Skip to main content

Improving Maternal Mental Health Following Preterm Birth Using an Expressive Writing Intervention: A Randomized Controlled Trial

Abstract

Evaluations of evidence-based, easily accessible, psychological interventions to improve maternal mental health following very preterm birth are scarce. This study investigated the efficacy and acceptability of the expressive writing paradigm for mothers of very preterm infants. The level of maternal posttraumatic stress and depressive symptoms was the primary outcome. Participants were 67 mothers of very preterm babies who were randomly allocated into the intervention (expressive writing; n = 33) or control group (treatment-as-usual; n = 32) when their infant was aged 3 months (corrected age, CA). Measurements were taken at 3 months (pre-intervention), 4 months (post-intervention), and 6 months CA (follow-up). Results showed reduced maternal posttraumatic stress (d = 0.42), depressive symptoms (d = 0.67), and an improved mental health status (d = 1.20) in the intervention group, which were maintained at follow-up. Expressive writing is a brief, cost-effective, and acceptable therapeutic approach that could be offered as part of the NICU care.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. Blencowe H, Cousens S, Chou D, Oestergaard M, Say L, Moller A-B et al (2013) Born too soon: the global epidemiology of 15 million preterm births. Reprod Health 10(Suppl 1):S2

    Article  PubMed  PubMed Central  Google Scholar 

  2. Goldenberg RL, Culhane JF, Iams JD, Romero R (2008) Epidemiology and causes of preterm birth. Lancet 371(9606):75–84

    Article  PubMed  Google Scholar 

  3. Doyle LW, Anderson PJ, Haslam R, Lee KJ, Crowther C (2014) School-age outcomes of very preterm infants after antenatal treatment with magnesium sulfate vs placebo. JAMA 312(11):1105–1113

    Article  PubMed  Google Scholar 

  4. Brett J, Staniszewska S, Newburn M, Jones N, Taylor L (2011) A systematic mapping review of effective interventions for communicating with, supporting and providing information to parents of preterm infants. BMJ Open 1(1):e000023

    Article  PubMed  PubMed Central  Google Scholar 

  5. Preyde M (2007) Mothers of very preterm infants: perspectives on their situation and a culturally sensitive intervention. Soc Work Health Care 44(4):65–83

    Article  PubMed  Google Scholar 

  6. Olshtain-Mann O, Auslander GK (2008) Parents of preterm infants two months after discharge from the hospital: are they still at (parental) risk? Health Soc Work 33(4):299–308

    Article  PubMed  Google Scholar 

  7. Lau R, Morse CA (2003) Stress experiences of parents with premature infants in a special care nursery. Stress Health 19(2):69–78

    Article  Google Scholar 

  8. Rautava P, Lehtonen L, Helenius H, Sillanpää M (2003) Effect of newborn hospitalization on family and child behavior: a 12-year follow-up study. Pediatrics 111(2):277–283

    Article  PubMed  Google Scholar 

  9. Shaw RJ, Lilo EA, Storfer-Isser A, Ball MB, Proud MS, Vierhaus NS et al (2014) Screening for symptoms of postpartum traumatic stress in a sample of mothers with preterm infants. Issues Mental Health Nurs 35(3):198–207

    Article  Google Scholar 

  10. Bener A (2013) Psychological distress among postpartum mothers of preterm infants and associated factors: a neglected public health problem. Revista Brasileira de Psiquiatria 35(3):231–236

    Article  PubMed  Google Scholar 

  11. Forcada-Guex M, Pierrehumbert B, Borghini A, Moessinger A, Muller-Nix C (2006) Early dyadic patterns of mother-infant interactions and outcomes of prematurity at 18 months. Pediatrics 118(1):e107–e114

    Article  PubMed  Google Scholar 

  12. Muller-Nix C, Forcada-Guex M, Pierrehumbert B, Jaunin L, Borghini A, Ansermet F (2004) Prematurity, maternal stress and mother-child interactions. Early Hum Dev 79(2):145–158

    Article  PubMed  Google Scholar 

  13. Borghini A, Pierrehumbert B, Miljkovitch R, Muller-Nix C, Forcada-Guex M, Ansermet F (2006) Mother’s attachment representations of their premature infant at 6 and 18 months after birth. Infant Mental Health J 27(5):494–508

    Article  Google Scholar 

  14. Udry-Jørgensen L, Pierrehumbert B, Borghini A, Habersaat S, Forcada-Guex M, Ansermet F et al (2011) Quality of attachment, perinatal risk, and mother–infant interaction in a high-risk premature sample. Infant Mental Health J 32(3):305–318

    Article  Google Scholar 

  15. Feldman R, Eidelman AI (2006) Neonatal state organization, neuromaturation, mother–infant interaction, and cognitive development in small-for-gestational-age premature infants. Pediatrics 118(3):e869–e878

    Article  PubMed  Google Scholar 

  16. Singh D, Newburn M (2000) Becoming a father—mens’ access to information and support about pregnancy, birth and life with a new baby. The National Childbirth Trust, London

    Google Scholar 

  17. Als H, Gilkerson L, Duffy FH, Mcanulty GB, Buehler DM, Vandenberg K et al (2003) A three-center, randomized, controlled trial of individualized developmental care for very low birth weight preterm infants: medical, neurodevelopmental, parenting, and caregiving effects. J Dev Behav Pediatr 24(6):399–408

    Article  PubMed  Google Scholar 

  18. Kaaresen PI, Rønning JA, Ulvund SE, Dahl LB (2006) A randomized, controlled trial of the effectiveness of an early-intervention program in reducing parenting stress after preterm birth. Pediatrics 118(1):e9–e19

    Article  PubMed  Google Scholar 

  19. Nurcombe B, Howell DC, Rauh VA, Teti DM, Ruoff P, Brennan J (1984) An intervention program for mothers of low-birthweight infants: preliminary results. J Am Acad Child Psychiatry 23(3):319–325

    Article  PubMed  Google Scholar 

  20. Benzies KM, Magill-Evans JE, Hayden KA, Ballantyne M (2013) Key components of early intervention programs for preterm infants and their parents: a systematic review and meta-analysis. BMC Pregnancy Childbirth 13(Suppl 1):S10

    Article  PubMed  PubMed Central  Google Scholar 

  21. Brecht CJ, Shaw RJ, St. John NH, Horwitz SM (2012) Effectiveness of therapeutic and behavioral interventions for parents of low-birth-weight premature infants: a review. Infant Mental Health J 33(6):651–665

    Article  Google Scholar 

  22. Borghini A, Habersaat S, Forcada-Guex M, Nessi J, Pierrehumbert B, Ansermet F et al (2014) Effects of an early intervention on maternal post-traumatic stress symptoms and the quality of mother-infant interaction: the case of preterm birth. Infant Behav Dev 37(4):624–631

    Article  PubMed  Google Scholar 

  23. Jotzo M, Poets CF (2005) Helping parents cope with the trauma of premature birth: an evaluation of a trauma-preventive psychological intervention. Pediatrics 115(4):915–919

    Article  PubMed  Google Scholar 

  24. Shaw RJ, St John N, Lilo EA, Jo B, Benitz W, Stevenson DK et al (2013) Prevention of traumatic stress in mothers with preterm infants: a randomized controlled trial. Pediatrics 132(4):e886–e894

    Article  PubMed  PubMed Central  Google Scholar 

  25. Bernard RS, Williams SE, Storfer-Isser A, Rhine W, Horwitz SM, Koopman C et al (2011) Brief cognitive–behavioral intervention for maternal depression and trauma in the neonatal intensive care unit: a pilot study. J Trauma Stress 24(2):230–234

    Article  PubMed  Google Scholar 

  26. Pennebaker JW, Beall SK (1986) Confronting a traumatic event: toward an understanding of inhibition and disease. J Abnorm Psychol 95(3):274

    Article  PubMed  Google Scholar 

  27. Pennebaker JW, Kiecolt-Glaser JK, Glaser R (1988) Disclosure of traumas and immune function: health implications for psychotherapy. J Consult Clin Psychol 56(2):239

    Article  PubMed  Google Scholar 

  28. Vidović A, Gotovac K, Vilibić M, Sabioncello A, Jovanović T, Rabatić S et al (2011) Repeated assessments of endocrine- and immune-related changes in posttraumatic stress disorder. Neuroimmunomodulation 18(4):199–211

    Article  PubMed  Google Scholar 

  29. Pennebaker JW, Chung CK (2011) Expressive writing: Connections to physical and mental health. Oxford handbook of Health Psychology, New York, pp 417–437

    Google Scholar 

  30. Pennebaker JW, Francis ME (1996) Cognitive, emotional, and language processes in disclosure. Cogn Emot 10(6):601–626

    Article  Google Scholar 

  31. Frattaroli J (2006) Experimental disclosure and its moderators: a meta-analysis. Psychol Bull 132(6):823

    Article  PubMed  Google Scholar 

  32. Doering LV, Moser DK, Dracup K (2000) Correlates of anxiety, hostility, depression, and psychosocial adjustment in parents of NICU infants. Neonatal Netw J Neonatal Nurs 19(5):15–23

    Article  Google Scholar 

  33. Younger JB, Kendell MJ, Pickler RH (1997) Mastery of stress in mothers of preterm infants. J Soc Pediatr Nurses JSPN 2(1):29–35

    Article  Google Scholar 

  34. Lindsay J, Roman L, DeWys M, Eager M, Levick J, Quinn M (1993) Creative caring in the NICU: parent-to-parent support. Neonatal Netw NN 12(4):37–44

    PubMed  Google Scholar 

  35. Harris AH (2006) Does expressive writing reduce health care utilization? A meta-analysis of randomized trials. J Consult Clin Psychol 74(2):243

    Article  PubMed  Google Scholar 

  36. Frisina PG, Borod JC, Lepore SJ (2004) A meta-analysis of the effects of written emotional disclosure on the health outcomes of clinical populations. J Nerv Ment Dis 192(9):629–634

    Article  PubMed  Google Scholar 

  37. Smyth JM (1998) Written emotional expression: effect sizes, outcome types, and moderating variables. J Consult Clin Psychol 66(1):174

    Article  PubMed  Google Scholar 

  38. Gray PH, Edwards DM, O’Callaghan MJ, Cuskelly M, Gibbons K (2013) Parenting stress in mothers of very preterm infants—Influence of development, temperament and maternal depression. Early Human Dev 89(9):625–629

    Article  Google Scholar 

  39. Macnab AJ, Beckett LY, Park CC, Sheckter L (1998) Journal writing as a social support strategy for parents of premature infants: a pilot study. Patient Educ Couns 33(2):149–159

    Article  PubMed  Google Scholar 

  40. Barry LM, Singer GH (2001) Reducing maternal psychological distress after the NICU experience through journal writing. J Early Interv 24(4):287–297

    Article  Google Scholar 

  41. Moher D, Schulz KF, Altman DG (2001) The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Med Res Methodol 1(1):2

    Article  PubMed  PubMed Central  Google Scholar 

  42. Faul F, Erdfelder E, Lang A-G, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39(2):175–191

    Article  PubMed  Google Scholar 

  43. Klein K, Boals A (2001) Expressive writing can increase working memory capacity. J Exp Psychol Gen 130(3):520

    Article  PubMed  Google Scholar 

  44. DeMier RL, Hynan MT, Harris HB, Manniello RL (1996) Perinatal stressors as predictors of symptoms of posttraumatic stress in mothers of infants at high risk. J Perinatol 16(4):276–280

    PubMed  Google Scholar 

  45. Association AP (2000) Diagnostic and statistical manual of mental disorders, 4th edn, Text Revision, American Psychiatric Publishing, Washington, DC

  46. Quinnell FA, Hynan MT (1999) Convergent and discriminant validity of the perinatal PTSD questionnaire (PPQ): a preliminary study. J Trauma Stress 12(1):193–199

    Article  PubMed  Google Scholar 

  47. Pierrehumbert B, Nicole A, Muller-Nix C, Forcada-Guex M, Ansermet F (2003) Parental post-traumatic reactions after premature birth: implications for sleeping and eating problems in the infant. Arch Dis Child Fetal Neonatal Ed 88(5):F400–F404

    Article  PubMed  PubMed Central  Google Scholar 

  48. Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150:782–786

    Article  PubMed  Google Scholar 

  49. Guedeney N, Fermanian J (1998) Validation study of the French version of the Edinburgh Postnatal Depression Scale (EPDS): new results about use and psychometric properties. Eur Psychiatry 13(2):83–89

    Article  PubMed  Google Scholar 

  50. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30(6):473–483

    Article  PubMed  Google Scholar 

  51. Leplege A, Ecosse E, Verdier A, Perneger TV (1998) The French SF-36 health survey: translation, cultural adaptation and preliminary psychometric evaluation. J Clin Epidemiol 51(11):1013–1023

    Article  PubMed  Google Scholar 

  52. Parry G, Tucker J, Tarnow-Mordi W (2003) Group UNSSC. CRIB II: an update of the clinical risk index for babies score. Lancet 361(9371):1789–1791

    Article  PubMed  Google Scholar 

  53. Scheiner AP, Sexton ME (1991) Prediction of developmental outcome using a perinatal risk inventory. Pediatrics 88(6):1135–1143

    PubMed  Google Scholar 

  54. Largo R, Pfister D, Molinari L, Kundu S, Lipp A, Due G (1989) Significance of prenatal, perinatal and postnatal factors in the development of AGA preterm infants at five to seven years. Dev Med Child Neurol 31(4):440–456

    Article  PubMed  Google Scholar 

  55. Tsivos Z-L, Calam R, Sanders MR, Wittkowski A (2015) Interventions for postnatal depression assessing the mother–infant relationship and child developmental outcomes: a systematic review. Int J Women’s Health 7:429–447

    Google Scholar 

  56. Milbury K, Spelman A, Wood C, Matin SF, Tannir N, Jonasch E et al (2014) Randomized controlled trial of expressive writing for patients with renal cell carcinoma. J Clin Oncol 32(7):663–670

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

Antje Horsch was supported by the Faculty of Biology and Medicine, University of Lausanne. We would like to thank all mothers who participated and Mehdi Mohammad Gholamrezaee for his statistical advice. Thank you to Karine Perretten, Laetizia von Laer Tschudin, Manon Macherel, Maria Campos, and Anaïs Torregrossa for their assistance.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Antje Horsch.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Horsch, A., Tolsa, JF., Gilbert, L. et al. Improving Maternal Mental Health Following Preterm Birth Using an Expressive Writing Intervention: A Randomized Controlled Trial. Child Psychiatry Hum Dev 47, 780–791 (2016). https://doi.org/10.1007/s10578-015-0611-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10578-015-0611-6

Keywords

  • Premature
  • NICU
  • Expressive writing
  • Intervention
  • Maternal mental health