Predictors of parental stress from admission to discharge in the neonatal special care unit

Abstract

Background Exacerbated parental stress during a stay in the neonatal intensive care unit can negatively impact the development of the hospitalized infant, strain the dyadic relationship and put parents at risk for poor mental health. It is therefore important to identify risk factors of stress throughout the duration of a hospitalization. This longitudinal study aimed to investigate sources of stress for mothers and fathers who had a baby in the neonatal special care unit. Methods Parents of 57 singletons and 11 twins (68 infants) admitted to a neonatal special care unit (46% for prematurity) were recruited. Sixty‐four mothers and 20 fathers were assessed at admission, and 60 mothers and 16 fathers at discharge. Participants reported their satisfaction with hospital information and completed the Perceived Stress Scale, the Brief Illness Perception Questionnaire and the Dyadic Adjustment Scale. Results Parents demonstrated similar stress trajectories, with stress on average declining over time. Higher maternal stress at admission was associated with a belief that the baby's illness would have a longer timeline, lower perceptions of treatment efficacy and lower satisfaction with the information received from medical staff. Younger age and lower levels of education predicted higher maternal stress at discharge. Fathers had higher stress at discharge when they were older, had a baby born at younger gestation and felt they had less control. At admission, information satisfaction was positively associated with parental beliefs about treatment efficacy and understanding the infant's condition. At discharge, information satisfaction was negatively associated with beliefs about illness severity and the likely time frame of the illness. Conclusion The findings highlight that parents' perceptions of their baby's illness and treatment at admission and discharge have a significant association with stress. Clinical staff can use these factors to identify parents who are at risk of exhibiting a greater level of stress over the hospitalization period.

Exploring the needs and coping strategies of New Zealand parents in the neonatal environment

“…This can be further enhanced by communicating with parents regarding their child's progress, providing individualised information on their infant's condition, and ensuring that parents feel their voices are heard regarding decision‐making. This is in line with recent local research in the area, with a study by Hames et al 22 . finding that the provision of appropriate information at different stages of the neonatal journey can allay concerns and alter parental perceptions of treatment efficacy and understanding of their infant's condition.…”

“…This is in line with recent local research in the area, with a study by Hames et al . 22 finding that the provision of appropriate information at different stages of the neonatal journey can allay concerns and alter parental perceptions of treatment efficacy and understanding of their infant's condition. Another consistent message from the present study is how encouraging parental participation in care and providing regular information not only addresses a desire for control amidst uncertainty, but may further assist in supporting independent parenting.…”

Depressive Symptoms in Fathers during the First Postpartum Year: The Influence of Severity of Preterm Birth, Parenting Stress and Partners’ Depression

“…On the contrary, the three groups did not differ at a global level or on PCDI and DC subscales. These findings seem to confirm that the consequences of preterm birth are related to its severity, with a greater psychological burden in terms of stress for fathers of severely preterm infants, particularly in the first months following birth, as evidenced by Ionio et al [ 26 ] and Hames et al [ 24 ]. In addition, they strengthen the empirical observation that the biggest source of stress is represented by parental role alteration, confirming previous studies [ 28 , 29 , 30 ].…”

“…In this sense, one of the psychological dimensions experienced by parents after preterm birth, and that could be related to depressive symptomatology, is a high level of stress (i.e., often referred to as psychological distress, parental stress, parenting stress, etc.). Several studies have indeed found a moderate–high amount of stress experienced by preterm babies’ mothers and fathers during baby hospitalization and also after discharge [ 24 , 25 , 26 , 27 ]. A systematic review highlighted that significant sources of high stress in fathers in NICU are represented by alteration of the parental role (e.g., limited or denied access to infant’s care, impaired opportunities to establish emotional bonding), infant appearance (e.g., perception of the infant as fragile, less responsive, more irritable), characteristics of NICU environment (e.g., intensity of sights and sounds of the NICU), staff communication (e.g., unsatisfying access to regular information about infant’s health and care) [ 28 ].…”

The Work of Mothering in the NICU

“…1,11 However, there is limited empirical description of the workful actions that parents do to be present. Challenges related to parenting an infant following preterm birth are addressed widely in the qualitative literature, 4,[13][14][15] but there are unspoken assumptions that parents can overcome barriers to being physically present. The aim of this study was to describe and examine how mothers' work was coordinated by institutional processes when participating in Alberta FICare.…”