Prevalence of and factors associated with postnatal depression and anxiety among parents of preterm infants: A systematic review and meta-analysis

Prevalence of postnatal anxiety disorders in mothers of preterm infants: a systematic review protocol

OBJECTIVE

The objective of this systematic review is to evaluate and synthesize the available evidence on the prevalence of postnatal anxiety disorders in mothers of preterm infants within 12 months of delivery.

INTRODUCTION

Mothers of preterm infants report more postpartum psychological problems than other mothers. Anxiety disorders are among the most frequently reported manifestations, and affect the quality of maternal care and the baby's development. However, data on the prevalence of postnatal anxiety disorders in mothers of preterm infants are inconsistent and imprecise. It is, therefore, necessary to estimate the prevalence of anxiety disorders among mothers of premature infants in order to develop appropriate interventions for screening, support, and treatment.

INCLUSION CRITERIA

This review will consider studies conducted in any setting and any geographical location that report on the prevalence of any anxiety disorders in mothers of preterm infants within 12 months of delivery. Any analytical or descriptive observational studies and experimental or quasi-experimental studies will be included.

METHODS

MEDLINE (Ovid), PsycINFO (Ovid), Embase (Elsevier), CINAHL (EBSCOhost), Google Scholar, MedNar, and the World Health Organization website will be searched for studies written in English or French. Screening, critical appraisal, and data extraction will be performed by 2 independent reviewers using the relevant JBI systematic review tools. The findings will be presented in narrative format, including tables and figures to aid in data presentation.

REVIEW REGISTRATION

PROSPERO CRD42023428202.

Improving Maternal Depression Screening in the Neonatal Intensive Care Unit

PURPOSE

To examine whether self-perceived benefits of mental health treatment differed between mothers of babies in the neonatal intensive care unit with and without a positive screen for depression based on their Edinburgh Postnatal Depression score.

STUDY DESIGN AND METHODS

Mothers were recruited in person pre-COVID-19 pandemic, and via phone call and online advertisement during the pandemic. Mothers completed a 10-item depression scale and whether they believed they would benefit from mental health treatment. A chi-square test determined the difference in perceived benefit between mothers who screened positively for depression and those who did not.

RESULTS

This secondary analysis included 205 mothers, with an average age of 29. Of the 68 mothers who screened positively for depression, 12 believed that would not benefit from mental health intervention. Of the 137 who screened negatively for depression, 18 believed they would benefit from mental health intervention. Mothers who screened negatively for depression were significantly less likely to believe they would benefit from mental health intervention.

CLINICAL IMPLICATIONS

Depression screening scales offer guidance on which mothers to flag for follow-up, but neither on how a mother will respond nor how to effectively approach a mother about her mental health. Nurses can improve identification and follow-up of depressed mothers in the neonatal intensive care unit by asking mothers about their perceived need for mental health treatment.

Parenting Expectations, NICU Experiences, and Maternal Psychological Outcomes: An Exploratory Mixed-Methods Study

BACKGROUND

Infant neonatal intensive care unit (NICU) hospitalization increases maternal risk for psychological distress. However, no universal screening standards exist and predicting maternal risk remains challenging. Reconceptualizing maternal distress in relation to differences between parenting expectations and NICU experiences may illuminate commonalities across a range of experiences.

PURPOSE

This study explored parenting expectation-experience differences (EEDs) among NICU mothers and assessed correlations between EED scores and psychological outcomes 1 to 5 years post-NICU hospitalization.

METHODS

A 3-phase explanatory sequential mixed-methods design was used. Pearson's correlation coefficients were used to measure relationships between EED scores and maternal psychological outcomes. Reflexive thematic analysis of one-on-one, semi-structured interviews contextualized EED scores.

RESULTS

Most participants (92.9%) reported negative EED scores, indicating NICU experiences fell short of parenting expectations. Significant inverse correlations were found between EED scores and maternal outcomes, including depression ( r = -0.25, P < .01), anxiety ( r = -0.25, P < .01) and posttraumatic stress disorder symptoms ( r = -0.41, P < .001), and perceived parenting self-efficacy ( r = -0.28, P < .01). Major qualitative themes included unexpected versus prepared, lost parenting experiences, and surviving and thriving. Data synthesis contextualized EED scores and revealed key differences in meaning ascribed to unmet parenting expectations.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Preparing mothers for infant NICU hospitalization and creating a NICU parenting environment, which better supports mothers and their engagement in parenting tasks, may help to reduce differences between parenting expectations and NICU experiences. Further research is needed to elucidate the impacts of parenting EEDs in this population.

Application of Trauma-Informed Care Principles to Care Needs Identified by Mothers of NICU-Hospitalized Children

Systematic uptake of family-centered care (FCC) interventions remains challenging and frequently suboptimal in many neonatal intensive care units (NICUs). Across NICUs in the United States, integrating family members as partners in infant caregiving and decision-making has not been well supported and routine screening and provision of psychological support for parents remains inadequate. Trauma-informed care (TIC) may offer a more comprehensive approach to NICU care which can encompass FCC principles and promote family recovery and resilience by recognizing and responding to the traumas experienced by NICU infants and families. The current paper aimed to understand needs identified by mothers of NICU-hospitalized children and reports a focused analysis of one-on-one interview data (n = 13 mothers) collected during a larger mixed methods study. Reflexive thematic analysis was used to understand needs identified by mothers and to explore how these needs aligned with TIC principles. Six themes were identified and subsequently examined in the context of the principles of TIC: I Just Had No Control, That Really Caught Us Off Guard, So Much Was Already Taken Away, We're People and There Needs To Be More Support and Practices Which Helped. Mothers' care needs were found to align with TIC principles. Findings suggest that implementation of TIC principles in NICU settings can support parental presence, participation in infant care, and mental health and support the potential of TIC as a more comprehensive approach to meeting the needs of NICU parents.

The effect of paternal anxiety on mother-infant bonding in neonatal intensive care

BACKGROUND

The hospitalization of a preterm infant in the NICU can lead to mental health difficulties in parents, but not much is known how paternal anxiety might affect the mother-infant relationship.

METHODS

This prospective cohort study is a secondary analysis investigating how paternal anxiety levels might affect maternal bonding in the NICU using the dataset of the multinational pragmatic randomized controlled trial LongSTEP. A linear mixed-effects model was used for correlations of paternal anxiety (GAD-7) and maternal bonding (PBQ) at NICU discharge, and at 6 and 12 months infant corrected age. Secondary analyses examined effects on paternal anxiety related to: site (Argentina, Colombia, Israel, Norway, and Poland), maternal depression (EPDS), infant gestational age at birth, paternal age, and type of pregnancy.

RESULTS

Paternal anxiety did not predict maternal bonding at NICU discharge (p = 0.096), at 6 months (p = 0.316), or at 12 months infant corrected age (p = 0.473). Secondary outcomes showed a statistically significant site effect, with higher paternal anxiety levels at the two Colombian sites at baseline (p = 0.014 and p = 0.020) and for one site at discharge (p = 0.012), but not for paternal age (p = 0.925 and p = 0.793), infant gestational age at birth (p = 0.974 and p = 0.686 and p = 0.340), or type of pregnancy (p = 0.381). Maternal depression predicted paternal anxiety at baseline (p < 0.001) and at discharge (p = 0.003).

CONCLUSIONS

In this study, paternal anxiety did not predict maternal bonding. Paternal anxiety varied by site, indicating a need for research on potential cultural differences in manifestation of paternal anxiety. Maternal depression predicted paternal anxiety, confirming a previously reported correlation. Further research on variations in paternal mental health in the neonatal period is warranted, as well as exploration of the social contagion of mental health in preterm parents.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03564184.

Prevalence of depression in melasma: a systematic review and meta-analysis

Background

Due to cosmetic disfigurement, melasma can negatively affect the quality of life and emotional and mental health, further leading to depression.

Objective

Prevalence rates of depression in patients with melasma vary widely across studies. The aim of this systematic review and meta-analysis was to estimate the prevalence of depression among melasma patients.

Methods

The PubMed, Embase, Web of Science, and Scopus databases were searched to identify articles evaluating the prevalence of depression in melasma patients from their inception to 12 July 2023. Studies were reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and a meta-analysis was performed using the Stata 14.0 software.

Results

Sixteen studies met the eligibility criteria out of the 859 studies, containing a total of 2,963 melasma patients for this systematic review and meta-analysis. Meta-analyses revealed that the pooled prevalence of depression among patients with melasma was 43.4% (95% CI 30.5-56.2%, Q-value = 808.859, d.f. = 15, p < 0.001, tau2 = 0.065, I2 = 98.1%). The meta-regression found that the publication year, sample size, and study quality were not significant moderators for the observed heterogeneity in prevalence. A subgroup analysis according to depression assessment methods showed that the prevalence of depressive disorders was 24.2% (95% CI 16.8-31.6%), and the prevalence of depressive symptoms was 45.1% (95% CI 31.2-59.0%). A subgroup analysis by geographic regions showed that patients in Asia had the highest prevalence of depression at 48.5% (95% CI 26.0-71.0%), compared to other regions. A subgroup analysis by study design showed that the prevalence of depression in case-control studies was almost identical to cross-sectional studies. In the case of OR, the pooled OR of depression between patients with melasma and health controls was 1.677 (95% CI 1.163-2.420, p = 0.606, I2 = 0.0%).

Conclusion

The prevalence of depression was relatively high in patients with melasma, and there was a correlation between melasma and depression, encouraging clinicians to screen for depression in their patients and providing a combination of physical and psychosocial support. If necessary, they should be referred to formal mental health services to seek professional psychological intervention.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, CRD42022381378.