OBJECTIVE: The current study evaluates a treatment intervention developed with the goal of reducing symptoms of posttraumatic stress, depression, and anxiety in parents of premature infants. METHODS: A total of 105 mothers of preterm infants (25–34 weeks’ gestational age; >600 g) were randomized to receive a 6-session intervention developed to target parental trauma as well as facilitate infant redefinition (n = 62) or to an active comparison group (n = 43). Mothers in the intervention group received a combination of trauma-focused treatments, including psychoeducation, cognitive restructuring, progressive muscle relaxation, and development of their trauma narrative. The intervention also incorporated material targeting infant redefinition, defined as the process of changing the mother’s negative perceptions of her infant and the parenting experience. RESULTS: Mothers in the intervention group reported a greater reduction in both trauma symptoms (Cohen’s d = 0.41, P = .023) and depression (Cohen’s d = 0.59, P < .001) compared with the comparison group. Patients under both conditions improved significantly in terms of anxiety, with no differences between groups. Results of the moderator analysis showed that mothers with higher ratings of baseline NICU stress benefited more from the intervention compared with mothers who had lower ratings (P = .036). CONCLUSIONS: This short, highly manualized intervention for mothers of preterm infants statistically significantly reduced symptoms of trauma and depression. The intervention is feasible, can be delivered with fidelity, and has high ratings of maternal satisfaction. Given that improvements in mothers’ distress may lead to improved infant outcomes, this intervention has the potential for a high public health impact.

WHAT'S KNOWN ON THIS SUBJECT: Interventions based on principles of trauma-focused cognitive behavior therapy have been shown to reduce symptoms of trauma and depression in mothers of premature infants. It is not known whether these benefits are sustained at long-term follow-up. WHAT THIS STUDY ADDS:A brief, cost-effective 6-session manualized intervention for parents of infants in the NICU was effective in reducing symptoms of parental trauma, anxiety, and depression at 6-month follow-up. There were no added benefits from a 9-session version of the treatment.abstract OBJECTIVE: Symptoms of posttraumatic stress disorder are a wellrecognized phenomenon in mothers of preterm infants, with implications for maternal health and infant outcomes. This randomized controlled trial evaluated 6-month outcomes from a skills-based intervention developed to reduce symptoms of posttraumatic stress disorder, anxiety, and depression. METHODS:One hundred five mothers of preterm infants were randomly assigned to (1) a 6-or 9-session intervention based on principles of trauma-focused cognitive behavior therapy with infant redefinition or (2) a 1-session active comparison intervention based on education about the NICU and parenting of the premature infant. Outcome measures included the Davidson Trauma Scale, the Beck Depression Inventory II, and the Beck Anxiety Inventory. Participants were assessed at baseline, 4 to 5 weeks after birth, and 6 months after the birth of the infant.RESULTS: At the 6-month assessment, the differences between the intervention and comparison condition were all significant and sizable and became more pronounced when compared with the 4-to 5-week outcomes: Davidson Trauma Scale (Cohen' s d = 20.74, P , .001), Beck Anxiety Inventory (Cohen' s d = 20.627, P = .001), Beck Depression Inventory II (Cohen' s d = 20.638, P = .002). However, there were no differences in the effect sizes between the 6-and 9-session interventions.CONCLUSIONS: A brief 6-session intervention based on principles of trauma-focused cognitive behavior therapy was effective at reducing symptoms of trauma, anxiety, and depression in mothers of preterm infants. Mothers showed increased benefits at the 6-month follow-up, suggesting that they continue to make use of techniques acquired during the intervention phase. Pediatrics 2014;134:e481-e488 AUTHORS:

Premature birth has been associated with multiple adverse maternal psychological outcomes that include depression, anxiety, and trauma as well as adverse effects on maternal coping ability and parenting style. Infants and children who are premature are more likely to have poorer cognitive and developmental functioning and, thus, may be harder to parent. In response to these findings, there have been a number of educational and behavioral interventions developed that target maternal psychological functioning, parenting and aspects of the parent-infant relationship. The current study aimed to both develop and evaluate a treatment that integrates, for the first time, effective interventions for both reducing symptoms of posttraumatic stress disorder (PTSD) as well as enhancing maternal-infant interactions. Conclusions from the study indicate that the intervention is feasible, able to be implemented with a high level of fidelity, and is rated as highly satisfactory by participants. Though encouraging, these findings are preliminary, and future studies should strive to reproduce these findings with a larger sample size and a comparison group.

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Objective There are no established screening criteria to help identify mothers of premature infants who at risk for symptoms of emotional distress. The current study, using data obtained from recruitment and screening in preparation for a randomized controlled trial, aimed to identify potential risk factors associated with symptoms of depression, anxiety and posttraumatic stress in a sample of mothers with premature infants hospitalized in a neonatal intensive care unit. Method 135 mothers of preterm infants born at 26-34 weeks of gestation completed three self-report measures, the Stanford Acute Stress Reaction Questionnaire, the Beck Depression Inventory, Second Edition and the Beck Anxiety Inventory to determine their eligibility for inclusion in a treatment intervention study based on clinical cut-off scores for each measure. Results Maternal sociodemographic measures, including race, ethnicity and age, maternal pregnancy history and measures of infant medical severity were not helpful in differentiating mothers who screened positive on one or more of the measures from those who screened negative. Conclusions Programs to screen parents of premature infants for the presence of symptoms of posttraumatic stress, anxiety and depression will need to adopt universal screening rather than profiling of potential high risk parents based on their sociodemographic characteristics or measures of their infant’s medical severity.