Cited by 348Infant Development and Preterm CareMaternal Mental Health During Pregnancy and PostpartumFamily and Disability Support Research

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Mothers and fathers in NICU: The impact of preterm birth on parental distress

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Ionio, Chiara, Colombo, Caterina, Brazzoduro, Valeria, Mascheroni, Eleonora, Confalonieri, Emanuela, Castoldi, Francesca, Lista, Gianluca·2016·Europe’s Journal of Psychology

DOI 10.5964/ejop.v12i4.1093PMC PMC5114875

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Abstract

Preterm birth is a stressful event for families. In particular, the unexpectedly early delivery may cause negative feelings in mothers and fathers. The aim of this study was to examine the relationship between preterm birth, parental stress and negative feelings, and the environmental setting of NICU. 21 mothers (age = 36.00 ± 6.85) and 19 fathers (age = 34.92 ± 4.58) of preterm infants (GA = 30.96 ± 2.97) and 20 mothers (age = 40.08 ± 4.76) and 20 fathers (age = 40.32 ± 6.77) of full-term infants (GA = 39.19 ± 1.42) were involved. All parents filled out the Parental Stressor Scale: Neonatal Intensive Care Unit, the Impact of Event Scale Revised, Profile of Mood States, the Multidimensional Scale of Perceived Social Support and the Post-Partum Bonding Questionnaire. Our data showed differences in emotional reactions between preterm and full-term parents. Results also revealed significant differences between mothers and fathers' responses to preterm birth in terms of stress, negative feelings, and perceptions of social support. A correlation between negative conditions at birth (e.g., birth weight and Neonatal Intensive Care Unit stay) and higher scores in some scales of Impact of Event Scale Revised, Profile of Mood States and Post-Partum Bonding Questionnaire were found. Neonatal Intensive Care Unit may be a stressful place both for mothers and fathers. It might be useful to plan, as soon as possible, interventions to help parents through the experience of the premature birth of their child and to begin an immediately adaptive mode of care.

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Almalki, M., Gildea, A., & Boyle, B. (2025) · Journal of Neonatal Nursing · doi:10.1016/j.jnn.2025.101655 · Cited by 27
The development of a digital educational program with parents of preterm infants and neonatal nurses to meet parents educational needs
Lebel, V., Héon, M., Juneau, A. L., Collette, K., & Feeley, N. (2020) · Journal of Neonatal Nursing · doi:10.1016/j.jnn.2020.06.004 · Cited by 26
Association of perceived social support and maternal adaptation with postpartum depression in mothers of infants hospitalized in neonatal intensive care units
Erbaba, H., & Pınar, G. (2020) · Journal of Neonatal Nursing · doi:10.1016/j.jnn.2020.11.005 · Cited by 24
Alberta Family Integrated Care™ and Standard Care: A Qualitative Study of Mothers’ Experiences of their Journeying to Home from the Neonatal Intensive Care Unit
Dien, R., Benzies, K., Zanoni, P., & Kurilova, J. (2022) · Global Qualitative Nursing Research · doi:10.1177/23333936221097113 · Cited by 26
“Mothers of preterm infants experience emotional distress related to the admission of their infant to the NICU (Feeley et al., 2016; Ionio et al., 2016; Lotterman et al., 2019).”
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The experience of fathers during the covid-19 UK maternity care restrictions
Andrews, K., Ayers, S., & Williams, L. R. (2022) · Midwifery · doi:10.1016/j.midw.2022.103434 · Cited by 23
The Anxiety Levels of the Parents of Premature Infants and Related Factors
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Social Support Provision: Perspective of Fathers With Preterm Infants
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Pre-term delivery, optimism and initial personal growth as predictors of mothers’ long-term personal growth
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“Giving birth to a premature baby may be particularly stressful (Gondwe & Holditch-Davis, 2015) due to the increased risk to the child’s life and development (Frey & Klebanoff, 2016; Ionio et al., 2016).”
Background
Psychosocial interventions and support programs for fathers of NICU infants – A comprehensive review
Ocampo, M. J., Tinero, J., & Rojas-Ashe, E. E. (2020) · Early Human Development · doi:10.1016/j.earlhumdev.2020.105280 · Cited by 22
Nursing Interventions to Reduce Stress in Families of Critical Care Patients: An Integrative Review
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Identification of the Range of Nursing Skills Used to Provide Social Support for Mothers of Preterm Infants in Neonatal Intensive Care
Eskandari, S., Mirhaghjou, S. N., Maleki, M., Mardani, A., Gholami, M., & Harding, C. (2021) · Critical Care Research and Practice · doi:10.1155/2021/6697659 · Cited by 21
“*is experience can also cause parents to experience physical and psychological problems such as sleeplessness, depression, despair, and emotional turmoil [2, 5, 7].”
Background
Perinatal care for the extremely preterm infant
Usuda, H., Carter, S. W. D., Takahashi, T., Newnham, J. P., Fee, E. L., Jobe, A. H., & Kemp, M. W. (2022) · Seminars in Fetal and Neonatal Medicine · doi:10.1016/j.siny.2022.101334 · Cited by 22
Risk factors and preventive strategies for post-traumatic stress disorder in neonatal intensive care unit
Chiara, M. D., Laccetta, G., Gangi, S., Santis, B. D., Spiriti, C., Attenni, M., Bertolaso, L., Boscarino, G., Nardo, M. C. D., Ciambra, G., et al. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.1003566 · Cited by 21
“Available evidence shows that parents who had NICU experience may have PTSD after their newborns’ premature birth (Ionio et al., 2016).”
Background
The predictive roles of parental stress and intolerance of uncertainty on psychological well-being of parents with a newborn in neonatal intensive care unit: a hierarchical linear regression analysis
Rambod, M., Pasyar, N., Mazarei, Z., & Soltanian, M. (2023) · BMC Pediatrics · doi:10.1186/s12887-023-04420-4 · Cited by 21
“The changes in parental role, financial burden, appearance and behavior of the baby, and light and sounds in the environment have been identified as the most stressful factors that cause negative feelings in parents [4, 5].”
Background
Potential Psychological and Biological Mechanisms Underlying the Effectiveness of Neonatal Music Therapy during Kangaroo Mother Care for Preterm Infants and Their Parents
Bieleninik, Ł., Ettenberger, M., Epstein, S., Elefant, C., & Arnon, S. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18168557 · Cited by 20
Effectiveness of psychosocial interventions on the psychological outcomes of parents with preterm infants: A systematic review and meta-analysis
Chan, S. H., & Shorey, S. (2023) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2023.10.028 · Cited by 19
Associations between prematurity, postpartum anxiety, neonatal intensive care unit admission, and stress
Worrall, S., Christiansen, P., Khalil, A. A., Silverio, S. A., & Fallon, V. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1323773 · Cited by 20
Cross‐sectional survey of factors associated with paternal involvement in the neonatal intensive care unit
Clarkson, G., Gilmer, M. J., Moore, E. R., Dietrich, M. S., & McBride, B. A. (2019) · Journal of Clinical Nursing · doi:10.1111/jocn.14981 · Cited by 19
Unplanned postdischarge healthcare utilisation, discharge readiness, and perceived quality of teaching in mothers of neonates hospitalized in a neonatal intensive care unit: A descriptive and correlational study
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Involvement of mothers in high-risk neonatal care: A capacity building program for neonatal nurses
Siva, N., Nayak, B. S., Lewis, L., Velayudhan, B., Phagdol, T., Sathish, Y., & Noronha, J. A. (2022) · Journal of Neonatal Nursing · doi:10.1016/j.jnn.2022.03.001 · Cited by 18
The Socio-Communicative Development of Preterm Infants Is Resistant to the Negative Effects of Parity on Maternal Responsiveness
Caldas, I. F. R., Garotti, M. F., Shiramizu, V. K. M., & Pereira, A. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.00043 · Cited by 17
“Another reason is that premature birth is both a stressful and emotionally demanding experience for parents (Singer et al., 1999; Forcada-Guex et al., 2011; Holditch-Davis et al., 2015; Horwitz et al., 2015; Ionio et al., 2016, 2017).”
Background
The impact of paternal feelings and stress on mother–child interactions and on the development of the preterm newborn
Ionio, C., Mascheroni, E., Banfi, A., Olivari, M. G., Colombo, C., Confalonieri, E., & Lista, G. (2018) · Early Child Development and Care · doi:10.1080/03004430.2018.1509858 · Cited by 18
Self-citation
Parental sense of competence, paternal stress and perceived construction of the relationship with the premature newborn: A mixed method study
Koliouli, F., Zaouche-Gaudron, C., Bourque, C. J., & Raynaud, J. (2022) · Early Human Development · doi:10.1016/j.earlhumdev.2022.105576 · Cited by 17
Dads in Distress: symptoms of depression and traumatic stress in fathers following poor fetal, neonatal, and maternal outcomes
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“One of the reasons for this is the difficulty of recruiting men into studies, particularly after traumatic events [6, 10, 17].”
BackgroundMethodResult
Developmental Cascades Link Maternal–Newborn Skin-to-Skin Contact with Young Adults’ Psychological Symptoms, Oxytocin, and Immunity; Charting Mechanisms of Developmental Continuity from Birth to Adulthood
Ulmer-Yaniv, A., Yirmiya, K., Peleg, I., Zagoory‐Sharon, O., & Feldman, R. (2023) · Biology · doi:10.3390/biology12060847 · Cited by 17
“Given that premature birth increases maternal anxiety and depressive symptoms in infancy [42,43], which often persist across the child’s first years [44], and better maternal mood predicts more positive child social–emotional, cognitive, and mental health outcomes [45,46], the improvement in maternal mood sets the chi…”
Background
Peer Support Increases Maternal Confidence, Kangaroo Mother Care Implementation and Weight Gain in LBW Infants
Kurniawati, K., Rustina, Y., & Budiati, T. (2019) · Comprehensive Child and Adolescent Nursing · doi:10.1080/24694193.2019.1594457 · Cited by 17
“Women with low-birthweight infants have been demonstrated to be more likely to experience shock, helplessness, distress, and emotional disturbance while their infant is hospitalized than those who give birth to healthy newborn infants (Hoffenkamp et al., 2015; Ionio et al., 2016).”
Background
Nurses' Perception of Family-Centered Care in Neonatal Intensive Care Units
Heidari, H., & Mardani‐Hamooleh, M. (2019) · Journal of Pediatric Intensive Care · doi:10.1055/s-0039-1695060 · Cited by 17
Oxytocin levels increase and anxiety decreases in mothers who sing and talk to their premature infants during a painful procedure
Filippa, M., Monaci, M. G., Spagnuolo, C., Di Benedetto, M., Serravalle, P., & Grandjean, D. (2023) · Children · doi:10.3390/children10020334 · Cited by 16
“Mothers often describe the experience of preterm birth and the subsequent hospitalization of their infant in the NICU as a profound source of anxiety [21] and as traumatic and overwhelming, making them feel powerless and confused in their maternal role [22,23].”
Background
Nursing support perceived by mothers of preterm infants in a neonatal intensive care unit in South Korea
Im, M., & Oh, J. (2021) · Child Health Nursing Research · doi:10.4094/chnr.2021.27.2.146 · Cited by 16
“Despite continuing developments and efforts to improve the survival rate of premature infants, there is a relative lack of interest in mothers who have given birth to premature infants [2].”
Background
The Effect of Supportive Nursing Interventions on Reducing Stress Levels of Mothers of Infants in the Neonatal Intensive Care Unit: A Randomized Controlled Trial
Yılmaz, G., & Alemdar, D. K. (2021) · Clinical Nursing Research · doi:10.1177/10547738211047359 · Cited by 18
“These topics were chosen after relevant literature search by the researcher (Konukbay & Arslan, 2011; Ionio et al., 2016; Uludağ & Ünlüoğlu, 2012) and based on the second author’s personal experience with parents of infants in the NICU.”
BackgroundMethod
The experience of fathers whose infants were hospitalized in Neonatal Intensive Care Unit in South Korea: A scoping review
Lee, J., & Choi, S. (2023) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2023.03.015 · Cited by 20
Fatherhood of a Premature Infant: “A Rough Roller-Coaster Ride”
Strauss, Z., Bar, M. A., & Stanger, V. (2019) · Journal of Family Issues · doi:10.1177/0192513x19832939 · Cited by 16
“Both mothers and fathers of premature infants find the neonatal intensive care unit (NICU) environment stressful (Ionio et al., 2016; Prouhet, Gregory, Russell, & Yaeger, 2018).”
Background
Psychological or educational eHealth interventions on depression, anxiety or stress following preterm birth: a systematic review
Feng, Y. Y., Liyanage, S. K., Jarde, A., & McDonald, S. D. (2020) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2020.1750576 · Cited by 16
Neonates as intrinsically worthy recipients of pain management in neonatal intensive care
İlhan, E., Pacey, V., Brown, L. S., Spence, K., Gray, K., Rowland, J., White, K., & Hush, J. M. (2020) · Medicine Health Care and Philosophy · doi:10.1007/s11019-020-09982-z · Cited by 16
“Parents in the NICU have described this as a compounding source of stress when they are already traumatised and emotionally fragile, often suffering in terms of a lack of post-partum bonding (Ionio et al. 2016), and anticipating grief in often unpredictable situations (JR personal experience; Valizadeh et al.”
Background
An active pursuit of reassurance—coping strategies of fathers with infants in the Neonatal Intensive Care Unit
Lian, B. X., Amin, Z., Sensaki, S., & Aishworiya, R. (2020) · Journal of Perinatology · doi:10.1038/s41372-020-00853-2 · Cited by 15
“Studies have shown that these parents often have increased levels of anxiety, depression, and post-traumatic stress disorder [5, 6].”
Background
Nurses’ experiences of caring for preterm infants in pain: A meta-ethnography
Zhao, T., Starkweather, A. R., Matson, A. P., Lainwala, S., Xu, W., & Cong, X. S. (2022) · International Journal of Nursing Sciences · doi:10.1016/j.ijnss.2022.09.003 · Cited by 15
“This finding is a necessary complement to other findings, focusing on mothers’ stress and infants’ stress [37,38].”
Result
Relationship Between Mothers’ Concerns and Nursing Support of Children Admitted to Baqiyatallah Al-Azam Hospital of Ali Abad Katoul, Golestan Province, Iran, in 2018
Bekmaz, K., Hojjati, H., & Akhoundzadeh, G. (2019) · Modern Care Journal · doi:10.5812/modernc.92471 · Cited by 15
“(34), the prolonged hospital stay was associated with higher levels of stress and more negative emotions such as anxiety, depression, and anger in mothers and fathers.”
Background
Maternal stress and perceived nurse support among mothers of premature infants in the neonatal intensive care unit of a tertiary hospital in Qatar
Mariano, K., Silang, J. P. B., Cui-Ramos, R., Galang-Gatbonton, G. R., Ridulme, Q. R., Gatbonton, R. R. G., & Peralta, A. B. (2021) · Journal of Neonatal Nursing · doi:10.1016/j.jnn.2021.08.002 · Cited by 15
Fathers' stress related to their infants' NICU hospitalization: A mixed research synthesis
Beck, C. T., & Vo, T. (2020) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2020.02.001 · Cited by 15
Emotional disorganization: The prominent experience of Iranian mothers with preterm neonate: A qualitative study
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“Preterm birth is a multi-problematic event with various consequences for the neonate’s growth and parents (Ionio et al., 2016; Mascheroni & Ionio, 2019).”
Background
Parent needs assessment instruments in neonatal intensive care units: Implications for parent education interventions
Ciupitu-Plath, C. C., Tietz, F., & Herzberg, J. (2021) · Patient Education and Counseling · doi:10.1016/j.pec.2021.03.022 · Cited by 14
The Relationship between Stress, Social Support, and Confidence in Paternal Role Perceived by Korean Fathers of High Risk Infants
Eom, J. H., & Im, Y. (2019) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2019.07.013 · Cited by 14
Parental emotional distress after discharge from the neonatal intensive care unit: A pilot study
Ouwendijk-Andréa, M., Bröring-Starre, T., Molderink, A. C., Laarman, C. A. R. C., Oostrom, K. J., & van Dijk-Lokkart, E. M. (2020) · Early Human Development · doi:10.1016/j.earlhumdev.2019.104892 · Cited by 13
Preterm Birth and Maternal Mood States: What Is the Impact on Bonding?
Ionio, C., Ciuffo, G., Colombo, C., Melani, O., Figlino, M. F., Landoni, M., Castoldi, F. M., Cavigioli, F., & Lista, G. (2024) · Pediatric Reports · doi:10.3390/pediatric16010004 · Cited by 14
“From evidence which has emerged in the current literature [37], our first hypothesis is that preterm birth does expose women to a greater chance of developing mood disorders during the postpartum phase [38].”
BackgroundSelf-citation
Effectiveness of Psychological Counseling Intervention in High-Risk Pregnancies in Italy
Burgio, S., Cucinella, G., Perino, A., Baglìo, G., Crifasi, L., Krysiak, R. G., Kowalcze, K. E., & Gullo, G. (2024) · Journal of Personalized Medicine · doi:10.3390/jpm14090976 · Cited by 13
“However, data analysis showed statistically significant differences regarding the experimental group and control group; thus, the counseling intervention supported a change in the experimental group, improving the mother–child relationship as indicated by industry literature [65,66].”

Authors: Ionio, C., Colombo, C., Brazzoduro, V., Mascheroni, E., Confalonieri, E., Castoldi, F., & Lista, G.
Affiliations: Università Cattolica del Sacro Cuore (IT)
Ospedale dei Bambini Vittore Buzzi (IT)
Corresponding author: Ionio, Chiara
ORCID: Ionio, Chiara
Brazzoduro, Valeria
Mascheroni, Eleonora
Confalonieri, Emanuela
Castoldi, Francesca
Lista, Gianluca
Venue: Europe’s Journal of Psychology
Publisher: Leibniz Institute for Psychology (ZPID)
Published: 2016-11-18
Volume: 12
Issue: 4
Pages: 604-621
ISSN: 1841-0413 (ISSN-L)
DOI: 10.5964/ejop.v12i4.1093
PMC: PMC5114875
OpenAlex: W2550032293
Cited by: 347
References: 60
Citations by year: 2026: 30 · 2025: 27 · 2024: 56 · 2023: 52 · 2022: 40 · 2021: 41 · 2020: 40 · 2019: 28 · 2018: 19 · 2017: 13 · 2016: 1
FWCI: 23.66
Type: journal article
Language: en
Open access: diamond
doi.org
Licence: cc-by
Locations: Europe’s Journal of Psychology (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
PsychOpen Gold (Leibniz Institute for Psychology) (submittedVersion, cc-by)
Psychology Archives (cc-by)
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
Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
Keywords: preterm birth, parental stress, parents, neonatal intensive care unit, negative emotions, perceived social support, postpartum bonding, birth weight, term infants, family stress

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Mothers and fathers in NICU: The impact of preterm birth on parental distress

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