Acute Posttraumatic Stress Symptoms Among Urban Mothers With Newborns in the Neonatal Intensive Care Unit: A Preliminary Study

Vanderbilt, Douglas; Bushley, Traute; Young, Robin; Frank, Deborah A.

doi:10.1097/dbp.0b013e318196b0de

Cited by 135 publications

(88 citation statements)

References 33 publications

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“…[1][2][3] This nonnormative transition to parenthood has been described as an "emotional crisis" 4 that typically is characterized by feelings of loss and grief, [5][6][7] which sometimes persist for months after the infant's NICU discharge. 1,[8][9][10][11] In some ways, adaptation to having a preterm infant is similar to adaptation to having a child with a disability; the mother must adjust her expectations and hopes for her child in the face of uncertainties, and she must mourn the hoped-for child while still embracing the child she has.…”

mentioning

confidence: 99%

Maternal Resolution of Grief After Preterm Birth: Implications for Infant Attachment Security

Shah

Clements²,

Poehlmann

2011

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT:For mothers of children with chronic medical conditions or disabilities, such as epilepsy or cerebral palsy, a history of maternal unresolved grief regarding the child's diagnosis has been associated with insecure infantmother attachment. WHAT THIS STUDY ADDS:Unresolved grief related to a preterm birth is associated with the development of insecure infantmother attachment. Mothers with resolved grief after preterm birth are 2.9 times as likely to have securely attached infants, compared with mothers with unresolved grief. abstract OBJECTIVE: This study explored the association between mothers' unresolved grief regarding their infant's preterm birth and infant-mother attachment security. We hypothesized that mothers with unresolved grief would be more likely to have insecurely attached infants at 16 months and that this association would be partially mediated by maternal interaction quality. METHODS:This longitudinal study focused on 74 preterm infants (age of Ͻ36 weeks) and their mothers who were part of a larger study of high-risk infants. The present analysis included assessment of neonatal and socioeconomic risks at NICU discharge; maternal depression, Reaction to Preterm Birth Interview findings, and quality of parenting at a postterm age of 9 months; and infant-mother attachment at postterm age of 16 months. Associations among findings of grief resolution with the Reaction to Preterm Birth Interview, quality of parenting interactions, and attachment security were explored by using relative risk ratios and logistic and multivariate regression models. RESULTS:The relative risk of developing insecure attachment when mothers had unresolved grief was 1.59 (95% confidence interval: 1.03-2.44). Controlling for covariates (adjusted odds ratio: 2.94), maternal feelings of resolved grief regarding the preterm birth experience were associated with secure infant-mother attachment at 16 months. Maternal grief resolution and interaction quality were independent predictors of attachment security. CONCLUSION:Maternal grief resolution regarding the experience of preterm birth and the quality of maternal interactions have important implications for emerging attachment security for infants born prematurely.

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confidence: 99%

Maternal Resolution of Grief After Preterm Birth: Implications for Infant Attachment Security

Shah

Clements²,

Poehlmann

2011

Pediatrics

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“…1,2 The complex reactions of these parents include feelings of guilt, sadness over the loss of the "perfect" child, depression, and posttraumatic stress disorder (PTSD). 1,[3][4][5] Vanderbilt et al 6 found that 23% of NICU mothers met criteria for acute stress disorder (ASD) while Pierrehumbert et al 7 documented the presence of symptoms of PTSD in 41% of NICU parents up to 14 months after their infant' s birth. Data also suggest that up to 83% of mothers who experience significant trauma also endorse distorted views of their infants.…”

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confidence: 99%

Prevention of Traumatic Stress in Mothers With Preterm Infants: A Randomized Controlled Trial

Shaw¹,

et al. 2013

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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.

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“…2 In addition to high rates of depression, [3][4][5] researchers have identified acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) as features of parental psychological reactions. [6][7][8][9][10][11][12] To date, interventions developed to reduce psychological distress in parents of preterm infants have been primarily supportive or educational in nature. [13][14][15] More recently, a small number of studies have evaluated intervention programs focused on reducing parental stress 16 and trauma symptoms.…”

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confidence: 99%

Prevention of Traumatic Stress in Mothers of Preterms: 6-Month Outcomes

et al. 2014

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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:

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Acute Posttraumatic Stress Symptoms Among Urban Mothers With Newborns in the Neonatal Intensive Care Unit: A Preliminary Study

Abstract: Addressing acute posttraumatic stress symptoms may enhance interventions to help urban families of NICU infants.

Cited by 135 publications

References 33 publications

Maternal Resolution of Grief After Preterm Birth: Implications for Infant Attachment Security

Maternal Resolution of Grief After Preterm Birth: Implications for Infant Attachment Security

Prevention of Traumatic Stress in Mothers With Preterm Infants: A Randomized Controlled Trial

Prevention of Traumatic Stress in Mothers of Preterms: 6-Month Outcomes

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