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Parent Mental Health Interventions in the NICU: A Systematic Review and Meta-Analysis
Claire E Niehaus Milligan1, Lauren R Hayes Austin2, Paige Auckland3
1Heart Mind Wellbeing Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Neonatal intensive care unit (NICU) interventions like psychotherapy and family-centered care significantly reduce parent anxiety, depression, and stress. These findings support implementing evidence-based strategies to improve parental mental health during NICU admissions.
Area of Science:
- Neonatal care
- Parental mental health
- Evidence-based interventions
Background:
- Parental mental health and stress during NICU admission negatively impact long-term parent and infant well-being.
- NICU stays present unique challenges for parents, affecting their psychological state.
Purpose of the Study:
- To systematically review and synthesize literature on NICU-based interventions aimed at supporting parental mental health.
- To inform clinical practice and guide the development of standards of care for NICU parents.
Main Methods:
- A comprehensive systematic search of major databases (PubMed, Embase, PsycINFO, etc.) was conducted for studies published between 2010 and 2024.
- Included studies were quantitative, focused on NICU interventions for parental mental health, used validated measures, and had infant admission data.
- Data extraction and synthesis followed PRISMA guidelines, with risk of bias assessed using Joanna Briggs Institute tools. Meta-analysis was performed where data permitted.
Main Results:
- The review included 160 studies involving 16,639 parents.
- Interventions such as psychotherapy, family-centered care, and bonding support significantly reduced parent anxiety and stress.
- Psychotherapy and expressive therapies showed effectiveness in reducing parent depression symptoms.
Conclusions:
- Effective NICU interventions exist to alleviate parental mental health symptoms.
- Hospitals should consider implementing resource-efficient interventions like family-centered care and education.
- Psychotherapy and emotional support interventions demonstrate consistent benefits across various mental health outcomes.
Importance:
Poor parent mental health and elevated stress during neonatal intensive care unit (NICU) admission are linked to adverse parent and infant health longitudinally.
Objective:
To summarize recent literature on NICU-based interventions to support parent mental health and guide standards of care.
Data Sources:
A systematic data search was conducted of PubMed, Cochrane CENTRAL, Embase, CINAHL, and PsycINFO from 2010 to December 2024.
Study Selection:
Studies were included if they were (1) a quantitative original study, (2) had an intervention in the NICU to support parental mental health, (3) used a validated measure of parent mental health or stress to assess outcomes, and (4) had at least 1 measurement while the infant was admitted. For the meta-analysis, studies also needed to report preintervention and postintervention means and SDs and report a control group for comparison.
Data Extraction And Synthesis:
Titles and abstracts, then full texts, were screened for inclusion criteria by 2 independent reviewers. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed for data extraction and synthesis, and Joanna Briggs Institute risk of bias tools were used. Study data were analyzed from February 2025 to January 2026.
Main Outcomes And Measures:
The primary outcomes were parent anxiety, depression, stress, and trauma symptoms captured by several validated self-report questionnaires.
Results:
This analysis included 160 studies with 16 639 parents (mean [SD] age, 30.2 [5.8] years; 13 760 female [93.5%]) including 85 estimates for meta-analysis. Bonding interventions (Hedges g, -0.90; 95% CI, -1.50 to -0.30), family-centered care and education (Hedges g, -1.49; 95% CI, -2.80 to -0.19), and psychotherapy and emotional support (Hedges g, -1.66; 95% CI, -1.97 to -1.34) were associated with a significant decrease in parent anxiety. Family-centered care and education (Hedges g, -0.75; 95% CI, -1.30 to -0.21), psychotherapy (Hedges g, -1.54; 95% CI, -2.17 to -0.19), and meditation and holistic interventions (Hedges g, -0.65; 95% CI, -1.20 to -0.10) were associated with a significant reduction in parent stress. Expressive and artistic therapies (Hedges g, -0.36; 95% CI, -0.68 to -0.04) and psychotherapy (Hedges g, -0.95; 95% CI, -1.80 to -0.10) were associated with a significant reduction in parent depression.
Conclusions And Relevance:
Results of this systematic review and meta-analysis suggest that, given several effective interventions to reduce parent mental health symptoms in the NICU, hospitals should consider implementing those that require few additional resources such as family-centered care and education and those that have the most consistent benefits across mental health outcomes, which were psychotherapy and emotional support interventions.
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