Uncertainty and perinatal post‐traumatic stress disorder in the neonatal intensive care unit

Abstract

Parents of infants in the neonatal intensive care unit (NICU) are at increased risk of developing perinatal post-traumatic stress disorder (PPTSD), a mental health condition known to interfere with healthy parental and infant attachment. Feelings of uncertainty about illness have been theorized as an antecedent to post-traumatic stress, however the relationship has not been explored in parents of infants requiring care in the NICU. The purpose of this prospective study was to explore parental uncertainty during and after NICU discharge and the relationship between uncertainty and PPTSD. The sample consisted of 319 parents during NICU hospitalization and 245 parents at 3 months postdischarge. Parents who screened positive for PPTSD 3 months after hospital discharge reported more uncertainty both while in the NICU and 3 months after hospital discharge (p < 0.001). In parents with a personal or family history of mental illness, the moderated/mediating structural probit analysis showed no direct or indirect effect of uncertainty during hospitalization or at 3 months after hospital discharge on screening positive for PPTSD. In parents who did not report personal or family history of mental illness, uncertainty at 3 months after hospital discharge had a direct effect (b = 0.678, p < 0.001) and indirect mediating effect (b = 0.276, p < 0.001) on screening positive for PPTSD. The results provide actionable implications for mental health and NICU providers: (1) routine screening for uncertainty and risk factors including previous personal and family history of mental illness, and (2) the development of NICU follow-up support services to mitigate risk for PPTSD.

Perspectives on Parenting in the NICU

“…NICU parents remain at risk for developing P-PTSD up to a year after their infant's discharge. 1,5 Every noticeable difference from your baby gets mentally tagged and then the worry sets in wondering if it was connected to their birth. Is this her normal or is it because she was born early or in the NICU?…”

“…But what many former NICU parents will tell you, is that even after leaving the NICU, the NICU never really leaves you. NICU parents remain at risk for developing P-PTSD up to a year after their infant's discharge 1,5. Every noticeable difference from your baby gets mentally tagged and then the worry sets in wondering if it was connected to their birth.…”

Feasibility of Stress Research in Premature Infant–Maternal Dyads During and After Neonatal Intensive Care Unit Hospitalization

“…For example, adverse neurobehavioral outcomes7 alterations in gut microbiome8 and epigenetic alterations have all been associated with excessive stress in premature infants 9. Similarly, mothers of premature infants have also reported adverse outcomes, including increased perinatal posttraumatic stress,10,11 and altered early infant–maternal relationships 12. Furthermore, maternal stress has been found to pass generationally, as mothers with a history of elevated stress are more likely to have children with mental and physical adverse outcomes 13,14.…”

Uncertainty and the NICU Experience: A Qualitative Evaluation of Family and Provider Perspectives

“…Uncertainty is defined as "the ability to determine the meaning of illness-related events and accurately anticipate or predict health outcomes" [5]. In a prospective study conducted to explore the relationship between feelings of uncertainty among parents of infants requiring NICU care and the increased risk of developing perinatal post-traumatic stress disorder (PPTSD), parents who screened positive for PPTSD 3 months after hospital discharge reported more uncertainty both while in the NICU and 3 months after hospital discharge [6]. In a study conducted to examine the roles of constructive and dysfunctional problem-solving strategies in the relationships between illness uncertainty and adjustment outcomes in caregivers of children newly diagnosed with cancer, greater dysfunctional problems-solving strategies were associated with higher levels of both uncertainty and poorer adjustment outcomes [7].…”