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Predictors of Improvement in Parental Stress After the First Three Months at Home with a Medically Fragile Infant
Andrea C Postier1,2,3, Laurie P Foster4, Stacy Remke5
1Division of Pediatric Pain, Palliative and Integrative Medicine, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA. Andrea.postier@ucsf.edu.
Insights
Parenting stress for infants with serious conditions decreases after hospital discharge, but remains high for role functioning and medical care. Younger parents and those with prior pregnancy loss showed greater stress improvement.
Area of Science:
- Pediatric Psychology
- Family Health
- Neonatal Care
Background:
- Parenting stress is significant for infants with life-limiting or life-threatening conditions.
- Limited understanding exists regarding parental stress during the initial months post-hospital discharge.
Purpose of the Study:
- To measure changes in parenting stress from hospital discharge (T1) to 3 months post-discharge (T2).
- To identify predictors of change in parenting stress for parents of medically fragile infants.
Main Methods:
- A repeated measures design assessed parenting stress in 52 parents (61 infants) at two timepoints.
- Participants were recruited from a Midwestern tertiary pediatric hospital between 2012-2014.
Main Results:
- Overall parenting stress scores improved from discharge to 3 months post-discharge.
- Stress related to parent role functioning and medical care participation did not significantly improve.
- Younger parental age and prior pregnancy-related loss predicted greater improvement in overall stress.
Conclusions:
- Transitioning home with a medically fragile infant is stressful, though some stress diminishes over 3 months.
- Specific areas, like role function and medical care, require targeted support.
- Screening for parental stress post-discharge is crucial for addressing unique support needs.
Objectives:
Little is known about the early stress experiences of parents of infants with serious life-limiting/life-threatening conditions during the initial months after discharge from hospital. The aim of the study was to measure change, and predictors of change, in parenting stress at the time of transition from hospital to home (T1) with a medically fragile infant, and after a 3-month period (T2).
Methods:
Parents of infants identified as meeting ≥ 1 palliative care referral criterion were recruited in a Midwestern United States tertiary pediatric hospital (2012-2014) within 2 weeks of hospital discharge. A repeated measures design was used to assess change on a validated parenting stress inventory over the two timepoints (T1 and T2). Fifty-two parents (61 infants) participated at T1 and 44 (85%) at T2.
Results:
On discharge (T1) stress was moderately high 3 months post discharge (T2) overall and domain-specific stress scores improved, except stress related to parent role functioning and participation in their child's medical care. Independent predictors of improvement in overall parenting stress scores (T2-T1) were being a younger parent and having experienced prior pregnancy-related loss.
Conclusions For Practice:
The time of discharge from hospital to home is often stressful for parents of medically fragile infants. Improvements were found during the first 3 months at home, but improvement was minimal for stress related to role function and providing medical care. Past experience with pregnancy-related loss and being younger were associated with improvement in stress across theoretical domains. Screening for stress should be included as part of routine pre- and post-neonatal intensive care unit discharge psychosocial assessments of parents caring for infants with serious illness to ensure their unique support needs continue to be met over time.
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