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Randomized Controlled Trial
. 2013 Oct;132(4):e886-94.
doi: 10.1542/peds.2013-1331. Epub 2013 Sep 2.

Prevention of traumatic stress in mothers with preterm infants: a randomized controlled trial

Richard J Shaw  1 , Nick St John, Emily A Lilo, Booil Jo, William Benitz, David K Stevenson, Sarah M Horwitz
Affiliations
Randomized Controlled Trial

Prevention of traumatic stress in mothers with preterm infants: a randomized controlled trial

Richard J Shaw et al. Pediatrics. 2013 Oct.

Abstract

Objective: The current study evaluates a treatment intervention developed with the goal of reducing symptoms of posttraumatic stress, depression, and anxiety in parents of premature infants.

Methods: A total of 105 mothers of preterm infants (25-34 weeks' gestational age; >600 g) were randomized to receive a 6-session intervention developed to target parental trauma as well as facilitate infant redefinition (n = 62) or to an active comparison group (n = 43). Mothers in the intervention group received a combination of trauma-focused treatments, including psychoeducation, cognitive restructuring, progressive muscle relaxation, and development of their trauma narrative. The intervention also incorporated material targeting infant redefinition, defined as the process of changing the mother's negative perceptions of her infant and the parenting experience.

Results: Mothers in the intervention group reported a greater reduction in both trauma symptoms (Cohen's d = 0.41, P = .023) and depression (Cohen's d = 0.59, P < .001) compared with the comparison group. Patients under both conditions improved significantly in terms of anxiety, with no differences between groups. Results of the moderator analysis showed that mothers with higher ratings of baseline NICU stress benefited more from the intervention compared with mothers who had lower ratings (P = .036).

Conclusions: This short, highly manualized intervention for mothers of preterm infants statistically significantly reduced symptoms of trauma and depression. The intervention is feasible, can be delivered with fidelity, and has high ratings of maternal satisfaction. Given that improvements in mothers' distress may lead to improved infant outcomes, this intervention has the potential for a high public health impact.

Trial registration: ClinicalTrials.gov NCT01307293.

Keywords: intervention; neonatal intensive care; posttraumatic stress disorder; premature infants.

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Figures

FIGURE 1
FIGURE 1
CONSORT diagram.
FIGURE 2
FIGURE 2
Longitudinal trajectories of primary and secondary outcomes (based on observed means by using all available cases at each assessment. At baseline, n = 43 for the comparison group and n = 62 for the intervention group. At 4 to 5 weeks, n = 41 for the comparison group and n = 57 for the intervention group. The thick lines represent means, and the thin lines represent 95% confidence bands.
FIGURE 3
FIGURE 3
Baseline NICU stress moderating the effect of intervention on DTS decline; DTS trajectories are based on mixed effects growth model estimates. The thick lines represent means, and the thin lines represent 95% confidence bands. The moderator analysis was conducted by using the continuous NICU stress measure. The score was split into 2 categories in the graphic to help readers visualize the moderating effect of NICU stress.
See this image and copyright information in PMC

References

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