Maternal depression and stress in the neonatal intensive care unit: associations with mother−child interactions at age 5 years
Open accessAbstract
Objective Previous studies suggest that maternal postpartum mental health issues may have an impact on parenting and child development in preterm infants, but have often not measured symptomatology in the neonatal intensive care unit (NICU) or followed families through early childhood. This study examines how maternal depressive symptoms and stress in the NICU are related to parenting behaviors at age 5 years, in mothers of children born very preterm (at ≤30 weeks' gestation).Method This longitudinal study followed a diverse sample of 74 very preterm children and their mothers. Maternal depression and stress were assessed in the NICU. At age 5, mother-child dyads were observed and coded for maternal intrusiveness, negativity, sensitivity, and positivity. Other covariates, including maternal and child intelligence, maternal education, income-to-needs ratio, maternal depression at age 5 years, and child sex were included in multivariate analyses.Results The interaction between maternal NICU stress and NICU depression for intrusiveness and negativity indicates that greater NICU depression was associated with more intrusiveness under medium or high levels of NICU stress, and more negativity under high levels of NICU stress. Furthermore, greater NICU depression was associated with less sensitivity, over and above other covariates.Conclusion Findings suggest that early maternal peripartum depression and stress in the NICU can have lasting impacts on multiple parenting behaviors, highlighting the need for screening and targeted interventions in the NICU.
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Maternal education can increase parental stress.
“maternal education (De Stasio et al., 2018; Gerstein et al., 2019; Howe et al., 2014; Kenyhercz and Nagy, 2020; Vriend et al., 2021)”
From Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings (2024) · cites this paper as Gerstein et al., 2019
The Results report the opposite direction: greater NICU stress was associated with less maternal education. The Discussion likewise says less education was correlated with greater NICU stress; neither passage establishes that education increases stress. (LLM, conf=0.87)
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Experimental — accuracy not yet measuredLength of hospital stay, immigration status, and socio-economic status can increase parental stress.
“Length of hospital stay, immigration status, socio-economic status (Gerstein et al., 2019; Vriend et al., 2021)”
From Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings (2024) · cites this paper as Gerstein et al., 2019
The Results report that greater maternal NICU stress was associated with lower income-to-needs ratios and less maternal education, supporting the socioeconomic-status part as an association. The Introduction describes NICU hospitalization as stressful, but does not link the length of stay to stress; the passages found do not address immigration status. The study concerns mothers of very preterm infants, and its associations do not establish that these factors cause stress to increase. (LLM, conf=0.88)
Experimental — accuracy not yet measuredApproximately 20% of VPT and EPT mothers had severe depressive symptoms at discharge, 4-6 months, and 12 months, compared with 12.1% prevalence in mothers of full-term infants in a UK cohort.
“~20 % of VPT and EPT mothers, respectively, had severe depressive symptoms compared with the 12.1 % of prevalence observed in a larger UK cohort study on mothers of full-term infants”
From Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings (2024) · cites this paper as Gerstein et al., 2019
The Results report that 21% of mothers of very preterm children had clinically significant depressive symptoms at NICU discharge, supporting the approximate 20% figure. The paper does not report separate rates for extremely preterm mothers or rates at 4–6 and 12 months; its Discussion says it had no term-infant comparison group, and it does not give the claimed 12.1% UK-cohort figure. Page numbers were not available in our copy. (LLM, conf=0.90)
Experimental — accuracy not yet measuredGerstein et al. (2019) found that prevalence of depression was in the normal range in a sample of 62 mothers of EPT at the five-year checkup visit.
“Differences might be subtle however, as Gerstein et al. (2019) found that prevalence of depression was in the normal range in a sample of 62 mothers of EPT at the five-year checkup visit.”
From Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings (2024) · cites this paper as Gerstein et al., 2019
The Results report that mean depression scores at the five-year assessment were below the clinical range, although 14% of mothers had mild or moderate-to-severe depression. The Participants section identifies 62 families, but describes their children as very preterm (≤30 weeks), not exclusively extremely preterm (EPT). The paper describes scores, rather than prevalence, as being in the normal range. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAt five years, 4% had moderate to severe depression and 10% had mild depression.
“At five years 4 % had moderate to severe depression and 10 % had mild”
From Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings (2024) · cites this paper as Gerstein et al., 2019
21% of mothers had postpartum depression at NICU discharge.
“Prevalence: 21 % of mothers had post- partum depression at NICU discharge.”
From Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings (2024) · cites this paper as Gerstein et al., 2019
Younger maternal age can increase parental stress.
“younger maternal age (Gerstein et al., 2019) can increase stress.”
From Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings (2024) · cites this paper as Gerstein et al., 2019
The Results report associations between NICU stress and income, maternal education, and child IQ, but do not report an association with maternal age. Searches for younger maternal age and maternal age–stress associations found no passage addressing the claim in our copy. (LLM, conf=0.76)
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References 54 · Cited by 97
- Authors
- Gerstein, E. D., Njoroge, W. F. M., Paul, R. A., Smyser, C. D., & Rogers, C. E.
- Affiliations
- University of Missouri–St. Louis (US)
- Washington University in St. Louis (US)
- Corresponding author
- Gerstein, Emily D.
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2019-03
- Volume
- 58
- Issue
- 3
- Pages
- 350-358.e2
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC6414066
- OpenAlex
- W2906718942
- Cited by
- 97
- References
- 54
- Citations by year
- 2026: 16 · 2025: 10 · 2024: 14 · 2023: 17 · 2022: 18 · 2021: 14 · 2020: 7 · 2019: 1
- FWCI
- 9.15
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (R01 HD057098, U54 HD087011, K23 MH105179, K02 NS089852, UL1 TR000448, KL2 TR000450)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- maternal depression, maternal stress, neonatal intensive care unit, very preterm infants, mother-child interaction, parental behavior, maternal intrusiveness, maternal negativity, maternal sensitivity, early childhood development
- MeSH terms
- Adult, Child, Preschool, Depression, Female, Gestational Age, Humans, Infant, Infant, Newborn, Infant, Premature, Intensive Care Units, Neonatal, Longitudinal Studies, Male, Mother-Child Relations, Mothers, Prospective Studies, Regression Analysis, Stress, Psychological, Intensive Care, Neonatal, Young Adult
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