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A global perspective on parental stress in the neonatal intensive care unit: a meta-analytic study

Abstract

Objectives

The Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) is a well-validated tool to assess different sources of stress in parents during the NICU hospitalization of their infant. The present meta-analytic study assessed the relative impact of different NICU-related sources of parental stress in a pool of studies conducted in a wide set of different countries. Also, differences in stress levels by parent gender and country, as well as the impact of infants’ neonatal characteristics and clinical conditions were explored.

Methods

Records were searched on PubMed, Scopus, and Web of Science (January 1993–December 2019). A purposive open search string was adopted: [“PSS:NICU”] OR [“PSS-NICU”] OR [“Parental Stressor Scale”]. A multiple random-effect meta-analysis was conducted on data from 53 studies extracted by independent coders.

Results

Parental role alteration emerged as the greatest source of stress for both mothers and fathers. Mothers reported higher stress levels compared to fathers. A significant difference emerged only for the subscale related to sights and sounds physical stimuli. No significant effects of infants’ neonatal characteristics (gestational age, birth weight) and clinical conditions (comorbidities) emerged. A marginal positive effect of NICU length of stay emerged on the global level of parents’ stress.

Conclusions

The current meta-analysis underlines that parental stress related to NICU admission is a worldwide healthcare issue. Immediate and tailored support to parents after the birth of their at-risk infant should be prioritized to reduce parental stress and to promote mothers and fathers’ emotional well-being and new-born neurodevelopmental outcomes.

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Fig. 1
Fig. 2: Funnel plots.
Fig. 3: PSS:NICU violin plots.
Fig. 4: Distribution of PSS:NICU scores among different countries.

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Funding

This study was supported by funds from the Italian Ministry of Health to IRCCS Mondino Foundation (“Ricerca Corrente 2020”, “5 per mille”) and to Fondazione IRCCS Policlinico San Matteo (“Ricerca Corrente 2020”).

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Correspondence to Livio Provenzi.

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Caporali, C., Pisoni, C., Gasparini, L. et al. A global perspective on parental stress in the neonatal intensive care unit: a meta-analytic study. J Perinatol 40, 1739–1752 (2020). https://doi.org/10.1038/s41372-020-00798-6

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