Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant

Abstract

Context: Few studies document how parents adapt to the experience of a very low-birth-weight (VLBW; <1500 g) birth despite societal concerns about the ethics and justification of intensive care for these infants.

Objective: To determine the degree and type of stress experienced over time by mothers whose infants vary in degree of prematurity and medical and developmental risk.

Design: Longitudinal prospective follow-up study of a cohort of mothers of high- and low-risk VLBW and term infants from birth to 3 years.

Setting: All level III neonatal intensive care units from a large midwestern metropolitan region.

Participants: Mothers and infants prospectively and consecutively enrolled in a longitudinal study between 1989 and 1991. High-risk VLBW infants were diagnosed as having bronchopulmonary dysplasia, and comparison groups were low-risk VLBW infants without bronchopulmonary dysplasia and term infants (>36 weeks, >2500 g).

Main outcome measures: Standardized, normative self-report measures of maternal psychological distress, parenting stress, family impact, and life stressors.

Results: Mothers of VLBW infants (high risk, n = 122; low risk, n = 84) had more psychological distress than mothers of term infants (n=123) at 1 month (13% vs 1%; P = .003). At 2 years, mothers of low-risk VLBW infants did not differ from term mothers, while mothers of high-risk infants continued to report psychological distress. By 3 years, mothers of high-risk VLBW children did not differ from mothers of term children in distress symptoms, while parenting stress remained greater. Severity of maternal depression was related to lower child developmental outcomes in both VLBW groups.

Conclusions: The impact of VLBW birth varies with child medical risk status, age, and developmental outcome. Follow-up programs should incorporate psychological screening and support services for mothers of VLBW infants in the immediate postnatal period, with monitoring of mothers of high-risk VLBW infants.

Figure 1.

Mean Scores on Brief Symptom Inventory Subscales of GSI, Depression, Anxiety, and Obsessive-Compulsive Behavior GSI indicates General Severity Index. All scores had significant group effects (P<.001) and group-by-time interactions (P = .05). High-risk very low-birth-weight (VLBW) scores differed significantly over time from low-risk VLBW and term scores in post hoc comparisons. For GSI scores, at birth, high risk are higher than term (t = 2.7; P = .007); at 2 years, high risk are higher than low risk (t = 2.4; P = .02) and high risk are higher than term (t = 1.9; P = .06); and at 3 years, high risk are higher than low risk (t = 2.6; P = .01) and high risk are higher than term (t = 1.7; P = .10). For depression scores, at birth, high risk are higher than term (t = 2.5; P = .01); at 2 years, high risk are higher than low risk (t = 2.4; P = .02); and at 3 years, high risk are higher than low risk (t = 1.7; P = .09). For anxiety, at birth, high risk are higher than term (t = 3.5; P<.001); at 8 months, high risk are higher than term (t = 1.9; P = .05); at 12 months, high risk are higher than low risk (t = 1.9; P = .06); at 2 years, high risk are higher than term (t = 1.9; P = .06); and at 3 years, high risk are higher than low risk (t = 2.2; P = .03). For obsessive-compulsive scores, at birth, high risk are higher than term (t = 3.2; P = .002); at 2 years, high risk are higher than low risk (t = 2.2; P = .03) and high risk are higher than term (t = 1.8; P = .08); and at 3 years, high risk are higher than low risk (t = 2.5; P = .01) and high risk are higher than term (t = 2.1; P = .03).

Figure 2.

Mean Scores on the Parenting Stress Index Child Domain Scale There was an overall group effect (F = 3094; P<.001) with a group-by-time interaction (F = 3.9; P = .008). High-risk very low-birth-weight (VLBW) scores differed significantly over time from term scores (t = 2.1; P = .03) in post hoc comparisons.

Figure 3.

Mean Number of Stressors in the Family Inventory of Life Events VLBW indicates very low birth weight. There were significant effects for the subscale of illness for group (F = 99.1; P = .04) and for the group-by-time interaction (F = 2.78; P<.05). For the pregnancy sub-scale, there was also a significant group-by-time interaction (F = 11.0; P<.001).

Figure 4.

Mean Scores on Subscales Within the Impact on Family Scale VLBW indicates very low birth weight. There was an overall group effect (P<.05) for the family/social (F = 4.4; P = .04) and personal (F = 4.2; P = .04) strain subscales and a trend for the financial subscale (F = 3.0; P = .09). There was a group-by-time interaction effect (P<.05) for the family/social (F = 4.0; P = .05) and financial (F = 3.5; P = .07) subscales.