Prevalence of anxiety and post-traumatic stress (PTS) among the parents of babies admitted to neonatal units: A systematic review and meta-analysis

Abstract

Background Parents of babies admitted to neonatal units (NNU) are exposed to a range of potentially distressing experiences, which can lead to mental health symptoms such as increased anxiety and post-traumatic stress (PTS). This review aimed to describe how anxiety and PTS are defined and assessed, and to estimate anxiety and PTS prevalence among parents of babies admitted to NNU.Method Medline, Embase, PsychoINFO, Cumulative Index to Nursing and Allied Health literature were searched to identify studies published prior to April 14, 2021. Included studies were assessed using Hoy risk of bias tool. A random-effects model was used to estimate pooled prevalence with 95% CIs. Potential sources of variation were investigated using subgroup analyses and meta-regression. The review is registered with PROSPERO (CRD42020162935).Findings Fifty six studies involving 6,036 parents met the review criteria; 21 studies assessed anxiety, 35 assessed PTS, and 8 assessed both. The pooled prevalence of anxiety was 41.9% (95%CI:30.9, 53.0) and the pooled prevalence of PTS was 39.9% (95%CI:30.8, 48.9) among parents up to one month after the birth. Anxiety prevalence decreased to 26.3% (95%CI:10.1, 42.5) and PTS prevalence to 24. 5% (95%CI:17.4, 31.6) between one month and one year after birth. More than one year after birth PTS prevalence remained high 27.1% (95%CI:20.7, 33.6). Data on anxiety at this time point were limited. There was high heterogeneity between studies and some evidence from subgroup and meta-regression analyses that study characteristics contributed to the variation in prevalence estimates.Interpretation The prevalence of anxiety and PTS was high among parents of babies admitted to NNU. The rates declined over time, although they remained higher than population prevalence estimates for women in the perinatal period. Implementing routine screening would enable early diagnosis and effective intervention.

Comparing the effect of a lactation-specific relaxation and visualisation intervention versus standard care on lactation and mental health outcomes in mothers of very premature infants (the EXPRESS trial): study protocol for a multi-centre, unmasked, randomised, parallel-group trial

“…The original STAI is a 20-item questionnaire with four answer options for each question ('not at all' , 'somewhat' , 'moderately' or 'very much'). The total score range is 20-80, with higher scores signifying more anxiety, <36 generally considered normal [50] and ≥40 signifying clinically significant anxiety [48] (although this cut off varies across the literature [5]). The shortened STAI-6 contains a subset of six questions, giving a score total of 6-24, which are then scaled to 20-80 for comparability [51].…”

“…Premature infants also have increased risk of long-term disability, which increases as the gestational age at birth decreases [4]. Premature birth has a significant effect on parental mental health-systematic review estimates that 42% of parents have significant anxiety and 40% have significant post-traumatic stress reactions in the first month after birth [5]. Between 29 and 40% of mothers have depression in this timeframe [6]-all of these figures are higher than found after term, healthy birth [5,6].…”

Post-traumatic stress disorder, anxiety, and care responses among mothers of preterm infants at one month of corrected age after discharge from the neonatal intensive care unit

“…and birth-related PTSD may reflect the continuation of non-specific symptoms, such as hyper-arousal [46] or causing anxiety [47]. These suggest that maternal PTSD may have further adverse effects on mental health of mothers.…”

Effect of family-centred care on parental mental health and parent–infant interactions for preterm infants: a systematic review protocol

“…Unexpected premature delivery may make parents feel anxious, depressed and stressed. [12][13][14][15] If the parents of premature infants do not receive proper support and guidance for their psychological problems, the negative impacts may not cease until the infant is discharged from the NICU, which will not only harm the physical and mental health of the parents but also affect the subsequent development of the premature infant. [16][17][18] The more severe the psychological problems of the parents are, such as a higher level of stress or depression, the more behavioural problems their preterm infants will encounter.…”