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Lisanti AJ, Dong F, Demianczyk A, Vogiatzi MG, Quinn R, Chittams J, Hoffman R, Medoff−Cooper B. Salivary Diurnal Cortisol Predicts Post-Traumatic Stress Symptoms in Parents of Infants With Congenital Heart Disease. Biol Res Nurs 2024; 26:341-349. [PMID: 38166230 PMCID: PMC11131345 DOI: 10.1177/10998004231224791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
BACKGROUND Parents of infants born with congenital heart disease (CHD) who require open heart surgery after birth are at risk for prolonged psychological distress. Even after their infants are discharged, parents may experience anxiety, depressive, and post-traumatic stress (PTS) symptoms; yet, it is unclear which parents are at greater risk for ongoing symptoms. The purpose of this study was to explore whether measures of the biomarker cortisol in parents during their infants' postoperative period were associated with subsequent psychological distress symptoms at three-month post discharge. METHODS This was a prospective, longitudinal exploratory study of 40 parents of infants with CHD after open heart surgery using consecutive enrollment. Parents provided diurnal saliva samples for two consecutive days in the postoperative period. Six predictors were summarized and generated including waking cortisol, bedtime cortisol, cortisol awaking response, area under curve with respect to the ground (AUCg), cortisol index, and cortisol slope. Self-report outcome measures on anxiety, depressive, and PTS symptoms were collected three-months post-discharge. Linear mixed models examined the associations between each predictor and each outcome while accounting for within-dyad variance using an unstructured covariance matrix. RESULTS Cortisol AUCg was a predictor of PTS at three-months post-discharge (β = .34, p = .03, Cohen's d = 2.05). No significant relationships were found with the other cortisol measures. CONCLUSIONS & IMPLICATIONS Findings suggest that cortisol area under curve may help to identify parents at risk for increased PTS in the months following their infants' hospitalization for cardiac surgery, serving as a foundation for future study in this area.
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Affiliation(s)
- Amy Jo Lisanti
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Research Institute, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Fanghong Dong
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Abigail Demianczyk
- Center for Pediatric Behavioral Health, Cleveland Clinic Children’s, Cleveland, OH, USA
| | - Maria G. Vogiatzi
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ryan Quinn
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Jesse Chittams
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca Hoffman
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Barbara Medoff−Cooper
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Research Institute, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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McCarty D, Silver R, Quinn L, Dusing S, O’Shea TM. Infant massage as a stress management technique for parents of hospitalized extremely preterm infants. Infant Ment Health J 2024; 45:11-21. [PMID: 38140832 PMCID: PMC10947750 DOI: 10.1002/imhj.22095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/19/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023]
Abstract
Mothers of infants born extremely preterm requiring prolonged medical intervention in the Neonatal Intensive Care Unit (NICU) are at high risk of developing stress. Parent-administered infant massage is a well-established, safe intervention for preterm infants with many developmental benefits, but the published literature has mostly examined its impact on infants and parents through self-reported or observational measures of stress. The aim of this study was to measure salivary cortisol, a biomarker for stress, in extremely preterm infants and their mothers immediately pre and post parent-administered infant massage in order to detect potential changes in physiologic stress. Twenty-two mother-infant dyads completed massage education with a physical or occupational therapist. All dyads provided salivary cortisol samples via buccal swab immediately pre- and post-massage at the second session. Of mothers determined to be "cortisol responders" (15/22), salivary cortisol levels were lower after massage (pre-minus post-level: -26.47 ng/dL, [CI = -4.40, -48.53], p = .016, paired t-test). Our primary findings include a clinically significant decrease (as measured by percent change) in maternal cortisol levels immediately post parent-administered massage, indicating decreased physiological stress. Integration of infant massage into NICU clinical practice may support maternal mental health, but further powered studies are necessary to confirm findings.
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Affiliation(s)
- Dana McCarty
- Department of Health Sciences, Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Rehabilitation Services, University of North Carolina Children’s Hospital, Chapel Hill, NC
| | - Rachel Silver
- Abilitations Children’s Therapy and Wellness Center, Knightdale, NC
| | - Lauren Quinn
- Department of Rehabilitation Services, University of North Carolina Children’s Hospital, Chapel Hill, NC
| | - Stacey Dusing
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
| | - T. Michael O’Shea
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina, Chapel Hill, NC
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Smith S, Tallon M, Smith J, Angelhoff C, Mörelius E. Parental sleep when their child is sick: A phased principle-based concept analysis. J Sleep Res 2022; 31:e13575. [PMID: 35468663 PMCID: PMC9786861 DOI: 10.1111/jsr.13575] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/28/2022] [Accepted: 02/16/2022] [Indexed: 12/30/2022]
Abstract
Sleep is a common challenge for parents with sick children and can impact parents' health, wellbeing, and caregiving responsibilities. Despite the vast research around parental sleep when their child is sick, the concept is not clearly defined. A phased principle-based concept analysis that includes triangulation of methods and quality criteria assessment was used to explore how the concept is described, used, and measured in the current literature. The aim was to analyse and clarify the conceptual, operational, and theoretical basis of parental sleep when their child is sick to produce an evidence-based definition and to identify knowledge gaps. A systematic literature search including databases CINAHL, Embase, MEDLINE, PsychARTICLES, PsychINFO, Pubmed, Scopus and Web of Science, identified 546 articles. The final dataset comprised 74 articles published between 2005 and 2021 and was assessed using a criteria tool for principle-based concept analysis. Data were managed using NVivo, and thematic analysis was undertaken. A precise definition is not present in the literature. Various tools have been used to measure parents' sleep, as well as exploration via interviews, open-ended questions, and sleep diaries. The terminology used varied. Parental sleep when their child is sick is interrelated with other concepts (e.g., stress). A recommended definition is offered. A conceptual understanding of parental sleep when their child is sick will help to guide translational research and to conduct studies critical to clinical practice and research. Future research includes developing a measurement tool for parental sleep when their child is sick to be used in study design and future interventions.
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Affiliation(s)
- Stephanie Smith
- School of Nursing and MidwiferyEdith Cowan UniversityPerthWAAustralia,Perth Children's HospitalNedlands, PerthWAAustralia
| | - Mary Tallon
- School of NursingCurtin UniversityPerthWAAustralia
| | - James Smith
- Centre for Precision HealthCollaborative Genomics and Translation GroupSchool of Medical and Health SciencesEdith Cowan UniversityPerthWAAustralia,Centre for Healthcare Resilience and Implementation ScienceAustralian Institute for Health InnovationMacquarie UniversitySydneyNSWAustralia
| | - Charlotte Angelhoff
- Crown Princess Victoria's Child and Youth Hospital and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Evalotte Mörelius
- School of Nursing and MidwiferyEdith Cowan UniversityPerthWAAustralia,Perth Children's HospitalNedlands, PerthWAAustralia
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Lisanti AJ, Demianczyk A, Vogiatzi MG, Quinn R, Chittams J, Hoffman R, Medoff-Cooper B. The Associations of Psychologic and Physiologic Manifestations of Parental Stress in Critical Congenital Heart Disease. Biol Res Nurs 2022; 24:316-326. [DOI: 10.1177/10998004221077136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The primary objective of this exploratory, feasibility study was to examine the relationships of self-reported perceived stressors and psychological stress responses with measures of the biomarker cortisol in parents of infants hospitalized after neonatal cardiac surgery for critical congenital heart disease (cCHD). Methods: This was a prospective, cross-sectional study of 28 biological mother–father dyads of neonates with cCHD using consecutive enrollment. In the postoperative period after neonatal cardiac surgery, parents provided awakening and diurnal saliva samples and self-report measures on stress, anxiety, depression, dyadic adjustment, and perceived severity of illness of their neonate. Results: Evaluable data, including salivary cortisol samples, were obtained for 27 of the 28 dyads enrolled in the study. Compared to fathers, mothers exhibited significantly higher mean cortisol values at wakeup ( p = .032), 30-minute post-wakeup ( p = .024), and bedtime ( p = .010) timepoints. Anxiety and depressive symptoms were both significant predictors of awakening cortisol measures. Depressive symptoms were also a predictor of diurnal cortisol ( p < .05). Stress arising from infant appearance and behavior was found to significantly predict cortisol awakening response ( p = .0403). Conclusions: Findings suggest that cortisol may be an important biomarker in the examination of parent stress in the pediatric cardiac intensive care unit (PCICU), serving as a foundation for future study in this area. Furthermore, we have provided preliminary evidence of feasibility of including saliva collection in studies of highly stressed parents in a challenging environment.
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Affiliation(s)
- Amy Jo Lisanti
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Research Institute, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Abigail Demianczyk
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maria G. Vogiatzi
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ryan Quinn
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Jesse Chittams
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca Hoffman
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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Smith S, Tallon M, Clark C, Jones L, Mörelius E. "You Never Exhale Fully Because You're Not Sure What's NEXT": Parents' Experiences of Stress Caring for Children With Chronic Conditions. Front Pediatr 2022; 10:902655. [PMID: 35832577 PMCID: PMC9271768 DOI: 10.3389/fped.2022.902655] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Children with chronic conditions are experiencing improved survival worldwide, and it is well-known that their parents are stressed. Yet, despite this knowledge, parents continue to experience stress. Our study explored the lived experience of parental stress when caring for children with various chronic conditions to identify opportunities to potentially reduce stress for these parents. This was an exploratory qualitative study using semi-structured interviews. To ensure appropriate research priorities were addressed, the study was co-designed with consumer and stakeholder involvement. Twenty parents were interviewed. Parents were recruited through a recognized family support organization for children with various care needs in Western Australia. Interviews were audio-recorded, transcribed verbatim, anonymized, and analyzed using Interpretative Phenomenological Analysis. Two superordinate themes were identified: (1) Gut instinct to tipping point included parents as unheard experts and their experiences of stress and becoming overwhelmed. (2) Losses and gains covered the parents' identity and relationship challenges and coping strategies with their children's unpredictable conditions. Parents' experiences of stress caring for children with chronic conditions can be applied to the Job-Demand Control-Support Model for occupational stress. Not only does this application provide a useful framework for practitioners but it adds a unique perspective that reflects the dual role of parents in caring for their children with chronic conditions as a parent but also a professional with a 24/7 workload. The parents' experiences highlight a need for improved support access, effective communication between parents and health care professionals, discharge preparation and information provision, and regular screening of parental stress with a referral pathway.
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Affiliation(s)
- Stephanie Smith
- School of Nursing and Midwifery, Edith Cowan University, Joondaulup, WA, Australia.,Perth Children's Hospital, Nursing Research Department, Nedlands, WA, Australia
| | - Mary Tallon
- School of Nursing, Curtin University, Bentley, WA, Australia
| | - Carrie Clark
- Kalparrin, Perth Children's Hospital, Nedlands, WA, Australia
| | | | - Evalotte Mörelius
- School of Nursing and Midwifery, Edith Cowan University, Joondaulup, WA, Australia.,Perth Children's Hospital, Nursing Research Department, Nedlands, WA, Australia
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Shi X, Nie X, Wu J. The cortisol awakening response and the late positive potentials evoked by unpleasant emotional pictures in healthy adults. Stress 2022; 25:40-47. [PMID: 34882046 DOI: 10.1080/10253890.2021.2008902] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The cortisol awakening response (CAR) refers to a sharp rise in cortisol concentrations within the 45 min following morning awakening. Alterations in CAR have been associated with various internalizing symptoms and brain function. The current study aimed to investigate the association between CAR and neural activity in response to unpleasant emotional pictures. A total of 46 healthy adults (22.55 years ± 1.69) collected saliva samples at 0, 30, and 45 min post-awakening on two days to assess the CAR. In the afternoon after CAR measurement on the first day, electroencephalograms were recorded when the participants completed a passive viewing task. The results showed that a greater CAR was associated with a decreased late positive potential difference score between unpleasant and neutral stimuli. This finding indicates that a larger CAR may be associated with decreased attentional engagement to unpleasant emotional information in healthy adults.
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Affiliation(s)
- Xia Shi
- Department of Psychology, Tianjin University of Technology and Education, Tianjin, China
| | - Xin Nie
- Department of Psychology, Tianjin University of Technology and Education, Tianjin, China
| | - Jianhui Wu
- Center for Brain Disorder and Cognitive Sciences, Shenzhen University, Shenzhen, Guangdong, China
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Areskoug Sandberg E, Duberg A, Lorenzon Fagerberg U, Mörelius E, Särnblad S. Saliva Cortisol in Girls With Functional Abdominal Pain Disorders: A Randomized Controlled Dance and Yoga Intervention. Front Pediatr 2022; 10:836406. [PMID: 35633978 PMCID: PMC9133484 DOI: 10.3389/fped.2022.836406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Functional abdominal pain disorders (FAPDs) are common among girls and has been associated with stress. Cortisol is one of the major stress hormones. Dance and yoga have been shown to reduce abdominal pain among girls with FAPDs. AIM To investigate the effect of an 8-month intervention with dance and yoga on cortisol levels in saliva among girls with FAPDs. METHODS A total of 121 girls aged 9-13 years with irritable bowel syndrome (IBS) or functional abdominal pain were included in the study. Participants were randomized into an intervention group and a control group. The intervention group attended a combined dance and yoga session twice a week for 8 months. Saliva samples were collected during 1 day, in the morning and evening, at baseline, and at 4 and 8 months. Subjective pain and stress were assessed as well. RESULTS No significant effects on saliva cortisol levels between groups were observed after completion of the intervention at 8 months. However, evening cortisol and evening/morning quotient were significantly reduced at 4 months in the intervention group compared to the control group (p = 0.01, p = 0.004). There was no association between cortisol quota and pain or stress. CONCLUSION Improvements in cortisol levels were seen in the intervention group at 4 months but did not persist until the end of the study. This indicates that dance and yoga could have a stress-reducing effect during the ongoing intervention.
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Affiliation(s)
- Elin Areskoug Sandberg
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Anna Duberg
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ulrika Lorenzon Fagerberg
- Centre for Clinical Research, Department of Paediatrics, Västmanland Hospital, Region Västmanland, Uppsala University, Västerås, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Evalotte Mörelius
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia.,Perth Children's Hospital, Nedlands, WA, Australia
| | - Stefan Särnblad
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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