Maternal mental health after infant discharge: a quasi-experimental clinical trial of family integrated care versus family-centered care for preterm infants in U.S. NICUs

Abstract

Background: Involvement in caregiving and tailored support services may reduce the risk of mental health symptoms for mothers after their preterm infant's neonatal intensive care unit (NICU) discharge. We aimed to compare Family-Centered Care (FCC) with mobile-enhanced Family-Integrated Care (mFICare) on post-discharge maternal mental health symptoms.

Method: This quasi-experimental study enrolled preterm infant (≤ 33 weeks)/parent dyads from three NICUs into sequential cohorts: FCC or mFICare. We analyzed post-discharge symptoms of perinatal post-traumatic stress disorder (PTSD) and depression using intention-to-treat and per protocol approaches.

Results: 178 mothers (89 FCC; 89 mFICare) completed measures. We found no main effect of group assignment. We found an interaction between group and stress, indicating fewer PTSD and depression symptoms among mothers who had higher NICU-related stress and received mFICare, compared with mothers who had high stress and received FCC (PTSD: interaction β=-1.18, 95% CI: -2.10, -0.26; depression: interaction β=-0.76, 95% CI: -1.53, 0.006). Per protocol analyses of mFICare components suggested fewer PTSD and depression symptoms among mothers who had higher NICU stress scores and participated in clinical team rounds and/or group classes, compared with mothers who had high stress and did not participate in rounds or classes.

Conclusion: Overall, post-discharge maternal mental health symptoms did not differ between the mFICare and FCC groups. However, for mothers with high levels of stress during the NICU stay, mFICare was associated with fewer post-discharge PTSD and depression symptoms.

Keywords: Family partnerships; Infant; Maternal depression; Parental stress; Perinatal PTSD.

Fig. 1

Participant flow diagram

Fig. 2

Interaction effects of parent NICU stress and mFICare intervention on PTSD symptoms (a) and depression (b) after NICU discharge. Dotted lines indicate the 95% confidence interval for each group. a. Mothers in the mFICare group with higher levels of NICU-related stress had lower post-discharge PPQ scores than similarly stressed mothers in the FCC group; mothers with lower levels of NICU-related stress had relatively few PTSD symptoms, regardless of intervention group (p = .012). b. A similar interaction pattern was found for maternal depression (EPDS) scores but did not reach statistical significance (p = .052)

Fig. 3

Interaction effect of parent NICU stress and attending mFICare clinical rounds on PTSD symptoms (a) and depression (b) after NICU discharge. Dotted lines indicate the 95% confidence interval for each group. a. Mothers with higher levels of NICU-related stress who participated in at least 2 daily rounds for their infant had lower post-discharge PPQ scores than similarly stressed mothers who did not; mothers with lower levels of NICU-related stress had relatively few PTSD symptoms, regardless of their participation in rounds (p = .022). b. A similar interaction pattern was found for maternal depression (EPDS) scores but did not reach statistical significance (p = .12)

Fig. 4

Interaction effect of mFICare parent classes and parent NICU stress and on PTSD symptoms (3a) and depression (3b) after NICU discharge. Dotted lines indicate the 95% confidence interval for each group. a. Mothers with higher levels of NICU-related stress who attended at least one parent class had lower post-discharge PPQ scores than similarly stressed mothers who did not attend classes; mothers with lower levels of NICU-related stress had relatively few PTSD symptoms, regardless of class attendance (p = .024). b. Mothers with higher levels of NICU-related stress who attended at least one parent class had lower post-discharge EPDS scores than similarly stressed mothers who did not attend classes; mothers with lower levels of NICU-related stress had relatively few depression symptoms, regardless of class attendance (p = .015)