Maternal post-traumatic stress and depression symptoms and outcomes after NICU discharge in a low-income sample: a cross-sectional study

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Abstract

Background

Having a preterm newborn and the experience of staying in the neonatal intensive care unit (NICU) has the potential to impact a mother’s mental health and overall quality of life. However, currently there are few studies that have examined the association of acute post-traumatic stress (PTS) and depression symptoms and infant and maternal outcomes in low-income populations.

Design/ methods

In a cross-sectional study, we examined adjusted associations between positive screens for PTS and depression using the Perinatal Post-traumatic stress Questionnaire (PPQ) and the Patient Health-Questionnaire 2 (PHQ-2) with outcomes using unconditional logistic and linear regression models.

Results

One hundred sixty-nine parents answered the questionnaire with 150 complete responses. The majority of our sample was Hispanic (68%), non-English speaking (67%) and reported an annual income of <$20,000 (58%). 33% of the participants had a positive PPQ screen and 34% a positive PHQ-2 screen. After adjusting for confounders, we identified that a positive PHQ-2 depression score was associated with a negative unit (95% CI) change on the infant’s Vineland Adaptive Behavior Scales, second edition of − 9.08 (− 15.6, − 2.6) ( p < 0.01). There were no significant associations between maternal stress and depression scores and infant Bayley Scales of Infant Development III scores or re-hospitalizations or emergency room visits. However, positive PPQ and screening score were associated with a negative unit (95% CI) unit change on the maternal Multicultural Quality of Life Index score of − 8.1 (− 12, − 3.9)( p < 0.01) and − 7.7 (− 12, − 3) ( p = 0.01) respectively.

Conclusions

More than one-third of the mothers in this sample screened positively for PTS and depression symptoms. Screening scores positive for stress and depression symptoms were associated with a negative change in some infant development scores and maternal quality of life scores. Thoughtful screening programs for maternal stress and depression symptoms should be instituted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-020-03536-0.

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Most cited references 55

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The Patient Health Questionnaire-2: validity of a two-item depression screener.

Kurt Kroenke, Robert L Spitzer, Janet B W Williams (2003)

A number of self-administered questionnaires are available for assessing depression severity, including the 9-item Patient Health Questionnaire depression module (PHQ-9). Because even briefer measures might be desirable for use in busy clinical settings or as part of comprehensive health questionnaires, we evaluated a 2-item version of the PHQ depression module, the PHQ-2. The PHQ-2 inquires about the frequency of depressed mood and anhedonia over the past 2 weeks, scoring each as 0 ("not at all") to 3 ("nearly every day"). The PHQ-2 was completed by 6000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-2 depression severity increased from 0 to 6, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and healthcare utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-2 score > or =3 had a sensitivity of 83% and a specificity of 92% for major depression. Likelihood ratio and receiver operator characteristic analysis identified a PHQ-2 score of 3 as the optimal cutpoint for screening purposes. Results were similar in the primary care and obstetrics-gynecology samples. The construct and criterion validity of the PHQ-2 make it an attractive measure for depression screening.

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Perinatal Depression: A Systematic Review of Prevalence and Incidence

Norma I Gavin, Bradley Gaynes, Kathleen N. Lohr … (2005)

We systematically review evidence on the prevalence and incidence of perinatal depression and compare these rates with those of depression in women at non-childbearing times. We searched MEDLINE, CINAHL, PsycINFO, and Sociofile for English-language articles published from 1980 through March 2004, conducted hand searches of bibliographies, and consulted with experts. We included cross-sectional, cohort, and case-control studies from developed countries that assessed women for depression during pregnancy or the first year postpartum with a structured clinical interview. Of the 109 articles reviewed, 28 met our inclusion criteria. For major and minor depression (major depression alone), the combined point prevalence estimates from meta-analyses ranged from 6.5% to 12.9% (1.0-5.6%) at different trimesters of pregnancy and months in the first postpartum year. The combined period prevalence shows that as many as 19.2% (7.1%) of women have a depressive episode (major depressive episode) during the first 3 months postpartum; most of these episodes have onset following delivery. All estimates have wide 95% confidence intervals, showing significant uncertainty in their true levels. No conclusions could be made regarding the relative incidence of depression among pregnant and postpartum women compared with women at non-childbearing times. To better delineate periods of peak prevalence and incidence for perinatal depression and identify high risk subpopulations, we need studies with larger and more representative samples.

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Is Open Access

Born Too Soon: The global epidemiology of 15 million preterm births

Hannah Blencowe, Simon Cousens, Doris Chou … (2013)

This second paper in the Born Too Soon supplement presents a review of the epidemiology of preterm birth, and its burden globally, including priorities for action to improve the data. Worldwide an estimated 11.1% of all livebirths in 2010 were born preterm (14.9 million babies born before 37 weeks of gestation), with preterm birth rates increasing in most countries with reliable trend data. Direct complications of preterm birth account for one million deaths each year, and preterm birth is a risk factor in over 50% of all neonatal deaths. In addition, preterm birth can result in a range of long-term complications in survivors, with the frequency and severity of adverse outcomes rising with decreasing gestational age and decreasing quality of care. The economic costs of preterm birth are large in terms of immediate neonatal intensive care, ongoing long-term complex health needs, as well as lost economic productivity. Preterm birth is a syndrome with a variety of causes and underlying factors usually divided into spontaneous and provider-initiated preterm births. Consistent recording of all pregnancy outcomes, including stillbirths, and standard application of preterm definitions is important in all settings to advance both the understanding and the monitoring of trends. Context specific innovative solutions to prevent preterm birth and hence reduce preterm birth rates all around the world are urgently needed. Strengthened data systems are required to adequately track trends in preterm birth rates and program effectiveness. These efforts must be coupled with action now to implement improved antenatal, obstetric and newborn care to increase survival and reduce disability amongst those born too soon. Declaration This article is part of a supplement jointly funded by Save the Children's Saving Newborn Lives programme through a grant from The Bill & Melinda Gates Foundation and March of Dimes Foundation and published in collaboration with the Partnership for Maternal, Newborn and Child Health and the World Health Organization (WHO). The original article was published in PDF format in the WHO Report "Born Too Soon: the global action report on preterm birth" (ISBN 978 92 4 150343 30), which involved collaboration from more than 50 organizations. The article has been reformatted for journal publication and has undergone peer review according to Reproductive Health's standard process for supplements and may feature some variations in content when compared to the original report. This co-publication makes the article available to the community in a full-text format.

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Author and article information

Contributors

Ashwini Lakshmanan:

ORCID: http://orcid.org/0000-0001-8259-1905

alakshmanan@chla.usc.edu

Journal

Journal ID (nlm-ta): BMC Pregnancy Childbirth

Journal ID (iso-abbrev): BMC Pregnancy Childbirth

Title: BMC Pregnancy and Childbirth

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2393

Publication date (Electronic): 12 January 2021

Publication date PMC-release: 12 January 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 48

Affiliations

[1 ]GRID grid.42505.36, ISNI 0000 0001 2156 6853, Division of Neonatology, LAC+USC Medical Center, Keck School of Medicine, , University of Southern California, ; Los Angeles, CA USA

[2 ]GRID grid.42505.36, ISNI 0000 0001 2156 6853, Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children’s Hospital Los Angeles, , Keck School of Medicine, University of Southern California, ; 4650 Sunset Boulevard, MS #31, Los Angeles, CA 90027 USA

[3 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Department of Preventive Medicine, , Johns Hopkins University, ; Baltimore, MD USA

[4 ]GRID grid.42505.36, ISNI 0000 0001 2156 6853, Section of Developmental-Behavioral Pediatrics, Children’s Hospital Los Angeles, , Keck School of Medicine, University of Southern California, ; Los Angeles, CA USA

[5 ]GRID grid.42505.36, ISNI 0000 0001 2156 6853, Leonard D. Schaeffer Center for Health Policy and Economics, , University of Southern California, ; Los Angeles, CA USA

[6 ]GRID grid.42505.36, ISNI 0000 0001 2156 6853, Division of Research on Children, Youth and Families, Children’s Hospital, , Keck School of Medicine, University of Southern California, ; Los Angeles, CA USA

[7 ]GRID grid.42505.36, ISNI 0000 0001 2156 6853, Department of Preventive Medicine, Keck School of Medicine, , University of Southern California, ; Los Angeles, CA USA

Author information

Ashwini Lakshmanan http://orcid.org/0000-0001-8259-1905

Article

Publisher ID: 3536

DOI: 10.1186/s12884-020-03536-0

PMC ID: 7802207

PubMed ID: 33435907

SO-VID: 5655a672-eb5a-4328-b8e7-066e41d2210e

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 8 September 2020

Date accepted : 30 December 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000008, David and Lucile Packard Foundation;

Award ID: Young Investigator Award

Award Recipient : Ashwini Lakshmanan

Custom metadata

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: post-traumatic stress,post partum depression,low-income,nicu

Data availability:

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: post-traumatic stress, post partum depression, low-income, nicu

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Maternal post-traumatic stress and depression symptoms and outcomes after NICU discharge in a low-income sample: a cross-sectional study

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Abstract

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Supplementary Information

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Advocacy for Maternal and Women’s Health

Most cited references 55

The Patient Health Questionnaire-2: validity of a two-item depression screener.

Perinatal Depression: A Systematic Review of Prevalence and Incidence

Born Too Soon: The global epidemiology of 15 million preterm births

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