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Misund AR, Nerdrum P, Bråten S, Pripp AH, Diseth TH. Long-term risk of mental health problems in women experiencing preterm birth: a longitudinal study of 29 mothers. Ann Gen Psychiatry 2013; 12:33. [PMID: 24176131 PMCID: PMC4175092 DOI: 10.1186/1744-859x-12-33] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 10/23/2013] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Several studies have reported significantly higher stress levels, both short and long terms, among mothers giving preterm birth compared with mothers giving birth at term. Stress, however, is a psychological phenomenon that may present as anxiety, depression and/or trauma reactions. In this study, the long-term mental health outcomes and the prevalence of anxiety, depression and trauma reactions in women experiencing preterm birth were explored. Interactional, main effect variables and predictors were identified. METHODS Twenty-nine mothers of 35 premature children born before the 33rd week of pregnancy were assessed within 2 weeks postpartum (T0), 2 weeks after hospitalization (T1), 6 months post-term (T2), and 18 months post-term (T3). The standardized psychometric methods Impact of Event Scale (IES), General Health Questionnaire (GHQ) and State Anxiety Inventory (STAI-X1) assessed the maternal mental health outcomes. RESULTS The maternal mental health problems except state anxiety decreased from T0 to T1, but remained high and stable at T3. The prevalence of posttraumatic stress reactions (PTSR) and posttraumatic stress disorder (PTSD) at T0 and T3 was 52% and 23%, respectively. We identified the time period between T0 and T1 to have a significant main effect on mental health outcomes. The predictors of higher levels of mental health problems were preeclampsia, previous psychological treatment, age, trait anxiety and infant's postnatal intraventricular haemorrhage. Bleeding in pregnancy predicted lower levels of mental health problems. CONCLUSIONS The prevalence of maternal mental health problems remained high, emphasizing the importance of effective interventions.
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Affiliation(s)
- Aud R Misund
- Faculty of Health Sciences, University College of Oslo and Akershus, HIOA, P,O, Box 4, St, Olavs plass, N-0130 Oslo, Norway.
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102
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Abstract
Fifty-six mothers of premature infants who participated in a study to reduce symptoms of posttraumatic stress disorder (PTSD) completed the Brief COPE, a self-report inventory of coping mechanisms, the Stanford Acute Stress Reaction Questionnaire to assess acute stress disorder (ASD) and the Davidson Trauma Scale to assess PTSD. 18 % of mothers had baseline ASD while 30 % of mothers met the criteria for PTSD at the 1-month follow-up. Dysfunctional coping as measured by the Brief COPE was positively associated with elevated risk of PTSD in these mothers (RR = 1.09, 95 % CI 1.02-1.15; p = .008). Maternal education was positively associated with PTSD; each year increase in education was associated with a 17 % increase in the relative risk of PTSD at 1 month follow-up (RR = 1.17, 95 % CI 1.02-1.35; p = .03). Results suggest that dysfunctional coping is an important issue to consider in the development of PTSD in parents of premature infants.
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103
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Shaw RJ, St John N, Lilo EA, Jo B, Benitz W, Stevenson DK, Horwitz SM. Prevention of traumatic stress in mothers with preterm infants: a randomized controlled trial. Pediatrics 2013; 132:e886-94. [PMID: 23999956 PMCID: PMC3784295 DOI: 10.1542/peds.2013-1331] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The current study evaluates a treatment intervention developed with the goal of reducing symptoms of posttraumatic stress, depression, and anxiety in parents of premature infants. METHODS A total of 105 mothers of preterm infants (25-34 weeks' gestational age; >600 g) were randomized to receive a 6-session intervention developed to target parental trauma as well as facilitate infant redefinition (n = 62) or to an active comparison group (n = 43). Mothers in the intervention group received a combination of trauma-focused treatments, including psychoeducation, cognitive restructuring, progressive muscle relaxation, and development of their trauma narrative. The intervention also incorporated material targeting infant redefinition, defined as the process of changing the mother's negative perceptions of her infant and the parenting experience. RESULTS Mothers in the intervention group reported a greater reduction in both trauma symptoms (Cohen's d = 0.41, P = .023) and depression (Cohen's d = 0.59, P < .001) compared with the comparison group. Patients under both conditions improved significantly in terms of anxiety, with no differences between groups. Results of the moderator analysis showed that mothers with higher ratings of baseline NICU stress benefited more from the intervention compared with mothers who had lower ratings (P = .036). CONCLUSIONS This short, highly manualized intervention for mothers of preterm infants statistically significantly reduced symptoms of trauma and depression. The intervention is feasible, can be delivered with fidelity, and has high ratings of maternal satisfaction. Given that improvements in mothers' distress may lead to improved infant outcomes, this intervention has the potential for a high public health impact.
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Affiliation(s)
| | - Nick St John
- Division of Neonatology, Stanford University School of Medicine, Palo Alto, California; and
| | | | - Booil Jo
- Departments of Psychiatry and Behavioral Sciences and
| | - William Benitz
- Division of Neonatology, Stanford University School of Medicine, Palo Alto, California; and
| | - David K. Stevenson
- Division of Neonatology, Stanford University School of Medicine, Palo Alto, California; and
| | - Sarah M. Horwitz
- Department of Child and Adolescent Psychiatry, New York University Medical School, New York, New York
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104
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Cacciani L, Di Lallo D, Piga S, Corchia C, Carnielli V, Chiandotto V, Fertz M, Miniaci S, Rusconi F, Caravale B, Cuttini M. Interaction of child disability and stressful life events in predicting maternal psychological health. Results of an area-based study of very preterm infants at two years corrected age. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:3433-3441. [PMID: 23920026 DOI: 10.1016/j.ridd.2013.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/10/2013] [Accepted: 07/10/2013] [Indexed: 06/02/2023]
Abstract
This study aimed at exploring the relationship between severe neuromotor and/or sensory disability in very preterm infants assessed at 2 years corrected age and their mothers' psychological health. Data on 581 Italian singletons born at 22-31 weeks of gestation in five Italian regions and their mothers were analyzed. Maternal psychological distress was measured through the General Health Questionnaire short version (GHQ-12). The prevalence of any maternal distress (GHQ scores ≥ 2) and of clinical distress (scores ≥ 5) were 31.3% and 8.1% respectively. At multivariable analysis, we found a statistically significant association between child's disability and mothers' GHQ scoring ≥ 5 (OR 3.45, 95% CI 1.07-11.15). Also lower maternal education appeared to increase the likelihood of psychological distress (OR 1.38, 95% CI 1.14-1.66). The impact of child disability was weaker in women who had experienced additional stressful life events since delivery, pointing to the existence of a "ceiling" effect. Maternal psychological assessment and support should be included in follow-up programs targeting very preterm infants.
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Affiliation(s)
- Laura Cacciani
- Regional Health Agency of Lazio, Via di S. Costanza 53, 00198 Rome, Italy.
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105
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Diffin J, Shields MD, Cruise S, Johnston L. Parents' experiences of caring for their infant following surgery in the neonatal period: A literature review. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.jnn.2012.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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106
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Bener A. Psychological distress among postpartum mothers of preterm infants and associated factors: a neglected public health problem. BRAZILIAN JOURNAL OF PSYCHIATRY 2013; 35:231-6. [DOI: 10.1590/1516-4446-2012-0821] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 05/14/2012] [Indexed: 11/21/2022]
Affiliation(s)
- Abdulbari Bener
- Weill Cornell Medical College, Qatar; The University of Manchester, UK
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107
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Shaw RJ, Sweester CJ, St John N, Lilo E, Corcoran JB, Jo B, Howell SHK, Benitz WE, Feinstein N, Melnyk B, Horwitz SM. Prevention of postpartum traumatic stress in mothers with preterm infants: manual development and evaluation. Issues Ment Health Nurs 2013; 34:578-86. [PMID: 23909669 PMCID: PMC3904539 DOI: 10.3109/01612840.2013.789943] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Premature birth has been associated with multiple adverse maternal psychological outcomes that include depression, anxiety, and trauma as well as adverse effects on maternal coping ability and parenting style. Infants who are premature are more likely to have poorer cognitive and developmental functioning and, thus, may be harder to parent, both as infants and as they get older. In response to these findings, a number of educational and behavioral interventions have been developed that target maternal psychological functioning, parenting, and aspects of the parent-infant relationship. The current study aimed to both develop and evaluate a treatment that integrates, for the first time, effective interventions for reducing symptoms of posttraumatic stress disorder (PTSD) and enhancing maternal-infant interactions. Conclusions from the study indicate that the intervention is feasible, able to be implemented with a high level of fidelity, and is rated as highly satisfactory by participants. Though encouraging, these findings are preliminary, and future studies should strive to reproduce these findings with a larger sample size and a comparison group.
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Affiliation(s)
- Richard J Shaw
- Division of Child and Adolescent Psychiatry, Stanford University School of Medicine, Palo Alto, California 94305-5719, USA.
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108
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Gangi S, Dente D, Bacchio E, Giampietro S, Terrin G, De Curtis M. Posttraumatic Stress Disorder in Parents of Premature Birth Neonates. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.sbspro.2013.06.365] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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109
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Hsu HC, Jeng SF. Differential Effects of Still-Face Interaction on Mothers of Term and Preterm Infants. Infant Ment Health J 2013. [DOI: 10.1002/imhj.21386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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110
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Caplan A. Psychological impact of esophageal atresia: review of the research and clinical evidence. Dis Esophagus 2013; 26:392-400. [PMID: 23679030 DOI: 10.1111/dote.12056] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal atresia (EA) occurs in one out of 2500 to 4500 live births. As the vast majority of infants are now surviving neonatal corrective surgery, the focus has shifted from mortality to morbidity associated with EA. However, little is known about its psychological morbidity. This paper synthesizes research and clinical evidence to highlight the psychological sequelae of EA, including its impact on parents' psychological functioning and its effects on child development from infancy to adulthood. Whether it is discovered at birth or prenatally, EA is a psychologically traumatic event, and parents are at risk for developing traumatic stress reactions following diagnosis. Neonatal surgery and intensive care, risk of complications, associated anomalies, and genetic etiologies multiply risk for parents' acute and post-traumatic stress disorders (PTSD). Parental PTSD has a negative impact on infant and child development through its effects on parenting skills and parent-child interactions. EA children are also at risk for PTSD because of invasive and stressful procedures they undergo during the neonatal period. Consequences of EA can have an important long-term impact on children's psychological and social development. The scant studies pertaining to cognitive functioning suggest that EA does not affect mental development during infancy, but may be associated with deficits as children reach school age. Long-term sequelae are unclear because psychological functioning in adults has not yet been adequately examined. Research and clinical evidence of psychological morbidity associated with EA has implications for clinical practice. Psychological support for parents must begin during the neonatal period and should continue as an integral component of long-term follow up for both children and parents. Support is best provided within the context of a multidisciplinary treatment team that follows patients from birth through childhood and adolescence. Psychological follow up should continue into adulthood, as patients grow up and transition from pediatric to adult health-care settings.
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Affiliation(s)
- A Caplan
- Division of Gastroenterology, Hepatology, and Nutrition, Sainte-Justine University Hospital Center, Montreal, Quebec, Canada.
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111
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Arnold L, Sawyer A, Rabe H, Abbott J, Gyte G, Duley L, Ayers S. Parents' first moments with their very preterm babies: a qualitative study. BMJ Open 2013; 3:e002487. [PMID: 23550091 PMCID: PMC3641451 DOI: 10.1136/bmjopen-2012-002487] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 03/01/2013] [Accepted: 03/04/2013] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To assess parents' first experiences of their very preterm babies and the neonatal intensive care unit (NICU). DESIGN Qualitative study using semistructured interviews. PARTICIPANTS 32 mothers and 7 fathers of very preterm babies (<32 weeks gestation). SETTING Three neonatal units in tertiary care hospitals in South East England. RESULTS Five themes were identified. The first describes parents' blurred recall of the birth. The second shows the anticipation of seeing and touching their baby for the first time was characterised by contrasting emotions, with some parents feeling scared and others excited about the event. The third theme describes parents' first sight and touch of their babies and their 'rollercoaster' of emotions during this time. It also highlights the importance of touch to trigger and strengthen the parent-baby bond. However, some parents were worried that touching or holding the baby might transmit infection or interfere with care. The fourth theme captures parents' impressions of NICU and how overwhelming this was particularly for parents who had not toured NICU beforehand or whose first sight of their baby was on NICU. The final theme captures unique experiences of fathers, in particular that many felt excluded and confused about their role. CONCLUSIONS This study informs family-centred care by providing insight into the experiences of parents of very preterm infants at a time when they are most in need of support. Clinical implications include the importance of offering parents preparatory tours of the NICU and including fathers.
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Affiliation(s)
- Leah Arnold
- School of Psychology, University of Sussex, Brighton, East Sussex, UK
| | - Alexandra Sawyer
- School of Psychology, University of Sussex, Brighton, East Sussex, UK
| | - Heike Rabe
- Academic Department of Paediatrics, Brighton and Sussex University Hospitals Trust, Royal Alexandra Children's Hospital, Brighton, UK
| | - Jane Abbott
- Bliss (The Special Care Baby Charity), London, UK
| | | | - Lelia Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Susan Ayers
- School of Health Sciences, City University London, London, UK
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112
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Scannavino CSS, Sorato DB, Lima MP, Franco AHJ, Martins MP, Morais Júnior JC, Bueno PRT, Rezende FF, Valério NI. Psico-Oncologia: atuação do psicólogo no Hospital de Câncer de Barretos. PSICOLOGIA USP 2013. [DOI: 10.1590/s0103-65642013000100003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A Psico-Oncologia surgiu a partir da necessidade do acompanhamento psicológico ao paciente com câncer, a sua família e à equipe que o acompanha. O papel do psicólogo em oncologia propõe o apoio psicossocial e psicoterapêutico diante do impacto do diagnóstico e de suas consequências e mostra a possibilidade de auxílio para melhor enfrentamento e qualidade de vida do doente e de seus familiares. O objetivo deste relato consiste em descrever a atuação desenvolvida por psicólogos do Serviço de Psicologia do Hospital de Câncer de Barretos/Fundação Pio XII - SP, uma instituição médica especializada em oncologia.
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113
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Morisod-Harari M, Borghini A, Hohlfeld P, Forcada-Guex M, Muller-Nix C. Influence d’une hospitalisation prénatale sur les facteurs de stress parentaux lors d’une naissance prématurée. ACTA ACUST UNITED AC 2013; 42:64-70. [DOI: 10.1016/j.jgyn.2012.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 07/05/2012] [Accepted: 07/13/2012] [Indexed: 11/28/2022]
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114
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The impact of subjective birth experiences on post-traumatic stress symptoms: a longitudinal study. Arch Womens Ment Health 2013; 16:1-10. [PMID: 22940723 DOI: 10.1007/s00737-012-0301-3] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 08/07/2012] [Indexed: 10/27/2022]
Abstract
The aim of this prospective study was to examine the etiology of post-traumatic stress symptoms following childbirth within a transactional framework of stress. Participants were women (N = 1,499) from the Akershus Birth Cohort. These women were followed from pregnancy to 8 weeks postpartum. We modeled predisposing factors (e.g., fear of childbirth) and precipitating factors (subjective and objective birth experiences) as predictors of post-traumatic stress symptoms. Post-traumatic stress symptoms were measured by means of the Impact of Event Scale, objective birth experiences by means of birth journals, and subjective birth experiences by means of three questions. A structural equation model showed that subjective birth experiences had the highest association with post-traumatic stress symptoms. Moreover, they mediated the effect of predisposing factors and objective birth experiences. The results suggest that women's subjective birth experiences are the most important factor in the development of post-traumatic stress symptoms following childbirth.
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115
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Lasiuk GC, Comeau T, Newburn-Cook C. Unexpected: an interpretive description of parental traumas' associated with preterm birth. BMC Pregnancy Childbirth 2013; 13 Suppl 1:S13. [PMID: 23445715 PMCID: PMC3561145 DOI: 10.1186/1471-2393-13-s1-s13] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preterm birth (PTB) places a considerable emotional, psychological, and financial burden on parents, families, health care resources, and society as a whole. Efforts to estimate these costs have typically considered the direct medical costs of the initial hospital and outpatient follow-up care but have not considered non-financial costs associated with PTB such as adverse psychosocial and emotional effects, family disruption, strain on relationships, alterations in self-esteem, and deterioration in physical and mental health. The aim of this inquiry is to understand parents' experience of PTB to inform the design of subsequent studies of the direct and indirect cost of PTB. The study highlights the traumatic nature of having a child born preterm and discusses implications for clinical care and further research. METHOD Through interviews and focus groups, this interpretive descriptive study explored parents' experiences of PTB. The interviews were audiotaped, transcribed, and analyzed for themes. Analysis was ongoing throughout the study and in subsequent interviews, parents were asked to reflect and elaborate on the emerging themes as they were identified. RESULTS PTB is a traumatic event that shattered parents' taken-for-granted expectations of parenthood. For parents in our study, the trauma they experienced was not related to infant characteristics (e.g., gestational age, birth weight, Apgar scores, or length of stay in the NICU), but rather to prolonged uncertainty, lack of agency, disruptions in meaning systems, and alterations in parental role expectations. Our findings help to explain why things like breast feeding, kangaroo care, and family centered practices are so meaningful to parents in the NICU. As well as helping to (re)construct their role as parents, these activities afford parents a sense of agency, thereby moderating their own helplessness. CONCLUSION These findings underscore the traumatic nature and resultant psychological distress related to PTB. Obstetrical and neonatal healthcare providers need to be educated about the symptoms of Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) to better understand and support parents' efforts to adapt and to make appropriate referrals if problems develop. Longitudinal economic studies must consider the psychosocial implications of PTB to in order to determine the total related costs.
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Affiliation(s)
- Gerri C Lasiuk
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405-87 Avenue, University of Alberta, Edmonton Alberta, Canada T6G 1C9.
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116
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Sawyer A, Rabe H, Abbott J, Gyte G, Duley L, Ayers S. Parents' experiences and satisfaction with care during the birth of their very preterm baby: a qualitative study. BJOG 2013; 120:637-43. [PMID: 23289929 PMCID: PMC3613739 DOI: 10.1111/1471-0528.12104] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2012] [Indexed: 11/29/2022]
Abstract
Objective To assess parents' experiences and satisfaction with care during very preterm birth and to identify domains associated with positive and negative experiences of care. Design Qualitative study using semi-structured interviews. Setting Three neonatal units in tertiary care hospitals in South-East England. Population Thirty-two mothers and seven fathers who had a baby born before 32 weeks of gestation and spoke English well. Methods Semi-structured interviews were conducted. Results were analysed using thematic analysis. Main outcome measures Participants' experiences and satisfaction with care during the birth of their preterm baby. Results Overall, 80% of participants were extremely satisfied with the care during the birth of their preterm baby, seven were generally satisfied but felt some things could be improved and one was dissatisfied. Four key determinants of experiences of care were identified: staff professionalism, which included information and explanation, being calm in a crisis, appearing confident and in control, and conversely not listening to the woman; staff empathy, which included caring and emotional support, and encouragement and reassurance; involvement of the father; and birth environment. Conclusions Although the determinants of experiences of care are generally consistent with previous research on term births, unique factors to preterm birth were identified. These were the importance of the staff appearing calm during the birth, and the staff portraying confidence and taking control during the birth. Women valued being listened to, and both they and their partners valued staff helping fathers to feel involved during the birth.
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Affiliation(s)
- A Sawyer
- School of Psychology, University of Sussex, Brighton, UK
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117
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Fathers with PTSD and depression in pregnancies complicated by preterm preeclampsia or PPROM. Arch Gynecol Obstet 2012. [DOI: 10.1007/s00404-012-2611-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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118
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Andersen LB, Melvaer LB, Videbech P, Lamont RF, Joergensen JS. Risk factors for developing post-traumatic stress disorder following childbirth: a systematic review. Acta Obstet Gynecol Scand 2012; 91:1261-72. [PMID: 22670573 DOI: 10.1111/j.1600-0412.2012.01476.x] [Citation(s) in RCA: 199] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Approximately 1-2% of women suffer from post-traumatic stress disorder (PTSD) postnatally. This review aims to elucidate how women at risk can be identified. METHODS A systematic search of the published literature was carried out using the MEDLINE database (November 2003 to 29 October 2010) with both MeSH terms and free text. Thirty-one studies were considered appropriate for qualitative synthesis. Articles were included on the basis of (a) publication pertaining to PTSD following childbirth, (b) study carried out in Western Europe and (c) publication written in English. The results were primarily based on observational studies. The literature was thoroughly read and results were compiled. Furthermore, a novel quality rating system was employed to minimize the impact of bias. RESULTS Subjective distress in labor and obstetrical emergencies were the most important risk factors. Infant complications, low support during labor and delivery, psychological difficulties in pregnancy, previous traumatic experiences, and obstetrical emergencies were identified as risk factors. CONCLUSIONS We have identified factors both strongly associated and non-associated with PTSD following childbirth. While the literature is limited by methodological shortcomings, a hypothesis regarding the development of PTSD is outlined, and recommendations with respect to screening and future research are provided.
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Affiliation(s)
- Louise B Andersen
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
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119
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Brecht C, Shaw RJ, Horwitz SM, John NHS. Effectiveness of therapeutic behavioral interventions for parents of low birth weight premature infants: A review. Infant Ment Health J 2012; 33:651-665. [PMID: 24532861 PMCID: PMC3925006 DOI: 10.1002/imhj.21349] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Premature birth has been associated with a number of adverse maternal psychological outcomes that include depression, anxiety, and trauma as well as adverse effects on maternal coping ability and parenting style. Infants and children who were premature are more likely to have poorer cognitive and developmental functioning and, thus, may be harder to parent. In response to these findings, there have been a number of educational and behavioral interventions developed that target maternal psychological functioning, parenting and aspects of the parent-infant relationship. Since the last comprehensive review of this topic in 2002, there have been a significant number of developments in the quality of the studies conducted and the theoretical models that address the experience of parents of premature infants. In the current review, eighteen new interventions were identified and grouped into four categories based on treatment length and the target of the intervention. Findings suggest a trend towards early, brief interventions that are theoretically based, specifically target parent trauma, and utilize cognitive behavioral techniques. Although it is difficult to generalize study findings, conclusions from the review suggest that targeted interventions may have positive effects on both maternal and infant outcomes.
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Affiliation(s)
- Carrie Brecht
- Department of Psychiatry and Behavioral Sciences and Department of Psychology, PGSP-Stanford Psy.D. Consortium
| | - Richard J Shaw
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Sarah M Horwitz
- Department of Psychiatry, New York University School of Medicine
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120
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Abstract
PURPOSE : To determine whether significant symptoms of acute stress disorder (ASD) are present in mothers of premature infants in the neonatal intensive care unit (NICU). SUBJECTS : Forty mothers of premature infants born less than 33 weeks and admitted into NICU. DESIGN : Prospective, cohort, within-subjects. METHODS : Mothers completed the Stanford Acute Stress Reaction Questionnaire, Edinburgh Postnatal Depression Scale, and the Acute Stress Disorder Interview to explore the number and severity of stress-related symptoms at 2 separate time periods, 7 to 10 days after birth, and 1 month after birth. RESULTS : Twenty-eight percent of the mothers met diagnostic criteria of ASD at 7 to 10 days after birth, and at 1 month after birth ASD symptoms persisted. The majority of the mothers described premature birth as a traumatic stressor. The most commonly met criteria were dissociation and anxiety. Significant symptoms of depression were found in 43% of mothers and persisted 1 month after birth. Rates of depression and moderate to severe symptoms of ASD were significantly related in mothers at 1 week and at 1 month after birth. CONCLUSIONS : The premature birth experience is traumatic for mothers and may lead to various emotional responses including stress-related symptoms such as depression and/or ASD. Mothers with significant symptoms of depression and those with symptoms of stress seem to be more at risk for developing symptoms of ASD.
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121
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Lilienfeld MV, Wendrich D, Ganseforth C, Lehmkuhl G, Roth B, Nußbeck S, Mehler K, Kribs A. Mutter-Kind-Interaktion bei Frühgeborenen. KINDHEIT UND ENTWICKLUNG 2012. [DOI: 10.1026/0942-5403/a000078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Die Mutter-Kind-Interaktion (MKI) Frühgeborener ist im Vergleich zu Reifgeborenen durch eine erhöhte mütterliche Intrusivität und Kontrolle gekennzeichnet. Analysiert wurde die MKI von Früh- und Reifgeborenen im Alter von 36 Monaten. 39 Frühgeborene < 1500 g (Studiengruppe) und 26 Reifgeborene (Kontrollgruppe) wurden im korrigierten Alter von 36 Monaten mittels Mannheimer Methode zur standardisierten Beobachtung der MKI im Kleinkindalter untersucht. Hierzu werden zwei fünfminütige Interaktionssituationen videographisch aufgezeichnet. Für die Lernsituation konnte nachgewiesen werden, dass die Mütter Frühgeborener weniger supportiv, häufiger restriktiv und unangemessen steuern, „negativer“ auf ihre Kinder reagieren und häufiger „negative“ Interaktionsauffälligkeiten zeigen. In der Spielsituation zeigte sich, dass Mütter frühgeborener Kinder häufiger negative Interaktionsauffälligkeiten sowie eine höhere negative Gestimmtheit und eine unangemessenere Steuerung aufweisen. Die Lernsituation zeigte sich in der Gruppe der Frühgeborenen als die „schwierigere“ Interaktion. Die Problematik der Mutter- Kind-Interaktion Frühgeborener bedarf besonderer Beachtung sowie früher Interventionen.
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Affiliation(s)
- Mirjam von Lilienfeld
- Universitätsklinik und Poliklinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Uniklinik Köln
| | - Daniela Wendrich
- Universitätsklinik und Poliklinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Uniklinik Köln
| | - Catharina Ganseforth
- Universitätsklinik und Poliklinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Uniklinik Köln
| | - Gerd Lehmkuhl
- Universitätsklinik und Poliklinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Uniklinik Köln
| | - Bernhard Roth
- Universitätsklinik für Kinder- und Jugendmedizin, Bereich Neonatologie und pädiatrische Intensivmedizin, Uniklinik Köln
| | - Susanne Nußbeck
- Humanwissenschaftliche Fakultät der Universität zu Köln, Department für Heilpädagogik, Bereich Heilpädagogische Psychologie
| | - Katrin Mehler
- Universitätsklinik für Kinder- und Jugendmedizin, Bereich Neonatologie und pädiatrische Intensivmedizin, Uniklinik Köln
| | - Angela Kribs
- Universitätsklinik für Kinder- und Jugendmedizin, Bereich Neonatologie und pädiatrische Intensivmedizin, Uniklinik Köln
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122
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Baum N, Weidberg Z, Osher Y, Kohelet D. No longer pregnant, not yet a mother: giving birth prematurely to a very-low-birth-weight baby. QUALITATIVE HEALTH RESEARCH 2012; 22:595-606. [PMID: 21926386 DOI: 10.1177/1049732311422899] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
In this article we present the findings of a qualitative examination of 30 mothers of very-low-birth-weight babies. Interviews conducted with the mothers when the babies were still in neonatal hospitalization show that virtually all the mothers described their delivery both as a traumatic event, and as a nonevent in which they felt that they barely participated. Most of them blamed themselves for not carrying full term, some blamed others, and some believed the premature delivery saved their baby's life. Following their truncated pregnancies, their "nonparticipation" in the delivery, and their separation from their newborn immediately after the delivery, virtually all the women reported difficulty grasping that they were mothers. Many reported a sense of loss, emptiness, and frustration that the baby was no longer inside. The women took a variety of measures, including magical means and parenting behaviors, to safeguard their vulnerable babies and to become mothers within the constraints of the neonatal unit.
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123
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Gambina I, Soldera G, Benevento B, Trivellato P, Visentin S, Cavallin F, Trevisanuto D, Zanardo V. Postpartum psychosocial distress and late preterm delivery. J Reprod Infant Psychol 2011. [DOI: 10.1080/02646838.2011.653962] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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124
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The cues and care randomized controlled trial of a neonatal intensive care unit intervention: effects on maternal psychological distress and mother-infant interaction. J Dev Behav Pediatr 2011; 32:591-9. [PMID: 21720259 DOI: 10.1097/dbp.0b013e318227b3dc] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study tested the efficacy of a brief intervention (Cues program) with mothers of very low birth weight (VLBW <1500 g) infants. The primary hypothesis was that mothers in the Cues program would report lower levels of anxiety compared with mothers in the control group. Secondary hypotheses examined whether Cues mothers would report less stress, depression, and role restriction, and exhibit more sensitive interactive behavior, than control group mothers. METHODS A total of 121 mothers of VLBW infants were randomly assigned to either the experimental (Cues) intervention or an attention control (Care) condition. The Cues program combined training to reduce anxiety and enhance sensitivity. The control group received general information about infant care. Both programs were initiated during the neonatal intensive care unit stay. Maternal anxiety, stress, depression, and demographic variables were evaluated at baseline, prior to randomization. Postintervention outcomes were assessed during a home visit when the infant was ∼6 to 8 weeks of corrected age. RESULTS Although mothers in the Cues group demonstrated greater knowledge of the content of the experimental intervention than mothers in the Care group, the groups did not differ in levels of anxiety, depression, and symptoms of posttraumatic stress. They were similar in their reports of parental role restrictions and stress related to the infant's appearance and behavior. Cues and Care group mothers were equally sensitive in interaction with their infants. CONCLUSION Nonspecific attention was as effective as an early skill-based intervention in reducing maternal anxiety and enhancing sensitive behavior in mothers of VLBW infants.
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O father, where art thou? Parental NICU visiting patterns during the first 28 days of life of very low-birth-weight infants. J Perinat Neonatal Nurs 2011; 25:342-8. [PMID: 22071618 DOI: 10.1097/jpn.0b013e318233b8c3] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To study the frequency and duration of parental visits to neonatal intensive care units (NICU) during the first 28 days of life of preterm infants in relation to medical variables, sociodemographic factors, and subsequent outpatient follow-up examinations. Retrospective chart review of 127 infants with a birth weight less than 1500 g born between Jan 1, 2009, and Dec 31, 2009, at 2 tertiary NICUs. The average frequency of parental visits during the first 28 days of life declined significantly over time (P < .05) while the duration of visits remained constant. Average frequency and duration of visits per day were consistently lower in fathers than in mothers (median [interquartile range]: 0.6 [0.4-1.0] per day vs 1.1 [0.9-1.4] per day, 72.5 [32.1-108.9 [min/d vs 133.4 [75.4-174.3] min/d). While a history of treatment for infertility was correlated with significantly more frequent and longer parental NICU visits in the first 2 weeks, having older children at home was correlated with shorter visits during the first week. Visiting patterns showed no relation to attendance at follow-up examinations at 6 months corrected age. Mothers spend more time with their preterm infants in NICUs than fathers. We suggest measures to increase paternal involvement with hospitalized preterm infants.
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126
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Beck CT, Gable RK, Sakala C, Declercq ER. Posttraumatic stress disorder in new mothers: results from a two-stage U.S. national survey. Birth 2011; 38:216-27. [PMID: 21884230 DOI: 10.1111/j.1523-536x.2011.00475.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prevalence rates of women in community samples who screened positive for meeting the DSM-IV criteria for posttraumatic stress disorder after childbirth range from 1.7 to 9 percent. A positive screen indicates a high likelihood of this postpartum anxiety disorder. The objective of this analysis was to examine the results that focus on the posttraumatic stress disorder data obtained from a two-stage United States national survey conducted by Childbirth Connection: Listening to Mothers II (LTM II) and Listening to Mothers II Postpartum Survey (LTM II/PP). METHODS In the LTM II study, 1,373 women completed the survey online, and 200 mothers were interviewed by telephone. The same mothers were recontacted and asked to complete a second questionnaire 6 months later and of those, 859 women completed the online survey and 44 a telephone interview. Data obtained from three instruments are reported in this article: Posttraumatic Stress Disorder Symptom Scale-Self Report (PSS-SR), Postpartum Depression Screening Scale (PDSS), and the Patient Health Questionnaire-2 (PHQ-2). RESULTS Nine percent of the sample screened positive for meeting the diagnostic criteria of posttraumatic stress disorder after childbirth as determined by responses on the PSS-SR. A total of 18 percent of women scored above the cutoff score on the PSS-SR, which indicated that they were experiencing elevated levels of posttraumatic stress symptoms. The following variables were significantly related to elevated posttraumatic stress symptoms levels: low partner support, elevated postpartum depressive symptoms, more physical problems since birth, and less health-promoting behaviors. In addition, eight variables significantly differentiated women who had elevated posttraumatic stress symptom levels from those who did not: no private health insurance, unplanned pregnancy, pressure to have an induction and epidural analgesia, planned cesarean birth, not breastfeeding as long as wanted, not exclusively breastfeeding at 1 month, and consulting with a clinician about mental well-being since birth. A stepwise multiple regression revealed that two predictor variables significantly explained 55 percent of the variance in posttraumatic stress symptom scores: depressive symptom scores on the PHQ-2 and total number of physical symptoms women were experiencing at the time they completed the LTM II/PP survey. CONCLUSION In this two-stage national survey the high percentage of mothers who screened positive for meeting all the DSM-IV criteria for a posttraumatic stress disorder diagnosis is a sobering statistic.
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Hoedjes M, Berks D, Vogel I, Franx A, Visser W, Duvekot JJ, Habbema JDF, Steegers EAP, Raat H. Symptoms of post-traumatic stress after preeclampsia. J Psychosom Obstet Gynaecol 2011; 32:126-34. [PMID: 21824043 DOI: 10.3109/0167482x.2011.599460] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
This study describes the prevalence of postpartum post-traumatic stress disorder (PTSD) based on the DSM-IV criteria, including its symptoms of intrusion, avoidance and hyperarousal after pregnancies complicated by preeclampsia, and examines which variables are associated with PTSD and its symptoms. Women whose pregnancies were complicated by preeclampsia completed the Self-Rating Inventory for PTSD at 6 and 12 weeks postpartum: 149 women completed this questionnaire on at least one time point. Logistic regression analyses were used to examine associations with PTSD and its symptoms. Results showed that the prevalence of PTSD was 8.6% at 6 weeks, and 5.1% at 12 weeks postpartum; 21.9% of the study sample experienced postpartum symptoms of intrusion at 6 weeks postpartum (11.7% at 12 weeks), 9.4% symptoms of avoidance (8.0% at 12 weeks), and 28.9% symptoms of hyperarousal (20.4% at 12 weeks). Younger age, severe preeclampsia, cesarean section, lower gestational age, lower birth weight, admission to the neonatal intensive care unit, and perinatal death were found to be associated with PTSD and its symptoms. There was a relatively high prevalence of postpartum symptoms of PTSD among women after preeclampsia. The prevalence was highest among younger women who experienced more adverse pregnancy outcomes.
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Affiliation(s)
- Meeke Hoedjes
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands.
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128
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Giacobbe A, Maggio Savasta L, De Dominici R, De Vivo A, Giacobbe V, Grasso R, Triolo O, Mancuso A. The influence of planned kinds of delivery on pregnant women’s emotional state. J Matern Fetal Neonatal Med 2011; 25:1188-90. [DOI: 10.3109/14767058.2011.600794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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129
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Binder WS, Zeltzer LK, Simmons CF, Mirocha J, Pandya A. The Father in the Hallway: Posttraumatic Stress Reactions in Fathers of NICU Babies. Psychiatr Ann 2011. [DOI: 10.3928/00485713-20110727-05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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130
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Vanderbilt D, Gleason MM. Mental health concerns of the premature infant through the lifespan. Pediatr Clin North Am 2011; 58:815-32, ix. [PMID: 21855709 DOI: 10.1016/j.pcl.2011.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Because of increased survival rates, neurodevelopmental issues, chronic medical problems, and sometimes complex family issues involved with prematurity, mental health clinicians commonly assess preterm clients and manage their behavioral and mental health problems. Understanding prematurity survival and neurodevelopmental outcomes is important for contextualizing the mental health problems seen in this high-risk population. This article provides a brief overview of prematurity outcomes in the domains of prematurity relevant to practicing child psychiatrists. Prematurity is also examined as it relates to parental mental health challenges, infant mental health outcomes, high frequency attention problems, and psychiatric disorders. The complex interactions between prematurity and family well-being are also highlighted. Finally, evidence-based treatment modalities involved in prevention and management are explored.
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Affiliation(s)
- Douglas Vanderbilt
- Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
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131
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Gungor I, Oskay U, Beji NK. Biopsychosocial risk factors for preterm birth and postpartum emotional well-being: a case-control study on Turkish women without chronic illnesses. J Clin Nurs 2011; 20:653-65. [PMID: 21320194 DOI: 10.1111/j.1365-2702.2010.03532.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS AND OBJECTIVES The study aimed to determine bio-psycho-social risk factors for preterm birth in a sample of Turkish women without chronic illnesses and evaluate their anxiety and depression in early postpartum period. BACKGROUND Preterm birth is a devastating event with long-term health and social implications. Studies have identified several risk factors; however, the contribution of these causes differs by ethnic groups. DESIGN This case-control study was conducted in a tertiary hospital in Istanbul over one year. In total, 149 preterm mothers were included in the case group and 150 term mothers who delivered in the same day with a case group woman were included in the control group. Chronic illnesses and anomalies were excluded. METHOD Data were gathered using a form that addressed risk factors for preterm birth. Multidimensional Scale of Perceived Social Support, Beck Depression Inventory and Spielberger's State-Trait Anxiety Inventory were administered within 24-72 hours after birth. RESULTS Logistic regression analysis revealed that partner's lower education (≤ 8 years), history of preterm birth, antenatal hospitalisation, genitourinary infection and irregular prenatal care were significant risk factors. Perceived social support from family and friends were significantly lower in preterm group. Preterm mothers experienced significantly more anxiety and depressive symptoms in early postpartum. CONCLUSION Many of the socio-economical and obstetric causes of preterm births were similar to other countries with higher preterm birth rates. Preterm births were associated with lower social support along with more anxiety and depressive symptoms in early postpartum. RELEVANCE TO CLINICAL PRACTICE Women who have established risk factors can be targeted for more intensive antenatal care for the prevention of preterm birth. Increased maternal anxiety and depression reveal the necessity of emotional support immediately after birth.
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Affiliation(s)
- Ilkay Gungor
- Department of Obstetric and Gynecologic Nursing, Istanbul University Florence Nightingale School of Nursing, Istanbul, Turkey.
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132
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Hesse M, Guldager S, Holm Linneberg I. Convergent validity of MCMI-III clinical syndrome scales. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2011; 51:172-84. [DOI: 10.1111/j.2044-8260.2011.02019.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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133
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Pizur-Barnekow K, Erickson S. Perinatal Posttraumatic Stress Disorder: Implications for Occupational Therapy in Early Intervention Practice. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/0164212x.2011.566165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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134
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Brummelte S, Grunau RE, Synnes AR, Whitfield MF, Petrie-Thomas J. Declining cognitive development from 8 to 18 months in preterm children predicts persisting higher parenting stress. Early Hum Dev 2011; 87:273-80. [PMID: 21334150 DOI: 10.1016/j.earlhumdev.2011.01.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 12/31/2010] [Accepted: 01/18/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Higher parenting stress in mothers of children born very preterm may be in part a response to poorer neurobehavioral development, reflecting realistic concerns in addition to adaptation to the trauma of preterm delivery. To our knowledge, there are few longitudinal studies of parenting stress that have addressed child cognitive competence. AIMS To examine parenting stress in preterm and full-term children at 8 and 18 months corrected chronological age (CCA), in relation to child cognitive development and behavior. SUBJECTS Participants were N=152 children (98 preterm born ≤32 weeks gestation, and 54 full-term) seen at 8 and 18 months CCA, and the primary caregiver parent. STUDY DESIGN/OUTCOME MEASURES: The Parenting Stress Index questionnaire was completed by a parent, child interactive behavior was videotaped, and the Bayley Scales of Infant Development (BSID II, Mental Development Index; MDI) were administered at both ages. RESULTS Total Parenting Stress was higher in preterm than full-term children at 8 and 18 months CCA (p<.02), accounted for primarily by the Child domain. Hierarchical regression showed (after controlling for neonatal risk, number of children in the home, child interactive behavior and maternal education) that decreasing Bayley MDI scores from 8 to 18 months CCA predicted higher parenting stress for preterm children. For full-term children, number of children in the home and child interactive behavior predicted parental stress at 18 months. CONCLUSION Higher parenting stress persisting to 18 months CCA in preterm children may partly reflect realistic parental concerns with their child's development.
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Affiliation(s)
- Susanne Brummelte
- Developmental Neurosciences & Child Health, Child and Family Research Institute, Vancouver, BC, Canada
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135
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Stramrood CAI, Wessel I, Doornbos B, Aarnoudse JG, van den Berg PP, Schultz WCMW, van Pampus MG. Posttraumatic Stress Disorder Following Preeclampsia and PPROM. Reprod Sci 2011; 18:645-53. [DOI: 10.1177/1933719110395402] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- C. A. I. Stramrood
- Department of Obstetrics & Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - I. Wessel
- Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands
| | - B. Doornbos
- University Center for Psychiatry, Groningen, The Netherlands
| | - J. G. Aarnoudse
- Department of Obstetrics & Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - P. P. van den Berg
- Department of Obstetrics & Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - W. C. M. Weijmar Schultz
- Department of Obstetrics & Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - M. G. van Pampus
- Department of Obstetrics & Gynecology, University Medical Center Groningen, Groningen, The Netherlands
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136
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Shah PE, Clements M, Poehlmann J. Maternal resolution of grief after preterm birth: implications for infant attachment security. Pediatrics 2011; 127:284-92. [PMID: 21242223 PMCID: PMC3025424 DOI: 10.1542/peds.2010-1080] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study explored the association between mothers' unresolved grief regarding their infant's preterm birth and infant-mother attachment security. We hypothesized that mothers with unresolved grief would be more likely to have insecurely attached infants at 16 months and that this association would be partially mediated by maternal interaction quality. METHODS This longitudinal study focused on 74 preterm infants (age of <36 weeks) and their mothers who were part of a larger study of high-risk infants. The present analysis included assessment of neonatal and socioeconomic risks at NICU discharge; maternal depression, Reaction to Preterm Birth Interview findings, and quality of parenting at a postterm age of 9 months; and infant-mother attachment at postterm age of 16 months. Associations among findings of grief resolution with the Reaction to Preterm Birth Interview, quality of parenting interactions, and attachment security were explored by using relative risk ratios and logistic and multivariate regression models. RESULTS The relative risk of developing insecure attachment when mothers had unresolved grief was 1.59 (95% confidence interval: 1.03-2.44). Controlling for covariates (adjusted odds ratio: 2.94), maternal feelings of resolved grief regarding the preterm birth experience were associated with secure infant-mother attachment at 16 months. Maternal grief resolution and interaction quality were independent predictors of attachment security. CONCLUSION Maternal grief resolution regarding the experience of preterm birth and the quality of maternal interactions have important implications for emerging attachment security for infants born prematurely.
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Affiliation(s)
- Prachi E. Shah
- Division of Child Behavioral Health, Department of Pediatrics, Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan
| | | | - Julie Poehlmann
- Department of Human Development and Family Studies, School of Human Ecology, and ,Waisman Center, University of Wisconsin, Madison, Wisconsin
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137
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Meijssen D, Wolf MJ, van Bakel H, Koldewijn K, Kok J, van Baar A. Maternal attachment representations after very preterm birth and the effect of early intervention. Infant Behav Dev 2011; 34:72-80. [DOI: 10.1016/j.infbeh.2010.09.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 08/02/2010] [Accepted: 09/24/2010] [Indexed: 11/27/2022]
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138
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Forcada-Guex M, Borghini A, Pierrehumbert B, Ansermet F, Muller-Nix C. Prematurity, maternal posttraumatic stress and consequences on the mother-infant relationship. Early Hum Dev 2011; 87:21-6. [PMID: 20951514 DOI: 10.1016/j.earlhumdev.2010.09.006] [Citation(s) in RCA: 207] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Revised: 09/23/2010] [Accepted: 09/23/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Premature birth is a stressful experience for parents. This study explores the links between maternal posttraumatic stress, maternal attachment representations of the infant and mother-infant dyadic interactions. METHODS The study enrols 47 preterm (GA<34 weeks) and 25 full-term infants. The Perinatal Posttraumatic Stress Disorder Questionnaire was administered to evaluate maternal posttraumatic stress symptoms. At 6 months of corrected age, maternal attachment representations of the infant were explored and coded with the Working Model of the Child Interview. Interactive characteristics were explored in a videotaped play session and coded with the Care Index. RESULTS Full-term mothers were more likely to follow a "Cooperative" dyadic pattern of interaction with the infant and demonstrate Balanced representations of the infant. Preterm mothers with high posttraumatic stress symptoms were more likely to follow a "Controlling" dyadic pattern of interaction, with more Distorted representations. In contrast, preterm mothers with low posttraumatic stress symptoms were more likely to fall into a "Heterogeneous" group of patterns of dyadic interaction, with Disengaged representations. Interestingly, in Cooperative preterm dyads, only 23% of the mothers demonstrated Balanced representations, despite rates of 69% in full-term Cooperative dyads. CONCLUSION Premature birth affects both mother-infant interaction characteristics and maternal representations of attachment with the infant. In particular, a "Controlling" dyadic pattern was associated with high maternal posttraumatic stress symptoms and Distorted maternal representations. It is important to examine the impact of maternal posttraumatic stress on the parent-infant relationship in order to plan supportive, preventive interventions in the neonatal period.
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Affiliation(s)
- Margarita Forcada-Guex
- Division of Neonatology, Department of Pediatrics, University Hospital Lausanne, Avenue Pierre-Decker 5, Lausanne, Switzerland
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139
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Pizur-Barnekow K. Maternal health after the birth of a medically complex infant: setting the context for evaluation of co-occupational performance. Am J Occup Ther 2010; 64:642-9. [PMID: 20825136 DOI: 10.5014/ajot.2010.08160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Physical and psychological health indicators of mothers who gave birth to medically complex infants were examined to explore potential risk factors for the development of chronic conditions and to develop a scholarly base that supports the inclusion of maternal health in the scope of early intervention practice. METHOD Ten mothers completed the Perinatal Posttraumatic Stress Disorder Questionnaire and the State Trait Anxiety Form Y-1. Nine women completed 24-h Holter recording. Frequency of symptoms of posttraumatic stress disorder (PTSD) and anxiety were determined. High frequency heart rate variability was examined for indicators of autonomic dysregulation. RESULTS Nine of 10 women reported symptoms associated with PTSD, and 2 of these women reported more severe symptoms. Two women demonstrated indicators of autonomic dysregulation. CONCLUSION Further research examining psychological and physical characteristics in mothers of infants at high risk is important to determine whether these women are at greater risk for chronic health conditions.
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Affiliation(s)
- Kris Pizur-Barnekow
- University of Illinois at Chicago, Department of Occupational Therapy, College of Applied Health Sciences, Department of Occupational Therapy, 1919 West Taylor Street, Room 351, MC 811, Chicago, IL 60612, USA.
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140
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Voegtline KM, Stifter CA. Late-preterm birth, maternal symptomatology, and infant negativity. Infant Behav Dev 2010; 33:545-54. [PMID: 20732715 DOI: 10.1016/j.infbeh.2010.07.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 03/10/2010] [Accepted: 07/18/2010] [Indexed: 11/16/2022]
Abstract
The present study examined infant negativity and maternal symptomatology by term status in a predominately low-income, rural sample of 132 infants (66 late-preterm) and their mothers. Late-preterm and term infants were group-matched by race, income, and maternal age. Maternal depression and anxiety symptoms were measured with the Brief Symptom Inventory 18 (BSI-18) when infants were 2 and 6 months of age. Also at 6 months, infant negativity was assessed by global observer ratings, maternal ratings, and microanalytic behavioral coding of fear and frustration. Results indicate that after controlling for infant age, late-preterm status predicted higher ratings of infant negativity by mothers, but not by global observers or microanalytic coding, despite a positive association in negativity across the three measures. Further, mothers of late-preterm infants reported more elevated and chronic co-morbid symptoms of depression and anxiety, which in turn, was related to concurrent maternal ratings of their infant's negativity. Mothers' response to late-preterm birth and partiality in the assessment of their infant's temperament is discussed.
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Affiliation(s)
- Kristin M Voegtline
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA 16802, USA.
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Abstract
Because of increased survival rates, neurodevelopmental issues, chronic medical problems, and sometimes complex family issues involved with prematurity, mental health clinicians commonly assess preterm clients and manage their behavioral and mental health problems. Understanding prematurity survival and neurodevelopmental outcomes is important for contextualizing the mental health problems seen in this high-risk population. This article provides a brief overview of prematurity outcomes in the domains of prematurity relevant to practicing child psychiatrists. Prematurity is also examined as it relates to parental mental health challenges, infant mental health outcomes, high frequency attention problems, and psychiatric disorders. The complex interactions between prematurity and family well-being are also highlighted. Finally, evidence-based treatment modalities involved in prevention and management are explored.
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142
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Vigod SN, Villegas L, Dennis CL, Ross LE. Prevalence and risk factors for postpartum depression among women with preterm and low-birth-weight infants: a systematic review. BJOG 2010; 117:540-50. [PMID: 20121831 DOI: 10.1111/j.1471-0528.2009.02493.x] [Citation(s) in RCA: 369] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although much is known about the risk factors for postpartum depression (PPD), the role of giving birth to a preterm or low-birth-weight infant has not been reviewed systematically. OBJECTIVE To review systematically the prevalence and risk factors for PPD among women with preterm infants. SEARCH STRATEGY Medline, CINAHL, EMBASE, PsycINFO and the Cochrane Library were searched from their start dates to August 2008 using keywords relevant to depression and prematurity. SELECTION CRITERIA Peer-reviewed articles were eligible for inclusion if a standardised assessment of depression was administered between delivery and 52 weeks postpartum to mothers of preterm infants. DATA COLLECTION AND ANALYSIS Data on either the prevalence of PPD or mean depression score in the target population and available comparison groups were extracted from the 26 articles included in the review. Risk factors for PPD were also extracted where reported. MAIN RESULTS The rates of PPD were as high as 40% in the early postpartum period among women with premature infants. Sustained depression was associated with earlier gestational age, lower birth weight, ongoing infant illness/disability and perceived lack of social support. The main limitation was that most studies failed to consider depression in pregnancy as a confounding variable. AUTHOR'S CONCLUSIONS Mothers of preterm infants are at higher risk of depression than mothers of term infants in the immediate postpartum period, with continued risk throughout the first postpartum year for mothers of very-low-birth-weight infants. Targeted clinical interventions to identify and prevent PPD in this vulnerable obstetric population are warranted.
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Affiliation(s)
- S N Vigod
- Women's College Hospital and Women's College Research Institute, Toronto, ON, Canada.
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143
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Alvarez L, Cayol V, Magny JF, Morisseau L. L'ombre des traumatismes périnatals sur les premiers liens. PSYCHIATRIE DE L ENFANT 2010. [DOI: 10.3917/psye.532.0609] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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144
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Feeley N, Zelkowitz P, Cormier C, Charbonneau L, Lacroix A, Papageorgiou A. Posttraumatic stress among mothers of very low birthweight infants at 6 months after discharge from the neonatal intensive care unit. Appl Nurs Res 2009; 24:114-7. [PMID: 20974070 DOI: 10.1016/j.apnr.2009.04.004] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 04/04/2009] [Indexed: 11/18/2022]
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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145
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Ahlund S, Clarke P, Hill J, Thalange NKS. Post-traumatic stress symptoms in mothers of very low birth weight infants 2-3 years post-partum. Arch Womens Ment Health 2009; 12:261-4. [PMID: 19322638 DOI: 10.1007/s00737-009-0067-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Accepted: 03/05/2009] [Indexed: 11/27/2022]
Abstract
We examined symptoms of post-traumatic stress disorder (PTSD) in mothers of very low birth weight (VLBW) infants 2-3 years post-partum, compared with mothers of term, normal weight infants. Mothers were asked to report current symptoms relating specifically to the birth of their infant using The Impact of Event Scale-Revised (IES-R). Mothers of VLBW infants recorded significantly higher levels of PTSD symptoms overall (median scores: VLBW 25 [range 2-82], versus controls: 0 [range 0-5], P < 0.001), and in all sub-categories (p < 0.001). These findings suggest that mothers of VLBW infants have a relatively high prevalence of symptoms of PTSD at 2-3 years postnatal.
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Affiliation(s)
- Susanne Ahlund
- Neonatal Unit, Norfolk and Norwich University Hospital, Norwich, UK.
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146
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Gamba Szijarto S, Forcada Guex M, Borghini A, Pierrehumbert B, Ansermet F, Müller Nix C. État de stress post-traumatique chez les mères et chez les pères d’enfants prématurés : similitudes et différences. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.neurenf.2009.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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147
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Muller-Nix C, Forcada-Guex M. Perinatal assessment of infant, parents, and parent-infant relationship: prematurity as an example. Child Adolesc Psychiatr Clin N Am 2009; 18:545-57. [PMID: 19486837 DOI: 10.1016/j.chc.2009.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This article reviews the stresses for parents, infants, and other caregivers during the period surrounding the birth of the premature infant. Principles of assessment of infant discomfort, parental stress, the parent-infant relationship, and the match of the medical caregiving environment to the individual infant's needs are discussed. Relevant tools to aide in these aspects of assessment are reviewed. The role of early assessment as preventive intervention and the indication for subsequent intervention in complicated cases of premature infants and their parents are further discussed. The article offers detailed clinical examples to illustrate these and other points throughout.
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Affiliation(s)
- Carole Muller-Nix
- Department of Child and Adolescent Psychiatry, University Hospital Lausanne, Hôpital Neslté, av. P. Decker 5, Lausanne 1011, Switzerland.
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148
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Baecke M, Spaanderman MEA, van der Werf SP. Cognitive function after pre-eclampsia: an explorative study. J Psychosom Obstet Gynaecol 2009; 30:58-64. [PMID: 19308784 DOI: 10.1080/01674820802546212] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Pre-eclampsia and eclampsia relate to cerebral damage. Memory and concentration problems are frequently reported after these pregnancy-related vascular complications. We tested the hypothesis that in formerly pre-eclamptic women cognitive functioning is impaired as compared with healthy parous controls. METHODS Women with a recent history of pre-term pre-eclampsia (PPE; n = 47), term pre-eclampsia (TPE; N = 18), pre-term birth (PBI; n = 32) or an uneventful pregnancy (UPR; n = 72) completed a set of questionnaires, measuring cognitive problems, PTSD, depression, anxiety and fatigue. In addition, in PPE and UPR participants we tested neuropsychological performance. RESULTS PBI is related to higher levels of post-traumatic distress symptoms, which in turn diminished the neuropsychological test performance of PPE women. Nonetheless, women in the PPE and TPE groups did not report more cognitive problems than women in the PBI and UPR groups, but PPE raised the need for psychosocial cared. CONCLUSIONS Cognitive complaints are common amongst young mothers. When tested, only those with psychological co-morbidity have neuropsychological impairment.
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Affiliation(s)
- Martina Baecke
- Department of Clinical Psychology, Medical Centre Spectrum, Enschede, The Netherlands.
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149
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Acute posttraumatic stress symptoms among urban mothers with newborns in the neonatal intensive care unit: a preliminary study. J Dev Behav Pediatr 2009; 30:50-6. [PMID: 19194322 DOI: 10.1097/dbp.0b013e318196b0de] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES 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). METHODS 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. RESULTS 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. CONCLUSIONS Addressing acute posttraumatic stress symptoms may enhance interventions to help urban families of NICU infants.
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150
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Zelkowitz P, Papageorgiou A, Bardin C, Wang T. Persistent maternal anxiety affects the interaction between mothers and their very low birthweight children at 24 months. Early Hum Dev 2009; 85:51-8. [PMID: 18632229 DOI: 10.1016/j.earlhumdev.2008.06.010] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Revised: 06/11/2008] [Accepted: 06/12/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND Parental distress following the birth of a premature infant diminishes the parent's ability to be sensitive to the infant's cues, and this may affect infant developmental outcomes. AIMS The present study examined the effects of maternal anxiety during infant hospitalization in the Neonatal Intensive Care Unit (NICU) on the interactive behavior of mothers with their very low birthweight (VLBW) children in toddlerhood. SUBJECTS A sample of 56 mothers and their VLBW infants were recruited in the NICU. STUDY DESIGN During the infant's NICU stay, mothers completed a self-report measure of trait anxiety. These mothers and their infants were followed when the infants were 24 months corrected age, when mothers and their children were videotaped during free play at home. These videotapes were then coded using the Emotional Availability Scales. RESULTS Maternal anxiety was not found to be related to severity of neonatal illness. Maternal anxiety in the NICU was associated with less sensitivity and less structure in interaction with their toddlers at 24 months corrected age, even controlling for maternal education and child birthweight. Children of mothers with higher anxiety scores in the NICU were less likely to involve their mothers in their play at 24 months corrected age. CONCLUSIONS Maternal anxiety in the NICU predicted adverse interactive behaviors when the children were 24 months corrected age. Early identification of anxious mothers in the NICU is needed in order to initiate preventive intervention to support the mother-infant relationship.
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Affiliation(s)
- Phyllis Zelkowitz
- Department of Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital and McGill University, Canada.
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