Psychological stress in mothers of neonates admitted to an intensive care unit

Susana Mesa Mesa, Alejandra Gómez García, Luisa Fernanda Naranjo Pérez, Laura Tobón Montoya, María Victoria Ocampo Saldarriaga, Juan David Velásquez Tirado, Gustavo Adolfo Constaín González, Carmenza Ricardo Ramírez, Yeison Felipe Gutiérrez Vélez, José Gabriel Franco Vásquez

DOI: https://doi.org/10.17711/SM.0185-3325.2021.031

Abstract


Introduction. The admission of the newborn to a neonatal intensive care unit (NICU) leads to maternal stress. This stress has deleterious consequences on the mother and the appropriate attachment with her child.

Objective. To assess the relationship of mothers’ sociodemographic, clinical, psychological, and psychiatric factors, as well as neonates’ clinical aspects with the level of psychological stress perceived by mothers of neonates admitted to the NICU.

Method. Cross-sectional study with 47 women over the age of 18, whose infants had been admitted to a NICU during the last 72 hours. Bivariate correlations and a multivariate linear model with the significant variables in the bivariate analyses where performed.

Results. According to the multivariate model, the perception of loneliness and the presence of at least one psychiatric diagnosis (depressive episode, dysthymia, generalized anxiety disorder, adjustment disorder, acute stress disorder, or substance use disorder) were associated with maternal stress. Problem-focused coping strategies were relevant within the model and could have protective value against stress. The model explained 73.5% of the stress severity variance (F 38.848; p
Discussion and conclusion. Stress in mothers of newborns admitted to a NICU is related to their feeling of loneliness and mental health. The mothers’ need for support and psychopathology are aspects to be considered when providing care to the newborns and their families. Training in coping strategies focused on specific situations could contribute to the reduction of mothers’ stress.

Keywords


Psychological stress; newborn infant; critical care; loneliness; perinatal psychiatry; psychologic adaptation

Full Text:

HTML PDF EPUB

References


American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5TM). Arlington, V.A.: American Psychiatric Publishing.

Austin, M.-P. (2003). Perinatal mental health: Opportunities and challenges for psychiatry. Australasian Psychiatry, 11(4), 399-403. doi: 10.1046/j.1440-1665.2003.02027.x

Carter, J. D., Mulder, R. T., & Darlow, B. A. (2007). Parental stress in the NICU: The influence of personality, psychological, pregnancy and family factors. Personality and Mental Health, 1(1), 40-50. doi: 10.1002/pmh.4

Cherry, A. S., Blucker, R. T., Thornberry, T. S., Hetherington, C., McCaffree, M. A., & Gillaspy, S. R. (2016). Postpartum depression screening in the Neonatal Intensive Care Unit: Program development, implementation, and lessons learned. Journal of Multidisciplinary Healthcare, 9, 59-67. doi: 10.2147/JMDH.S91559

de Jong, G. M., van Sonderen, E., & Emmelkamp, P. M. G. (1999). A comprehensive model of stress: The roles of experienced stress and neuroticism in explaining the stress–distress relationship. Psychotherapy and Psychosomatics, 68(6), 290-298. doi: 10.1159/000012346

de Kloet, E. R., Joëls, M., & Holsboer, F. (2005). Stress and the brain: From adaptation to disease. Nature Reviews Neuroscience, 6(6), 463-475. doi: 10.1038/nrn1683

Doering, L. V., Moser, D. K., & Dracup, K. (2000). Correlates of anxiety, hostility, depression, and psychosocial adjustment in parents of NICU infants. Neonatal Network, 19(5), 15-23. doi: 10.1891/0730-0832.19.5.15

Dudek-Shriber, L. (2004). Parent stress in the Neonatal Intensive Care Unit and the influence of parent and infant characteristics. American Journal of Occupational Therapy, 58(5), 509-520. doi: 10.5014/ajot.58.5.509

Epel, E. S., Crosswell, A. D., Mayer, S. E., Prather, A. A., Slavich, G. M., Puterman, E., & Mendes, W. B. (2018). More than a feeling: A unified view of stress measurement for population science. Frontiers in Neuroendocrinology, 49, 146-169. doi: 10.1016/j.yfrne.2018.03.001

Field, A. (2013). Discovering statistics using IBM SPSS statistics (4th ed.). London: SAGE Publications Ltd.

Goh, C., & Agius, M. (2010). The stress-vulnerability model how does stress impact on mental illness at the level of the brain and what are the consequences? Psychiatria Danubina, 22(2), 198-202.

Golbidi, S., Frisbee, J. C., & Laher, I. (2015). Chronic stress impacts the cardiovascular system: Animal models and clinical outcomes. American Journal ofPhysiology - Heart and Circulatory Physiology, 308(12), H1476-H1498. doi: 10.1152/ajpheart.00859.2014

Gönülal, D., Yalaz, M., Altun-Köroǧlu, Ö., & Kültürsay, N. (2014). Both parents of neonatal intensive care unit patients are at risk of depression. Turkish Journal of Pediatrics, 56(2), 171-176.

Gorritza Pérez, R. R., Bárcenas Bellót, Y., Gorrita Pérez, Y., & Brito Herrera, B. (2013). Maternal stress and anxiety and their association with successful breastfeeding. Revista Cubana de Pediatria, 86(2), 179-188. Retrieved from http://scielo.sld.cu/pdf/ped/v86n2/ped06214.pdf

Heuer, L. (1993). Parental stressors in a pediatric intensive care unit. Pediatric Nursing, 19(2), 128-131.

Hynan, M. T., Steinberg, Z., Baker, L., Cicco, R., Geller, P. A., Lassen, S., … Stuebe, A. (2015). Recommendations for mental health professionals in the NICU. Journal of Perinatology, 35(Suppl 1), S14-S18. doi: 10.1038/jp.2015.144

Ionio, C., Mascheroni, E., Colombo, C., Castoldi, F., & Lista, G. (2019). Stress and feelings in mothers and fathers in NICU: Identifying risk factors for early interventions. Primary Health Care Research & Development, 20, e81. doi: 10.1017/S1463423619000021

Jee, R. A., Shepherd, J. R., Boyles, C. E., Marsh, M. J., Thomas, P. W., & Ross, O. C. (2012). Evaluation and comparison of parental needs, stressors, and coping strategies in a pediatric intensive care unit. Pediatric Critical Care Medicine, 13(3), e166-e175. doi: 10.1097/PCC.0b013e31823893ad

Joëls, M., & Baram, T. Z. (2009). The neuro-symphony of stress. Nature Reviews Neuroscience, 10(6), 459-466. doi: 10.1038/nrn2632

Jubinville, J., Newburn-Cook, C., Hegadoren, K., & Lacaze-Masmonteil, T. (2012). Symptoms of acute stress disorder in mothers of premature infants. Advances in Neonatal Care, 12(4), 246-253. doi: 10.1097/ANC.0b013e31826090ac

Kim, P. (2021). How stress can influence brain adaptations to motherhood. Frontiers in Neuroendocrinology, 60, 100875. doi: 10.1016/j.yfrne.2020.100875

Lasheras, G., Farré-Sender, B., Porta, R., & Mestre-Bach, G. (2020). Risk factors for postpartum depression in mothers of newborns admitted to neonatal intensive care unit. Journal of Reproductive and Infant Psychology, 1-15. doi: 10.1080/02646838.2020.1775793

Lasiuk, G. C., Comeau, T., & Newburn-Cook, C. (2013). Unexpected: An interpretive description of parental traumas’ associated with preterm birth. BMC Pregnancy and Childbirth, 13(Suppl 1), S13. doi: 10.1186/1471-2393-13-s1-s13

Lau, C. (2001). Effects of stress on lactation. Pediatric Clinics of North America, 48(1), 221-234. doi: 10.1016/s0031-3955(05)70296-0

Lefkowitz, D. S., Baxt, C., & Evans, J. R. (2010). Prevalence and correlates of posttraumatic stress and postpartum depression in parents of infants in the Neonatal Intensive Care Unit (NICU). Journal of Clinical Psychology in Medical Settings, 17(3), 230-237. doi: 10.1007/s10880-010-9202-7

Levenstein, S., Prantera, C., Varvo, V., Scribano, M. L., Berto, E., Luzi, C., & Andreoli, A. (1993). Development of the perceived stress questionnaire: A new tool for psychosomatic research. Journal of Psychosomatic Research, 37(1), 19-32. doi: 10.1016/0022-3999(93)90120-5

McEwen, B. S. (2007). Physiology and neurobiology of stress and adaptation: Central role of the brain. Physiological Reviews, 87(3), 873-904. doi: 10.1152/physrev.00041.2006

Montirosso, R., Provenzi, L., Calciolari, G., & Borgatti, R. (2012). Measuring maternal stress and perceived support in 25 Italian NICUs. Acta Paediatrica, 101(2), 136-142. doi: 10.1111/j.1651-2227.2011.02440.x

Muller-Nix, C., Forcada-Guex, M., Pierrehumbert, B., Jaunin, L., Borghini, A., & Ansermet, F. (2004). Prematurity, maternal stress and mother-child interactions. Early Hum Development, 79(2), 145-158. doi: 10.1016/j.earlhumdev.2004.05.002

Obregon, E., Litt, J. S., Patel, P., Ziyeh, T., & McCormick, M. C. (2019). Health related quality of life (HRQoL) in mothers of premature infants at NICU discharge. Journal of Perinatology, 39(10), 1356-1361. doi: 10.1038/s41372-019-0463-1

Olhaberry, M., Escobar, M., San Cristóbal, P., Santelices, M. P., Farkas, C., Rojas, G., & Martínez, V. (2013). Intervenciones psicológicas perinatales en depresión materna y vínculo madre-bebé: una revisión sistemática. Terapia Psicológica, 31(2), 249-261. doi: 10.4067/S0718-48082013000200011

Ortega, G., Ibáñez, M., & Moro, M. (1997). EPQ-R Cuestionario revisado de personalidad de Eysenck versión completa (EPQ-R) y abreviada (EPQ-RS). Madrid: TEA Ediciones.

Palma I, E., Von Wussow K, F., Morales B, I., Cifuentes R, J., & Ambiado T, S. (2017). Estrés en padres de recién nacidos hospitalizados en una unidad de paciente crítico neonatal. Revista Chilena de Pediatría, 88(3), 332-339. doi: 10.4067/S0370-41062017000300004

Prouhet, P. M., Gregory, M. R., Russell, C. L., & Yaeger, L. H. (2018). Fathers’ stress in the neonatal intensive care unit: A systematic review. Advances in Neonatal Care, 18(2), 105-120. doi: 10.1097/ANC.0000000000000472

Richardson, D. K., Corcoran, J. D., Escobar, G. J., & Lee, S. K. (2001). SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risk scores. The Journal of Pediatrics, 138(1), 92-100. doi: 10.1067/mpd.2001.109608

Roque, A. T. F., Lasiuk, G. C., Radünz, V., & Hegadoren, K. (2017). Scoping review of the mental health of parents of infants in the NICU. Journal of Obstetric, Gynecologic & Neonatal Nursing, 46(4), 576-587. doi: 10.1016/j.jogn.2017.02.005

Russell, D. W. (1996). UCLA Loneliness Scale (Version 3): Reliability, validity, and factor structure. Journal of Personality Assessment, 66(1), 20-40. doi: 10.1207/s15327752jpa6601_2

Sandín, B., & Chorot, P. (2003). Cuestionario de Afrontamiento del Estrés (CAE): desarrollo y validación preliminar. Revista de Psicopatología y Psicología Clínica, 8(1), 39-53. doi: 10.5944/rppc.vol.8.num.1.2003.3941

Segre, L. S., McCabe, J. E., Chuffo-Siewert, R., & O’Hara, M. W. (2014). Depression and anxiety symptoms in mothers of newborns hospitalized on the neonatal intensive care unit. Nursing Research, 63(5), 320-332. doi: 10.1097/NNR.0000000000000039

Shaw, R. J., Deblois, T., Ikuta, L., Ginzburg, K., Fleisher, B., & Koopman, C. (2006). Acute stress disorder among parents of infants in the neonatal intensive care nursery. Psychosomatics, 47(3), 206-212. doi: 10.1176/appi.psy.47.3.206

Shorey, S., Chee, C. Y. I., Ng, E. D., Chan, Y. H., Tam, W. W. S., & Chong, Y. S. (2018). Prevalence and incidence of postpartum depression among healthy mothers: A systematic review and meta-analysis. Journal of Psychiatric Research, 104, 235-248. doi: 10.1016/j.jpsychires.2018.08.001

Sikorova, L., & Kucova, J. (2012). The needs of mothers to newborns hospitalized in intensive care units. Biomedical Papers, 156(4), 330-336. doi: 10.5507/bp.2011.046

Tahirkheli, N. N., Cherry, A. S., Tackett, A. P., McCaffree, M. A., & Gillaspy, S. R. (2014). Postpartum depression on the neonatal intensive care unit: Current perspectives. International Journal of Women’s Health, 6, 975-987. doi: 10.2147/IJWH.S54666

Tandberg, B. S., Sandtrø, H. P., Vårdal, M., & Rønnestad, A. (2013). Parents of preterm evaluation of stress and nursing support. Journal of Neonatal Nursing, 19(6), 317-326. doi: 10.1016/j.jnn.2013.01.008

Vanderbilt, D., Bushley, T., Young, R., & Frank, D. A. (2009). Acute posttraumatic stress symptoms among urban mothers with newborns in the neonatal intensive care unit: A preliminary study. Journal of Developmental & Behavioral Pediatrics, 30(1), 50-56. doi: 10.1097/DBP.0b013e318196b0de

Varma, J. R., Nimbalkar, S. M., Patel, D., & Phatak, A. G. (2019). The level and sources of stress in mothers of infants admitted in neonatal intensive care unit. Indian Journal of Psychological Medicine, 41(4), 338-342. doi: 10.4103/IJPSYM.IJPSYM_415_18

Woodward, L. J., Bora, S., Clark, C. A. C., Montgomery-Hönger, A., Pritchard, V. E., Spencer, C., & Austin, N. C. (2014). Very preterm birth: Maternal experiences of the neonatal intensive care environment. Journal of Perinatology, 34(7), 555-561. doi: 10.1038/jp.2014.43

Wormald, F., Tapia, J.L., Torres,G., Cánepa, P., González,M. A., Rodríguez, D., … Neocosur NeonatalNetwork(Red Neonatal Neocosur). (2015). Stress in parents of very low birth weight preterm infants hospitalized in neonatal intensive care units. A multicenter study. Archivos Argentinos de Pediatria, 113(4), 303-309. doi: 10.5546/aap.2015.303