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. 2024 Apr 8;8(Suppl 2):e002429.
doi: 10.1136/bmjpo-2023-002429.

Parental stress, depression, anxiety and participation in care in neonatal intensive care unit: a cross-sectional study in Italy comparing mothers versus fathers

Jenny Bua  1 , Paolo Dalena  2   3 , Ilaria Mariani  4 , Martina Girardelli  5 , Maddalena Ermacora  1 , Ursula Manzon  1 , Sabrina Plet  1 , Laura Travan  1 , Marzia Lazzerini  4   6
Affiliations

Parental stress, depression, anxiety and participation in care in neonatal intensive care unit: a cross-sectional study in Italy comparing mothers versus fathers

Jenny Bua et al. BMJ Paediatr Open. .

Abstract

Background: This study aimed at documenting the levels of stress, depression, anxiety and participation in care among mothers versus fathers of newborns hospitalised in a third-level neonatal intensive care unit (NICU) in Northern Italy.

Methods: Parental stress, depression and anxiety were assessed by the Parental Stressor Scale in NICU (PSS:NICU), the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI). Participation in care was evaluated with the Index of Parental Participation. Differences between mothers and fathers were assessed with the Mood's median test and z-test, respectively for continuous and discrete variables. Multivariate analyses controlling for potential confounders were performed to confirm gender differences.

Results: 191 parents (112 mothers and 79 fathers) were enrolled. Mothers reported significantly higher median scores for stress (2.9 vs 2.2, p<0.001) and trait anxiety (37 vs 32, p=0.004) and higher depression rates (EPDS ≥12: 43.8% vs 19.0%, p<0.001). 'High stress' (PSS:NICU ≥3) was reported by 45.5% of mothers compared with 24.1% of fathers (p=0.004). The frequency of the three conditions simultaneously was significantly higher among mothers (20.0% vs 3.8%, p=0.016), with the vast majority of mothers (76.0%) suffering from at least one condition compared with less than half of fathers (45.3%, p<0.001). Participation in care was more frequent in mothers (median score: 19 vs 15, p<0.001), with the exception of activities related to advocacy (median 5 vs 4, p=0.053). In a multivariate analysis, gender differences in mental health outcomes did not change.

Conclusions: Routine screening of mental distress among parents of infants in NICU is warranted, and gender differences need to be acknowledged in order to deliver tailored support and to promote collaboration with the family of vulnerable newborns. Knowledge and skills on how to prevent and cope with mental distress of parents should be part of the core curriculum of staff working in NICU.

Keywords: caregivers; neonatology.

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Conflict of interest statement

Competing interests: No, there are no competing interests.

Figures

Figure 1
Figure 1
Stress (median SOL scores), depression (EPDS≥12) and anxiety levels (mild, moderate, severe) among mothers and fathers. Sample size=191 (130 for STAI). Red asterisk=significant difference between mothers and fathers (p<0.05). EPDS, Edinburgh Postnatal Depression Scale; PSS:NICU, Parental Stressor Scale in NICU; SOL, stress occurrence level; STAI-Y1, State Anxiety Scale; STAI-Y2, Trait Anxiety Scale.
Figure 2
Figure 2
Differences in pattern of overlaps among conditions between mothers and fathers. For anxiety, STAI state score was considered. Sample size=75 (mothers), 55 (fathers). EPDS, Edinburgh Postnatal Depression Scale; PSS:NICU, Parental Stressor Scale in NICU; STAI, State Anxiety Scale-Y1.
Figure 3
Figure 3
IPP median subscores in mothers and fathers. Red asterisk=significant difference between mothers and fathers (p<0.05). Sample size=191. IPP, Index of Parental Participation.
Figure 4
Figure 4
Single items in IPP questionnaire in mothers and fathers. Red asterisk=significant difference between mothers and fathers (p<0.05). Sample size=191. IPP, Index of Parental Participation.
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