Prevalence and Correlates of Posttraumatic Stress and Postpartum Depression in Parents of Infants in the Neonatal Intensive Care Unit (NICU)

A Nurse-Based Model of Psychosocial Support for Emotionally Distressed Mothers of Infants in the NICU

Mothers whose infants are hospitalized in the NICU are frequently emotionally distressed, particularly early in the hospitalization. The Family-Centered Developmental Care philosophy, widely adopted by NICUs, calls for an expanded focus on the well-being of the entire family. In this article, we describe an innovative, nurse-delivered program for emotionally distressed mothers of infants in the NICU that includes screening and an empirically supported counseling approach: Listening Visits.

Screening for Depressive and Anxiety Symptoms During Pregnancy and Postpartum at a Japanese Perinatal Center

BACKGROUND

We examined the current status of depressive and anxiety symptoms in Japanese women during pregnancy and postpartum.

METHODS

We asked 220 Japanese women who gave birth to singleton babies at term to answer the two self-administered questionnaires (Whooley's two questions and two-item generalized anxiety disorder scale) at first, second and third trimester of pregnancy and 1 month after delivery.

RESULTS

The rates of women with depressive symptoms were common during the first trimester of pregnancy (25%) and the postpartum (17%), while the women with anxiety symptoms were common during the first trimester of pregnancy (36%). Eight percent women had histories of mental disorders, and 95% of them showed depressive and/or anxiety symptoms somewhere during pregnancy. Of the women who had depressive symptoms during postpartum, 86% showed depressive and/or anxiety symptoms somewhere during pregnancy.

CONCLUSION

Screening for depressive and anxiety symptoms during pregnancy was suggested to be useful to detect high risk women of postpartum depression.

Risk factors for the development of post-traumatic stress disorder and coping strategies in mothers and fathers following infant hospitalisation in the neonatal intensive care unit

AIMS AND OBJECTIVES

The aim of this study was to identify the potential risk factors for the development of post-traumatic stress disorder in mothers and fathers following infant hospitalisation in the neonatal intensive care unit.

BACKGROUND

The development of neonatal intensive care units has increased the survival rate of infants. However, one of the major parental problems is post-traumatic stress disorder.

DESIGN

An observational study covered 125 parents (72 mothers and 53 fathers) of infants aged 3-12 months who were hospitalised in the neonatal intensive care unit during the neonatal period.

SETTING

Third-referral neonatal intensive care unit. Several standardised and self-reported research tools were used to estimate the level of post-traumatic stress symptoms (Impact Event Scale-Revised), perceived stress (Perceived Stress Scale) and coping strategies (COPE Inventory). The respondents also completed a Parent and Infant Characteristic Questionnaire.

RESULTS

The mothers and fathers did not differ in their parental and infant characteristics. Post-traumatic stress disorder was present in 60% of the mothers and 47% of the fathers. Compared to the fathers, the mothers felt greater stress (p = .020) and presented a higher severity of post-traumatic stress disorder (p < .001). Previous miscarriages (p = .023) and the presence of chronic diseases (p = .032) were risk factors for post-traumatic stress disorder in the mothers. In the fathers, an Apgar test at 1 min after birth (p = .030) and a partner's post-traumatic stress disorder (p = .038) were related to post-traumatic stress disorder. The mothers compared to the fathers were more likely to use strategies such as: positive reinterpretation and growth, focusing on and venting of emotions, instrumental social support, religious coping and acceptance. In the fathers, the predictors included an Apgar score at 1 min after birth, a lack of congenital anomalies in the child and mental disengagement.

CONCLUSION

Risk factors for post-traumatic stress disorder, as well as coping strategies, differ in women compare to men.

RELEVANCE TO CLINICAL PRACTICE

Knowledge of risk factors for post-traumatic stress disorder, specific to men and women, may help identify the parents in whom probability of the occurrence of this disorder is increased.

Addressing Unmet Maternal Health Needs at a Pediatric Specialty Infant Care Clinic

OBJECTIVE

The objective of this intervention was to evaluate the feasibility of screening mothers of medically fragile infants in the domains of 1) depression, 2) tobacco exposure, and 3) family planning at a post-neonatal intensive care unit (NICU) developmental pediatric visit. Additionally, we sought to estimate the percentage who met criteria for further evaluation in the three domains assessed.

METHODS

A cross-sectional questionnaire was administered to 100 caregivers of medically fragile infants at a specialty, post-NICU clinic visit. Participants' responses in three domains were evaluated and appropriate referrals were provided. Analysis was then restricted to the 87 biological mothers who completed the screening. Study staff contacted the mothers 2 months later to determine whether services had been accessed and to assess overall satisfaction with the screening within the pediatric visit. Qualitative interviews were conducted with pediatric clinic staff.

RESULTS

Screening questionnaires were completed by 87 biological mothers. Twenty-two mothers (25%) met referral criteria. Pediatric clinic staff and providers were comfortable administering the screening instrument, and there was minimal disruption to clinic flow.

CONCLUSIONS

Mothers of medically fragile infants are likely to have unmet health care needs that can be identified at a specialty pediatric clinic visit. A screening and referral intervention can be implemented with minimal interruption in pediatric clinic flow and is acceptable to mothers and pediatric providers.

Kangaroo care and postpartum depression: The role of oxytocin

Problem

Postpartum depression occurs in about 10–22% of women after birth and adversely affects their health and the health of their newborn. Kangaroo care is known to have many health-related benefits for both the mother and her newborn.

Purpose

The aim of this review was to gather the evidence linking the effects of kangaroo care with postpartum depression, specifically focusing on the proposed underlying mechanism involving the release of oxytocin.

Method

The literature review was conducted by targeting PubMed, CINAHL, and Google Scholar databases. The search terms used were postpartum depression, postnatal depression, oxytocin, oxytocin hormone, postpartum depression, kangaroo care, and skin-to-skin contact.

Results

Kangaroo care was found to play an important role in decreasing the risk for postpartum depression. Skin-to-skin contact during kangaroo care was found to trigger the release of oxytocin, which is hypothesized to minimize the risk for depressive symptoms as well as decrease maternal stress. The oxytocinergic system regulates the release of oxytocin, which is an effect that is opposite that which occurs with the human stress response, in which the sympathetic nervous system is activated to release catecholamines in response to harmful or threatening stimuli. The oxytocinergic system regulates calmness, connection, and socialization processes. During kangaroo care, oxytocin blocks the stress response and decreases the circulation of catecholamines, yielding positive outcomes that include maternal stress reduction and prevention of postpartum depression.

Conclusion

Kangaroo care can be used as a non-pharmacological intervention to prevent or decrease the risk of postpartum depression.

Communicating with parents in neonatal intensive care units: The impact on parental stress

OBJECTIVE

To analyse stress in parents whose infants with very low birth weight have just concluded high-level care in a Neonatal Intensive Care Unit (NICU). More specifically, we aimed 1) to identify groups of parents in the NICU who are particularly at risk of experiencing stress, and 2) to explore the effects of clinical staffś communication on parental stress.

METHODS

Our multi-center-study evaluated views from 1277 parents about care for 923 infants in 66 German NICUs. Answers were linked with separately evaluated medical outcomes of the infants. Separate generalised mixed models estimated the influence of personal, medical and communication-related characteristics on specific parental stress.

RESULTS

Parents of a younger age and those of infants with severe prognoses were more likely to experience stress. While empathetic communication as one aspect of staffś communication was shown as appropriate in reducing parental stress, an initial introduction and the quantity of information were only slightly associated with lower levels of stress.

CONCLUSION

Results provide evidence for the need to involve parents empathetically from the beginning of their child's stay in the NICU.

PRACTICE IMPLICATIONS

Staff in the NICU should communicate empathetically and help to reduce stress in parents particularly at risk.

Parent Support Programs and Coping Mechanisms in NICU Parents

BACKGROUND

Many neonatal intensive care unit (NICU) parents experience emotional distress leading to adverse infant outcomes. Parents may not cope positively in stressful situations, and support programs often are underutilized.

PURPOSE

To determine coping mechanisms utilized by NICU parents, and types of support programs parents are likely to attend. To determine whether sociodemographic and length-of-stay differences impact coping mechanisms utilized, and types of support programs preferred.

METHODS

A correlational cross-sectional survey design was used. The 28-item Brief COPE tool, questions about demographics and preferred support program styles, was distributed to a convenience sample of NICU parents in a level IV NICU in the southeastern United States.

RESULTS

One hundred one NICU parents used coping mechanisms, with acceptance emotional support, active coping, positive reframing, religion, planning, and instrumental support being the most common. Preferred support classes were infant development and talking with other NICU parents. Caucasians more commonly coped using active coping, planning, emotional support, acceptance, instrumental support, and venting compared with other races. Women utilized self-blame coping mechanisms more often compared with men. Younger parents were more likely to use venting and denial coping mechanisms. Parents with a shorter stay utilized self-distraction coping and preferred the class of talking with other parents.

IMPLICATIONS FOR PRACTICE

Support program preference, type of coping mechanism utilized, and sociodemographic factors may be used to guide the creation of NICU support programs.

IMPLICATIONS FOR RESEARCH

Additional studies are needed to determine whether support program offering according to preferences and sociodemographic characteristics increases attendance and decreases emotional distress.

Integrative Review of Technology to Support Communication With Parents of Infants in the NICU

OBJECTIVE

To synthesize findings from the published literature on the use of technology in the NICU to improve communications and interactions among health care providers, parents, and infants.

DATA SOURCES

Electronic databases including Ovid MEDLINE, CINAHL, Web of Science, and Google Scholar were searched for related research published through May 2016. The reference lists of all studies were reviewed, and a hand search of key journals was also conducted to locate eligible studies.

STUDY SELECTION

Eleven studies (five quantitative, two qualitative, and four mixed methods) were identified that met the inclusion criteria. Only studies published in English were included.

DATA EXTRACTION

Whittemore and Knafl's methodology for conducting integrative reviews was used to guide data extraction, analysis, and synthesis. Data were extracted and organized according to the following headings: author, year, and location; study purpose and design; sample size and demographics; technology used; study findings; and limitations.

DATA SYNTHESIS

Various technologies were used, including videoconferencing, videophone, and commercially available modalities such as Skype, FaceTime, AngelEye, and NICView Webcams. In the 11 studies, three main outcomes were evaluated: parents' perception of technology use, health care providers' perceptions of technology use, and objective outcomes, such as parental anxiety or stress or infant length of stay. Overall, parents and health care providers perceived the varied interventions quite favorably, although a few significant differences were found for the objective measures.

CONCLUSION

Several interventions have been tested to improve communications and promote interactions among NICU health care team members, parents, and infants. Although initial findings are positive, research in this area is quite limited, and the reviewed studies had several limitations. There is a significant need for further rigorous research to be conducted with diverse samples.

NICU-based Interventions To Reduce Maternal Depressive and Anxiety Symptoms: A Meta-analysis

CONTEXT

Parents whose infants are being treated in the NICU are at high risk for depression and anxiety, with negative implications for parenting and infant development.

OBJECTIVE

We conducted a systematic review and meta-analysis of NICU-based interventions to reduce maternal depressive or anxiety symptoms.

DATA SOURCES

PubMed, Embase, PsychInfo, Cochrane, and CINAHL were searched for relevant studies. Reference lists from selected studies were reviewed.

STUDY SELECTION

Inclusion criteria included randomized controlled design, a parent-focused intervention delivered in the NICU, valid maternal depressive or anxiety symptom measures at pre- and postintervention, and publication in a peer-reviewed journal in English.

DATA EXTRACTION

Data extraction was conducted independently by 2 coders.

RESULTS

Twelve studies met inclusion criteria for qualitative review; 2 were excluded from quantitative analyses for high risk of bias. Fixed- and random-effects models, with 7 eligible studies assessing depressive symptoms, indicated an effect of -0.16 (95% confidence interval [CI], -0.32 to -0.002; P < .05) and, with 8 studies assessing anxiety symptoms, indicated an effect of -0.12 (95% CI, -0.29 to 0.05; P = .17). The subset of interventions using cognitive behavioral therapy significantly reduced depressive symptoms (effect, -0.44; 95% CI, -0.77 to -0.11; P = .01).

LIMITATIONS

The small number and methodological shortcomings of studies limit conclusions regarding intervention effects.

CONCLUSIONS

Combined intervention effects significantly reduced maternal depressive but not anxiety symptoms. The evidence is strongest for the impact of cognitive behavioral therapy interventions on maternal depressive symptoms.

Lived experiences of parents of premature babies in the intensive care unit in a private hospital in Johannesburg, South Africa

Background

Many of the 15 million premature babies born worldwide every year survive because of advanced medical interventions. Their parents have intense experiences when their babies are in the intensive care unit (ICU), and these have an impact on their thoughts, feelings and relationships, including their relationships with their premature babies.

Objectives

The aim of the study was to explore and describe the lived experiences of parents of premature babies in an ICU.

Method

Research design was qualitative, exploratory, descriptive and contextual. A purposive sample of parents with premature babies in an ICU in a private hospital in Johannesburg Gauteng in South Africa was used. Eight parents, four mothers and four fathers, married and either Afrikaans or English-speaking, were included in the study. Data were collected by conducting in-depth phenomenological interviews with them and making use of field notes. Trustworthiness was ensured by implementing the strategies of credibility, transferability, dependability and confirmability. Ethical principles such as autonomy, beneficence, non-maleficence and justice were adhered to throughout the research process.

Results

Thematic analyses were utilised to analyse the data. Two themes in the experiences of parents with premature babies in ICU became apparent. Parents experienced thoughts, emotions and hope while their premature babies were in the ICU as well as challenges in their relationships and these challenges influenced their experiences.

Recommendations

Mindfulness of intensive care nurses should be facilitated so that intensive care nurses can promote the mental health of parents with premature babies in the ICU.

Conclusion

Parents with premature babies in the ICU have thoughts and emotional experiences which include hope and they affect parents’ relationships.

UNPACKING THE BURDEN OF CARE FOR INFANTS IN THE NICU

Infants who begin early life in the medicalized environment of the neonatal intensive care unit (NICU) experience disruption to numerous fundamental expectancies. In the NICU, infants are exposed to chronic, extreme stressors that include painful medical procedures and parental separation. Due to their preverbal stage of development, infants are unable to fully express these experiences, and linking these experiences to long-term outcomes has been difficult. This clinical article proposes the terminology Infant Medical Trauma in the NICU (IMTN) to describe the infant experience. Following a discussion of the NICU as an adverse childhood event, the article has three sections: (a) the unique and critical factors that define the newborn period, (b) a review of the IMTN conceptual model, and (c) recommendations for supportive neuroprotective strategies to moderate the intensity of adverse NICU infant experiences.

Parental engagement and early interactions with preterm infants during the stay in the neonatal intensive care unit: protocol of a mixed-method and longitudinal study

INTRODUCTION

The preterm infants' developmental outcomes depend on biological and environmental risk factors. The environmental factors include prolonged parental separation, less exposure to early mother/father-infant interactions and the parents' ability to respond to the trauma of premature birth. In the case of premature birth, the father's ability to take an active part in the care of the infant from the start is essential. The parents' emotional closeness to the preterm infant hospitalised in the neonatal intensive care unit (NICU) may be crucial to the well-being of the newborn, the development of mutual regulation, the establishment of a functioning parent-infant affective relationship and the parents' confidence in their ability to provide care for their baby.

METHODS AND ANALYSIS

This is a mixed-method, observational and longitudinal study. The methodological strategy will include: (1) ethnographic observation in a level III NICU located in Italy for a duration of 18 months; (2) 3-minute video recordings of mother-infant and father-infant interaction in the NICU; (3) a semistructured interview with fathers during the infants' hospital stay; (4) 3-minute video recordings of mother-infant and father-infant face-to-face interaction in the laboratory at 4 months of corrected age; (5) self-report questionnaires for parents on depression and quality of the couple relationship at the approximate times of the video recording sessions.

ETHICS AND DISSEMINATION

The study protocol was approved by the Ethical Committee for Clinical Trials of the Verona and Rovigo Provinces. Results aim to be published in international peer-reviewed journals, and presented at relevant national and international conferences. This research project will develop research relevant to (1) the quality and modalities of maternal and paternal communication with the preterm infant in the NICU; (2) the influence of maternal/paternal social stimulation on the infant behavioural states; (3) the quality and modalities of paternal support to the partner and possible influences on mother-infant relationship.

Neonatal Nurses NICU Quality Improvement: Embracing EBP Recommendations to Provide Parent Psychosocial Support

BACKGROUND

The neonatal intensive care unit (NICU) can be a stressful environment for infants, their families, and the healthcare team. There is an immediate need for neonatal nurses to embrace and translate the new National Perinatal Association recommendations for psychosocial support of NICU parents into clinical practice to demonstrate best practices for infants, their families, and the whole team.

PURPOSE

To summarize the current evidence-based practice recommendations and to provide suggestions for team members to develop strategies to adopt and implement them through quality improvement (QI) projects.

METHODS

Literature reviews were conducted by the original 6 National Perinatal Association workgroup teams and covered all levels of available evidence (eg, qualitative, quantitative, and clinical research, guidelines, and clinical and parental expertise). Evidence was synthesized to formulate this set of recommendations published in December 2015. We describe their applicability to the vital role of neonatal nurses, while elucidating QI projects that track measurements of change to translate these recommendations into practice.

RESULTS

Neonatal nurses are in an ideal position to transform systems of support for NICU parents through the adoption of these recommendations at the bedside, and further to identify areas for QI to enhance implementation.

IMPLICATIONS FOR PRACTICE

Neonatal nurses are integral to problem solving and identifying QI strategies for translating these recommendations into NICU clinical practice to improve parent psychosocial support.

IMPLICATIONS FOR RESEARCH

This article disseminates evidence and encourages scientific investigation into various methods of supporting emotional health of NICU parents to create better health outcomes.

Mental Health Among Parents of Children With Critical Congenital Heart Defects: A Systematic Review

Background

Parents of children with critical congenital heart defects (PCCHDs) may be at high risk for mental health morbidity; however, the literature is not well characterized. Given that compromised parental mental health can lead to long‐term cognitive, health‐related, and behavioral problems in children, a systematic review of this literature could provide informed recommendations for continued research and enhance the care of families of children living with critical congenital heart defects.

Methods and Results

We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines that resulted in 30 studies on the mental health of PCCHDs. The literature revealed that PCCHDs are at an elevated risk for psychological problems, particularly in the immediate weeks and months following cardiac surgery. Up to 30% of PCCHDs have symptoms consistent with a diagnosis of posttraumatic stress disorder, with over 80% presenting with clinically significant symptoms of trauma; 25% to 50% of PCCHDs reported clinically elevated symptoms of depression and/or anxiety, and 30% to 80% reported experiencing severe psychological distress. There was high variability in measurements used to assess study outcomes, methodological quality, and sociocultural composition of the parents included in the studies.

Conclusions

There is an urgent need for additional research on the severity, course, persistence, and moderators of these mental health problems over time, and for the development and testing of screening approaches and interventions that can be feasibly delivered in the context of ongoing pediatric cardiac care.

A good resource for parents, but will clinicians use it?: Evaluation of a resource for paediatric end-of-life decision making

Background

Communication with parents about end-of-life care and decisions is a difficult and sensitive process. The objective of the present study was to ascertain clinicians’ views on the acceptability and usefulness of a handbook and web-based resource (Caring Decisions) that was designed as an aid for parents facing end-of-life decisions for their child.

Methods

Qualitative interviews were conducted with a range of health professionals who provide care to children facing life-limiting conditions.

Results

Data analysis confirmed the acceptability and usefulness of the resource. Two major themes were revealed: 1. Family empowerment, with sub-themes Giving words and clarity, Conversation starter, ‘I’m not alone in this’, and A resource to take away, highlighted how the resource filled a gap by supporting and enabling families in a multitude of ways; 2. Not just for families, with sub-themes A guide for staff, When to give the resource?, How to give the resource and Who should give the resource?, explored the significant finding that participants viewed the resource as a valuable tool for themselves, but its presence also brought into relief potential gaps in communication processes around end-of-life care.

Conclusion

The interview data indicated the positive reception and clear value and need for this type of resource. However, it is likely that successful resource uptake will be contingent on discussion and planning around dissemination and use within the health care team.

Does maternal psychological distress affect neurodevelopmental outcomes of preterm infants at a gestational age of ≤32weeks

BACKGROUND

There is some evidence that maternal psychological status in the prenatal and postnatal periods is associated with infants' cognitive, behavioural, and emotional functions.

AIM

The aim of this study was to examine the relationships of maternal depression and anxiety with neurodevelopmental outcomes of preterm infants with a gestational age of ≤32weeks, examined at a corrected age of 18 to 22months.

STUDY DESIGN

Cross-sectional study.

SUBJECTS

In total, 220 preterm infants with a gestational age of ≤32weeks who were born from January 2008 to September 2011 and admitted to the neonatal intensive care unit were prospectively examined.

OUTCOME MEASURES

Neurodevelopmental evaluation was performed at a corrected age of 18 to 22months by a developmental paediatrician using the Bayley Scales of Infant Development II (BSID-II). The Beck Depression Inventory and Beck Anxiety Inventory were used to assess maternal depression and anxiety at the same visit as the neurodevelopmental evaluation.

RESULTS

The depression scores of mothers of infants with a Mental Development Index (MDI) score of <70 were significantly higher than those of mothers of infants with an MDI score of >70 (16.3±12.8 vs 8.8±7.0, p<0.001). The depression scores of mothers of infants with neurodevelopmental impairment were also significantly higher than those without neurodevelopmental impairment (12.8±10.5 vs 8.8±7.3, p=0.003). There was no relationship between the presence of cerebral palsy or a Psychomotor Developmental Index (PDI) score of <70 and the mothers' depression scores. Multiple regression analysis revealed that maternal depression and the occurrence of more than two sepsis attacks were associated with an MDI score of <70, and grade III to IV intraventricular haemorrhage was associated with neurodevelopmental impairment and a PDI score of <70.

CONCLUSION

Maternal depression is negatively associated with the neurodevelopment of preterm infants at a gestational age of ≤32weeks. Maternal psychological well-being should be taken into consideration during the long-term follow-up of preterm infants.

Impact of perinatal asphyxia on parental mental health and bonding with the infant: a questionnaire survey of Swiss parents

OBJECTIVE

To compare current mental health symptoms and infant bonding in parents whose infants survived perinatal asphyxia in the last 2 years with control parents and to investigate which sociodemographic, obstetric and neonatal variables correlated with parental mental health and infant bonding in the asphyxia group.

DESIGN

Cross-sectional questionnaire survey of parents whose children were registered in the Swiss national Asphyxia and Cooling register and of control parents (Post-traumatic Diagnostic Scale, Hospital Anxiety and Depression Scale, Mother-to-Infant Bonding Scale).

RESULTS

The response rate for the asphyxia group was 46.5%. Compared with controls, mothers and fathers in the asphyxia group had a higher frequency of post-traumatic stress disorder (PTSD) symptoms (p<0.001). More mothers (n=28, 56%) had a symptom diagnosis of either full or partial PTSD than controls (n=54, 39%) (p=0.032). Similarly, more fathers (n=31, 51%) had a symptom diagnosis of either partial or full PTSD than controls (n=19, 33%) (p=0.034). Mothers reported poorer bonding with the infant (p=0.043) than controls. Having a trauma in the past was linked to more psychological distress in mothers (r=0.31 (95% CI 0.04 to 0.54)) and fathers (r=0.35 (95% CI 0.05 to 0.59)). For mothers, previous pregnancy was linked to poorer bonding (r=0.41 (95% CI 0.13 to 0.63)). In fathers, therapeutic hypothermia of the infant was related to less frequent PTSD symptoms (r=-0.37 (95% CI -0.61 to -0.06)) and past psychological difficulties (r=0.37 (95% CI 0.07 to 0.60)) to more psychological distress. A lower Apgar score was linked to poorer bonding (r=-0.38 (95% CI -0.64 to -0.05)).

CONCLUSIONS

Parents of infants hospitalised for perinatal asphyxia are more at risk of developing PTSD than control parents.

Mothers and Fathers in NICU: The Impact of Preterm Birth on Parental Distress

Preterm birth is a stressful event for families. In particular, the unexpectedly early delivery may cause negative feelings in mothers and fathers. The aim of this study was to examine the relationship between preterm birth, parental stress and negative feelings, and the environmental setting of NICU. 21 mothers (age = 36.00 ± 6.85) and 19 fathers (age = 34.92 ± 4.58) of preterm infants (GA = 30.96 ± 2.97) and 20 mothers (age = 40.08 ± 4.76) and 20 fathers (age = 40.32 ± 6.77) of full-term infants (GA = 39.19 ± 1.42) were involved. All parents filled out the Parental Stressor Scale: Neonatal Intensive Care Unit, the Impact of Event Scale Revised, Profile of Mood States, the Multidimensional Scale of Perceived Social Support and the Post-Partum Bonding Questionnaire. Our data showed differences in emotional reactions between preterm and full-term parents. Results also revealed significant differences between mothers and fathers’ responses to preterm birth in terms of stress, negative feelings, and perceptions of social support. A correlation between negative conditions at birth (e.g., birth weight and Neonatal Intensive Care Unit stay) and higher scores in some scales of Impact of Event Scale Revised, Profile of Mood States and Post-Partum Bonding Questionnaire were found. Neonatal Intensive Care Unit may be a stressful place both for mothers and fathers. It might be useful to plan, as soon as possible, interventions to help parents through the experience of the premature birth of their child and to begin an immediately adaptive mode of care.

Neonates and Infants Discharged Home Dependent on Medical Technology: Characteristics and Outcomes

BACKGROUND

Preterm neonates and neonates with complex conditions admitted to a neonatal intensive care unit (NICU) may require medical technology (eg, supplemental oxygen, feeding tubes) for their continued survival at hospital discharge. Medical technology introduces another layer of complexity for parents, including specialized education about neonatal assessment and operation of technology. The transition home presents a challenge for parents and has been linked with greater healthcare utilization.

PURPOSE

To determine incidence, characteristics, and healthcare utilization outcomes (emergency room visits, rehospitalizations) of technology-dependent neonates and infants following initial discharge from the hospital.

METHODS

This descriptive, correlational study used retrospective medical record review to examine technology-dependent neonates (N = 71) upon discharge home. Study variables included demographic characteristics, hospital length of stay, and type of medical technology used. Analysis of neonates (n = 22) with 1-year postdischarge data was conducted to identify relationships with healthcare utilization. Descriptive and regression analyses were performed.

FINDINGS

Approximately 40% of the technology-dependent neonates were between 23 and 26 weeks' gestation, with birth weight of less than 1000 g. Technologies used most frequently were supplemental oxygen (66%) and feeding tubes (46.5%). The mean total hospital length of stay for technology-dependent versus nontechnology-dependent neonates was 108.6 and 25.7 days, respectively. Technology-dependent neonates who were female, with a gastrostomy tube, or with longer initial hospital length of stay were at greater risk for rehospitalization.

IMPLICATIONS FOR PRACTICE

Assessment and support of families, particularly mothers of technology-dependent neonates following initial hospital discharge, are vital.

IMPLICATIONS FOR RESEARCH

Longitudinal studies to determine factors affecting long-term outcomes of technology-dependent infants are needed.

Extended family support for parents faced with life-support decisions for extremely premature infants

PURPOSE

To outline parents' descriptions of extended family involvement and support surrounding decision making for their extremely preterm infant.

DESIGN

Collective case study design in a prospective, descriptive, longitudinal research. Seventy-five digitally recorded interviews were done with parents before and after the birth.

SAMPLE

Fifty-four parents (40 mothers, 14 fathers).

MAIN OUTCOME VARIABLE

Categories of family involvement and support in the parents' decision making.

RESULTS

Most parents did not seek advice from family members for life-support decisions made prenatally. Instead, parents made the decision as a couple with their physician without seeking family input. Family members provided certain types of support: emotional support, advice and information, prayer, and instrumental help such as child care. Most parents described at least one way their family supported them. For postnatal and end-of-life decisions, parents were more likely to seek advice from extended family in addition to the other forms of support.

Effect of Parent Presence During Multidisciplinary Rounds on NICU-Related Parental Stress

OBJECTIVE

To evaluate the effect of parent presence during multidisciplinary rounds on NICU-related parental stress.

DESIGN

Quasi-experimental study.

SETTING

University-affiliated, 24-bed NICU located within a children's hospital that admits infants from birth to 6 months of age.

PARTICIPANTS

One hundred thirty-two parents of infants admitted to the NICU for the first time.

METHODS

All parents completed the Parent Stressor Scale: NICU (PSS:NICU) on Study Days 0 and 3. In addition to usual family communication practices, parents in the experimental group were offered the opportunity to participate in multidisciplinary rounds on their infants.

RESULTS

A total of 132 parents completed the study; the first 46 parents were enrolled in the control group, and the subsequent 86 parents in the experimental group. Overall PSS:NICU scores decreased significantly in the experimental group between Study Days 0 and 3 (mean ± standard error [SE] = -0.24 ± 0.07, p < .001), but the change was not significantly different between the control and experimental groups (mean ± SE = -0.12 ± 0.10, p = .25). The PSS:NICU Parental Role Alteration subscale decreased by the largest margin in the experimental group (mean ± SE = -0.42 ± 0.09, p < .0001), but the change was not significantly different between groups (mean ± SE = -0.26 ± 0.14, p = .06). Overall PSS:NICU stress scores were higher in mothers than fathers (mothers, mean ± SE = 3.4 ± 0.81; fathers, mean ± SE = 2.7 ± 0.67; p < .001).

CONCLUSION

Providing parents with the opportunity to participate in multidisciplinary rounds did not affect NICU-related parental stress. Mothers reported higher levels of stress than fathers.

Infant Medical Trauma in the Neonatal Intensive Care Unit (IMTN): A Proposed Concept for Science and Practice

BACKGROUND

Trauma is an innately subjective experience ensuing from a deeply distressing event. Research has demonstrated that while the environment of the neonatal intensive care unit (NICU) is capable of providing extraordinary lifesaving measures following birth, the experience may be disruptive to several key aspects of early development, placing infants at risk for adverse behavioral, cognitive, and emotional outcomes.

PURPOSE

This article provides rationale for the concept of Infant Medical Trauma in the NICU (IMTN) as a means of describing this unique stress experience. A triad of cumulative early life NICU experiences (stress, parental separation, and pain) is proposed to influence an infant's swinging neurodevelopmental pendulum amid the potential outcomes of risk and resilience.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Creating language that describes the infant experience brings meaning and calls caregivers and parents to action to consider strategies that may improve long-term health. Actively seeking opportunities to decrease the allostatic load of at-risk infants may support an infant's pendulum to swing toward a path of resilience, thereby moderating his or her early life adverse experience.

Palliative care for extremely premature infants and their families

Extremely premature infants face multiple acute and chronic life-threatening conditions. In addition, the treatments to ameliorate or cure these conditions often entail pain and discomfort. Integrating palliative care from the moment that extremely premature labor is diagnosed offers families and clinicians support through the process of defining goals of care and making decisions about life support. For both the extremely premature infant who dies soon after birth and the extremely premature infant who experiences multiple complications over weeks and months in the neonatal intensive care unit, palliative care can maintain a focus on infant comfort and family support. This article highlights the ways in which palliative care can be incorporated into intensive care for all critically ill infants.

The contribution of maternal psychological functioning to infant length of stay in the Neonatal Intensive Care Unit

OBJECTIVE

Assess maternal psychological functioning within the Neonatal Intensive Care Unit (NICU) and its contribution to neonate length of stay (LOS) in the NICU.

STUDY DESIGN

Mothers of infants admitted to the NICU (n=111) were assessed regarding postpartum depression, postpartum social support, postpartum NICU stress, and maternal anxiety at 2 weeks postpartum. Illness severity was assessed with the Clinical Risk Index for Babies (CRIB).

RESULTS

Postpartum depression was not significantly correlated with LOS, but was significantly correlated with trait anxiety (r=0.620), which was significantly correlated with LOS (r=0.227). Among mothers with previous mental health history, substance abuse history and CRIB score were the best predictors of LOS. For mothers without a prior mental health issues, delivery type, stress associated with infant appearance, and CRIB scores were the best predictors of LOS. In this group, LOS was found to increase on average by 7.06 days per one unit increase in stress associated with infant appearance among mothers with the same delivery type and CRIB score.

CONCLUSION

Significant correlations of trait anxiety, stress associated with infant appearance, and parental role with LOS support the tenet that postpartum psychological functioning can be associated with NICU LOS.

Infancy and pediatric cancer: an exploratory study of parent psychological distress

BACKGROUND

Research on the psychological experiences of parents of infants within pediatric oncology is sparse. This study examined rates and indicative risk factors for psychological distress in parents where there is either an infant patient or infant sibling of a patient.

METHODS

Participants were mothers (n = 41) and fathers (n = 25) of infants under 2 years who either had a cancer diagnosis (n = 37; infant patients) or was an infant sibling of an older child with cancer (n = 29; infant siblings) recruited from a single oncology center. There were 21 couple dyads. Parents completed the Depression Anxiety Stress Scales short form and the Posttraumatic Stress Disorder Checklist.

RESULTS

Mothers (47.5%) and fathers (37.5%) reported elevated, cancer-related posttraumatic stress symptoms. Rates of depression (12.2% of mothers and 12.0% of fathers) and anxiety symptoms (17.1% of mothers and 8.0% of fathers) were lower. Compared with parents of infant patients, parents of infant siblings reported significantly higher rates of depressive symptoms and trends toward higher rates of posttraumatic stress symptoms and anxiety symptoms. Parent anxiety was higher with increased time post diagnosis. No demographic or illness-related variables were associated with psychological distress, with the exception of the number of children in the family.

CONCLUSIONS

Parent-child relationships are of fundamental importance during infancy. This study provides novel data highlighting the psychological impact for parents when a cancer diagnosis is made during this critical developmental period, including the contribution of family structure to parental distress. Results provide further support for applying a traumatic stress framework when exploring parent experiences of pediatric cancer. Copyright © 2016 John Wiley & Sons, Ltd.

Maternal Origin and Risk of Neonatal and Maternal ICU Admission

OBJECTIVES

To evaluate maternal world region of birth, as well as maternal country of origin, and the associated risk of admission of 1) a mother to a maternal ICU, 2) her infant to a neonatal ICU, or 3) both concurrently to an ICU.

DESIGN

Retrospective population-based cohort study.

SETTING

Entire province of Ontario, Canada, from 2003 to 2012.

PATIENTS

All singleton maternal-child pairs who delivered in any Ontario hospital.

MEASUREMENTS AND MAIN RESULTS

We explored how maternal world region of birth, and specifically, maternal country of birth for the top 25 countries, was associated with the outcome of 1) neonatal ICU, 2) maternal ICU, and 3) both mother and newborn concurrently admitted to ICU. Relative risks were adjusted for maternal age, parity, income quintile, chronic hypertension, diabetes mellitus, obesity, dyslipidemia, drug dependence or tobacco use, and renal disease. Compared with infants of Canadian-born mothers (110.7/1,000), the rate of neonatal ICU admission was higher in immigrants from South Asia (155.2/1,000), Africa (140.4/1,000), and the Caribbean (167.3/1,000; adjusted relative risk, 1.41; 95% CI, 1.36-1.46). For maternal ICU, the adjusted relative risk was 1.79 (95% CI, 1.43-2.24) for women from Africa and 2.21 (95% CI, 1.78-2.75) for women from the Caribbean. Specifically, mothers from Ghana (adjusted relative risk, 2.71; 95% CI, 1.75-4.21) and Jamaica (adjusted relative risk, 2.74; 95% CI, 2.12-3.53) were at highest risk of maternal ICU admission. The risk of both mother and newborn concurrently admitted to ICU was even more pronounced for Ghana and Jamaica.

CONCLUSIONS

Women from Africa and the Caribbean and, in particular, Ghana and Jamaica, are at higher risk of admission to ICU around the time of delivery, as are their newborns.

The co-existence of depression, anxiety and post-traumatic stress symptoms in the perinatal period: A systematic review

OBJECTIVE

to identify and appraise the current international evidence regarding the presence and prevalence of the co-existence of depression, anxiety and post-traumatic stress symptoms in the antenatal and post partum period.

METHODS

using a list of keywords, Medline, CINHAL, Cochrane Library, EMBASE, PsychINFO, Web of Science and the Index of Theses and Conference Proceedings (Jan 1960 - Jan 2015) were systematically searched. Experts in the field were contacted to locate papers that were in progress or in press. Reference lists from relevant review articles were searched. Inclusion criteria included full papers published in English reporting concurrent depression, anxiety and post-traumatic stress symptoms in pregnant and post partum women. A validated data extraction review tool was used.

FINDINGS

3424 citations were identified. Three studies met the full inclusion criteria. All reported findings in the postnatal period. No antenatal studies were identified. The prevalence of triple co-morbidity was relatively low ranging from 2% to 3%.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

triple co-morbidity does occur, although the prevalence appears to be low. Due to the presentation of complex symptoms, women with triple co-morbidity are likely to be difficult to identify, diagnose and treat. Clinical staff should be aware of the potential of complex symptomatology.

Evaluation of the maternal and fetal risk factors associated with neonatal care unit hospitalization time

OBJECTIVE

To evaluate maternal and neonatal risk factors associated with the length of hospital stay in the neonatal intensive care unit (NICU).

MATERIAL AND METHOD

This retrospective observational study was based on 3607 newborns who were admitted to the NICU of a tertiary teaching hospital from January 2012 through December 2014. Known obstetric risk factors associated with duration of hospitalization in NICUs were assessed including intrauterine growth restriction, maternal diabetes, oligohydramnios, chorioamnionitis, premeture rupture of membranes, preeclampsia, congenital malformations, neonatal sepsis, premature retinopathy, intracranial bleeding, necrotizing enterocolitis, meconium aspiration, maternal hypertension, fetal congenital cardiac malformations, congenital metabolic diseases, congenital hypothyroidism, pneumonia, pulmonary hypertension, bronchopulmonary dysplasia, pneumothorax and respiratory distress syndrome.

RESULTS

Gestational age (beta coefficient: -0.244, p<0.001) and birth weight (beta coefficient: -0.237, p<0.001) were significant confounders for duration of hospitalization in newborns.

CONCLUSION

Gestational age and the birth weight were the most important confounders for duration of hospitalization. Neonate care in developing countries would further benefit from additional large population-based long-term studies with broad parameters.

Factors Associated with Post-Traumatic Symptoms in Mothers of Preterm Infants

OBJECTIVES

Symptoms of post-traumatic distress in mothers of preterm infants have been a subject of mental health research. The aim of this study was to assess the prevalence of and risk factors associated with such symptoms in mothers of preterm infants in Taiwan.

METHODS

This was a cross-sectional study performed between January 1, 2010 and June 30, 2011. One hundred and two mothers of preterm infants born at less than 37 weeks gestation and with a subsequent neonatal intensive care unit (NICU) stay between 2005 and 2009 were recruited. Participants completed a demographic questionnaire, the Impact of Event Scale-Revised (IES-R), the Center for Epidemiologic Studies Depression Scale (CES-D) and the neuroticism subscale of the Maudsley Personality Inventory (MPI). The preterm infants' data were taken from medical records.

RESULTS

The prevalence of symptoms of distress was 25.5% (26/102) in the participants. These symptoms were associated with previous miscarriages, preterm premature rupture of membranes, neurotic personality and depression.

CONCLUSIONS

The experience of preterm birth and NICU hospitalization can be traumatic to mothers. Early support for mothers during the preterm infants' NICU stay and transition to home care are recommended.

Parental Leave Policy as a Strategy to Improve Outcomes among Premature Infants

Although gains have been made in premature birth rates among racial and ethnic minority and low socioeconomic status populations, tremendous disparities still exist in both prematurity rates and health outcomes for preterm infants. Parental involvement is known to improve health outcomes for preterm babies. However, a gap in evidence exists around whether parental involvement can help ameliorate the disparities in both short- and long-term out-comes for their preterm children. Families more likely to experience preterm birth are also less likely to have access to paid leave and thus experience significant systemic barriers to involvement, especially when their newborns are hospitalized. This article describes the research gap in this area and explores pathways by which social workers may ameliorate disparities in preterm birth outcomes through practice, policy, and research.

Anxiety levels of mothers with newborns in a Neonatal Intensive Care Unit in Turkey

Objective:

To compare the anxiety levels of mothers with newborns in a Neonatal Intensive Care Unit (NICU) and mothers with healthy newborns in a postpartum care service (PCS).

Methods:

This descriptive study was conducted in state and medical school hospitals located in Eskisehir and Afyon, Turkey. The first 200 mothers, including mothers with newborns in a PCS (n=100) and mothers with newborns in a NICU (n=100); participants were followed starting March 1, 2014. Questionnaires to determine the characteristics of mothers and newborns were used as data collection tools, including the State-Trait Anxiety Inventory Scale (STAI TX-1 – STAI TX-2).

Results:

Trait anxiety levels were not significantly different between mothers with newborns in the NICU and mothers with newborns in PCS (t=0.588, p=0.557), whereas state anxiety levels were significantly different between the two groups (t=-5.109, p=<0.001). The state anxiety levels of mothers whose infants were in the NICU were determined to be higher compared to those of mothers whose infants were in PCS.

Conclusion:

Being a mother of a sick newborn can elevate anxiety and lead to in mothers. During this challenging time, the support of nurses can increase mothers’ abilities to cope with the stress of a sick newborn.

Parents perceptions of stress in a neonatal intensive care unit in Rwanda

Background

Having a newborn infant hospitalised in the neonatal intensive care unit (NICU) is an unexpected and stressful event for a family. A number of potential stressors to which family members of patients in these units may be exposed have been identified, although no studies about this issue have been conducted in Rwanda.

Aim

The aim of this study was to describe and analyse parental perception of stress that resulted from having their infant admitted to a NICU in Kigali, Rwanda.

Method

A quantitative survey was used to describe and analyse parents’ perceptions of stress when they had an infant admitted to a NICU. The Parental Stress Scale: Neonatal Intensive Care Unit was used to measure the level of stress that those parents experienced.

Results

The results indicated that parents experienced stress from having their infants cared for in a NICU. The most stressful events were the appearance and behaviour of the baby with a mean score of 4.02, whilst the subscale items related to sights and sounds were found to be the least significant source of stress for parents with a mean score of 2.51. In addition, the current study found that parents’ age, educational level, occupation, and infant birth weight were associated with parental stress.

Conclusion

The study established that a range of factors was responsible for parental stress when a baby was cared for in a NICU. Identification of these factors could enable health professionals from a hospital in Kigali, Rwanda, to facilitate parents’ adjusting and coping.

NICU discharge planning and beyond: recommendations for parent psychosocial support

Parents will interact with a multitude of teams from various disciplines during their child's admission to the neonatal intensive care unit. Recognition of the emotional stressors experienced by these parents is a first step in working to provide the crucial support and parenting skills needed for bonding and caring for their infant from admission through discharge and beyond. Family-centered care involves time-sensitive two-way communication between parents and the multidisciplinary team members who coordinate care transition by providing emotional, educational, medical and home visitor support for these families. To do this well, a thoughtful exchange of information between team members and parents is essential to identify psychosocial stress and ameliorate family concerns. Parents will need emotional and educational support and follow-up resources. Establishing individualized, flexible but realistic, pre- and post-discharge plans with parents is needed to start their healthy transition to home and community.

Recommendations for enhancing psychosocial support of NICU parents through staff education and support

Providing psychosocial support to parents whose infants are hospitalized in the neonatal intensive care unit (NICU) can improve parents' functioning as well as their relationships with their babies. Yet, few NICUs offer staff education that teaches optimal methods of communication with parents in distress. Limited staff education in how to best provide psychosocial support to families is one factor that may render those who work in the NICU at risk for burnout, compassion fatigue and secondary traumatic stress syndrome. Staff who develop burnout may have further reduced ability to provide effective support to parents and babies. Recommendations for providing NICU staff with education and support are discussed. The goal is to deliver care that exemplifies the belief that providing psychosocial care and support to the family is equal in importance to providing medical care and developmental support to the baby.

Transtorno do estresse pós-traumático no puerpério em uma maternidade de alto risco fetal no Município do Rio de Janeiro, Brasil

Resumo O objetivo deste artigo é estimar a magnitude de transtorno do estresse pós-traumático (TEPT) no puerpério em uma maternidade de referência para agravos perinatais e identificar subgrupos vulneráveis. Trata-se de um estudo transversal realizado uma maternidade de alto risco fetal no Rio de Janeiro, Brasil, com 456 mulheres que realizaram o parto na instituição. O Trauma History Questionnaire e o Post-Traumatic Stress Disorder Checklist foram utilizados para captar experiências traumáticas e sintomas de TEPT, respectivamente. A prevalência geral de TEPT foi de 9,4%. O TEPT mostrou-se mais prevalente entre mulheres com três ou mais partos, que tiveram recém-nascido com Apgar no 1º minuto menor ou igual a sete, com histórico de agravo mental antes ou durante a gravidez, com depressão pós-parto, que sofreram violência física ou psicológica perpetrada por parceiro íntimo na gravidez, que tiveram experiência sexual não desejada e que foram expostas a cinco ou mais traumas. Rápido diagnóstico e tratamento são fundamentais para melhorar a qualidade de vida da mulher e a saúde do recém-nascido.

Depression Management by NICU Nurses

The purpose of this article was to evaluate attitudes of mothers of newborns hospitalized on the neonatal intensive care unit (NICU) toward nurse-delivered depression screening and counseling. NICU mothers ( N = 200) completed questionnaires assessing their views toward being screened for depression by nurses, treatment provider preference, and interest in learning about Listening Visits (LV), a nurse-delivered intervention. The views of 23 LV recipients were also assessed. Most mothers were receptive to depression screening by nurses, two thirds would see a nurse for counseling, and half were interested in learning more about LV. Among LV recipients, half readily embraced the idea and the remaining recipients were skeptical but opted to try. After receiving LV, recipients unanimously rated LV and the skill of the LV provider highly. Screening and counseling by NICU nurses could increase detection of depression and treatment use among at-risk women. Assessing nurses’ perspectives about implementing this model of care is an important future research direction.

Maternal psychological distress and visitation to the neonatal intensive care unit

AIM

To examine associations between maternal neonatal intensive care unit (NICU) visitation rates, maternal psychological distress ('distress') and preterm infant outcome post-NICU discharge in a contemporary cohort of very low birthweight (VLBW) infants.

METHODS

This was a prospective study of 69 mothers and their VLBW infants. Distress was assessed 1-month postbirth, 2 weeks prior to NICU discharge and after NICU discharge at 4-month corrected age (CA). Maternal NICU visitation rates were calculated for the first 2 weeks and 1-month postbirth as well as for the entire NICU hospitalization. Regression analyses adjusted for the impact of (i) maternal and infant characteristics and distress on maternal visitation rates and (ii) the impact of visitation on long-term maternal distress and rates of infant clinic attendance and rehospitalization.

RESULTS

Greater number of children in the home, maternal exposure to a greater number of potentially traumatic events prior to childbirth and lower maternal anxiety consistently predicted lower visitation rate. Lower maternal visitation rate predicted higher maternal depression scores at infants' 4-month CA visit. Maternal NICU visitation rate did not predict post-NICU discharge infant clinic attendance or rehospitalization.

CONCLUSION

Distress is an important predictor of visitation. In turn, visitation is associated with long-term maternal distress.

Depression, anxiety, and perinatal-specific posttraumatic distress in mothers of very low birth weight infants in the neonatal intensive care unit

OBJECTIVE

To compare the trajectories and determine the predictors of maternal distress defined as a continuous spectrum of symptomatology and elevated symptomatology, of depression, anxiety, and perinatal-specific posttraumatic stress (PPTS), in mothers of very low birth weight (VLBW) infants throughout the neonatal intensive care unit (NICU) hospitalization.

METHOD

Sixty-nine mothers completed psychological questionnaires within the first month of their infant's NICU hospitalization and again 2 weeks before NICU discharge. Multiple regression models determined maternal psychological, reproductive, sociodemographic, and infant medical predictors of maternal distress.

RESULTS

Perinatal-specific posttraumatic stress remained stable throughout the NICU hospitalization, whereas other aspects of distress declined. Previous psychological history and infant medical variables predicted higher PPTS but no other aspects of distress. Reproductive variables predicted anxiety and PPTS; history of fetal loss initially predicted lower PPTS but throughout hospitalization primipara status emerged as a predictor of higher anxiety and PPTS. Sociodemographic variables predicated initial, but not later, depressive distress.

CONCLUSIONS

Psychological screening is important in the NICU. The PPTS profile suggests it may require distinct treatment. Primiparas should be targeted for intervention.

Are unmet breastfeeding expectations associated with maternal depressive symptoms?

OBJECTIVE

Most US women intend and initiate breastfeeding, yet many do not breastfeed as long as desired. Not meeting one's own prenatal expectations is a plausible mechanism for the previously observed association between lack of breastfeeding and postpartum depression (PPD). This study explored whether meeting prenatal expectations for exclusive breastfeeding was associated with PPD symptoms.

METHODS

The 2005 Infant Feeding Practices Study II (IFPSII) followed US mothers, primarily white women with higher education and income, from midpregnancy to 1 year postpartum. Depressive symptoms were defined as Edinburgh Postnatal Depression Scale (EPDS) of 10 or higher, measured at 2 months postpartum. Logistic regression analysis evaluated the odds of maternal depressive symptoms as a function of meeting prenatal expectations for exclusive breastfeeding, accounting for breastfeeding behavior, demographics, and postnatal experiences.

RESULTS

Among IFPSII participants, 1501 intended exclusive breastfeeding and completed the EPDS. At 2 months, 589 (39.2%) had met prenatal expectations for exclusive breastfeeding. EPDS was 10 or higher for 346 participants (23.1%). Adjusted odds of depressive symptoms were lower among women meeting prenatal exclusive breastfeeding expectations versus those who were not (odds ratio 0.71, 95% confidence interval 0.52-0.96). In subgroup analysis, there was no association between met expectations and depressive symptoms among women with lower incomes (<200% federal poverty level) or those intending mixed breast and formula feeding.

CONCLUSIONS

Among middle- and higher-income women who intended exclusive breastfeeding, those meeting prenatal breastfeeding expectations reported fewer PPD symptoms at 2 months postpartum. Clinician understanding and support of maternal expectations may improve maternal mental health.