Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Uptake and impact of journaling program on wellbeing of NICU parents



This pilot study evaluated a brief parent journaling program in the neonatal intensive care unit (NICU).

Study design

Hundred NICU parents were randomized to a control group (no journal) or an intervention group (journal provided). Parents reported pre- and post-intervention anxiety and depression symptoms using the hospital anxiety and depression scale (HADS) and qualitative journal use data. The analysis included Student’s paired two-tailed t-test and two-way ANOVA. This study was registered with on April 1, 2020, NCT04331925.


At baseline, clinically significant anxiety was more prevalent than depression (66% vs. 23%). Post-intervention scores were best predicted by baseline scores. Relative to controls, intervention group parents experienced a decrease in anxiety from baseline (t = −1.983, p = 0.056). The same effect was not seen for depression. Most intervention group parents used the journal and provided positive feedback.


Journal use rates and positive feedback support the acceptability of a NICU journaling program.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it


Prices may be subject to local taxes which are calculated during checkout


  1. Davidson JE, Aslakson RA, Long AC, Puntillo KA, Kross EK, Hart J, et al. Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Crit Care Med. 2017;45:103–22.

    Article  Google Scholar 

  2. Garrouste-Orgeas M, Perier A, Mouricou P, Gregoire C, Bruel C, Brochon C, et al. Writing in and reading ICU diaries: qualitative study of families’ experience in the ICU. PLoS ONE. 2014;9:e110146.

    Article  Google Scholar 

  3. Jones C, Backman C, Griffiths RD. Intensive care diaries and relatives’ symptoms of posttraumatic stress disorder after critical illness: a pilot study. Am J Crit Care. 2012;21:172–6.

    Article  Google Scholar 

  4. Davis L, Edwards H, Mohay H, Wollin J. The impact of very premature birth on the psychological health of mothers. Early Hum Dev. 2003;73:61–70.

    Article  Google Scholar 

  5. American Academy of Pediatrics Committee on Hospital Care. Family-centered care and the pediatrician’s role. Pediatrics. 2003;112:691–6.

    Article  Google Scholar 

  6. Macnab AJ, Beckett LY, Park CC, Sheckter L. Journal writing as a social support strategy for parents of premature infants: a pilot study. Patient Educ Couns. 1998;33:149–59.

    Article  CAS  Google Scholar 

  7. Barry LM, Singer GH. Reducing maternal psychological distress after the NICU experience through journal writing. J Early Interv. 2001;24:287–97.

    Article  Google Scholar 

  8. Greene MM, Rossman B, Meier P, Patra K. Elevated maternal anxiety in the NICU predicts worse fine motor outcome in VLBW infants. Early Hum Dev. 2018;116:33–9.

    Article  Google Scholar 

  9. Dryer K, Williamson RAP, Hargreaves DS, Rosen R, Deeny SR. Associations between parental mental health and other family factors and healthcare utilization among children and young people: a retrospective, cross-sectional study of linked healthcare data. BMJ Paediatr. 2018;2:e000266.

    Article  Google Scholar 

  10. Turney K. Maternal depression and childhood health inequalities. J Health Soc Behav. 2011;52:314–32.

    Article  Google Scholar 

  11. Crawford JR, Henry JD, Crombie C, Taylor EP. Brief report normative data for the HADS from a large non-clinical sample. Br J Clin Psychol. 2001;40:429–34.

    Article  CAS  Google Scholar 

  12. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.

    Article  CAS  Google Scholar 

  13. Karsh I, Jungeblut A, Jenkins L, Kolstad A. Adult literacy in America: a first look at the result of the national adult literacy survey. National Center for Education Statistics, US Department of Education; Washington, DC: 2006.

  14. Pennebaker JW, Beal SK. Confronting a traumatic event: toward an understanding of inhibition and disease. J Abnorm Psychol. 1986;95:274–81.

    Article  CAS  Google Scholar 

  15. Zhou Y, Cao Z, Yang M, Xi X, Guo Y, Fang M, et al. Comorbid generalized anxiety disorder and its association with quality of life in patients with major depressive disorder. Sci Rep. 2018;7:40511.

    Article  Google Scholar 

  16. Brown TA, Campbell LA, Lehman CL, Grisham JR, Mancill RB. Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. J Abnorm Psychol. 2001;110:585–99.

    Article  CAS  Google Scholar 

  17. McLean CP, Asnaani A, Litz BT, Hofmann SG. Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. J Psychiatr Res. 2011;45:1027–35.

    Article  Google Scholar 

Download references


This study was supported by the Mildred Stahlman Division of Neonatology at Vanderbilt University Medical Center. Statistical support was provided by the Vanderbilt Institute for Clinical and Translational Research.


This study was funded by Vanderbilt Institute for Clinical and Translational Research (VR52927) and the John and Leslie Hooper Neonatal-Perinatal Endowment Fund.

Author information

Authors and Affiliations



ASW, ZEW, and LNR conceptualized and designed the study. ASW and LNR drafted the initial manuscript. LNR collected data. All authors played a critical role in study development and reviewed and revised the manuscript.

Corresponding author

Correspondence to Laura N. Russell.

Ethics declarations

Conflict of interest

The authors declare no competing interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Russell, L.N., Gregory, M.L., Warren, Z.E. et al. Uptake and impact of journaling program on wellbeing of NICU parents. J Perinatol 41, 2057–2062 (2021).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


Quick links