Parental Stress, Depression, and Participation in Care Before and During the COVID-19 Pandemic: A Prospective Observational Study in an Italian Neonatal Intensive Care Unit

Abstract

Background: Recent studies reported, during the COVID-19 pandemic, increased mental distress among the general population and among women around the childbirth period. COVID-19 pandemic may undermine the vulnerable well-being of parents in Neonatal Intensive Care Units (NICUs). Objective: Our study aimed to explore whether parental stress, depression, and participation in care in an Italian NICU changed significantly over three periods: pre-pandemic (T₀), low (T₁), and high COVID-19 incidence (T₂). Methods: Enrolled parents were assessed with the Parental Stressor Scale in the NICU (PSS:NICU), Edinburgh Postnatal Depression Scale (EPDS), and Index of Parental Participation (IPP). Stress was the study primary outcome. A sample of 108 parents, 34 for each time period, was estimated to be adequate to detect a difference in PSS:NICU stress occurrence level score (SOL) of 1.25 points between time periods. To estimate score differences among the three study periods a non-parametric analysis was performed. Correlation among scores was assessed with Spearman rank coefficient. Results: Overall, 152 parents were included in the study (62 in T₀, 56 in T₁, and 34 in T₂). No significant differences in the median PSS:NICU, EPDS, and IPP scores were observed over the three periods, except for a slight increase in the PSS:NICU parental role sub-score in T₂ (T₀ 3.3 [2.3-4.1] vs. T₂ 3.9 [3.1-4.3]; p = 0.038). In particular, the question regarding the separation from the infant resulted the most stressful aspect during T₂ (T₀ 4.0 [4.0-5.0] vs. T₂ 5.0 [4.0-5.0], p = 0.008). The correlation between participation and stress scores (r = 0.19-022), and between participation and depression scores (r = 0.27) were weak, while among depression and stress, a moderate positive correlation was found (r = 0.45-0.48). Conclusions: This study suggests that parental stress and depression may be contained during the COVID-19 pandemic, while participation may be ensured.

Keywords: COVID-19; depression; neonatal ICU; parents; participation; stress.

Figure 1

Stress (PSS:NICU), depression (EPDS), and participation in care (IPP) during three COVID-19 pandemic periods. PSS:NICU (Stress Occurrence Level and Overall Stress Level) and IPP scores are presented as medians. EPDS ≥12 is presented as percentage and standard deviation. Maximum scores vary for each IPP subdomain and are graphically shown with a dashed line. *statistically significance; T₀, pre-pandemic; T₁, low COVID-19 incidence; T₂, high COVID-19 incidence. PSS:NICU, Parenteral Stressor Scale in the NICU; EPDS, the Edinburgh Postnatal Depression Scale; IPP, Index of Parental Participation.

Figure 2

Correlation between IPP, EPDS and PSS:NICU SOL and OSL scores. All correlations were significant (p < 0.05). PSS:NICU, Parental Stressor Scale in the NICU; SOL, Stress Overall Level; OSL, Overall Stress Level; EPDS, the Edinburgh Postnatal Depression Scale; IPP, Index of Parenteral Participation.