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A mindfulness intervention to reduce maternal distress in neonatal intensive care: a mixed methods pilot study

  • Tamar Mendelson
  • Ciara McAfee
  • April Joy Damian
  • Amitoj Brar
  • Pamela Donohue
  • Erica Sibinga
Original Article

Abstract

Mothers with an infant in the neonatal intensive care unit (NICU) are at risk for depression, anxiety, and trauma symptoms, with negative implications for maternal-infant bonding, maternal well-being, and infant development. Few interventions to promote NICU mothers’ mental health, however, have been developed or tested. This pre-post pilot study assessed feasibility, acceptability, and preliminary outcomes of a mindfulness intervention for NICU mothers. Twenty-seven mothers were recruited from a university NICU and offered a mindfulness intervention via introductory video and audio-recorded practices. Participants completed a baseline self-report survey. After 2 weeks of engaging with intervention materials, participants completed a second survey and in-depth interview. Quantitative data were analyzed using paired t tests; qualitative data were analyzed using thematic coding. Twenty-four women (89%) completed the study. Quantitative data indicated significant improvements in depressive, anxiety, and trauma symptoms, negative coping, NICU-related stress, and sleep (p < 0.05). Qualitative data identified themes of perceived improvements in psychological distress and stress symptoms, self-care, and relationships. Findings support the mindfulness intervention’s feasibility, acceptability, and potential promise for reducing maternal distress and promoting well-being. Use of video and audio modalities may facilitate program sustainability and scale up. Further research on the program is merited.

Keywords

Neonatal intensive care Mindfulness Maternal distress Maternal well-being 

Notes

Acknowledgements

We thank Trish Magyari for her collaboration on the development of the mindfulness intervention content and associated video and audio recordings and the Johns Hopkins Children’s Center NICU social workers for their assistance with study implementation. We also thank the mothers who participated in this study.

Funding Information

This research was supported by a grant from the Zanvyl and Isabelle Krieger Fund.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflicts of interest.

References

  1. Baer RA, Smith GT, Hopkins J, Krietmeyer J, Toney L (2006) Using self-report assessment methods to explore facets of mindfulness. Assessment 13:27–45CrossRefPubMedGoogle Scholar
  2. Bergstrom EB, Wallin L, Thomson G, Flacking R (2012) Postpartum depression in mothers of infants cared for in a neonatal intensive care unit—incidence and associated factors. Journal of Neonatal Nursing 18:143–151CrossRefGoogle Scholar
  3. Brown KW, Ryan RM (2003) The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol 84:822–848CrossRefPubMedGoogle Scholar
  4. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index (PSQI): a new instrument for psychiatric research and practice. Psychiatry Res 28:193–213CrossRefPubMedGoogle Scholar
  5. Cardena E, Koopman C, Classen C, Waelde LC, Spiegel D (2000) Psychometric properties of the Stanford Acute Stress Reaction Questionnaire (SASRQ): a valid and reliable measure of acute stress. J Trauma Stress 13:719–734CrossRefPubMedGoogle Scholar
  6. Carver CS (1997) You want to measure coping but your protocol’s too long: consider the Brief COPE. Int J Behav Med 4:92–100CrossRefPubMedGoogle Scholar
  7. Chiesa A, Serretti A (2009) A systematic review of neurobiological and clinical features of mindfulness meditations. Psychol Med 27:1–14Google Scholar
  8. Cooper LG, Gooding JS, Gallagher J, Sternesky L, Ledsky R, Berns SD (2007) Impact of a family-centered care initiative on NICU care, staff, and families. J Perinatol 27:S32–S37CrossRefPubMedGoogle Scholar
  9. Fanti KA, Henrich CC (2010) Trajectories of pure and co-occurring internalizing and externalizing problems from age 2 to age 12: findings from the National Institute of Child Health and Human Development Study of Early Child Care. Dev Psychol 46(5):1159–1175CrossRefPubMedGoogle Scholar
  10. George A, Luz RF, Tycney CD, Thilly N, Spitz E (2013) Anxiety symptoms and coping strategies in the perinatal period. BMC Pregnancy and Childbirth 13:1–6CrossRefGoogle Scholar
  11. Guardino CM, Schetter CD (2014) Coping during pregnancy: a systematic review and recommendations. Health Psychol Rev 8:70–94CrossRefPubMedGoogle Scholar
  12. Harrison W, Goodman D (2015) Epidemiologic trends in neonatal intensive care, 2007-2012. JAMA Pediatr 169(9):855–862CrossRefPubMedGoogle Scholar
  13. Hofmann SG, Sawyer AT, Witt AA, Oh D (2010) The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol 78:169–183CrossRefPubMedPubMedCentralGoogle Scholar
  14. Howland LC, Pickler RH, McCain NL, Glaser D, Lewis M (2011) Exploring biobehavioral outcomes in mothers of preterm infants. MCN Am J Matern Child Nurs 36:91–97CrossRefPubMedGoogle Scholar
  15. Huhtala M, Korja R, Lehtonen L, Haataja L, Lapinleimu H, Rautava P; PIPARI Study Group (2012) Parental psychological well-being and behavioral outcome of very low birth weight infants at 3 years. Pediatrics 129:e937–e944Google Scholar
  16. Kroenke K, Strine TW, Spritzer RL, Williams JB, Berry JT, Mokdad AH (2009) The PHQ-8 as a measure of current depression in the general population. J Affect Disord 114:163–173CrossRefPubMedGoogle Scholar
  17. Kuppala VS, Tabangin M, Haberman B, Steichen J, Yolton K (2012) Current state of high-risk infant follow-up care in the United States: results of a national survey of academic follow-up programs. J Perinatol 32(4):293–298CrossRefPubMedGoogle Scholar
  18. Lee YS, Garfield C, Massey N, Chaysinh S, Hassan S (2011) NICU-2-HOME: supporting the transition to home from the neonatal intensive care unit using a mobile application. Paper presented at: proceedings of the 2011 annual conference extended abstracts on human factors in computing systemsGoogle Scholar
  19. Lefkowitz DS, Baxt C, Evans JR (2010) Prevalence and correlates of posttraumatic stress and postpartum depression in parents of infants in the neonatal intensive care unit (NICU). J Clin Pychol Med Settings 17:230–237CrossRefGoogle Scholar
  20. Linehan M (1993) Cognitive-behavioral treatment of borderline personality disorder. The Guilford Press, New YorkGoogle Scholar
  21. Lutz A, Slagter HA, Dunne JD, Davidson RJ (2008) Attention regulation and monitoring in meditation. Trends Cogn Sci 12:163–169CrossRefPubMedPubMedCentralGoogle Scholar
  22. Marlow N, Wolke D, Bracewell MA, Samara M (2005) Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med 352:9–19CrossRefPubMedGoogle Scholar
  23. Melnyk BM, Alpert-Gillis L, Feinstein NF, Fairbanks E, Schultz-Czarniak J, Hust D, Sherman L, LeMoine C, Moldenhauer Z, Small L, Bender N, Sinkin, MD RA (2001) Improving cognitive development of low-birth-weight premature infants with the COPE program: a pilot study of the benefit of early NICU intervention with mothers. Res Nurs Health 24:373–389Google Scholar
  24. Melnyk BM, Feinstein NF, Alpert-Gillis L, Fairbanks E, Crean HF, Sinkin RA, Stone PW, Small L, Tu X, Gross SJ (2006) Reducing premature infants’ length of stay and improving parents’ mental health outcomes with the Creating Opportunities for Parent Empowerment (COPE) neonatal intensive care unit program: a randomized, controlled trial. Pediatrics 118:e1414–e1427CrossRefPubMedGoogle Scholar
  25. Mendelson T, Cluxton-Keller F, Vullo G, Tandon SD, Noazin S (2017) NICU-based interventions to reduce maternal depression and anxiety: a meta-analysis. Pediatrics 139:e20161870Google Scholar
  26. Miles MS, Funk SG, Carlson J (1993) Parental stressor scale: neonatal intensive care unit. Nurs Res 42:148–152CrossRefPubMedGoogle Scholar
  27. Miles MS, Holditch-Davis D, Schwartz TA, Scher M (2007) Depressive symptoms in mothers of prematurely born infants. J Dev Behav Pediatr 28(1):36–44CrossRefPubMedGoogle Scholar
  28. Mohr DC, Burns MN, Schueller SM, Clarke G, Klinkman M (2013) Behavioral intervention technologies: evidence review and recommendations for future research in mental health. Gen Hosp Psychiatry 35:332–338CrossRefPubMedGoogle Scholar
  29. Neff KD (2003) Development and validation of a scale to measure self-compassion. Self Identity 2:223–250CrossRefGoogle Scholar
  30. Nijjar PS, Puppala VK, Dickinson O, Duval S, Duprez D, Kreitzer MJ, Benditt DG (2014) Modulation of the autonomic nervous system assessed through heart rate variability by a mindfulness-based stress reduction program. Int J Cardiol 177(2):557–559CrossRefPubMedGoogle Scholar
  31. Obeidat HM, Bond EA, Callister LC (2009) The parental experience of having an infant in the newborn intensive care unit. J Perinat Educ 18(3):23–29CrossRefPubMedPubMedCentralGoogle Scholar
  32. Okun ML, Luther J, Prather AA, Perel M, Wisniewski S, Wisner KL (2011) Changes in sleep quality, but not hormones, predict time to postpartum depression recurrence. J Affect Disord 130:378–384CrossRefPubMedGoogle Scholar
  33. Owens JE, Schorling J, Plews-Ogan M, Goodman M, Moorman R, Zaklin R, Dent J (2016) A randomized controlled trial evaluating mindfulness-based stress reduction (MBSR) for the treatment of palpitations: a pilot study. Int J Cardiol 223:25–27CrossRefPubMedGoogle Scholar
  34. Pinelli J, Saigal S, Bill Wu Y-W, Cunningham C, DiCenso A, Steele S, Austin P, Turner S (2008) Patterns of change in family functioning, resources, coping and parental depression in mothers and fathers of sick newborns over the first year of life. Journal of Neonatal Nursing. 14:156–165CrossRefGoogle Scholar
  35. Schwartz RM, Kellogg R, Muri JH (2000) Specialty newborn care: trends and issues. J Perinatol 20(8):520–529CrossRefPubMedGoogle Scholar
  36. Shaw RJ, St John N, Lilo EA, Jo B, Benitz W, Stevenson DK, Horwitz SM (2013) Prevention of traumatic stress in mothers with preterm infants: a randomized controlled trial. Pediatrics 132(4):e886–e894CrossRefPubMedPubMedCentralGoogle Scholar
  37. Shaw RJ, Lilo EA, Storfer-Isser A, Ball MB, Proud MS, Vierhaus NS, Huntsberry A, Mitchell K, Adams MM, Horwitz SM (2014a) Screening for symptoms of postpartum traumatic stress in a sample of mothers with preterm infants. Issues Ment Health Nurs 35:198–207CrossRefPubMedPubMedCentralGoogle Scholar
  38. Shaw RJ, St John N, Lilo E, Jo B, Benitz W, Stevenson DK, Horwitz SM (2014b) Prevention of traumatic stress in mothers of preterms: 6-month outcomes. Pediatrics 134:e481–e488CrossRefPubMedPubMedCentralGoogle Scholar
  39. Sibinga EMS, Perry-Parrish C, Chung SE, Johnson SB, Smith M, Ellen JM (2013) School-based mindfulness instruction for urban male youth: a small randomized controlled trial. Prev Med 57:799–801CrossRefPubMedGoogle Scholar
  40. Silverstein M, Feinberg E, Cabral H, Sauder S, Egbert L, Schainker E, Kamholz K, Hegel M, Beardslee W (2011) Problem-solving education to prevent depression among low-income mothers of preterm infants: a randomized controlled pilot trial. Arch Womens Ment Health 14:317–324CrossRefPubMedPubMedCentralGoogle Scholar
  41. Simpson W, Glazer M, Michalski N, Steiner M, Frey BN (2014) Comparative efficacy of the generalized anxiety disorder 7-item scale and the Edinburgh postnatal depression scale as screening tools for generalized anxiety disorder in pregnancy and the postpartum period. Can J Psychiatr 59:434–440CrossRefGoogle Scholar
  42. Singer LT, Salvator A, Guo S, Collin M, Lilien L, Baley J (1999) Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant. J Am Med Assoc 281:799–805CrossRefGoogle Scholar
  43. Smith MV, Gotman N, Lin H, Yonkers KA (2010) Do the PHQ-8 and the PHQ-2 accurately screen for depressive disorders in a sample of pregnant women? Gen Hosp Psychiatry 32:544–548CrossRefPubMedPubMedCentralGoogle Scholar
  44. Spitzer RL, Kroenke K, Williams JBW, Lowe B (2006) A brief measure for assessing generalized anxiety disorder. Arch Intern Med 166:1092–1097CrossRefPubMedGoogle Scholar
  45. Tang YY, Ma Y, Fan Y, Feng H, Wang J, Feng S, Lu Q, Hu B, Lin Y, Li J, Zhang Y, Wang Y, Zhou L, Fan M (2009) Central and autonomic nervous system interaction is altered by short-term meditation. Proc Natl Acad Sci 106:8865–8870CrossRefPubMedGoogle Scholar
  46. Taylor A, Atkins R, Kumar R, Adams D, Glover V (2005) A new mother-to-infant bonding scale: links with early maternal mood. Arch Womens Ment Health 8(1):45–51CrossRefPubMedGoogle Scholar
  47. Taylor BL, Cavanagh K, Strauss C (2016) The effectiveness of mindfulness-based interventions in the perinatal period: a systematic review and meta-analysis. PLoS One 11:1–29Google Scholar
  48. Vaucher YE, Peralta-Carcelen M, Finer NN, Carlo WA, Gantz MG, Walsh MC, Laptook AR, Yoder BA, Faix RG, Das A, Schibler K, Rich W, Newman NS, Vohr BR, Yolton K, Heyne RJ, Wilson-Costello DE, Evans PW, Goldstein RF, Acarregui MJ, Adams-Chapman I, Pappas A, Hintz SR, Poindexter B, Dusick AM, McGowan E, Ehrenkranz RA, Bodnar A, Bauer CR, Fuller J, O'Shea TM, Myers GJ, Higgins RD, SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network (2012) Neurodevelopmental outcomes in the early CPAP and pulse oximetry trial. N Engl J Med 367:2495–2504CrossRefPubMedPubMedCentralGoogle Scholar
  49. Woolhouse H, Mercuri K, Judd F, Brown SJ (2014) Antenatal mindfulness intervention to reduce depression, anxiety, and stress: a pilot randomized controlled trial of the MindBodyBaby program in an Australian tertiary maternity hospital. BMC Pregnancy and Childbirth 14:1–16CrossRefGoogle Scholar
  50. Yawn BP, Pace W, Wollan PC, Bertram S, Kurland M, Graham D, Dietrich A (2009) Concordance of Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ-9) to assess increased risk of depression among postpartum women. J Am Board Fam Med 22:483–491CrossRefPubMedGoogle Scholar
  51. Zelkowitz P, Bardin C, Papageorgiou A (2007) Anxiety affects the relationship between parents and their very low birth weight infants. Infant Ment Health Jornal 28:296–313CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Tamar Mendelson
    • 1
  • Ciara McAfee
    • 2
  • April Joy Damian
    • 1
  • Amitoj Brar
    • 1
  • Pamela Donohue
    • 1
    • 3
  • Erica Sibinga
    • 3
  1. 1.Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.University of Texas at AustinAustinUSA
  3. 3.Johns Hopkins School of MedicineBaltimoreUSA

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