Infant, maternal, and neighborhood predictors of maternal psychological distress at birth and over very low birth weight infants’ first year of life
Open accessAbstract
Objective: To use a social-ecological conceptualization to analyze change of maternal distress, defined as depression, anxiety, and perinatal-specific post-traumatic stress (PPTS), across very low birth weight (VLBW) infants' first year of life and to identify infant, maternal, and neighborhood predictors of these changes over time. Methods: Mothers of VLBW infants (n = 69) completed psychological distress questionnaires 2 to 4 weeks after infant birth, 2 weeks before infant discharge from neonatal intensive care unit, and at infants' 4- and 8-month corrected age (age adjusted for prematurity). Infant and maternal sociodemographic data were collected from medical chart review. Neighborhood data were obtained through US census data. Multilevel linear growth modeling was used to (1) predict unstandardized estimates of mothers' initial levels of depression, anxiety, and PPTS at the time of infant's birth and the rate of change of these markers of distress over time and (2) model unstandardized estimates of infant, maternal, and neighborhood as predictors of distress at infants' birth and change over time. Results: Unstandardized estimates from multilevel linear growth modeling revealed depression (−2.8), anxiety (−1.4), and PPTS (−0.7) declined over infants' first year of life (<0.001). Mothers residing in lower-income homes and neighborhoods, respectively, reported lower anxiety (−11.2, p = 0.03) and PPTS (−31.1, p = 0.01) at infant birth. Greater infant birth weight predicted both lower anxiety (−0.02, p = 0.02) and lower PPTS (−0.02, p = 0.005). Conclusion: Mothers psychologically recover over VLBW infants' first year of life. Results add to a building literature about socioeconomically disadvantaged mothers of preterm infants, reporting lower distress; this warrants additional research.
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At eight months, there was a significant association between lower birth weight and higher anxiety in 69 mothers of VPT infants that could not be explained by socio-economic factors.
“At eight months, Greene et al. (2019) found a significant association between lower birth weight and higher anxiety in 69 mothers of VPT infants that could not be explained by socio-economic factors.”
From Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings (2024) · cites this paper as Greene et al., 2019
The Results (Anxiety; page unavailable) associate lower birth weight with higher maternal anxiety at infant birth, but explicitly state that by eight months corrected age, anxiety was similar regardless of birth weight or income status. The claimed significant association at eight months is therefore contrary to the reported finding. (LLM, conf=0.90)
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Experimental — accuracy not yet measuredA few studies observed a difference in level of PTSS symptoms at birth, 6 and 18 months and five years.
“A few studies that report comparative results observed a difference in level of PTSS symptoms at birth, 6 and 18 months respectively (Greene et al., 2019; Hall et al., 2017; Turpin et al., 2019) and five years (Barthel et al., 2020).”
From Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings (2024) · cites this paper as Greene et al., 2019
The Results > PPTS section reports differences in maternal posttraumatic stress symptom scores at the infant’s birth by birth weight, traumatic-event exposure, and neighborhood poverty. It also reports declining scores over the first year. However, the Methods section says the first assessment occurred a mean of 28.1 days after birth, and this study did not compare mothers of very low birth weight infants with a separate infant group. The 6-month, 18-month, and five-year findings are attributed to the other cited studies, not Greene et al. (LLM, conf=0.83)
Experimental — accuracy not yet measuredGreene et al. (2019) did not find that a lower birth weight predicted higher depression among 69 mothers of ELBW infants at four and eight months after birth.
“Four and eight months after birth, Greene et al. (2019) did not find that a lower birth weight predicted higher depression among 69 mothers of ELBW infants.”
From Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings (2024) · cites this paper as Greene et al., 2019
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredGreene et al. (2019) found that lower birth weight predicted higher PTSS at birth, but not at 4 or 8 months, among 69 mothers.
“Regarding these, it should be mentioned that Greene et al. (2019) only found that a lower birth weight predicted higher PTSS at birth, but not at 4 or 8 months ( n = 69).”
From Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings (2024) · cites this paper as Greene et al., 2019
The Results (PPTS section; page unavailable) report that lower birth weight predicted higher posttraumatic stress symptoms at birth. The Methods identify follow-ups at 4 and 8 months corrected age, and the Results report 69 mothers initially enrolled. The paper says birth weight did not significantly predict change in symptoms over time; it does not establish that birth weight was unrelated to symptoms at either follow-up. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn mothers of very preterm infants, post-traumatic stress symptoms (PTSS) are prevalent in the first two years following birth and up to five years after it.
“In mothers of VPT infants, PTSS are prevalent in the first two years following birth and up to five years after it (Barthel et al., 2020; Cam bonie et al., 2017; Greene et al., 2019; Hall et al., 2017; Misund et al., 2013; Rodríguez et al., 2020; Turpin et al., 2019).”
From Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings (2024) · cites this paper as Greene et al., 2019
The Results (PPTS section; page unavailable) report post-traumatic stress symptom scores in mothers of very low birth weight infants during the infants’ first year, with scores declining over that period. The paper does not establish that symptoms are prevalent through the first two years or up to five years after birth, and its study population is defined by birth weight rather than very preterm birth. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Birth weight predicts PTSS and anxiety at birth, and anxiety in the first year.
“Regression analysis shows that birth weight predicts PTSS and anxiety at birth, and anxiety in the first year.”
From Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings (2024) · cites this paper as Greene et al., 2019
Four American studies did not find an association between low gestational age or birth weight and higher depression.
“Furthermore, four American studies (Garfield et al., 2021; Greene et al., 2019; Hawes et al., 2016; Quist et al., 2019) did not find an association between low gestational age (GA) or birth weight and higher depression.”
From Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings (2024) · cites this paper as Greene et al., 2019
Symptoms of anxiety can be correlated with sociodemographic risk factors.
“but research suggests that symptoms of anxiety can be correlated with sociodemographic risk factors (Greene et al., 2019; Haeusslein et al., 2021; Kenyhercz and Nagy, 2020; Misund et al., 2013; Treyvaud et al., 2014; 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 Greene et al., 2019
Past trauma can predict postpartum PTSS.
“and that past trauma can predict post-partum PTSS (Greene et al., 2019).”
From Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings (2024) · cites this paper as Greene et al., 2019
45.7% of mothers had a score at or above threshold on the PPQ.
“45.7 % of the mothers had a score of or above on the PPQ”
From Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings (2024) · cites this paper as Greene et al., 2019
The Results > PPTS section gives the PPQM cutoff for elevated symptoms (>19) and an estimated mean score of 13.43, but does not report the percentage of mothers above the cutoff. Searches for “45.7” and the proportion above the PPQM threshold found no matching figure in our copy; page numbers were unavailable. (LLM, conf=0.76)
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- Authors
- Greene, M. M., Schoeny, M., Rossman, B., Patra, K., Meier, P. P., & Patel, A. L.
- Affiliations
- Rush University Medical Center (US)
- Corresponding author
- Greene, Michelle M.
- Venue
- Journal of Developmental & Behavioral Pediatrics
- Published
- 2019-10
- Volume
- 40
- Issue
- 8
- Pages
- 613-621
- ISSN
- 0196-206X (ISSN-L)
- PMC
- PMC6800614
- OpenAlex
- W2966034548
- Cited by
- 21
- References
- 27
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 7 · 2023: 3 · 2022: 1 · 2021: 2 · 2020: 1
- FWCI
- 1.03
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Developmental & Behavioral Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5r01nr010009-05)
- National Institute of Nursing Research (R01-NR010009)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R03HD081412)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- maternal distress, maternal depression, maternal anxiety, very low birth weight infants, preterm infants, socio-ecological model, neighborhood disadvantage, maternal income, birth weight, maternal recovery, first year of life, neonatal intensive care
- MeSH terms
- Psychological Distress, Adult, Anxiety, Depression, Female, Humans, Infant, Infant, Newborn, Longitudinal Studies, Mothers, Pregnancy, Pregnancy Complications, Residence Characteristics, Stress Disorders, Post-Traumatic, Stress, Psychological, United States, Child of Impaired Parents, Infant, Very Low Birth Weight
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