Parental stress, depression, anxiety and participation to care in neonatal intensive care units: results of a prospective study in Italy, Brazil and Tanzania

Abstract

Background: Studies comparing the frequency of different mental health conditions across different settings and evaluating their association with parental participation in newborn care are lacking. We aimed at evaluating the frequency of parental stress, anxiety and depression, along with the level of participation in newborn care, among parents of newborns in Italy, Brazil and Tanzania.

Methods: Parental stress, anxiety, depression and participation in care were assessed prospectively in parents of newborns in eight neonatal intensive care units (NICUs) utilising: the Parental Stressor Scale in NICU (PSS:NICU); the Edinburgh Postnatal Depression Scale (EPDS) and EPDS-Anxiety subscale (EPDS-A); the Index of Parental Participation in NICU (IPP-NICU). Univariate and multivariate analyses were conducted.

Results: Study outcomes were assessed on 742 parents (Brazil=327, Italy=191, Tanzania=224). Observed scores suggested a very high frequency of stress, anxiety and depression, with an overall estimated frequency of any of the mental health condition of 65.1%, 52.9% and 58.0% in Brazil, Italy, Tanzania, respectively (p<0.001). EPDS scores indicating depression (cut-off: ≥13 for Brazil and Tanzania, ≥12 for Italy) were significantly more frequent in Tanzania (52.3%) when compared with either Brazil (35.8%) and Italy (33.3%) (p<0.001). Parental participation in care was also significantly higher in Tanzania (median IPP-NICU=24) than in the other two countries (median=21 for Brazil, 18 for Italy, p<0.001). Severe stress (PSS:NICU ≥4) was significantly more frequently reported in Brazil (22.6%), compared with Italy (4.7%) and Tanzania (0%, p<0.001). Factors independently associated with either parental stress, anxiety or depression varied by country, and a significant association with parental participation in care was lacking.

Conclusions: Study findings suggest that parental stress, anxiety and depression are extremely frequent in NICUs in all countries despite diversity in the setting, and requiring immediate action. Further studies should explore the appropriate level of parental participation in care in different settings.

Keywords: Neonatology.

Figure 1. Study flow diagram. NICU, neonatal intensive care unit.

Figure 2. Frequency of detected parental depression, anxiety, stress and intersections among identified populations. For anxiety, the EPDS-A score was used. For PSS:NICU, the SOL score was used. Depression cut-offs: EPDS≥12 for Italy and≥13 for Brazil and Tanzania. EPDS, Edinburgh Postnatal Depression Scale; NICU, neonatal intensive care unit; PSS:NICU, Parental Stressor Scale in NICU; SOL, stress occurrence level.

Figure 3. Frequency of parental depression, anxiety (STAI score) and stress and intersections among identified populations. For PSS:NICU, the SOL score was used. For STAI, the STAI State score was used. Depression cut-offs: EPDS≥12 for Italy and≥13 for Brazil. In Tanzania, the STAI score was not collected. EPDS, Edinburgh Postnatal Depression Scale; NICU, neonatal intensive care unit; PSS:NICU, Parental Stressor Scale in NICU; SOL, stress occurrence level; STAI, State-Trait Anxiety Inventory.

Figure 4. Severity of stress, depression and anxiety (median scores). The figure shows the median, the mean (represented by a ‘X’) and the IQR of each score. EPDS, Edinburgh Postnatal Depression Scale; NICU, neonatal intensive care unit; PSS:NICU, Parental Stressor Scale in NICU; STAI, State-Trait Anxiety Inventory.

Figure 5. Stress by domain (median scores). The figure shows the median and the IQR of the PSS:NICU. NICU, neonatal intensive care unit; PSS:NICU, Parental Stressor Scale in NICU.

Figure 6. Parental participation, by domain (median scores). The figure shows the median and the IQR of the IPP-NICU. NICU, neonatal intensive care unit; IPP-NICU, Index of Parental Participation in NICU.