aware of parents' various needs in neonatal intensive care units and of their important role as constant caregivers. Hospital-based neonatal care should be specifically designed to supply positive support and necessary strategies for parents to strengthen their confidence in parenting infants.
... 23 At baseline, parents of babies in the NICU are at significantly increased risk of depression, anxiety, and trauma, which can persist for long periods after discharge. 43 As many as two in three mothers of preterm infants in the NICU have depressive symptoms, and up to half have symptoms of anxiety. Approximately one in four parents will experience symptoms of posttraumatic stress. ...
Article
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The novel coronavirus disease 2019 (COVID-19) pandemic is affecting care for high-risk newborns in ways that will likely be sustained beyond the initial pandemic response. These novel challenges present an urgent imperative to understand how COVID-19 impacts parent, family, and infant outcomes. We highlight three areas that warrant targeted attention: (1) inpatient care: visitation policies, developmental care, and communication practices; (2) outpatient care: high-risk infant follow-up and early intervention programs; and (3) parent psychosocial distress: mental health, social support, and financial toxicity. Changes to care delivery in these areas provide an opportunity to identify and implement novel strategies to provide family-centered care during COVID-19 and beyond. Key Points
... It is difficult for healthcare providers to predict which parents in the NICU will develop symptoms of PTSD. It is unclear whether an infant's illness severity is a risk factor for the development of parental PTSD, with conflicting results from prior studies [10][11][12]. Maternal stress, which is more studied than PTSD, has been shown to not be associated with infant illness or with healthcare providers' perceptions of infant illness, but rather with a parents' perception of infant illness [13]. It is unknown whether parent or healthcare provider perception of illness severity are associated with the development of perinatal PTSD. ...
Article
Parents of infants in the Neonatal Intensive Care Unit (NICU) are at increased risk of developing perinatal post‐traumatic stress disorder (PPTSD), a mental health condition known to interfere with healthy parental and infant attachment. Feelings of uncertainty about illness have been theorized as an antecedent to post‐traumatic stress, however the relationship has not been explored in parents of infants requiring care in the NICU. The purpose of this prospective study was to explore parental uncertainty during and after NICU discharge and the relationship between uncertainty and PPTSD. The sample consisted of 319 parents during NICU hospitalization and 245 parents at 3 months postdischarge. Parents who screened positive for PPTSD 3 months after hospital discharge reported more uncertainty both while in the NICU and 3 months after hospital discharge (p < 0.001). In parents with a personal or family history of mental illness, the moderated/mediating structural probit analysis showed no direct or indirect effect of uncertainty during hospitalization or at 3 months after hospital discharge on screening positive for PPTSD. In parents who did not report personal or family history of mental illness, uncertainty at 3 months after hospital discharge had a direct effect (b = 0.678, p < 0.001) and indirect mediating effect (b = 0.276, p < 0.001) on screening positive for PPTSD. The results provide actionable implications for mental health and NICU providers: (1) routine screening for uncertainty and risk factors including previous personal and family history of mental illness, and (2) the development of NICU follow‐up support services to mitigate risk for PPTSD.
... Comparatively, the severity of posttraumatic symptoms at 12 months was also correlated with the delivery conditions (C-section) and positively correlated with the scores of anxiety and depression of the mother at all assessment times but was not correlated any longer with the characteristics of the preterm child at birth. The literature on the subject is quite contradictory: on one hand, many articles state maternal, infant or external factors as predictors of postpartum PTSD, such as anxiety or depression symptoms in mothers, young maternal age, higher maternal education, C-section, young gestational age, birth weight, length of stay at the hospital, less social support in the perinatal period [27][28][29][30][31][32]. On the other hand, some other authors found no significant association between postpartum PTSD and these factors [33,34]. ...
Article
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Posttraumatic reactions are common among mothers of preterm infants and can have a negative influence on their quality of life and lead to interactional difficulties with their baby. Given the possible trajectories of posttraumatic reactions, we hypothesized that prevalences of postpartum posttraumatic reactions at given times underestimate the real amount of mothers experiencing these symptoms within 18 months following delivery. Additionally, we examined whether sociodemographic and clinical characteristics of dyads influence the expression of posttraumatic symptoms among these mothers. A sample of 100 dyads was included in this longitudinal study led by 3 french university hospitals. Preterm infants born before 32 weeks of gestation and their mothers were followed-up over 18 months and attended 5 visits assessing the infants’ health conditions and the mothers’ psychological state with validated scales. Fifty dyads were retained through the 18 months of the study. The period prevalence of posttraumatic reactions was calculated and a group comparison was conducted to determine their predictive factors. Thirty-six percent of the mothers currently suffered from posttraumatic symptoms 18 months after their preterm delivery. The 18 months period prevalence was 60.4% among all the mothers who participated until the end of the follow-up. There was a statistical link between posttraumatic symptoms and a shorter gestational age at delivery, C-section, and the mother’s psychological state of mind at every assessment time. Only a small proportion of mothers were receiving psychological support at 18 months. Preterm mothers are a population at risk of developing a long-lasting postpartum posttraumatic disorder, therefore immediate and delayed systematic screenings for posttraumatic symptoms are strongly recommended to guide at-risk mothers towards appropriate psychological support.
... Research has shown that sexual violence not only affects the wellbeing of victims but also their motherhood. Traumatized mothers are generally less sensitive and less responsive (Schechter et al., 2010;Feeley et al., 2011), less emotional available (van Ee and Kleber, 2013;Cohen and Shulman, 2019) and show more dissociated and insensitive parenting behavior due to memories of the traumatic experience (Green and Goldwyn, 2002). In the case of rape induced pregnancy, a mother has to cope with the social, physical, and mental health consequences of sexual violence while dealing with her pregnancy as a consequence of this violence (Bosmans, 2007;Scott et al., 2015;van Ee and Blokland, 2019). ...
Article
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Mothers and their children born of sexual violence are at heightened risk for developing an insecure attachment relationship. These mothers and their children often enter care late or not at all, as they are not identified by health care professionals. In this qualitative study, semi structured interviews were conducted with sixteen professionals in primary care for pregnant women and/or young mothers with the aim to identify the status quo in knowledge and skills, challenges, and opportunities. Participants included among others professionals working at Youth Services, psychologists, and clinical nurse specialists. Through a thematic analysis, five themes were identified: the knowledge of the professional, discussing the sexual violence, suitable interventions, points of attention during care, and recommendations. Analysis revealed that three groups of professionals can be distinguished, based on their level of awareness of this target group and their available knowledge and skills. To improve primary care for mothers with children born of sexual violence an increase in awareness, knowledge, and skills is a necessary prerequisite. Scientifically based best practices are therefore necessary for health care professionals to provide adequate care for mothers with children born of sexual violence.
... The mothers in the experimental group seemed to have devel- with earlier studies that reported psychological stress as one of the factors that influence a mother's potential to interact effectively with her premature infant and that stress sensation was found to be related to less warm and less responsive maternal behaviour (Assel et al., 2002;Ong et al., 2019;Feeley et al., 2011;Zelkowitz et al., 2009). Therefore, an emotionally charged event like this is when both mother and infant are willing to adopt new behaviours to minimize health risks. ...
Article
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To assess the effectiveness of the maternal kangaroo care education programme over 1 month and 3 months on the mother's perception, knowledge, perceived barriers and stress. A quasi‐experimental and longitudinal study was conducted among mothers with premature infants. Forty‐eight mother‐infant dyads were enrolled per arm in the control and experimental groups. The control group received standard routine care, while the experimental group received a maternal kangaroo care education program. Data were collected through self‐administered Kangaroo Care Questionnaires. Chi‐square, the general linear model and repeated measures ANOVA were used to analyse data. The demographics are a majority of Malay mothers with multipara, a caesarean delivery with prematurity. At 3 months post‐intervention, the experimental group reported a significant reduction in stress, a positive perception and good knowledge towards kangaroo care implementation. The mothers' perceived barriers towards kangaroo care significantly decreased after 3 months in the experimental group.
... An infant's NICU stay is stressful and anxiety provoking for parents, and many feel ill-equipped to handle the experience [6][7][8]. Maternal depression and anxiety can be associated with infant feeding problems and can impact parenting decisions and practices [9]. Children of mothers with depression may not receive timely age-appropriate well child visits and immunizations and are more likely to receive Emergency Department (ED) care [10]. ...
Article
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Background Peer support during inpatient hospitalization has been recommended for NICU parents and can improve maternal mental health. Less is known about the impact of peer support after NICU discharge on parental mental health and infant healthcare utilization. Methods Three hundred families of infants approaching discharge from a Level IV NICU were randomized to receive a care notebook (control) or care notebook plus peer support for 12 months (intervention). Participants reported on measures of stress, depression, anxiety, self-efficacy, and infant healthcare utilization. Analysis compared outcomes between control and treatment groups. Results Parental depression, anxiety, stress, and self-efficacy improved significantly for all participants, yet there were no differences between control and intervention groups. Infant ED visits, hospitalizations, immunization status, and developmental status at 12 months did not differ between groups. Conclusions Peer support after NICU discharge did not improve self-reported parental mental health measures or infant healthcare utilization. Clinical trial registration NCT02643472.
... As time away from her infant increases, maternal-infant bonding and attachment become more difficult to establish. [5][6][7][8] For attachment, mother and baby should spend a time together right after birth. However, in many clinical settings, there remains some reluctance to implement this approach for preterm babies. ...
Article
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Background: Mothers of preterm infants begin their journey of motherhood in stressful, highly medicalized environment of Neonatal Intensive Care Unit which influences variety of factors. The objective of study was to explore experiences of mothers having preterm infants admitted in NICU. Methods: Qualitative phenomenological study design was used and total of nine mothers having preterm infants were selected purposively from NICU unit of Universal College of Medical Sciences, Teaching Hospital. Data was collected using in-depth interview guidelines and analyzed using Colaizzi’s steps. Results: Six themes were emerged after analysis i.e. experiences of holding a premature baby for first time, emotional experiences, familial experiences, mother-child bonding, interaction with NICU staffs and coping strategies adopted during hospital stay. Mothers experienced contradictory emotions while holding their preterm for first time. They felt emotional detachment due to the emergency NICU admission. Mothers were anxious about unpredictable life span of baby and blamed themselves for early delivery. Although they faced economic hardship for prolonged NICU stay, they received familial support for financial expenses. During their visit to NICU, mothers felt health professionals to be supportive. To deal with these emotions, mothers adopted coping strategies like acceptance of the situation, devotion towards god, attachment with family. Conclusions: Mothers were unprepared about the birth of baby so early. So, they experienced problems like emotional detachment, and economic hardship due to emergency NICU admission. Hence, health professionals need to pay more attention to reduce anxiety of mothers by providing continuous communication about baby’s progress.
... In a study of parents of infants with neonatal seizures, many of whom received hypothermia treatment, over half experienced symptoms of anxiety, and one-third experienced symptoms of depression at the time of discharge [22]. Up to one-quarter of all parents experiencing a NICU stay will have long-standing symptoms of post-traumatic stress [27,28]. ...
Neonates and families face challenges in hypothermic therapy, including trauma to parents, extreme emotions, and unfamiliarity with the medical system. Communication is an essential element to supporting parents while their children are in the NICU, and beyond, building the foundation for the ongoing relationship the family has with the medical system. Significant consideration needs to be given to the critical element of integrating the family into the care of a baby being treated with therapeutic hypothermia. Clinicians can promote healing of accumulated traumas of parents through ensuring parent's emotional safety, facilitating a trusting relationship, and promoting parent empowerment. Connecting parents with resources, especially peer support, is an essential part of a hospital stay. In this chapter, we explore best practices to support families during and after hypothermic therapy.
... [24,51,52] According to some studies, the prevalence of postpartum PTSD wais 1.7%-9%, while in preterm delivery it was 23%-35% in mothers admitted to the neonatal intensive care unit. [53,54] The results of Gray's study on parental stress in mothers with preterm delivery showed that postpartum stress levels of these mothers were not different from the mothers with term infants. [21] In our study, as in the above-mentioned studies, the level of maternal stress was increased, so that 90% of the mothers had moderate stress and 10% had high levels of stress. ...
Article
Background: Women who experience stillbirth and preterm delivery are likely to be associated with an increased risk of posttraumatic stress disorder (PTSD) compared to women with live births and dose religious attitude related to posttraumatic stress? The aim of the study was promotion PTSD following traumatic birth experiences and the influence of maternity religious Attitude. Materialsand methods: A cross-sectional analytical study was conducted at selected hospitals of Shiraz University of Medical Sciences on 82 subjects in 2018. The instruments were demographic questionnaire, Religious Attitude questionnaire, and Mississippi PTSD Scale which were completed after delivery. Data were analyzed using SPSS software, version 22, using the Pearson correlation test. Results: About 75% stillbirth group and 65% of the preterm delivery group had a high level of religious attitude. In the stillbirth group, 90% had high levels of PTSD and in the preterm delivery group, 90% had moderate stress, and 10% had high PTSD levels. The correlation between religious attitude and PTSD after stillbirth was 0.373 with a significance level of 0.018. Therefore, there was a significant positive relationship between religious attitude and PTSD. However, the relationship between religious attitude and PTSD after preterm delivery was not statistically significant (P = 0.158). Conclusion: PTSD was significantly higher in mothers with stillbirth and had a significant relationship with religious attitude. However, in mothers of preterm infants, the level of stress was moderate and did not have a significant relationship with religious attitude. The findings indicate the need of mothers for interventions to cope better with the physical and psychological problems of stillbirth and preterm delivery.
... Additionally, parents may experience high levels of stress and helplessness [69], the inability to always be part of their infant's care [70], the need to leave their infant in the hospital feeling like "an amputation, over and over" [65] and the worry about their infant's developmental outcomes both while in NICU and at home [71,72]. All these aspects may contribute to the emergence of symptoms of post-traumatic stress disorder (PTSD) [73,74], which can affect the quality of the childparent relationship and parenting skills [75]. ...
Article
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Parents who have infants hospitalised in neonatal intensive care units (NICUs) experience high levels of stress, including post-traumatic stress disorder (PTSD) symptoms. However, whether sounds contribute to parents’ stress remains largely unknown. Critically, researchers lack a comprehensive instrument to investigate the relationship between sounds in NICUs and parental stress. To address this gap, this report presents the “Soundscape of NICU Questionnaire” (SON-Q), which was developed specifically to capture parents’ perceptions and beliefs about the impact that sound had on them and their infants, from pre-birth throughout the NICU stay and in the first postdischarge period. Parents of children born preterm (n = 386) completed the SON-Q and the Perinatal PTSD Questionnaire (PPQ). Principal Component Analysis identifying underlying dimensions comprising the parental experience of the NICU soundscape was followed by an exploration of the relationships between subscales of the SON-Q and the PPQ. Moderation analysis was carried out to further elucidate relationships between variables. Finally, thematic analysis was employed to analyse one memory of sounds in NICU open question. The results highlight systematic associations between aspects of the NICU soundscape and parental stress/trauma. The findings underscore the importance of developing specific studies in this area and devising interventions to best support parents’ mental health, which could in turn support infants’ developmental outcomes.
... While this is the best option to ensure infant survival, parent's experiences in the NICU can be daunting (Sadrudin et al., 2012). Infant-maternal attachment necessary for stability and psychological growth is lost or disrupted, with most parents having a myriad of negative feelings, from psychologicalguilt, shock, depression (Poehlmann et al., 2009), anxiety (Feeley et al., 2011;Zelkowitz et al., 2009), to physical disposition (lack of confidence, feeling of despair) and behavioural (powerless, alienation and ambivalence). Moreover, the complex nature of the NICU environment can be intimidating to some parents. ...
Article
Background Having an infant in the neonatal intensive care unit (NICU) is associated with intense emotional stress for both mothers and fathers. However, with the right support from staff, this stress can be reduced significantly. Although evidence on needs of parents in the neonatal unit exists, there is lack of a systematic integrative review on the support needs of parents in the neonatal unit. Current review evidence is needed to support busy neonatal unit clinicians in their practice. Aim and objectives The purpose of this integrative review is to explore the current available evidence to describe and understand the support needs of parents of infants in the NICU. Methods The integrative review process of Whittemore and Knafl (2005) was used to guide this study. Six databases—MEDLINE, CINHAL, PubMed, Scopus, Google Scholar and PsycINFO—were searched for eligible studies using relevant keywords. Primary studies published in English language from 2010 to 2021 were reviewed following a pre-determined inclusion criteria. Studies that met the inclusion criteria were critically appraised using the Mixed Methods Appraisal Tool (MMAT). The review report is guided by the PRISMA 2020 checklist for systematic reviews. Results Overall, 24 primary qualitative, quantitative and mixed methods studies were included in the review. Analysis of included studies resulted in six themes that demonstrate the support needs of parents in the NICU; 1. Information needs; 2. Emotionally intelligent staff; 3. Hands-on support; 4. Targeted support; 5. Emotional needs; and 6. Practical needs. Conclusion This review has presented the current evidence on the needs of parents from their own perspective. Healthcare workers’ understanding and supporting these needs in the NICU is likely to increase parental satisfaction and improve health outcomes for parents, infants and their family. Relevance to clinical practice Parents of infants in the NICU require staff support to enhance their experiences, well-being, caring and parenting confidence during admission and post-discharge. As parents are in constant need for informational, emotional and practical support, continuing professional development for NICU staff should place emphasis on effective communication strategies, enhancing emotional intelligence and empathy among staff. NICU staff should build positive ongoing relationships with parents and provide targetted support for mothers and fathers.
... Prior trauma exposure may increase the risk of posttraumatic stress following a NICU admission. NICU research demonstrates that adult trauma predicts NICU-specific posttraumatic stress symptoms across both high-and lowincome samples [11,12,16]. However, the impact of ACEs on NICU-related posttraumatic stress is less clear. ...
Article
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To evaluate acute stress disorder (ASD) symptoms and their predictors in Neonatal Intensive Care Unit (NICU) mothers. In this cross-sectional study, 119 mothers (~72% Medicaid) completed surveys during the first month of their infants’ hospitalizations. Correlations and structural equation models (SEMs) evaluated relations among mothers’ childhood trauma history, infant health appraisals, objective infant health, and ASD. ASD symptoms (~55%) and childhood trauma (~33%) were prevalent. ASD was correlated with childhood trauma, infant health, and infant health appraisals. All SEMs had good fit, indicating that (a) infant health appraisals partially mediated relations between childhood trauma and ASD, and (b) infant health appraisals fully mediated relations between objective infant health and ASD. ASD symptoms are prevalent among NICU mothers regardless of infant health severity. Recognition of childhood trauma history and appraisals of infant health is critical for trauma-informed care.
... It is difficult for healthcare providers to predict which parents in the NICU will develop symptoms of PTSD. It is unclear whether an infant's illness severity is a risk factor for the development of parental PTSD, with conflicting results from prior studies [10][11][12]. Maternal stress, which is more studied than PTSD, has been shown to not be associated with infant illness or with healthcare providers' perceptions of infant illness, but rather with a parents' perception of infant illness [13]. It is unknown whether parent or healthcare provider perception of illness severity are associated with the development of perinatal PTSD. ...
Article
Background: Risk factors for perinatal posttraumatic stress disorder (PTSD) among parents of an infant in the NICU have varied in previous literature. The relationships between perception of illness severity and objective measures of illness severity with PTSD are not well understood. Aims: To determine if PTSD among parents after an infant NICU discharge can be predicted by 1) objective measures of infant illness severity or 2) perceptions of infant illness severity. Study design: A prospective, observational study. Subjects: Parent/infant dyads who were in the NICU for ≥14 days. Outcome measures: Objective measures of illness severity were obtained from the electronic health record. Perceptions of illness were measured by the response to the question, "How sick is your child/patient?" on a 5-point Likert scale. The Perinatal Post-Traumatic Stress Disorder Questionnaire (PPQ) was completed by parents three months after discharge. Results: One hundred ninety-four dyads participated in the study, 86% of parents completed follow up screening. 25% of parents screened positive for PTSD. Parents perceived infants to be sick more often than hospital caregivers. In bivariate analysis many objective measures of illness severity were associated with PTSD. Parent perceptions of illness were also associated with PTSD after adjusting for objective measures of illness (OR 3.2, 95% CI 1.1-6.1, p = 0.008). Conclusions: PTSD in parents after NICU discharge is multifactorial. Objective illness risk factors can be used to screen parents at risk. Hospital caregivers should strive to understand parents' perception of illness and improve communication to potentially decrease PTSD after discharge.
Article
Parents of infants who require neonatal intensive care unit (NICU) hospitalization encounter stressors that place them at a higher risk of developing a mental health issue during and after NICU discharge. This population is often underdiagnosed, leading to potential detrimental effects on parenting behaviours, parent/infant bonding, and child neurodevelopment. This review explores what mental health issues parents experience during and after NICU discharge, what mental health resources are currently available, what mental health screening tools are used, and what factors place NICU parents at an increased risk of developing a mental health issue. The review revealed that mental health issues are not isolated; if a parent experiences psychological distress, it can progress to depression or post-traumatic stress disorder (PTSD) if left untreated. Psychotherapy most frequently contributed to a reduction in mental health symptoms, but was rarely offered beyond NICU discharge.
Article
Background: Infants discharged from the neonatal intensive care unit (NICU) dependent on medical technology (eg, respiratory or nutritional support) are a growing vulnerable population. These infants are medically fragile, prone to emergency department visits and readmissions, and require increased caregiver demands at home. The experiences of their maternal caregiver's after NICU discharge however, are not well understood. Purpose: This qualitative descriptive study addressed this knowledge gap by interviewing mothers of technology-dependent infants about their experience during their first 2 weeks transitioning to home from the NICU. This is a critical period in which mothers must first assume advanced caretaking responsibilities in the home. Methods: Eight mothers participated in semistructured audio-recorded interviews via the Web conferencing system Zoom and completed demographic questionnaires. Results: Five themes emerged from the data that described essential features of the mothers' transition to home: (a) needing coordinated discharge care; (b) establishing a routine; (c) being an advocate; (d) having a support system; and (e) finding normalcy. An additional important finding of this study was the presence of maternal posttraumatic stress and postpartum depression. Implications for practice: Results highlight the importance of providing mothers hands-on practice opportunities and identifying social support and home healthcare options prior to discharge of technology-dependent infants. Implications for research: Future research should focus on multidisciplinary interventions targeted toward discharge preparation, transitional support, and understanding maternal psychiatric symptoms among mothers of technology-dependent infants.
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Background Parents of babies admitted to neonatal units (NNU) are exposed to a range of potentially distressing experiences, which can lead to mental health symptoms such as increased anxiety and post-traumatic stress (PTS). This review aimed to describe how anxiety and PTS are defined and assessed, and to estimate anxiety and PTS prevalence among parents of babies admitted to NNU. Method Medline, Embase, PsychoINFO, Cumulative Index to Nursing and Allied Health literature were searched to identify studies published prior to April 14, 2021. Included studies were assessed using Hoy risk of bias tool. A random-effects model was used to estimate pooled prevalence with 95% CIs. Potential sources of variation were investigated using subgroup analyses and meta-regression. The review is registered with PROSPERO (CRD42020162935). Findings Fifty six studies involving 6,036 parents met the review criteria; 21 studies assessed anxiety, 35 assessed PTS, and 8 assessed both. The pooled prevalence of anxiety was 41.9% (95%CI:30.9, 53.0) and the pooled prevalence of PTS was 39.9% (95%CI:30.8, 48.9) among parents up to one month after the birth. Anxiety prevalence decreased to 26.3% (95%CI:10.1, 42.5) and PTS prevalence to 24.5% (95%CI:17.4, 31.6) between one month and one year after birth. More than one year after birth PTS prevalence remained high 27.1% (95%CI:20.7, 33.6). Data on anxiety at this time point were limited. There was high heterogeneity between studies and some evidence from subgroup and meta-regression analyses that study characteristics contributed to the variation in prevalence estimates. Interpretation The prevalence of anxiety and PTS was high among parents of babies admitted to NNU. The rates declined over time, although they remained higher than population prevalence estimates for women in the perinatal period. Implementing routine screening would enable early diagnosis and effective intervention. Funding This research is funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Maternal and Neonatal Health and Care, PR-PRU-1217-21202. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Article
Purpose The aim of the study was: (1) to determine whether post-traumatic stress symptoms (PTSS) intensification in a spouse/partner is an essential predictor for PTSS intensification in the parents of children who were treated in the NICU during the neonatal period and (2) to indicate the relationship between psychological variables linked to stress intensification and coping styles with PTSS intensification. Design The research sample consisted of 41 couples of parents of infants aged between 3 and 11 months old, who had been treated in a NICU during the neonatal period. The Impact Event Scale – Revised was used to assess PTSS, the Perceived Stress Scale was applied to assess stress, and the Coping Inventory for Stressful Situations was used to measure the coping style. Data were analysed statistically using descriptive statistics, and hierarchical regression was performed to indicate PTSS predictors. Results PTSS intensification in men was 39.17 ± 17.17 points and in women it was 48.93 ± 18.97 points. The majority of the fathers (68.5%) and of the mothers (82.9%) scored more than 33 points in the IES-R scale, which suggests PTSD. Significant PTSS predictors in the fathers were: PTSS intensification in the partner, the level of perceived stress and emotion-oriented coping. Significant PTSS predictors in women were: avoidance-oriented style in stressful situations and PTSD intensification in the father. Conclusion Post-traumatic stress symptoms in a partner is a significant predictor for post-traumatic stress symptoms in the mothers and fathers of children previously treated in NICU. Practice implications Demonstrating a significant correlation between PTSS in a parent and their partner, as well as stress coping has crucial clinical implications both in terms of prevention and diagnosis.
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Erken doğum 37 haftadan önce olan doğumları tanımlamak için; ''erken doğan'' ya da ''prematüre'' bebek terimi ise 37 haftadan önce doğan bebekleri tanımlamak için kullanılmaktadır. Doğumdan sonra, erken doğan bebeklerin içinde bulundukları zorlu tıbbi durum, doğumdan sonra bebeğin yeni doğan yoğun bakım ünitesinde (YYBÜ) kalmasını gerektirebileceği, genellikle bebeklerle ebeveynleri arasındaki ten-tene ilişkiyi engelleyebileceği ve anne-bebek ilişkisinde olumsuz etki yaratabileceği için, hem yeni doğan bebek hem de anne için stres verici olabilmektedir. Yapılan çalışmalar, erken doğumun annenin yaşadığı psikolojik sorunlarla ilişkili olabildiğini, travma sonrası stres belirtileri ve/veya travma sonrası stres bozukluğunun, erken doğumu takiben annenin yaşadığı ruh sağlığı sorunlarından olabildiğini ortaya koymaktadır. Doğum sonrasında yaşanan olumsuz duyguların yalnızca anne sağlığını değil aynı zamanda bebeğin gelişimini de etkilediği bilinmektedir. Annenin erken doğumun ardından yasayacağı travma sonrası stres (TSS), annenin bebeğini algılamasını etkileyerek olağan anne-bebek ilişkisini sekteye uğratabilmektedir. Alanyazında erken doğum sonrası TSS belirtilerine odaklanan çok az sayıda çalışma olmasından hareketle, bu derleme makalesinde, erken doğan bebek annelerinin yaşadıkları TSS tepkileri ve belirtileri ile TSSB, TSS ile ilişkili etmenler, TSS’nin anne-bebek etkileşimini nasıl etkilediği ve TSS belirtilerine yönelik oluşturulmuş müdahale programları ele alınacaktır.
Chapter
For parents, making decisions around withdrawal or withholding of treatment and accepting that their baby is not going to survive is arguably the hardest decision they will have to make for their baby. The nurses’ role is pivotal in helping to support parents during this difficult decision-making process, as nurses can facilitate communication between all those involved, provide information and stability for parents, and monitor the progress of the infant at the heart of the decision-making process. As such, nurses must form part of the multidisciplinary team when discussions take place around the reorientation of care (RCN, Career education and competence framework for neonatal nursing in the UK, 2015). This chapter will cover the theoretical background to the context of decision-making in the neonatal unit, exploring the attitudes of those involved and the needs of the parents at this stressful time. Practical information will then be explored and how the neonatal nurse can transfer this knowledge into practice, providing the best possible support for parents. If there is misalignment between decision makers, seeking ethical guidance will be discussed, whilst case studies will be used to highlight the clinical application of decision-making within neonatal palliative care. This chapter will explore the decision-making process for critically ill infants on the neonatal unit, and the nurses role when transitioning from active to palliative care.
Article
Objective. This study aims to investigate whether posttraumatic stress disorder (PTSD) symptoms exist >1 year after neonatal intensive care unit (NICU) experience and whether PTSD symptomatology differs across parents of infants of different gestational age categories. Methods. A survey was given to parents at routine NICU follow-up visits. Parents completed the PTSD CheckList-Civilian (PCL-C), a standardized scale comprising 17 key symptoms of PTSD. Parents also rated how traumatic their birth experience, first day in the NICU, and first week in the NICU were from "Not Traumatic at All" to "Most Traumatic." Fisher's exact test was used to compare PCL-C responses across gestational age categories (Extremely Preterm, Very Preterm, Moderate to Late preterm, and Full Term). Results. Eighty parents participated. In total, 15% of parents had "Moderate to High Severity" PTSD symptoms. There were no statistical differences in PTSD prevalence between parents of children <1 year old and parents of children >1 year old (P = .51). There was also no statistical difference in prevalence of "Moderate to High Severity" level of PTSD symptoms across gestational age (P = .16). Overall, 38% of parents rated at least one experience as "Most traumatic." Conclusion. A high percentage of parents who had a recent NICU experience and parents who had a NICU experience more than a year ago demonstrated PTSD symptoms. In light of these results, many parents of NICU graduates-both mothers and fathers-would benefit from access to long-term counseling services.
Article
Maternal posttraumatic stress symptoms (PTSS) are associated with adverse consequences for older children, but very few studies have examined links between perinatal maternal PTSS and infant outcomes. Trauma exposure and psychopathology, including PTSS, is often heightened for women during pregnancy through 1 year postpartum. Therefore, the perinatal period may be a critical time for understanding the risk maternal PTSS and other mental health factors pose to the socioemotional and physical health of infants. The present study explored the relation between maternal PTSS and infant socioemotional and physical health problems in a sample of racially and ethnically diverse mother‐infant dyads (N = 295) assessed prenatally and at 12 months postpartum. This study also examined whether there are: (1) moderating effects of maternal depressive symptoms and parenting stress on these associations and (2) indirect effects of PTSS on infant outcomes through observed maternal sensitivity. Results indicated that postpartum depressive symptoms and parenting stress, rather than PTSS, were associated with greater infant socioemotional health problems. However, prenatal PTSS were associated with greater infant physical health problems when mothers also reported clinically significant levels of postpartum depressive symptoms. Maternal sensitivity was not associated with maternal PTSS, depressive symptoms, or parenting stress, nor was it related to infant socioemotional and physical health; thus, maternal sensitivity was not tested as an intermediary mechanism linking maternal mental health with infant outcomes. Implications for promoting maternal mental health in the perinatal period to bolster socioemotional and physical health of infants are discussed.
Article
This qualitative grounded theory pilot study investigated the concerns and coping mechanisms of mothers of very low-birth-weight (VLBW; <1500 g) infants following discharge from the neonatal intensive care unit in Alberta, Canada. In-depth, semistructured, face-to-face, audio-recorded interviews were conducted with women of VLBW infants. Interviews lasting 75 to 90 minutes were transcribed verbatim and coded using grounded theory methodology. Data saturation and theoretical redundancy were achieved in interviews with 6 mothers of VLBW infants. The core variable of "reconstructing normal" emerged from the interview data. Women indicated that mothering a VLBW infant is an unfolding experience that is continuously being revised, creating a new sense of normal. The construct consists of 4 categories; mother-infant relationship, maternal development, maternal caregiving and role-reclaiming strategies, and infant developmental milestones. Findings from this study suggest that women found the transition into motherhood following the birth of a VLBW infant as a multidimensional and dynamic process. Further research is warranted to confirm these results and to further explore mothering issues with VLBW infants.
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The emotional distress resulting from the experience of giving birth to a preterm infant (gestational age , 37 weeks) and the subsequent neonatal unit hospitalisation may be a traumatic experience for parents. In the present systematic literature review, studies on parental posttraumatic symptomatology following birth of a premature infant were reviewed. A total of 5 studies were identified. All studies reviewed found that posttraumatic symptomatology is quite common in parents or primary caregivers of premature infants. However, methodological weaknesses of relevant studies (e.g. use of convenience samples, lack of pre – delivery assessments) make it difficult to draw consistent conclusions regarding prevalence of posttraumatic symptomatology in this population group or whether the experience of a premature birth could be responsible for the development of PTSD. Directions for future research are discussed.
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Traumatic stress symptoms from multiple causes are endemic among impoverished women who are also at high risk for delivering infants requiring neonatal intensive care unit (NICU) care, but whether this event itself constitutes a distinct traumatic stress trigger is unknown. Previous research does suggest having an infant in the NICU generates traumatic stress among white middle-class mothers, stress that can impact their infant's behavior and development. This study evaluated the prevalence of acute posttraumatic stress symptoms among low-income mothers of infants admitted to the NICU compared with similar mothers with infants in the well baby nursery (WBN). A total of 59 NICU and 60 WBN mothers were recruited from the Boston Medical Center. Within the first week after birth, all participants were assessed for postpartum acute posttraumatic stress and depression symptoms and asked about lifetime traumatic events before the birth of their baby. The acute posttraumatic stress symptoms were analyzed as a continuous variable and whether they reached the categorical severity criteria for acute stress disorder. NICU mothers show increased symptoms of acute posttraumatic stress and depression. Twenty-three percent of NICU and 3% of WBN reached severity criteria for acute stress disorder. When controlling for relevant covariates, having a newborn in the NICU had a significant association with the number of mothers' acute posttraumatic stress symptoms not fully explained by their symptoms of depression or prior lifetime history of traumatic events. Addressing acute posttraumatic stress symptoms may enhance interventions to help urban families of NICU infants.
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This paper reviews recent epidemiologic studies of posttraumatic stress disorder (PTSD) in the general population. Estimates of the prevalence of exposure to traumatic events vary with the method used to ascertain trauma exposure and the definition of the stressor criterion. Changes in the DSM-IV definition of "stressor" have increased the number of traumatic events experienced in the community that can be used to diagnose PTSD and thus, the number of PTSD cases. Risk factors for PTSD in adults vary across studies. The 3 factors identified as having relatively uniform effects are 1) preexisting psychiatric disorders, 2) a family history of disorders, and 3) childhood trauma. In civilian populations, women are at a higher risk for PTSD than are men, following exposure to traumatic events. Most community residents have experienced 1 or more PTSD-level traumas in their lifetime, but only a few succumb to PTSD. Trauma victims who do not succumb to PTSD are not at an elevated risk for the subsequent onset of major depression or substance use disorders, compared with unexposed persons.
Objective To examine mothers’ responses to having a premature infant in the neonatal intensive-care unit and to determine the degree to which they appear similar to a posttraumatic stress response. Design Mothers were enrolled in this descriptive, correlational study shortly before the infant was discharged from the hospital. Data were collected at enrollment and when the infant was 6 months old, corrected for prematurity. Participants A convenience sample of 30 mothers of high-risk premature infants. Interventions None. Main Outcome Measures A semistructured interview of the mothers was conducted at 6 months corrected age. Interview responses were analyzed to identify three symptoms related to posttraumatic stress disorder: re-experiencing, avoidance, and increased arousal. Other measures focused on maternal psychological well-being—neonatal intensive-care unit stress, depressive symptoms, and worry about the infant—and demographic characteristics. Infant illness severity included birth weight, length of mechanical ventilation, multiple birth, and the severity of neurological insults. Results All mothers interviewed had at least one posttraumatic symptom, 12 had two, and 16 had three symptoms. Twenty-six mothers reported increased arousal; re-experiencing and avoidance were reported by 24 mothers each. The number, but not the type, of posttraumatic stress symptoms was related to maternal psychological well-being. Maternal demographic characteristics, except marital status, and infant illness severity, were unrelated to posttraumatic stress symptoms. Conclusions These mothers appeared to be experiencing emotional responses similar to posttraumatic stress reactions at 6 months after their child's expected birth date. Since maternal emotional responses may affect the parenting of premature infants, additional nursing research is needed to provide a basis for interventions with these highly vulnerable mothers and infants.
Article
A pilot study was conducted to assess the feasibility and acceptability of an intervention program for mothers of very low birth-weight infants in the neonatal intensive care unit (NICU). Thirty-three mothers of infants born weighing less than 1500 g. A single-group, pretest-posttest design was used. Preintervention mothers completed self-report questionnaires and their interaction with their infant was observed. Mothers then received the intervention program. Mothers were assessed twice postintervention, first when the infant was 1/2 months old and again at 6 months. At the postintervention assessments, mothers completed the same questionnaires and interaction was observed. Mothers completed the State-Trait Anxiety Inventory, the revised Parental Stress Scale: Neonatal Intensive Care Unit, the NICU Parental Beliefs Scale, and the Perinatal PTSD Questionnaire. Interactions between mothers and infants were rated by trained research staff using the Index of Parental Behaviour in the NICU. Postintervention mothers also responded to a questionnaire that assessed their perceptions of the intervention program. It was feasible to enroll mothers because 62% of eligible mothers agreed to participate. However, 39% of mothers who enrolled withdrew. Most of the mothers who withdrew did so before even beginning the intervention, and many of these women were mothers of multiples. It was also feasible to provide the intervention because more than 80% of mothers who began the intervention received all 6 teaching sessions. Mothers found both the content and the format of the program to be acceptable. There were nonetheless several challenges in conducting an intervention study with mothers early in the NICU hospitalization. The results of this pilot study are encouraging. It was found to be both feasible and acceptable to provide the intervention program to mothers during the NICU hospitalization. The effectiveness of this program needs to be assessed in a randomized controlled trial.
Article
We developed a nursery Neurobiologic Risk Score (NBRS) based on potential mechanisms of brain cell injury in preterm infants and correlated it with developmental outcome at the corrected ages of 6, 15, and 24 months. The NBRS was determined at 2 weeks of age and at the time of discharge from intensive care in 58 preterm infants with birth weights less than or equal to 1500 gm. The NBRS correlated significantly with the Bayley Scales of Infant Development, Mental Development Index (MDI) (r = -0.61 to -0.40) and Psychomotor Development Index (PDI) (r = -0.59 to -0.46), and with abnormal neurologic examination findings (r = 0.59 to 0.73) at the three testing periods. Although 12 of the 13 items composing the NBRS individually correlated with one or more outcome variables, seven items (infection, blood pH, seizures, intraventricular hemorrhage, assisted ventilation, periventricular leukomalacia, and hypoglycemia) accounted for almost all of the explained variance. Logistic regression of individual items demonstrated intraventricular hemorrhage to be the most important item for predicting the MDI at 24 months; pH was the most influential item for predicting the PDI at every testing period. A shorter, revised NBRS that included only the seven significant items demonstrated as strong a correlation with developmental outcome as the original NBRS. A revised 2-week score of greater than or equal to 5 or a discharge score of greater than or equal to 6 demonstrated 100% specificity and had a 100% positive predictive value for an abnormal outcome at 24 months of age in this group of infants. We conclude that the NBRS identifies during the intensive care nursery stay those infants at highest risk for an abnormal outcome related to nursery events. In addition, analysis of NBRS items provides insight into the relative importance of individual factors for influencing mental, motor, and neurologic outcome.
Article
We investigated the relationship between the stress of a high-risk birth and the development of symptoms of posttraumatic stress disorder in mothers. Six measures of perinatal stressors (gestational age of the baby, birth weight, length of hospital stay for the baby, a postnatal complications rating for the infant, and Apgar scores at 1 and 5 minutes) were used to predict the frequency of posttraumatic stress symptoms. Severity of infant complications, gestational age, and length of stay accounted for 35% of the variance in reports of posttraumatic stress symptoms. Both mothers of premature infants and mothers of term infants hospitalized in a neonatal intensive care unit reported significantly more symptoms of posttraumatic stress than mothers of healthy term infants (p < 0.01). We conclude that the birth of an infant at high risk, especially one with severe medical complications, can have long-term emotional consequences for the baby's mother.
Article
Maternal attachment representations were assessed using the George, Kaplan, and Main (1985) Adult Attachment Interview (AAI), and emotional availability during observed mother-child interactions was assessed using the third edition of the Emotional Availability (EA) Scales (Biringen, Robinson, & Emde, 1998). This edition of EA included four parental scales and two child scales (Maternal Sensitivity, Structuring, Nonintrusiveness and Nonhostility; and Child Responsiveness and Child Involvement). Separate Hierarchical Multiple Regressions (HMRs) were computed to examine the prediction of the separate EA dimensions from demographic information, the AAI classification, and AAI scales. These analyses indicated that each of the EA dimensions (with the exception of maternal nonintrusiveness and nonhostility) was predicted by the AAI classification and/or AAI scales. Using three-step HMRs, the strongest prediction was for maternal sensitivity where 54% of the total variance in maternal sensitivity was explained by maternal education, AAI classification, and AAI 'state of mind' scales. Maternal nonhostility was predicted by maternal education and gender of the child, with lower-income mothers and mothers of girls demonstrating greater hostility.
Article
To examine mothers' responses to having a premature infant in the neonatal intensive-care unit and to determine the degree to which they appear similar to a posttraumatic stress response. Mothers were enrolled in this descriptive, correlational study shortly before the infant was discharged from the hospital. Data were collected at enrollment and when the infant was 6 months old, corrected for prematurity. A convenience sample of 30 mothers of high-risk premature infants. None. A semistructured interview of the mothers was conducted at 6 months corrected age. Interview responses were analyzed to identify three symptoms related to posttraumatic stress disorder: re-experiencing, avoidance, and increased arousal. Other measures focused on maternal psychological well-being--neonatal intensive-care unit stress, depressive symptoms, and worry about the infant--and demographic characteristics. Infant illness severity included birth weight, length of mechanical ventilation, multiple birth, and the severity of neurological insults. All mothers interviewed had at least one posttraumatic symptom, 12 had two, and 16 had three symptoms. Twenty-six mothers reported increased arousal; re-experiencing and avoidance were reported by 24 mothers each. The number, but not the type, of posttraumatic stress symptoms was related to maternal psychological well-being. Maternal demographic characteristics, except marital status, and infant illness severity, were unrelated to posttraumatic stress symptoms. These mothers appeared to be experiencing emotional responses similar to posttraumatic stress reactions at 6 months after their child's expected birth date. Since maternal emotional responses may affect the parenting of premature infants, additional nursing research is needed provide a basis for interventions with these highly vulnerable mothers and infants.
Article
Progress in perinatal medicine has made it possible to increase the survival of very or extremely low birthweight infants. Developmental outcomes of surviving preterm infants have been analysed at the paediatric, neurological, cognitive, and behavioural levels, and a series of perinatal and environmental risk factors have been identified. The threat to the child's survival and invasive medical procedures can be very traumatic for the parents. Few empirical reports have considered post-traumatic stress reactions of the parents as a possible variable affecting a child's outcome. Some studies have described sleeping and eating problems as related to prematurity; these problems are especially critical for the parents. To examine the effects of post-traumatic reactions of the parents on sleeping and eating problems of the children. Fifty families with a premature infant (25-33 gestation weeks) and a control group of 25 families with a full term infant participated in the study. Perinatal risks were evaluated during the hospital stay. Mothers and fathers were interviewed when their children were 18 months old about the child's problems and filled in a perinatal post-traumatic stress disorder questionnaire (PPQ). The severity of the perinatal risks only partly predicts a child's problems. Independently of the perinatal risks, the intensity of the post-traumatic reactions of the parents is an important predictor of these problems. These findings suggest that the parental response to premature birth mediates the risks of later adverse outcomes. Preventive intervention should be promoted.
Article
Previous studies have shown that premature birth and the immaturity of the child can affect the quality of the parent-child relationship. The present study examines the relationship between maternal and infant interactional behavior over time and infant perinatal risk factors as well as maternal perinatal recollected traumatic experience. Few studies have explored the relationship between maternal stress and the quality of parent-infant interaction. Mother-child interaction was recorded at 6 and 18 months of infant's age, in a population of 47 preterm infants (GA<34 weeks) and 25 full-term infants, born in 1998, during a play interaction. According to the Care Index, sensitivity, control and unresponsiveness have been used to code maternal interactional characteristics, and cooperation, compliance-compulsiveness, difficulty and passivity have been used to code the infant's interactional characteristics. The level of maternal stress was evaluated with the Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ), and the infant's perinatal risk factors were assessed with the Perinatal Risk Inventory (PERI). Mothers of high-risk infants, as well as mothers that had experienced traumatic stress in the perinatal period, were less sensitive and more controlling at 6 months. The interactional behavior of the preterm infant was different from that of the full-term infant at 18 months of age, and was correlated with maternal traumatic stress but not with perinatal risk factors. These results underline the importance of maternal traumatic experience related to premature birth and its potential long lasting influence on mother-child interactional behavior.
Article
For parents, the premature birth of a child represents a traumatic event for which they are poorly prepared. To date, the focus of scientific interest has been on maternal psychological stress responses, such as anxiety and depression, or on appropriate coping mechanisms, whereas only scant attention has been paid to the traumatic aspect of the maternal experience after very low-birth-weight (VLBW) birth. The present study is the first to investigate the posttraumatic stress response of mothers after the birth of a VLBW infant in a prospective longitudinal study. Fifty mothers of VLBW infants were examined at four measuring time points (1-3 days pp, 14 days pp and 6 and 14 months pp) with respect to posttraumatic symptoms [Impact of Event Scale (IES-R)], psychiatric diagnosis (SKID I for DSM-IV) and the extent of depression [Beck Depression Inventory (BDI) and Montgomery Asberg Depression Scale (MADRS)] and anxiety [State-Trait Anxiety Inventory (STAI) and Hamilton Anxiety Scale (HAMA)]. The control group comprised a group of 30 mothers after the uncomplicated spontaneous birth of a healthy child. At all four measuring timepoints (except 6 months pp), the mothers of the premature infants recorded significantly higher values for traumatic experience and depressive symptoms and anxiety compared with the controls. In contrast to the mothers in the control group, the mothers of the premature infants displayed no significant reduction in posttraumatic symptoms (IES-total), even 14 months after birth. The results indicate that the situation of a mother who has given birth to a VLBW infant is a complex, with long-term traumatic event necessitating ongoing emotional support extending beyond the period immediately after the birth.
Article
The authors examined the prevalence of acute stress disorder (ASD) in parents of infants hospitalized in the neonatal intensive care unit (NICU). Forty parents were assessed after the birth of their infants. Parents completed self-report measures of ASD, parental stress, family environment, and coping style: 28% of parents developed symptoms of ASD. ASD was associated with female gender, alteration in parental role, family cohesiveness, and emotional restraint. Family environment and parental coping style are significantly associated with the development of trauma symptoms. Results from this study suggest potential interventions to help minimize psychological distress in parents.
Article
The objectives of this study were to assess qualitatively mothers' physical and psychological health, their perception of their child's health and development, and their difficulties with childcare from 2 months post discharge to 1 year after a very preterm delivery. The study population included all mothers who delivered before 33 weeks of amenorrhea between November 1998 and November 1999 in a Parisian maternity unit and between February 2000 and February 2001 in a maternity unit located in Rouen (France). Twenty-one of the 38 mothers contacted agreed to participate (55%). Semi-structured interviews were conducted by a clinical psychologist at the woman's home. They were taped, fully transcribed and subjected to content analysis. The main difficulties reported by mothers at 1 year were fatigue, depressive mood, anxiety and physical symptoms. Depressive mood was associated with social isolation, post-traumatic symptoms, withdrawal and feelings of guilt. Most mothers also described their child as being difficult and tiring. Mothers' reports about their own health and difficult behaviour of their child were more negative at 1 year than at 2 months post discharge. The mothers' psychological distress following a very preterm birth did not improve between 2 months post discharge and 1 year after delivery. Comprehensive follow-up care programmes should take into account this consequence of a very preterm birth and provide access to adequate psychological support, care or treatment.
Promoting mothers' ability to interact sensitively with their very-low-birthweight infant: A pilot study
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Promoting mothers' ability to interact sensitively with their very-low-birthweight infant: A pilot study
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