Abstract
Low birth weight (LBW) infants pose a challenge for developing countries. Mothers of LBW are thus at risk of psychological stress and postpartum depression. This study was to identify the correlation between mothers’ characteristics and their anxiety about having hospitalized low birth weight infants. This study used a descriptive correlation design and involved 90 respondents who met the inclusion criteria. The result of this study indicated that most of the mothers were categorized in non-risk age, unemployed or housewife, and having secondary education. Overall, the respondents showed mild anxiety and no significant correlation between mothers’ characteristics and their anxiety (P>0.05). However, there was a significant correlation between her income and mother’s level of anxiety (P<0.05). The conclusion could be use as the basic data for developing the program related to health promotion in overcoming the anxiety in LBW infant’s mothers.
Key words: LBW infants, mothers’, characteristics, anxiety, psychological
Introduction
Low birth weight (LBW) infants pose a challenge for developing countries due to their incidence rate, which ranged from 5% to 33% with an average of 16.5%.1 In Indonesia, the average birth rate of LBW infants is 10%.2 LBW infants are treated separately from their parents, which limits contact between mother and baby, and triggers the mothers’ anxiety. Mothers of LBW are thus at risk of psychological stress and postpartum depression. These psychological symptoms might be reduced if the infants remained with their mothers instead.3
Some psychological problems commonly experienced by mothers of LBW infants include depression, anxiety, stress, and a sense of losing control of their baby’s health care.4 Yelland et al. reported that 12.7% of 4,366 puerperal mothers in Australia exhibited anxiety. In general, the mothers stated that they experienced stress during the first six months postpartum.5 The mothers’ anxiety could be influenced by emotional, cognitive, and psychological factors.6 The mothers’ social-cultural background could also contribute to anxiety. Parents may experience anxiety when they feel threatened by helplessness, losing control, feelings of worthless, fear of failing to survive, fear of infant death, and feelings of isolation.
Ezpezel and Canam stated that the interaction among the nurses, parents, and baby would change in accordance with the baby’s condition. Critical condition will cause the nurses to focus on instrumental and assessment support for the baby so that they will engage in shorter communications with the mother. Factual information is still given, but the implementation of care will focus on the use of medical devices. Continuing to provide information is important to help parents feel supported, calm, and well.7 Therefore, this study aimed to identify other factors that influence the LBW infant mothers’ anxiety.
Materials and Methods
This analytical study, conducted from May to June 2018, used a quantitative method and a cross-sectional research approach in a hospital in Jakarta. Respondents were selected by using purposive sampling because there are diverse samples in this study;8 the selection process yielded 90 respondents who were willing to participate and who met the inclusion criteria: postpartum mothers who gave birth to LBW infants who were hospitalized in the perinatology ward. This research has obtained ethical approval from the Research Ethics Committee of the Faculty of Nursing Universitas Indonesia by number 172/UN.F12.D/HKP.02.04/2018.
The instruments used were the questionnaires of respondent characteristic and the Hamilton Anxiety Rating Scale (HARS), these tool is known to be valid and reliable with Cronbach’s alpha of 0.793, where the reliability of the questionnaires was considered to be good if the Cronbach’s alpha was >0.60. The independent variables of this study were the mothers’ characteristics, namely age, education, income, occupation, gestational age, type of birth, source of support, and hospital payment method. The dependent variable was the level of anxiety, which was categorized as mild, moderate to severe. Subsequently, the data was analyzed using the Chi-Square test.
Results
The data of respondent characteristics is presented in Table 1. Table 1 shows that most of the mothers were considered nonrisk in terms of age (20-35 years) (77.8%), and had passed secondary education (53.5%). Most of the respondents were unemployed or housewives (84.4%), with monthly family income above the regional minimum wage (90%). In this study, when the respondent hospitalization, they received much support from family members (94.4%) rather than hospital staff. In general, the distribution of anxiety level was categorized as mild (65.6%).
In this study, a bivariate analysis was conducted to measure the correlation between the respondents’ characteristics and their anxiety level, as presented in Table 2. Table 2 showed that mothers with earned income below the regional minimum wage exhibited a higher rate of moderate-severe anxiety. The statistical analysis yielded a weak, positive correlation (r= 0.220) and a statistically significant correlation (P< 0.05) between income level and level of anxiety. However, the other characteristics did not make any significant difference to the anxiety levels of LBW mothers.
Discussion
Preterm birth and care in the NICU are considered to be bad experiences that could affect a mother’s emotional condition.9 Parents are likely to experience higher levels of anxiety that are influenced by the severity of the disease, the ward condition, and the psychosocial feeling of separation.10 Most of the mothers in this study were categorized as non-risk in terms of age (20-35 years).
The results indicated that of the nine characteristics examined in the study, only income significantly influenced the level of anxiety (P=0.032). This finding was in line with the research conducted by Said, Kanine, and Bidjuni, who found a correlation between family income and anxiety on primigravida mothers in the Community Health Center (CHC) in Tuminting with P=0.001.11 It was also in line with Bener, who explained that lower monthly income significantly resulted in higher levels of anxiety for mothers of preterm babies compared to mothers of full-term babies.12
Table 1.
Distribution of respondents based on the characteristics of mothers who gave birth to LBW Infants in hospital, May-June 2018 (n=90).
| Variable | Category | Total (n=90) | Percentage (%) |
|---|---|---|---|
| Age | At risk (<20 or >35 years) | 20 | 22.2 |
| Non-risk (20-35 years) | 70 | 77.8 | |
| Education | Primary (≤SD) | 2 | 2.2 |
| Secondary (SMP-SMA) | 484 | 53.4 | |
| Tertiary (>SMA) | 0 | 44.4 | |
| Occupation | Employed | 14 | 15.6 |
| Unemployed | 76 | 84.4 | |
| Income | <Regional Minimum Wage | ||
| >Regional Minimum Wage | 981 | 1090 | |
| Gestational age | <24-30 weeks | 13 | 14.4 |
| 31-35 weeks | 48 | 53.4 | |
| 36-42 weeks | 29 | 32.2 | |
| Type of birth | Normal | ||
| C-section | 3753 | 41.158.9 | |
| Parity | Primipara | 31 | 34.4 |
| Multipara | 59 | 65.6 | |
| Source of support | Family | 85 | 94.4 |
| Hospital Staffs | 5 | 5.6 | |
| Hospital payment method | Personal | 6 | 6.7 |
| Insurance | 4 | 4.48 | |
| BPJS | 80 | 8.9 | |
| Level of anxiety | Mild | 59 | 65.63 |
| Moderate-Severe | 31 | 4.4 |
Table 2.
The correlation of respondent characteristics to LBW infants mothers’ level of anxiety (n=90).
| Variable | Variable | Level of anxiety | r | 95%CI | P-value | |
|---|---|---|---|---|---|---|
| Mild | Moderate-severe | |||||
| Age | At risk | 10 | 10 | 0.172 | 0.429 (0.155-1.182) | 0.097 |
| Non-risk | 49 | 21 | ||||
| Education | Primary | 30 | 21 | 0.160 | 0.493 (0.198-1.223) | 0.124 |
| Secondary-Tertiary | 29 | 10 | ||||
| Occupation | Employed | 10 | 4 | 0.053 | 1.378 (0.394-4.813) | 0.615 |
| Unemployed | 49 | 27 | ||||
| Income | <RMW | 3 | 6 | 0.220 | 0.223 (0.052-0.965) | 0.032 |
| >RMW | 56 | 25 | ||||
| Gestational age | <28-37 weeks | 42 | 19 | 0.100 | 1.560 (0.624-3.901) | 0.340 |
| 36-42 weeks | 17 | 12 | ||||
| Type of birth | Normal | 21 | 16 | 0.153 | 0.518 (0.214-1.235) | 0.142 |
| C-Section | 38 | 15 | ||||
| Parity | Primipara | 23 | 8 | 0.131 | 1.837 (0.704-4.796 | 0.211 |
| Multipara | 36 | 23 | ||||
| Source of support | Family | 57 | 28 | 0.139 | 3.054 (0.482-19.33) | 0.216 |
| Hospital Staffs | 2 | 3 | ||||
| Payment method | Personal | 4 | 2 | 0.06 | 1.055 (0.182-6.105) | 0.953 |
| Insurance & BPJS | 55 | 29 | ||||
Differences in gestational age did not result in significant differences in anxiety levels in this study. The results showed that most of the respondents who had preterm babies experienced only mild anxiety. This finding was not in line with the research conducted by Bener, who explained that mothers of preterm baby exhibited higher anxiety than mothers with babies of normal gestational age (P<0.001).12
In addition, the results showed no significant correlation between education and level of anxiety. Parents with a higher level of education indirectly want to know more about the diseases of their baby, and the more information they receive from the doctors and nurses, the more anxious they will be.13 This was inversely proportional to the study conducted by Damarwati, who stated that parents with a lower level of education would experience more stress compared to those who had a higher level of education.14
The results showed no significant correlation between mothers’ occupation and their anxiety level. It was in line with Said, Kanine, and Bidjuni, who stated there is no correlation between occupation and anxiety in primigravida mothers in CHC Tuminting.11 A study conducted by Abdelsalam also explained that there is no significant correlation between being employed and the level of anxiety in mothers of preterm babies.15
Conclusions
Income earned by parents of low birth weight babies could significantly influence mothers’ anxiety. Mothers who have an income lower than the regional minimum wage will experience more moderate-severe anxiety compared to mothers who have an income higher than the regional minimum wage. Therefore, it is important to pay more attention to mothers with low incomes in order to prevent anxiety and improve maternal and child health conditions.
Acknowledgments
The writer would like to express his gratitude to all the infants who participated in this study and their mothers.
Funding Statement
Funding: This study was supported by Hibah PITTA B 2019, funded by DRPM Universitas Indonesia (No. NKB-0505/UN2.R3.1/HKP.05. 00/2019).
References
- 1.UNICEF. The state of the world’s children 2012: Children in an urban world. United Nation Children’s Fund; 2012. Available from: https://www.unicef.org/sowc2012/pdfs/SOWC-2012-Main-Report_EN_21Dec2011.pdf. [Google Scholar]
- 2.The Ministry of Health Republic of Indonesia. Rencana strategis kementerian kesehatan tahun 2015-2019. The Ministry of Health Republic of Indonesia. Report No. HK.02.02/MENKES/52/2015; 2015. Available from: https://www.kemkes.go.id/resources/download/info-publik/Renstra-2015.pdf. [Google Scholar]
- 3.Miles MS, Holditch-Davis D, Schwartz TA, Scher M. Depressive symptoms in mothers of prematurely born infants. J Dev Behav Pediatr 2007;28:36-44. [DOI] [PubMed] [Google Scholar]
- 4.Lim E. Stress, social support, and low birth: Birth to twenty Cohort (BT20). New Haven, Connecticut: Yale School of Public Health; 2016. [Google Scholar]
- 5.Yelland J, Sutherland G, Brown SJ. Postpartum anxiety, depression and social health: Findings from a population- based survey of Australian women. BMC Public Health 2012;20:1-11. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Stuart GW. Principles and practice of psychiatric nursing. 10th ed. Canada: Elsevier Mosby Inc; 2013. [Google Scholar]
- 7.Espezel H, Canam C. Parent-nurse interaction: Care of hospitalized children. J Adv Nurs 2007;44:34-41. [DOI] [PubMed] [Google Scholar]
- 8.Martínez-Mesa J, González-Chica DA, Duquia RP, et al. Sampling: How to select participants in my research study? An Bras Dermatol 2016;91:326-30. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Trumello C, Candelori C, Cofini M, et al. Mothers’ depression, anxiety, and mental representations after preterm birth: A study during the infant's hospitalization in a neonatal intensive care unit. Front Public Health 2018; 6:1-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Gönülal D, Yalaz M, Altun-Köroğlu O, Kültürsay N. Both parent of neonatal intensive care unit patients are at risk depression. Turk J Pediatr 2014;56: 171-6. [PubMed] [Google Scholar]
- 11.Said N, Karine E, Bidjuni H. Hubungan faktor sosial ekonomi dengan kecemasan ibu primigravida di Puskesmas Tuminting. Jurnal Keperawatan 2015;3:1-8. [Google Scholar]
- 12.Bener A. Psychological distress among postpartum mothers of preterm infants and associated factors: A neglected public health problem. Braz J Psychiatry 2013;35:231-6. [DOI] [PubMed] [Google Scholar]
- 13.Gass CS, Curiel RE. Test anxiety in relation to measure of cognitive and intellectual functioning. Arch Clin Neuropsychol 2014;26:396-404. [DOI] [PubMed] [Google Scholar]
- 14.Darmawati T. A description of parental anxiety level who have infants being treated in the NICU room at Fatmawati General Hospital, Jakarta. [Unpublished Thesis]. Depok: Universitas Indonesia; 2012. [Google Scholar]
- 15.Abdelsalam ZAM. Relationship among depression, anxiety and mother infant bonding in mothers of premature babies. SOJ Nurs Health Care 2017;3:1-7. [Google Scholar]