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

Abstract

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:

Preventing post‐traumatic stress disorder following childbirth and traumatic birth experiences: a systematic review

“…Of the 13 included articles, 12 were randomized controlled trials and one was a case control study (43; see Table for levels of evidence and details of each study).…”

Risk factors for the development of post‐traumatic stress disorder and coping strategies in mothers and fathers following infant hospitalisation in the neonatal intensive care unit

“…| 4437 reducing post-traumatic stress symptoms, brought other benefits such as improvement in mother-infant interactions quality, increase in maternal sensitivity and infant cooperation during interactions (Borghini et al, 2014), as well as a decrease in anxiety and depression (Shaw et al, 2014), improvement in parental psychological flexibility and mindfulness (Burke et al, 2014) and decrease prolonged grief symptoms (Kersting et al, 2013). However, some authors reported no effects of the Internet-based intervention (Galvin & Muscara, 2014;Marsac et al, 2013).…”

“…() show that parents’ post‐traumatic stress symptoms, depression and anxiety were reduced by a 10‐week guided self‐help programme via the Internet, based on the principles of cognitive behaviour therapy. Many authors have shown that their interventions, in addition to reducing post‐traumatic stress symptoms, brought other benefits such as improvement in mother‐infant interactions quality, increase in maternal sensitivity and infant cooperation during interactions (Borghini et al., ), as well as a decrease in anxiety and depression (Shaw et al., ), improvement in parental psychological flexibility and mindfulness (Burke et al., ) and decrease prolonged grief symptoms (Kersting et al., ). However, some authors reported no effects of the Internet‐based intervention (Galvin & Muscara, ; Marsac et al., ).…”

“…Appearance and behaviour of a child, lack of opportunity or limitation of parental roles and the sights and sounds in the NICU are listed as the most important stressors related to the treatment (Miles, Funk, & Carlson, 1993). Depression, anxiety disorders and post-traumatic stress disorder (PTSD) are relatively common among mothers and fathers of children hospitalised in NICUs (Segre, Chuffo-Siewert, Brock, & O'Hara, 2013;Segre, McCabe, Chuffo-Siewert, & O'Hara, 2014;Shaw, Bernard, Storfer-Isser, Rhine, & Horwitz, 2013;Shaw, St John, et al, 2013;Shaw et al, 2014).…”

Does she think she’s supported? Maternal perceptions of their experiences in the neonatal intensive care unit

“…Mothers of premature infants were recruited into a previously described randomized controlled trial 21,22 to evaluate whether a six-session psychosocial/educational intervention reduced their symptoms of emotional stress.…”