Evolution of Depression and Anxiety Symptoms in Parents of Very Preterm Infants During the Newborn Period | Anxiety Disorders | JAMA Pediatrics | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.204.186.91. Please contact the publisher to request reinstatement.
1.
Gray  RF, Indurkhya  A, McCormick  MC.  Prevalence, stability, and predictors of clinically significant behavior problems in low birth weight children at 3, 5, and 8 years of age.  Pediatrics. 2004;114(3):736-743.PubMedGoogle ScholarCrossref
2.
Goodman  SH, Rouse  MH, Connell  AM, Broth  MR, Hall  CM, Heyward  D.  Maternal depression and child psychopathology: a meta-analytic review.  Clin Child Fam Psychol Rev. 2011;14(1):1-27.PubMedGoogle ScholarCrossref
3.
Vigod  SN, Villegas  L, Dennis  C-L, Ross  LE.  Prevalence and risk factors for postpartum depression among women with preterm and low-birth-weight infants: a systematic review.  BJOG. 2010;117(5):540-550.PubMedGoogle ScholarCrossref
4.
Meyer  EC, Coll  CT, Lester  BM, Boukydis  CF, McDonough  SM, Oh  W.  Family-based intervention improves maternal psychological well-being and feeding interaction of preterm infants.  Pediatrics. 1994;93(2):241-246.PubMedGoogle Scholar
5.
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(1-2):61-70.PubMedGoogle ScholarCrossref
6.
Mackley  AB, Locke  RG, Spear  ML, Joseph  R.  Forgotten parent: NICU paternal emotional response.  Adv Neonatal Care. 2010;10(4):200-203.PubMedGoogle ScholarCrossref
7.
Singer  LT, Salvator  A, Guo  S, Collin  M, Lilien  L, Baley  J.  Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant.  JAMA. 1999;281(9):799-805.PubMedGoogle ScholarCrossref
8.
Auslander  GK, Netzer  D, Arad  I.  Parental anxiety following discharge from hospital of their very low birth weight infants.  Fam Relat. 2003;52(1):12-21.Google ScholarCrossref
9.
Singer  LT, Davillier  M, Preuss  L,  et al.  Feeding interactions in infants with very low birth weight and bronchopulmonary dysplasia.  J Dev Behav Pediatr. 1996;17(2):69-76.PubMedGoogle ScholarCrossref
10.
Feldman  R, Eidelman  AI, Sirota  L, Weller  A.  Comparison of skin-to-skin (kangaroo) and traditional care: parenting outcomes and preterm infant development.  Pediatrics. 2002;110(1, pt 1):16-26.PubMedGoogle ScholarCrossref
11.
Lambrenos  K, Weindling  AM, Calam  R, Cox  AD.  The effect of a child’s disability on mother’s mental health.  Arch Dis Child. 1996;74(2):115-120.PubMedGoogle ScholarCrossref
12.
Spittle  AJ, Thompson  DK, Brown  NC,  et al.  Neurobehaviour between birth and 40 weeks’ gestation in infants born <30 weeks’ gestation and parental psychological wellbeing: predictors of brain development and child outcomes.  BMC Pediatr. 2014;14(1):111.PubMedGoogle ScholarCrossref
13.
Radloff  LS.  The CES-D scale: a self-report depression scale for research in the general population.  Appl Psychol Meas. 1977;1(3):385-401. doi:10.1177/014662167700100306.Google ScholarCrossref
14.
Pridham  K, Brown  R, Clark  R,  et al.  Effect of guided participation on feeding competencies of mothers and their premature infants.  Res Nurs Health. 2005;28(3):252-267.PubMedGoogle ScholarCrossref
15.
Saigal  S, Stoskopf  BL, Burrows  E, Streiner  DL, Rosenbaum  PL.  Stability of maternal preferences for pediatric health states in the perinatal period and 1 year later.  Arch Pediatr Adolesc Med. 2003;157(3):261-269.PubMedGoogle ScholarCrossref
16.
Zigmond  AS, Snaith  RP.  The hospital anxiety and depression scale.  Acta Psychiatr Scand. 1983;67(6):361-370.PubMedGoogle ScholarCrossref
17.
Herrmann  C.  International experiences with the Hospital Anxiety and Depression Scale: a review of validation data and clinical results.  J Psychosom Res. 1997;42(1):17-41.PubMedGoogle ScholarCrossref
18.
Bjelland  I, Dahl  AA, Haug  TT, Neckelmann  D.  The validity of the Hospital Anxiety and Depression Scale: an updated literature review.  J Psychosom Res. 2002;52(2):69-77.PubMedGoogle ScholarCrossref
19.
Carter  JD, Mulder  RT, Bartram  AF, Darlow  BA.  Infants in a neonatal intensive care unit: parental response.  Arch Dis Child Fetal Neonatal Ed. 2005;90(2):F109-F113.PubMedGoogle ScholarCrossref
20.
Treyvaud  K, Doyle  LW, Lee  KJ,  et al.  Social-emotional difficulties in very preterm and term 2 year olds predict specific social-emotional problems at the age of 5 years.  J Pediatr Psychol. 2012;37(7):779-785.PubMedGoogle ScholarCrossref
21.
Roberts  G, Howard  K, Spittle  AJ, Brown  NC, Anderson  PJ, Doyle  LW.  Rates of early intervention services in very preterm children with developmental disabilities at age 2 years.  J Paediatr Child Health. 2008;44(5):276-280.PubMedGoogle ScholarCrossref
22.
Kersting  A, Dorsch  M, Wesselmann  U,  et al.  Maternal posttraumatic stress response after the birth of a very low-birth-weight infant.  J Psychosom Res. 2004;57(5):473-476.PubMedGoogle ScholarCrossref
23.
Buist  AE, Austin  M-PV, Hayes  BA,  et al.  Postnatal mental health of women giving birth in Australia 2002-2004: findings from the beyondblue National Postnatal Depression Program.  Aust N Z J Psychiatry. 2008;42(1):66-73.PubMedGoogle ScholarCrossref
24.
Australian Bureau of Statistics.  National Survey of Mental Health and Wellbeing: Summary of Results, 2007. Canberra, Australia: Australian Bureau of Statistics; 2008.
25.
Blom  EA, Jansen  PW, Verhulst  FC,  et al.  Perinatal complications increase the risk of postpartum depression: the Generation R Study.  BJOG. 2010;117(11):1390-1398.PubMedGoogle ScholarCrossref
26.
Paulson  JF, Bazemore  SD.  Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis.  JAMA. 2010;303(19):1961-1969.PubMedGoogle ScholarCrossref
Original Investigation
September 2016

Evolution of Depression and Anxiety Symptoms in Parents of Very Preterm Infants During the Newborn Period

Author Affiliations
  • 1Newborn Research Centre, Royal Women’s Hospital, Melbourne, Australia
  • 2Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Melbourne, Australia
  • 3Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
  • 4Department of Physiotherapy, University of Melbourne, Melbourne, Australia
  • 5Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Australia
  • 6Department of Paediatrics, University of Melbourne, Melbourne, Australia
  • 7Psychology Service, Royal Children’s Hospital, Melbourne, Australia
  • 8Department of Neonatal Services, Royal Women’s Hospital, Melbourne, Australia
  • 9Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
JAMA Pediatr. 2016;170(9):863-870. doi:10.1001/jamapediatrics.2016.0810
Abstract

Importance  Mothers experience heightened depression and anxiety following very preterm (VPT) birth, but how these symptoms evolve during the first months after birth is unknown. Research on the psychological adjustment of fathers following VPT birth is limited.

Objectives  To describe the trajectory and predictors of distress in parents of VPT infants during the first 12 weeks after birth, and to compare rates of depression and anxiety in parents of VPT infants with those in parents of healthy full-term (FT) infants shortly after birth and at 6 months’ postnatal age.

Design, Setting, and Participants  Longitudinal, prospective, follow-up cohort study of depression and anxiety symptoms in parents of VPT infants (<30 weeks’ gestational age; admitted to the neonatal intensive care unit at the Royal Women’s Hospital, Melbourne, Australia, between January 21, 2011, and December 23, 2013), documented every 2 weeks until age 12 weeks and at age 6 months, as well as in parents of healthy FT infants (≥37 weeks’ gestational age; birth weight >2499 g; born at the Royal Women’s Hospital between August 15, 2012, and March 26, 2014; not admitted to the neonatal nursery) shortly after birth and at age 6 months.

Exposure  Birth of a VPT infant.

Main Outcomes and Measures  Symptoms of depression (Center for Epidemiological Studies Depression Scale) and anxiety (Hospital Anxiety and Depression Scale).

Results  The study included 113 mothers (mean [SD] age at birth, 32.7 [5.3] years) and 101 fathers (mean [SD] age at birth, 34.7 [6.4] years) of 149 VPT infants (49% male; 84 singletons, 65 multiples; mean [SD] birth weight, 1021 [261] g) as well as 117 mothers (mean [SD] age at birth, 32.9 [4.8] years) and 110 fathers (mean [SD] age at birth, 35.9 [5.3] years) of 151 healthy FT infants (50% male; 149 singletons, 2 multiples; mean [SD] birth weight, 3503 [438] g). Mean scores and rates of depression and anxiety reduced over time for parents of VPT infants in the 12 weeks after birth: the mean (95% CI) change in depression score per week was −0.52 (−0.73 to −0.31; P < .001) for mothers and −0.39 (−0.56 to −0.21; P < .001) for fathers; the mean (95% CI) change in anxiety score per week was −0.16 (−0.26 to −0.05; P = .003) for mothers and −0.22 (−0.31 to −0.15; P < .001) for fathers. However, rates never dropped below 20%. Few perinatal or social risk factors predicted longitudinal changes in depression or anxiety. Compared with parents of FT infants, parents of VPT infants had higher rates of depression shortly after birth (mothers: 6% vs 40%; odds ratio [OR] = 9.9; 95% CI, 4.3 to 23.3; P < .001; fathers: 5% vs 36%; OR = 11.0; 95% CI, 4.1 to 29.6; P < .001) and at 6 months (mothers: 5% vs 14%; OR = 2.9; 95% CI, 1.0 to 8.2; P = .04; fathers: 6% vs 19%; OR = 3.4; 95% CI, 1.3 to 9.0; P = .01) as well as anxiety shortly after birth (mothers: 13% vs 48%; OR = 6.5; 95% CI, 3.3 to 12.6; P < .001; fathers: 10% vs 47%; OR = 7.8; 95% CI, 3.7 to 16.8; P < .001) and at 6 months (mothers: 14% vs 25%; OR = 2.1; 95% CI, 1.0 to 4.3; P = .05; fathers: 10% vs 20%; OR = 2.3; 95% CI, 1.0 to 5.3; P = .05).

Conclusions and Relevance  Mothers and fathers of VPT infants had elevated rates of depression and anxiety symptoms that declined over time, although remaining above expected levels throughout the newborn period and at 6 months.

×