Journal of Clinical Psychology in Medical Settings

, Volume 17, Issue 3, pp 230–237 | Cite as

Prevalence and Correlates of Posttraumatic Stress and Postpartum Depression in Parents of Infants in the Neonatal Intensive Care Unit (NICU)

  • Debra S. Lefkowitz
  • Chiara Baxt
  • Jacquelyn R. Evans
Article

Abstract

The purpose of this study was to assess the prevalence and correlates of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in mothers and fathers, and postpartum depression (PPD) in mothers, of infants in the Neonatal Intensive Care Unit (NICU). 86 mothers and 41 fathers completed measures of ASD and of parent perception of infant medical severity 3–5 days after the infant’s NICU admission (T1), and measures of PTSD and PPD 30 days later (T2). 35% of mothers and 24% of fathers met ASD diagnostic criteria at T1, and 15% of mothers and 8% of fathers met PTSD diagnostic criteria at T2. PTSD symptom severity was correlated with concurrent stressors and family history of anxiety and depression. Rates of ASD/PTSD in parents of hospitalized infants are consistent with rates in other acute illness and injury populations, suggesting relevance of traumatic stress in characterizing parent experience during and after the NICU.

Keywords

Posttraumatic stress Postpartum depression Neonatal intensive care Infants Psychosocial screening 

References

  1. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
  2. Aucott, S., Donohue, P. K., Atkins, E., & Allen, M. C. (2002). Neurodevelopmental care in the NICU. Mental Retardation and Developmental Disabilities Research Review, 8, 298–308.CrossRefGoogle Scholar
  3. Aylward, G. P. (2002). Cognitive and neuropsychological outcomes: More than IQ scores. Mental Retardation and Developmental Disabilities Research Review, 8, 234–240.CrossRefGoogle Scholar
  4. Balluffi, A., Kassam-Adams, N., Kazak, A., Tucker, M., Dominguez, T., & Helfaer, M. (2004). Traumatic stress in parents of children admitted to the pediatric intensive care unit. Pediatric Critical Care Medicine, 5, 547–553.CrossRefPubMedGoogle Scholar
  5. Beck, C. T. (2003). Recognizing and screening for postpartum depression in mothers of NICU infants. Advances in Neonatal Care, 3, 37–46.CrossRefPubMedGoogle Scholar
  6. Beck, C. T., & Gable, R. K. (2000). Postpartum Depression Screening Scale: Development and psychometric testing. Nursing Research, 49, 272–282.CrossRefPubMedGoogle Scholar
  7. Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy, 34, 669–673.CrossRefPubMedGoogle Scholar
  8. Bronner, M. B., Kayser, A., Knoester, H., Bos, A. P., Last, B. F., & Grootenhuis, M. A. (2009). A pilot study on peritraumatic dissociation and coping styles as risk factors for posttraumatic stress, anxiety and depression in parents after their child’s unexpected admission to a Pediatric Intensive Care Unit. Child and Adolescent Psychiatry and Mental Health, 3, 33.CrossRefPubMedGoogle Scholar
  9. Bronner, M. B., Knoester, H., Bos, A. P., Last, B. F., & Grootenhuis, M. A. (2008). Follow-up after paediatric intensive care treatment: Parental posttraumatic stress. Acta Paediatrica, 97, 181–186.CrossRefPubMedGoogle Scholar
  10. Bronner, M. B., Peek, N., Knoester, H., Bos, A. P., Last, B. F., & Grootenhuis, M. A. (2010). Course and predictors of posttraumatic stress disorder in parents after pediatric intensive care treatment of their child. Journal of Pediatric Psychology, Advance Access, 1–10.Google Scholar
  11. Bryant, R. A., Moulds, M. L., & Guthrie, R. M. (2000). Acute Stress Disorder Scale: A self-report measure of acute stress disorder. Psychological Assessment, 12, 61–68.CrossRefPubMedGoogle Scholar
  12. Civic, D., & Holt, V. L. (2000). Maternal depressive symptoms and child behavior problems in a nationally representative normal birthweight sample. Maternal Child Health Journal, 4, 215–221.CrossRefGoogle Scholar
  13. Colville, G. A., & Gracey, D. (2006). Mothers’ recollections of the Paediatric Intensive Care Unit: Associations with psychopathology and views on follow-up. Intensive and Critical Care Nursing, 22, 49–55.CrossRefPubMedGoogle Scholar
  14. Joseph, R. A., Mackley, A. B., Davis, C. G., Spear, M. L., & Locke, R. G. (2007). Stress in fathers of surgical neonatal intensive care unit babies. Advances in Neonatal Care, 7, 321–325.PubMedGoogle Scholar
  15. Kassam-Adams, N., & Winston, F. K. (2004). Predicting child PTSD: The relationship between acute stress disorder and PTSD in injured children. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 403–411.CrossRefPubMedGoogle Scholar
  16. Kazak, A. E., & Baxt, C. (2007). Families of infants and young children with cancer: A post-traumatic stress framework. Pediatric Blood and Cancer, 49, 1109–1113.CrossRefPubMedGoogle Scholar
  17. Kazak, A. E., Kassam-Adams, N., Schneider, S., Zelikovsky, N., Alderfer, M. A., & Rourke, M. (2006). An integrative model of Pediatric Medical Traumatic Stress (PMTS). Journal of Pediatric Psychology, 31, 343–355.CrossRefPubMedGoogle Scholar
  18. Kazak, A., Schneider, S., & Kassam-Adams, N. (2009). Pediatric medical traumatic stress. In M. Roberts & R. Steele (Eds.), Handbook of pediatric psychology (4th ed., pp. 205–215). New York: Guilford.Google Scholar
  19. Leonard, L. G. (1998). Depression and anxiety disorders during multiple pregnancy and parenthood. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 27, 329–337.CrossRefPubMedGoogle Scholar
  20. Liu, W. F., Laudert, S., Perkins, B., Macmillan-York, E., Martin, S., & Graven, S. (2007). The development of potentially better practices to support the neurodevelopment of infants in the NICU. Journal of Perinatology, 27, S48–S74.CrossRefPubMedGoogle Scholar
  21. Manne, S. L., Du Hamel, K., Gallelli, K., Sorgen, K., & Redd, W. H. (1998). Posttraumatic stress disorder among mothers of pediatric cancer survivors: Diagnosis, comorbidity, and utility of the PTSD checklist as a screening instrument. Journal of Pediatric Psychology, 23, 357–366.CrossRefPubMedGoogle Scholar
  22. Miles, M. S., & Holditch-Davis, D. (1997). Parenting the prematurely born child: Pathways of influence. Seminars in Perinatology, 21, 254–266.CrossRefPubMedGoogle Scholar
  23. Murray, L., & Cooper, P. (1997). Effects of postnatal depression on infant development. Archives of Diseases in Children, 77, 99–101.CrossRefGoogle Scholar
  24. O’Hara, M., & Swain, A. (1996). Rates and risk of postpartum depression—a meta-analysis. International Review of Psychiatry, 8, 37–54.CrossRefGoogle Scholar
  25. Patino-Fernandez, A. M., Pai, A. L., Alderfer, M. A., Hwang, W. T., Reilly, A. T., & Kazak, A. E. (2008). Acute stress in parents of children newly-diagnosed with cancer. Pediatric Blood and Cancer, 50, 289–292.CrossRefPubMedGoogle Scholar
  26. Scrandis, D. A., Sheikh, T. M., Niazi, R., Tonelli, L. H., & Postolache, T. T. (2007). Depression after delivery: Risk factors, diagnostic and therapeutic considerations. Scientific World Journal, 7, 1670–1680.PubMedGoogle Scholar
  27. Shaw, R. J., Deblois, T., Ikuta, L., Ginzburg, K., Fleisher, B., & Koopman, C. (2006). Acute stress disorder among parents of infants in the neonatal intensive care nursery. Psychosomatics, 47, 206–212.CrossRefPubMedGoogle Scholar
  28. Taylor, H. G., Klein, N., & Hack, M. (2000). School-age consequences of birth weight less than 750 g: A review and update. Developmental Neuropsychology, 17, 289–321.CrossRefPubMedGoogle Scholar
  29. Veddovi, M., Kenny, D., Gibson, F., Bowen, J., & Starte, D. (2001). The relationship between depressive symptoms following premature birth, mothers’ coping style, and knowledge of infant development. Journal of Reproductive and Infant Psychology, 19, 313–323.Google Scholar
  30. Weathers, F., & Ford, J. (1996). Psychometric properties of the PTSD Checklist (PCL-C, PCL-S, PCL-M, PCL-PR). In B. H. Stamm (Ed.), Measurement of stress, trauma, and adaptation. Lutherville, MD: Sidran Press.Google Scholar
  31. Winston, F. K., Kassam-Adams, N., Vivarelli-O’Neill, C., Ford, J., Newman, E., Baxt, C., et al. (2002). Acute stress disorder symptoms in children and their Parents after pediatric traffic injury. Pediatrics, 109, e90.CrossRefPubMedGoogle Scholar
  32. Zaers, S., Waschke, M., & Ehlert, U. (2008). Depressive symptoms and symptoms of post-traumatic stress disorder in women after childbirth. Journal of Psychosomatic Obstetrics and Gynecology, 29, 61–71.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Debra S. Lefkowitz
    • 1
  • Chiara Baxt
    • 1
  • Jacquelyn R. Evans
    • 1
    • 2
  1. 1.Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.University of Pennsylvania School of MedicinePhiladelphiaUSA

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