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Parental resilience and psychological distress in the neonatal intensive care unit

Abstract

Objective

To evaluate the associations between parental resilience and psychological distress during the neonatal intensive care unit (NICU) hospitalization.

Study design

Observational cohort study of parents of preterm infants (n = 45) admitted to a NICU between December 2017–October 2019. Data on resilience and psychological distress were collected using validated scales. Regression analysis was used to evaluate associations.

Result

One-third of NICU parents screened positive for depression or anxiety. There were no identified sociodemographic factors or parental engagement activities associated with resilience. Parents with higher resilience had lower scores on depression and anxiety screens. However, resilience alone was not a predictor for a positive depression or anxiety screen (aOR 0.93, CI 0.86–1.00; aOR 0.95, CI 0.89–1.02, respectively).

Conclusion

Resilience may be associated with lower scores on depression and anxiety screens but is not an independent predictor for a positive screen during the early NICU hospitalization.

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Fig. 1: Flowchart for study participants.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Greene MM, Rossman B, Patra K, Kratovil AL, Janes JE, Meier PP. Depression, anxiety, and perinatal-specific posttraumatic distress in mothers of very low birth weight infants in the neonatal intensive care unit. J Dev Behav Pediatr. 2015;36:362–70.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Lefkowitz DS, Baxt C, Evans JR. Prevalence and correlates of posttraumatic stress and postpartum depression in parents of infants in the Neonatal Intensive Care Unit (NICU). J Clin Psychol Med Settings. 2010;17:230–7.

    Article  PubMed  Google Scholar 

  3. Tahirkheli NN, Cherry AS, Tackett AP, McCaffree MA, Gillaspy SR. Postpartum depression on the neonatal intensive care unit: current perspectives. Int J Women’s Health. 2014;6:975–87.

    Google Scholar 

  4. Vigod SN, Villegas L, Dennis CL, Ross LE. Prevalence and risk factors for postpartum depression among women with preterm and low-birth-weight infants: a systematic review. BJOG. 2010;117:540–50.

    Article  CAS  PubMed  Google Scholar 

  5. Soghier LM, Kritikos KI, Carty CL, Glass P, Tuchman LK, Streisand R, et al. Parental depression symptoms at neonatal intensive care unit discharge and associated risk factors. J Pediatrics. 2020;227:163–9.

  6. Dennis CL, Coghlan M, Vigod S. Can we identify mothers at-risk for postpartum anxiety in the immediate postpartum period using the State-Trait Anxiety Inventory? J Affect Disord. 2013;150:1217–20.

    Article  PubMed  Google Scholar 

  7. Rogers CE, Kidokoro H, Wallendorf M, Inder TE. Identifying mothers of very preterm infants at-risk for postpartum depression and anxiety before discharge. J Perinatol. 2013;33:171–6.

    Article  CAS  PubMed  Google Scholar 

  8. Mendelson T, Cluxton-Keller F, Vullo GC, Tandon SD, Noazin S. NICU-based interventions to reduce maternal depressive and anxiety symptoms: a meta-analysis. Pediatrics. 2017;139:e20161870.

  9. Mughal MK, Giallo R, Arnold PD, Kehler H, Bright K, Benzies K, et al. Trajectories of maternal distress and risk of child developmental delays: Findings from the All Our Families (AOF) pregnancy cohort. J Affect Disord. 2019;248:1–12.

    Article  PubMed  Google Scholar 

  10. Herrman H, Stewart DE, Diaz-Granados N, Berger EL, Jackson B, Yuen T. What is resilience? Can J Psychiatry. 2011;56:258–65.

    Article  PubMed  Google Scholar 

  11. Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18:76–82.

    Article  PubMed  Google Scholar 

  12. Jacelon CS. The trait and process of resilience. J Adv Nurs. 1997;25:123–9.

    Article  CAS  PubMed  Google Scholar 

  13. Long AC, Kross EK, Curtis JR. Family-centered outcomes during and after critical illness: current outcomes and opportunities for future investigation. Curr Opin Crit Care. 2016;22:613–20.

    Article  PubMed  Google Scholar 

  14. Rossman B, Greene MM, Kratovil AL, Meier PP. Resilience in mothers of very-low-birth-weight infants hospitalized in the NICU. J Obstet Gynecol Neonatal Nurs. 2017;46:434–45.

    Article  PubMed  Google Scholar 

  15. Pinelli J. Effects of family coping and resources on family adjustment and parental stress in the acute phase of the NICU experience. Neonatal Netw. 2000;19:27–37.

    Article  CAS  PubMed  Google Scholar 

  16. Lian BX, Amin Z, Aishworiya R. Juggling multiple roles amidst uncertainty: the Asian Father’s perspective of an infant in neonatal intensive care unit. Am J Perinatol. 2021;38:1420–7.

    Article  PubMed  Google Scholar 

  17. Ivashchuk A, Guillen U, Mackley A, Locke R, Sturtz W. Parental protective factors and stress in NICU mothers and fathers. J Perinatol. 2021;41:2000–8.

    Article  PubMed  Google Scholar 

  18. Ferrand A, Gorgos A, Ali N, Payot A. Resilience rather than medical factors: how parents predict quality of life of their sick newborn. J Pediatr. 2018;200:64–70.e5.

    Article  PubMed  Google Scholar 

  19. Dahan S, Bourque CJ, Reichherzer M, Prince J, Mantha G, Savaria M, et al. Community, hope, and resilience: parental perspectives on peer support in neonatology. J Pediatr. 2022;243:85–90.e2.

    Article  PubMed  Google Scholar 

  20. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81.

    Article  PubMed  Google Scholar 

  21. Programs AoMaCH. Life Course Indicator: Concentrated Disadvantage. Association of Maternal and Child Health Programs; 2013. http://www.amchp.org/programsandtopics/data-assessment/LifeCourseIndicatorDocuments/LC-06_ConcentratedDisad_Final-4-24-2014.pdf.

  22. Messer LC, Laraia BA, Kaufman JS, Eyster J, Holzman C, Culhane J, et al. The development of a standardized neighborhood deprivation index. J Urban Health. 2006;83:1041–62.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Garg B, Sharma D, Farahbakhsh N. Assessment of sickness severity of illness in neonates: review of various neonatal illness scoring systems. J Matern Fetal Neonatal Med. 2018;31:1373–80.

    Article  PubMed  Google Scholar 

  24. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782–6.

    Article  CAS  PubMed  Google Scholar 

  25. Spielberger C, Gorsuch R, Lushene R, Vagg PR, Jacobs G. Manual for the State-Trait Anxiety Inventory (Form Y1 – Y2). Palo Alto, CA: Consulting Psychologists Press; 1983.

  26. Britton JR. Maternal anxiety: course and antecedents during the early postpartum period. Depress Anxiety. 2008;25:793–800.

    Article  PubMed  Google Scholar 

  27. Miles MS, Funk SG, Carlson J. Parental Stressor Scale: neonatal intensive care unit. Nurs Res. 1993;42:148–52.

    Article  CAS  PubMed  Google Scholar 

  28. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The Multidimensional Scale of Perceived Social Support. J Personal Assess. 1988;52:30–41.

    Article  Google Scholar 

  29. Guintivano J, Manuck T, Meltzer-Brody S. Predictors of postpartum depression: a comprehensive review of the last decade of evidence. Clin Obstet Gynecol. 2018;61:591–603.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Pearlstein T, Howard M, Salisbury A, Zlotnick C. Postpartum depression. Am J Obstet Gynecol. 2009;200:357–64.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Silverman ME, Reichenberg A, Savitz DA, Cnattingius S, Lichtenstein P, Hultman CM, et al. The risk factors for postpartum depression: a population-based study. Depress Anxiety. 2017;34:178–87.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Garfield CF, Lee YS, Warner-Shifflett L, Christie R, Jackson KL, Miller E. Maternal and paternal depression symptoms during NICU stay and transition home. Pediatrics. 2021;148:e2020042747.

  33. Caporali C, Pisoni C, Gasparini L, Ballante E, Zecca M, Orcesi S, et al. A global perspective on parental stress in the neonatal intensive care unit: a meta-analytic study. J Perinatol. 2020;40:1739–52.

    Article  PubMed  Google Scholar 

  34. Hames JL, Gasteiger C, McKenzie MR, Rowley S, Serlachius AS, Juth V, et al. Predictors of parental stress from admission to discharge in the neonatal special care unit. Child Care Health Dev. 2021;47:243–51.

    Article  PubMed  Google Scholar 

  35. Haley WE, Roth DL, Coleton MI, Ford GR, West CA, Collins RP, et al. Appraisal, coping, and social support as mediators of well-being in black and white family caregivers of patients with Alzheimer’s disease. J Consult Clin Psychol. 1996;64:121–9.

    Article  CAS  PubMed  Google Scholar 

  36. Ong HL, Vaingankar JA, Abdin E, Sambasivam R, Fauziana R, Tan ME, et al. Resilience and burden in caregivers of older adults: moderating and mediating effects of perceived social support. BMC Psychiatry. 2018;18:27.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Wilks SE, Croom B. Perceived stress and resilience in Alzheimer’s disease caregivers: testing moderation and mediation models of social support. Aging Ment Health. 2008;12:357–65.

    Article  PubMed  Google Scholar 

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Funding

This publication was supported by Award Numbers UL1TR001876 and KL2TR001877 from the NIH National Center for Advancing Translational Sciences. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Center for Advancing Translational Sciences of the National Institutes of Health.

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Authors and Affiliations

Authors

Contributions

OO, YY, LW, KK, RS, CT, KF, LS: contributed to the conception, design, analysis, and interpretation of the data. OO, YY, KK: enrolled study participants. OO: Wrote first draft of manuscript. YY, LW, KK, RS, CT, KF, and LS: Critically reviewed and made edits to the manuscript. All authors approved the final version and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Ololade Okito.

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The authors declare no competing interests.

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Okito, O., Yui, Y., Wallace, L. et al. Parental resilience and psychological distress in the neonatal intensive care unit. J Perinatol 42, 1504–1511 (2022). https://doi.org/10.1038/s41372-022-01478-3

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