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Published on: June 13, 2021
Associations of NICU-Specific Stressors with Postpartum Depression in a Freestanding Children's Hospital NICU
Katey E Mari1, Morgan K Hoke2,3, Niesha Darden4
1Department of Anthropology, University of Pennsylvania, Philadelphia, Pennsylvania.
Insights
Postpartum parents of infants in the neonatal intensive care unit (NICU) face high rates of postpartum depression (PPD). NICU stressors, particularly parental role stress, significantly increase PPD risk, highlighting the need for integrated mental healthcare.
Area of Science:
- Perinatal mental health
- Neonatal intensive care unit (NICU) care
- Psychiatry
Background:
- Postpartum depression (PPD) is a significant concern for parents with infants requiring neonatal intensive care.
- Neonatal intensive care unit (NICU) environments present unique stressors for parents.
- Understanding the link between NICU stressors and PPD is crucial for improving maternal and infant outcomes.
Purpose of the Study:
- To investigate the association between neonatal intensive care unit (NICU)-related stressors and postpartum depression (PPD) in birthing parents.
- To determine if social support modifies the relationship between NICU stressors and PPD.
- To inform clinical practice regarding mental health support for parents in NICU settings.
Main Methods:
- A cross-sectional study was conducted with parents of infants hospitalized in a NICU for at least six weeks.
- Validated scales were used to assess NICU stressors (Parental Stressor Scale: NICU) and PPD symptoms (Edinburgh Postnatal Depression Scale).
- Modified Poisson regression models were employed to calculate adjusted risk ratios, controlling for social support and other covariates.
Main Results:
- 41% of parents screened positive for postpartum depression (PPD).
- Increased overall NICU stressors (aRR: 1.39) and parental role stress (aRR: 1.78) were significantly associated with a higher risk of PPD.
- Social support did not significantly modify the association between NICU stressors and PPD.
Conclusions:
- Postpartum parents of infants with prolonged NICU hospitalizations are at high risk for PPD.
- NICU-related stressors, especially those impacting the parental role, are linked to increased PPD risk.
- Implementing universal PPD screening and treatment in NICUs is recommended to improve maternal and child well-being.
Abstract:
This study aimed to measure associations of neonatal intensive care unit (NICU)-related stressors with postpartum depression (PPD) among birthing parents of infants in a large, quaternary care, urban, U.S. children's hospital NICU.We performed a cross-sectional study of parents of infants continuously hospitalized for at least the first 6 weeks of life. Participants completed the Parental Stressor Scale: NICU and Edinburgh Postnatal Depression Scale (EPDS). An EPDS score of ≥ 10 indicated a positive PPD screen. The Multidimensional Scale of Perceived Social Support assessed emotional, practical, and informational support from family, friends, and significant others. Modified Poisson regression models calculated risk ratios of PPD per interquartile range (IQR) increment of NICU stressor scores adjusted for social support, history of anxiety or depression, infant gestational age at birth, and infant age at survey completion. We also explored whether social support modified these associations.Of the 83 participants, 34 (41%) screened positive for PPD. Per IQR increment, overall NICU stressors (adjusted risk ratio [aRR]: 1.39; 95% confidence interval [CI]: 1.01-1.92) and parental role stress (aRR: 1.78; 95% CI: 1.18-2.68) were associated with higher risk of PPD in adjusted models. Social support did not modify associations of NICU stressors with PPD.PPD was common in this population of postpartum parents of infants with long hospitalizations. PPD was associated with overall NICU stressors and loss of parental role. Given the importance of maternal mental health for family wellbeing, universal PPD screening and capacity to treat PPD in freestanding children's hospital NICUs may improve maternal and child outcomes. · Postpartum NICU parents are at high risk of PPD.. · Overall, NICU and parental role stress increased PPD risk.. · Social support did not modify observed associations.. · NICUs should implement repeated PPD screening.. · Improved mental healthcare for NICU parents is crucial..
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