Postpartum Depressive Symptoms in Parents at Discharge from the Neonatal Intensive Care Unit (NICU): Risk Factors and Association with Parental Stress

Abstract

Background: NICU parents are at risk for poor emotional functioning, including mood disorders, anxiety, and parental distress. Identifying factors associated with poor emotional functioning can help identify at-risk parents who may benefit from mental health support. Objective: To determine the prevalence of depressive symptoms among parents at NICU discharge, risk factors associated with elevated depression scores, and the relationship between depressive symptoms, anxiety, and NICU parental stress. Methods: Data were collected from parents (n=300) and infants (n=300) enrolled in a randomized trial of peer-to-peer support after NICU discharge. Baseline parent and infant characteristics were collected by pre-discharge survey and chart review. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale (CES-D) short form (10 items). Parental NICU stress was assessed using measure 1 (stress occurrence) of the Parental Stressor Scale:NICU (PSS:NICU) (46 items), containing four subscales: infant appearance/behavior, parental role alteration, NICU environment, and parental relationship with staff. Regression and partial correlation methods were used to test for relationships between depressive symptoms, stress, and parent and infant factors. Parent factors included age, sex, race, education, work, relationship status, and number of other children at home. Infant factors included sex, gestational age (GA), birth weight, and length of stay (LOS). Results: Approximately 45% of parents had elevated CES-D scores ≥10 points (Table 1). The mean(SD) age of parents was 30(7) years, 89% were mothers, and 44% self-identified as African American, with 45% reporting a college degree or higher. Most parents were married/partnered (53%), employed pre-NICU (71%), and first-time parents (43%). Infants were predominantly male (58%), with birth weights ≥2500 g (58%) and GAs ≥37 weeks (57%) (Table 2). The majority of infants had a LOS >2 weeks (54%). In adjusted models, female baby gender (p=0.014), GA (p=0.006), and LOS (p=0.045) were all associated with increased odds of having an elevated CES-D score. Parents of infants with GAs ≥37 weeks had a 6.6-fold (95%CI: 2.2-19.7) increased odds of having an elevated CES-D score compared to those with GAs < 28 weeks GA. Parental NICU stress was lower in parents older in age (p=0.009), but higher in mothers vs. fathers (p=0.002). CES-D scores were positively correlated with total PSS:NICU scores (partial r2=0.14) and subscale scores (all p≤0.001). In adjusted models, each 1-point increase in total PSS:NICU score was associated with a 2.4-point (95% CI: 1.6-3.10, p < 0.001) increase in total CES-D score. Conclusion: Almost half of surveyed parents experienced depressive symptoms at NICU discharge. Infant GA was a strong predictor of elevated CES-D scores, and NICU parental stress was positively correlated with depressive symptoms. Further investigation of risk factors associated with depression is planned, as is the examination of peer-to-peer support on depressive symptoms after NICU discharge.