Fathers' Heightened Stress Responses to Recounting their NICU Experiences Months after Discharge: A Mixed Methods Pilot Study

Abstract

Objective The acute and traumatic events associated with having a newborn who requires admission to the neonatal intensive care unit (NICU) may elicit long-term concerns for parents postdischarge. Cognitive processing of taxing events influences recurring stress responses, which can be inferred via biomarkers such as salivary cortisol (sCort) and skin conductance (SC). In addition, personal narratives provide an important insight into individual perceptions and coping strategies. The current pilot study aimed to (1) test the hypotheses that fathers' sCort and SC would peak in response to stress induction and decrease during recovery, (2) examine associations among stress biomarkers and stress perceptions, (3) explore fathers' narratives using thematic analysis, and (4) integrate fathers' narrative themes with their stress responsivity. Study Design Using a convergent mixed methods approach, we enrolled 10 fathers of infants formerly cared for in NICU who underwent a Trier Social Stress Test including recounting their NICU experience months postdischarge. Stress responsivity was measured via sCort and SC, while stress perceptions were identified by using the Perceived Stress Scale and Distress Thermometer-Parent. Personal narratives were explored by using thematic analysis. Results The significant rise in fathers' sCort and SC in response to stress induction was reflected in narrative themes including loss, worry, and role strain. Subsequently, fathers' sCort and SC returned to baseline, which was illustrated by themes such as role strength, coping, and medical staff interactions. Fathers' stress measured by PSS was lower than that required for mental health referral, and did not correlate with stress biomarkers. Conclusion Salivary cortisol and skin conductance are useful biomarkers of paternal stress responsivity and recovery. Thematic analysis identified fathers' NICU stressors and coping strategies that mirrored their stress responsivity patterns. Further studies are needed to more broadly examine the sociodemographic variables that influence stress reactivity and perceptions in parents of infants formerly cared for in NICU. Key Points

Sociodemographic risk factors, parental stress and social support in the neonatal intensive care unit

“…Prior research has demonstrated greater stress related to role alterations for mothers compared with fathers 18 28. Still other research has highlighted unique stressors for fathers in the NICU including divided attention between infant and partners 29 30. In this study, we found that mothers reported less parental stress than fathers.…”

Parental stress and depression in the NICU: an analysis of psychosocial evaluations, infant factors, and stress-related salivary biomarkers

“…Parental feelings of stress and depression may be new in onset or be exacerbated by preexisting individual and extrinsic risk factors. Salivary stress biomarkers, e.g., salivary cortisol, coupled with validated screening questionnaires, an approach not previously much used 51 , are useful tools in detecting parents at risk for stress and depression following their infants' NICU admission. Of note, we did not find a close association between infant illness severity or signs of ICU management, measured by the NTISS, with parental PPD or stress/anxiety.…”