Table 4.
Characteristics of included studies - PTS.
| Study ID, country | Study design &setting, Study period, Neonatal unit type of care, length of stay | Study objective | Study inclusion criteria | Study exclusion criteria | Parents’ characteristics | Babies’ characteristics |
|---|---|---|---|---|---|---|
| 1. Aftyaka | ||||||
| Aftyka 2014, Poland | Cross-sectional, 1 centre in Lublin, July 2012 to October 2014, NNU - level III mean length of stay mothers = 21.2 (SD, 25.3) days, fathers = 24.8 (SD, 29.2) days | To determine the frequency and medical, demographic risk factors for PTSD in parents of NNU neonates | Mother and fathers of infants who were hospitalised in NNU | Inability to read and write in Polish, lack of consent to participate in the project and taking care of a child by legal guardians who were not the parents | N = 39 mothers, N = 27 fathers. mothers age = mean 31.0 (SD 5.4) yrs, fathers age = 32.8 (SD 4.6) yrs, higher education: mothers = 16 (46%) vs. fathers = 14 (64%), nulliparous 21 (54%) = first born fathers 13 (50%), SES = mothers employed 16 (46%) vs fathers 14 (64%); parity ethnicity & relationship = NR | N = 42, GA = infants of mothers = 34.3 (SD, 4.8) wks; BW = 2362 (SD, 1050)g, included babies with congenital malformations |
| Aftyka 2017 & 2020, Poland | Cross-sectional, 1 centre in Lublin, the only paediatric university hospital in south-eastern Poland July 2012 to October 2014, NNU – level III, mean length of stay = mothers 21.6 (33.6) vs fathers 20.7 (23.4) days | To describe coping strategies and identify the potential risk factors related to basic sociodemographic and medical data as well as coping with the development of PTSD in the parents of NNU neonates | Biological parents of NNU babies, speak and write in Polish | Inability to read and write in Polish, lack of consent to participate in the project and taking care of a child by legal guardians who are not the parents | N =72 mothers, N = 53 fathers, mothers age = 30.3 (SD, 5.1), fathers age = 32.3 (5.2) years, living with partner = 49 couples, party, ethnicity, education, SES = NR |
Mothers N = NR, GA = 34.74 (SD, 4.67) wks, BW = 2,407 (SD, 963)g, fathers: N = NR, GA = 34.60 (SD, 5.05) wks, BW = 2,377 (SD, 1025)g |
|
2. Ahlund 2009, England |
Cross-sectional study, 1 centre Norfolk & Norwich University Hospitals, Babies born in 2004, questionnaire sent in 2006; NNU, length of stay = NR | To determine the prevalence of symptoms of PTSD 2–3 years after delivery in mothers who had given birth to VLBW infants <1500g |
Mothers of VLBW<1500g alive babies, identified from neonatal register | Not alive infants at the assessment time | N = 70 mothers eligible, N= 24 responded, other characteristics: NR | N= NR, BW = median 1,120 g (range= 634–1,490)g; GA < 37 wks, median 30.2 wks (range 24–34) |
| 3. Barr 2010, Australia | Prospective cohort study, 1 centre, Royal Alexandra Hospital for Children, December 2007 through November 2008, NNU, referral center for newborn infants with complex medical, cardiac, and surgical diseases, length of stay => 4 days |
To explore the relation between personality predisposition to shame, and fear of death of parents of NNU infants |
English literate, infant was≥ 34 wks at birth, treated in the NNU for at least 4 days, alive when the study questionnaires were completed | Not alive infants at the assessment time | N= 204 parents, 110 mothers and 94 fathers, mother's age, mean (30.2) SD 5.64 vs. father's 33.4(6.63) yrs, Parents Oceanian (68%), European (12%), Asian (9%), Middle Eastern (8%), and other (3%), (37%), university degree (30%), living with partner: 96%; parity & SES: NR |
N= NR, GA ≥34 wks, BW= NR |
| 4. Chang 2016, Taiwan | Cross sectional, 1 centre, January 2010 to June 2011, NNU, length of stay <60.00 ± 53.78 days | To estimate the prevalence of symptoms of distress in mothers of preterm NNU infants and factors complications of delivery for these symptoms | Parents to babies <37 weeks gestation, admission to the NNU, and infant survival at the time of the interview | Not understanding Chinese, refused to consent, babies with congenital chromosomal abnormalities/congenital defects, significant heart disease after birth, or died during the hospital stay or after leaving the NNU, mothers with major illnesses, cancer, or psychiatric disorders | N = 102 mothers, mothers mean age = 34.28 (SD, 4.45), Nulliparous: (36.27%), education: > 12 years = 95 (94.14%), SES household income of ≦600,000 NTD (about 19,679 USD) = 52 (50.98%); ethnicity & relationship status = NR | N = NR, GA = 31.53 (SD, 2.97) wks, BW = 1661.86 (SD, 563.82)g |
| 5. Clark 2021, USA | Cross-sectional study, 1 Midwestern centre, July 2009 - July 2014, NNU level IV, length of stay = NR | To characterise the experience of bereaved parents of babies admitted to NNU |
Parents of infants who died within the previous five years in level IV NNU |
Age <18 years, infants died within the past 3 months, not speaking English | N = 40 mothers, mean age = 33.33 yrs, white = 35 (88%); living with partner = 32 (80%); education (secondary) = 34 (85%); N = 27 fathers mean age 36.74 yrs, white = 16 (58%); living with partner = 24 (60%), education (secondary)= 18 (67%), SES & parity = NR |
N, BW & GA = NR |
| 6. Eutrope 2014a, France | Prospective cohort, 3 centres in Reims, Besancon and Nancy, January 2008 and January 2010, NNU, length of stay = NR | To describe precocious maternal feelings when the mother has to face the premature birth of her infant | Mothers to infants < 32 wks |
For mothers psychiatric illness, drug or alcohol abuse, aged <18 yrs, language barriers; for newborns = unfavourable vital prognosis evaluated Perinatal Risk Inventory score >=10 infants risk of significant developmental disabilities and malformation and/or genetic anomaly diagnosed | N= 100 mothers at visit one, N= 93 at visit two, mean age 29.8 (SD,6.0), range 17– 45 yrs, 92% lived with partners, education = higher education 79.29%, SES = 69% work, nulliparous 48%,ethnicity = NR | N=100 visit one, visit two N= 93, GA < 32 wks, mean BW = 1320g, all singleton |
| 7. Feeley 2011, Canada | Prospective cohort, 2 centres University Teaching Hospital in Montreal, study period = NR, levels 3B (provides mechanical ventilation no major surgery) or 3C (provides major neonatal surgery but neither open-heart surgery nor extracorporeal membrane oxygenation, length of stay = NR | To examine mother's PTSD symptoms in relation to mothers and infants’ characteristics and to the quality of mothers' interaction with infants & their development | Mothers to NNU infant with BW < 1,500 g, GA < 32 wks speak English or French, and lived within 1-hour drive from hospital | Babies with congenital anomalies, sensory/motor disability | N = 21 mothers, age = 21 to 41, mean 30.9 SD,5.4) yrs, all lived with partners & house wives, nulliparous = 71.4% (n = 15). education: 11 -18 (M = 15. 2, SD = 1.9) yrs, ethnicity North American born (n = 12, 57.1%), 9 (42.8%) born elsewhere, 3 women (14.3%) had resided in Canada <1 yr | N= 21,GA < 32 wks, singletons, 29% (n = 6) twins or triplets, BW&GA= NR |
| 8. Forcada-Guex 2011, Switzerland | Cohort, 1 centre at University of Lausanne Hospital, January to December 1998, NNU Level 3, length of stay = NR | To clarify links between maternal traumatic reactions, quality of mother–infant interactions and maternal representations of infant's attachment | Mothers to preterm baby GA < 34 wks | Infant malformation, chromosomal abnormalities and fetopathy, parents’ psychiatric illness and/or drug abuse, not speaking French | N= 47 mothers nulliparous = 30 (64%), living with partner = 39 (83%) nationality (Switzerland & EU) = 44 (94%), SES* = 2.4 (0.6%), education= NR |
N = 47, GA mean = 31 wks (SD, 2), singleton = 37 (79%), BW = NR |
| 9. Garfield 2015a, USA | Cross-sectional; 2 hospitals inner-city medical centres serving underserved and uninsured populations, study period, NNU level & length of stay = NR | To identify risk factors among urban, low-income mothers, to enable NNU healthcare providers more effectively screening and referral | Mothers of VLBW<1500 g and preterm < 37 wks, English speaking, no current mental health diagnosis, infants clinically stable and did not have a congenital neurological problems or symptoms of substance abuse | < 18 yrs old, ongoing critical illness (HIV, seizure), major depression, psychosis, bipolar disease; mothers to infants receiving mechanical ventilation | N = 113 mothers, mean age = 24.7 (SD = 5.17) yrs, ethnicity African American = 81%, living with partner: 52.3%, education high school graduates = 43%, SES = 39% received public aid and an additional 40% were uninsured; parity =NR | N = NR, GA <37 wks, BW =mean 1073 (SD, 342)g |
| 10. Gateau 2021, USA | Cross-sectional; 1 centre in Los Angeles, 2013 – 2015, NNU level & length of stay: NR | To report the prevalence acute posttraumatic stress & depression in low-income families after NNU discharge |
One parent English- or Spanish-speaking to preterm infants who were up to 24 months corrected age with completed developmental assessments |
NR | N = 139 mothers, age = NR, ethnicity = white 10 (1%), Hispanic 102 (73%), black & others: 25 (18%), education (college): 76 (55%); SES (< $20,000 income)= 82 (59%); parity& living with partner =NR | N =116; GA = < 24 - < 28 (n= 52), 28 - 33 (n=57), >34 - <37: (n=7); BW <1,500 (n = 85); BW ≥1500 -<2,500 = (n=16); BW ≥2,500 = (n=7) |
| 11. Goutaudier 2011, France | Mixed method design, Quant-cohort; 1 centre; November 2009 to May 2010; NNU level & length of stay = NR | To assess mothers’ experience of preterm delivery and hospitalisation and psychopathological consequences | Mothers age >18 yrs, French speaking ad delivered preterm NNU babies | NR | N= 27, age 19–36 yrs, mean 29 (SD, 2.7), yrs CS: 15 (56%), other characteristics: NR |
N= 27, GA = 27 -37 wks, mean= 30.6 (SD,2.7) wks, 22.2% born at 32–37 wks; 48.1% born at 28– 31 weka; 29.7% <28 wks, BW = NR |
| 12. Greene 2015 & 2018a, USA | Prospective cohort; 1 urban centre; 2011-2012; NNU level IV, length of stay: NR | To identify the associations between elevated maternal depression, anxiety and PPTS at two time points during the NNU hospitalization | English-speaking mothers, >18 years, babies more likely to survive and VLBW<1500g | Congenital anomalies, drug users | N = 69 at T1, N= 64 at T2, age = 27 (SD, 6) yrs, nulliparous 23 (34%), ethnicity black = 38 (54%), Non-Hispanic white = 18 (26%), Hispanic = 12 (17%), living with partner = 32 (51%); education: highest grade completed mean = 13.4 (SD, 2.4) | N = 69, GA = 27.5 (SD, 2.2) wks, range 23.2- 32.30 wks; BW = 957(SD, 243)g |
| 13. Harris 2018a, USA | Cohort study; 2 centres Saint Louis Children's Hospital & Barnes Jewish Hospital's Special Care Nursery, January to June 2015, NNU Level III & IV length of stay = 83.4 (40.9) days |
To examine early mental health challenges in mothers of VPT in NNU and mothers of full-term babies, to factors associated with high levels of maternal psychological distress |
Mothers who had an infant born = <32 weeks GA & no congenital anomalies | Drug use mothers | N=37 mothers, age = 29.7 (6.4) yrs, multiple birth 5 (13%), SES (<$25,000) = 16 (43%), college degree 15 (41%), single 7 (19%) | N= 50, GA ≤32 wks, BW = mean 1104.0 (SD, 416.7)g |
| 14. Helle 2018a, Germany | Cross-sectional study, 3 largest perinatal medical centres in Hamburg, 2006 – 2008; NNU, level & length of stay = NR | To investigate the level of postpartum PTS, prevalence of and risk for postpartum PTSD and Acute Stress Disorder in both parents with a preterm VLBW infant compared to parents with term infants and identifying predictors for postpartum PTSS | VBW <1500g, PT<37 wks GA | Insufficient German skills, inability to follow study procedures, premature discharge, residing too far from the study centre, infant died before the first assessment | N = 111 mothers, N = 78 fathers, mothers mean age = 32.6 (SD, 4.7) yrs, nulliparous = 82 (73.9%), living with partner = 109 (98%), SES Low = 11 (10%), ethnicity & education | N = NR, GA = 28.2 (SD, 2.7), BW = 1095.9 (SD, 330.4)g, singleton birth = 76 (68.5%), twin - 32 (28.8%), triplet = 3 (2.7%) |
|
15. Holditch-Davis 2009, USA |
Cohort longitudinal repeated measures design as part of RCT - NNUs of 2 hospitals in one state, study period, NNU level & length of stay = NR | To examine inter-relationships among stress due to infant appearance and behaviour in the NNU exhibited by African American mothers of preterm infants | African American biological mothers of preterm infants < 1500 gm at birth or requiring mechanical ventilation. Mothers were recruited when their infants were no longer critically ill | Infants with congenital, symptomatic from substance exposure, hospitalized > 2 months post-term, or triplets or part of a higher order multiples set; mothers with no custody, follow-up for 2 years unlikely, HIV+, < 15 yrs, critically ill, not speak English, mental health problems | N=177 mothers, mean age=25.9 (SD, 6.5) yrs, living with partner = 6.1%., mean education =12.6 years (SD, 1.8); SES Public assistance =52.8%; ethnicity: all African American, parity = NR | N= NR; mean GA=28.3 (SD,2.9)wks; mean BW=1107 (SD,394)g |
| 16. Holditch-Davis 2015a, USA | Cohort, longitudinal repeated measure design as part of a randomized controlled trial - NNUs of 4 hospitals in two states, study period, NNU level & length of stay = NR | To estimate the inter-correlations between depressive symptoms, state anxiety, PTS, stress due to infant appearance and behaviour, and stress due to parental role alteration in a multi-ethnic sample of m others of preterm infants during initial hospitalization | Mothers of PT babies of BW< 1750g | Parents to infant with congenital neurological, symptoms of substance exposure, age< 15yrs; HIV+; psychosis/bipolar disease; depression, critical illness; non-English speaking), or follow-up for 12 months was unlikely | N= 232 mothers, age mean =27.0 yrs (SD,6.1), living with partner= 32.3%, mean education =13.4 yrs (SD,2.3), ethnicity white=19.8%, black=69.8%, Hispanic=8,1%, other=1.9%. nulliparous=55.1%., SES= Public assistance=20.3% | N= NR; mean GA=27.2 wks (SD,2.9); BW= mean1006.2 (SD,326)g |
| 17. Jubinville 2012, Canada | Prospective cohort, 1 centre in Alberta; February - May, 2008; NNU, level III, length of stay = NR | To determine whether significant symptoms of (Acute Stress Disorder) are present in mothers of premature NNU infants | Mothers of infants’ < 33 weeks GA admitted to NNU |
Infant with foetal anomaly, severe illness requires compassionate care and/ or maternal illness precluded NICU visit and assessing women at 7 -10 days after birth | N= 40 mothers, mean age 29.2 (SD, 5.8) yr, education above high school = 24 (60%), high SES (income =$60 000 per year = 23(58%), living with partner = 37(93%), majority white n = NR | N= 52, 10 twins, & one triplets, BW mean 1374.5 (SD, 466.1)g, rang 640-2220 g; GA =mean 29.0 (SD,2.6) wks, range=24.0-32.0) wks |
| 18. Koliouli 2016, France | Cross-sectional, 1 centre at University Hospital of Toulouse, January 2013 - March 2014; NNU level = NR, length of stay = Postmenstrual age at discharge = 39.8 wks (SD, 5.2) | To explore the feelings of stress, PTSD, and the coping strategies of fathers of premature infants | French-speaking fathers of preterm infants GA < 35 wks | Fathers to infants with congenital problems | N= 48 fathers, mean age 33.5 (SD = 3.5) yrs, all living with partner, 91.5% French, 51.1% University degree, SES = 37.2% intellectual profession | N= 48, 52.5% born at GA 26-28 wks, 47.5% at 29-35 wks |
| 19. Lefkowitz 2010, USA | Prospective cohort, 1 large eastern United States Children Hospital, 9 months period, NNU level IV, length of stay = 91 days (SD, 37.1) days | To assess the prevalence and correlates of (Acute Stress Disorder) and (PTSD) in mothers and fathers, and postpartum depression (PPD) in mothers, of NNU | Mothers and Fathers of infants on NICU who were anticipated to stay on NNU >5 days | Inability to read English, parent age <18, or if the child's death appeared imminent | N= 89 mothers, N=41 fathers, mean mothers age = 29 yrs vs 33 yrs for fathers, ethnicity = Caucasian mothers 71% vs. 81% fathers, education college degree 24.4%, mothers vs 21.4%. fathers, relationship status & SES = NR | N = NR, GA < 30 wks |
| 20. Lotterman 2019, Columbia | Cohort study, 1 centre Morgan Stanley Children's Hospital, Columbia University Medical Centre, NNU level III& IV; length of stay 83.4 (SD,40.9) days, study period = NR | To explore whether mothers of moderate- to late-preterm infants had elevated rates of psychological symptoms | Mothers of moderate- to late-preterm infants | Mothers to babies born <32 wks or later than 36 weeks, or if they had been in the NNU for longer than 6 months | N=91 mothers at NNU admission, N = 76 (83.5%) at 6 months, mean age = 32.45 (SD, 6.78) yrs, ethnicity = 40.7% Caucasian, 38.9% Hispanic 17.4% African American, 10.5% Asian, 2.3% American Indian/Alaskan Native, 29.1% other, mean years of education =14.29 (SD,4.30) yrs, living with partner = 86.6%; parity &SES= NR | N= NR; GA 32–37 wks, GA= mean 33.53 (SD, 1.33) wks, BW= NR |
| 21. Malin, 2020, USA | Cohort study, 1 centre,; NNU – level IV, length of stay ≥14 days, study period = NR | To determine if PTSD among parents of NNU babies can be predicted by objective measures or perceptions of infant illness severity |
Parent of infants who were in NNU ≥14 days | Parents did not speak English, infants discharged home with their non-biological parent, infant was previously discharged home/ transferred, infants who died in NNU |
N= 164 parents; living with partner = 154 (94%), SES (government insurance) = 82 (50%); parity, ethnicity & education = NR | N = 164; GA = 23-28 wks (n=36), 29-33 wks (n=60), 34-36 wks = (n=29), >37 wks = (n=39); BW <1000g = (n=28); BW > 1000g = (n=136) |
| 22. Misund 2013, 2014 & 2016a, Norway | Cohort study, 1 centre Oslo University hospital, June 2005 to July 2008 in two periods of measurement; NNU level & length of stay = NR | To explore long-term mental health outcomes in mothers experiencing preterm birth and to identify interactional, main effect variables and predictors |
Mothers to preterm babies <33 wks admitted to NNU | Mothers of severely ill babies that the medical staff estimated to have poor chance of survival, and non-Norwegian speakers | N=29 mothers at 2 wks post birth, N=27 at 2 wks after NNU admission, N= 26 at 6 & 18 months post term, age: 33.7 yrs (4.3), 89.7% > 12 years education = 29 N= 26 at 18 months mean age =33.7 (SD, 4.3) yrs, nulliparous = 18 (62.1%) education≥12 years = 26 (89.7%); all living with partner, SES= 13.8% unemployed, nulliparous 62.1%, ethnicity= NR | N= 35, GA=29 median(range=24-32) wks median BW=1.2 kg (range=0.6-2.0); 40% twins |
| 23. Naeem 2019, Iran | Descriptive-comparative study cohort, 2 hospitals (Yas and Vali-e-asr Hospitals); NNU, 2016 and 2017; length of stay = NR | To compare the prevalence of PTSD in parents of hospitalized preterm and term neonates | Parents of NNU preterm (GA 24 - 36 wks), and parents to hospitalized terms (GA >38 wks) Both aged 2 to 5 days |
Parental psychiatric or underlying diseases, smoking and drug abuse | N=80 parents mothers vs. fathers: N=79 vs. 79, education: upper diploma 57 (72.2%) vs. 51 (64.6%), unemployed 67 (84.8%) vs. 6 (7.6%) full term: N=80 parents, mothers vs. fathers: N:80 vs 80, education upper diploma: 50 (62.5%) vs. 47 (58.82%) unemployed 69 (86.3%) vs. 4(5%) |
PT: N=80; GA: GA 24 - 36 wks), FT: N=80, GA >38 wks |
| 24. Pace 2020a, Australia | Prospective cohort; 1 centre Royal Women's Hospital, Melbourne, January 2011 to December 2013; NNU level & Length of stay = NR |
To report the proportion of parents of VPT infants with PTSS symptoms at different time points |
Families with very preterm infants, GA <30 wks admitted to NNU | Parents who did not speak English, infants with congenital abnormalities, unlikely to survive | Mothers 89, Fathers 75v 92 mothers &/or 75 SES parents (high risk): 45 (43%) Mean mothers age: 33 (5.3) yrs; mothers education (>12 yrs): 62 (67%); fathers age: 35 (6.2) yrs; fathers education (> 12 yrs): 45 (60%) |
N= 131; GA < 30 wks; mean GA 27.8 (1.5) wks; mean BW 1038 (261)g |
|
25. Pierrehumb 2003, Switzerland |
Prospective cohort,1 centre Lausanne University Hospital; January to December 1998, NNU; level & length of stay= NR |
To examine the effects of post-traumatic reactions of the parents on sleeping and eating problems of the children | Preterm infants <33 wks; infants were grouped into low and high risk based on perinatal risk inventory, basis of perinatal factors such as the Apgar score, gestational age, weight, head growth, electroencephalogram, ultrasonogram, and ventilation | Infant malformation, chromosome abnormality, and fetopathy; parental psychiatric illness and/or drug abuse, not speaking French | Low risk N= 23 mothers, N = 18 fathers, mothers age = 30.9 (SD, 4.3), fathers age = NR, parity = 0.45 (SD,0.59), single mother: 0/23. High risk N = 28 mothers, N = 23 fathers, mothers age = 31.3 (5.0), fathers age = NR, parity = 0.81 (SD, 1.24), relationship status: single mother = 1/27, ethnicity, education & SES = NR | Low risk babies: N =23 (GA = 31.3 wks (SD,1.5), BW = 1615g (SD, 280), High risk: N =27; GA = 24/27 (89%); BW = 1131 (SD, 318)g |
| 26. Rodriguez 2020, Argentina | Cohort study; 1 centre, March 3, 2014-November 22, 2016; NNU level & length of stay = NR | To detect PTSD frequency and symptoms among mothers of VLBW preterm < 32 wks |
Mothers with singleton pregnancies to VLBW (<1,500g) preterm babies (<32 weeks) |
Mothers with psychiatric disorders before and/or during gestation, babies with chronic conditions & congenital malformations |
N = 146 mothers, age ≤21 to ≥ 42 years, other characteristics = NR | N =146, GA < 32 wks, BW < 1,500g |
| 27. Sharp 2021, USA | Cross-sectional – survey study via social media, November 2015 - July 2016, number of centres & NNU level = NR |
To report on maternal perceived stress to infants’ NNU admission and the relationship between traumatic childbirth and PTSD | Biological mothers =>18-years-old, USA residents, complete the survey in English, alive infants age 1-4 months |
Completing < 75% of the survey, infants age > 1-4 months | N = 77 mothers, mean age =39.6 (5.8) yrs; Ethnicity = White: 68 (88.3%); Hispanic: 7 (9.1%); living with partner: 73 (94.8%); Education (Bachelor's degree or above) = 35 (45%); SES (unemployed) = 26 (47%); Nulliparous = 32 (41.6%) |
N= NR, BW <2,500g = 47 (61.0%), GA < 37 wks= 43 (55.8%) |
| 28. Shaw | ||||||
| Shaw 2006, USA | Prospective cohort, 1 centre, NNU, study period, NNU level & length of stay = NR | To examine the prevalence of (Acute Stress Disorder) in parents of NNU infants | English-speaking parents to infants in NNU | NR | N = 40, 24 couples,13 mothers, 3 fathers; mothers mean age = 33.96 years, ethnicity Caucasian (60%), living with partner = 87%, education B.A/B.S (72%), fathers mean age 37, ethnicity Caucasian (92.3%), living with partner(100%), education higher (41.7%), SES = family income > $80,000 a year 87.2%), parity=NR | N = NR, GA mean 31.46 wks (SD, 4.91) wks, BW mean 1,811.44 (SD, 986.97)g |
| Shaw 2009, USA (Follow-up of 2006) |
Prospective cohort, 1 centre, NNU, mean hospital stay 12 (SD, 8) days, study period = NR | To describe the early-onset symptoms of Acute Stress DISORDE in parents and factors related to PTSD, identifying high-risk parents who may benefit from early intervention | English-speaking parents of NNU infants | NR | N = 18, N = 11 mothers, N = 7 fathers, mothers age = 34.55 (SD, 4.41) yrs, fathers age = 36.57 (SD, 4.79) yrs. parity = NR, ethnicity: mothers white = 7 (63.6%), Asian = 3 (27.3%), fathers white = 6 (85.7%), Asian = 1 (14.3%), fathers & mothers all living with partner, education mothers higher 10 (91%) vs 6 (86%) fathers: full time job fathers 100% vs 60% mothers, parity = NR | N = NR, GA = 30.89 (SD, 4.11) wks, range (27 to 41) wk, BW mean = 1,664.39 (SD, 908.21)g, range (1052-4004)g |
| 29. Shaw 2014, USA | Cross-sectional, Lucile Packard Children's and El Camino Hospitals in northern California, July 2011 and December, 2012, highly specialized NNU level & length of stay = NR | To determine whether there are easily identifiable maternal socio-demograp; hic characteristics, aspects of their pregnancy history or factors related to their infant's medical history in postpartum mothers who screen positive for symptoms of psychological distress | English- and Spanish-speaking mothers of infants born between 26 and 34 weeks, weighing >1000 g, likely to survive | Psychiatric risk factors including suicidal or homicidal ideation or the presence of psychotic symptoms, for babies no major health complications such as congenital abnormalities | N = 135, age = 31.4 (SD, 5.5), nulliparous = 16 (53.3%), ethnicity white 19 (63.3%), black 0 (0%), Asian 10 (33.3%), other = 1 (3.3%), Hispanic = 13 (43.3%), living with partner = 29 (96.7%), education postgraduate degree = 11 (36.7%), SES: <$50k = 9 (30%) | N=NR; GA= 26-34 wks, BW = NR |
| 30. Schecter 2020, USA | Cross-sectional, 2 centres NNUs at 1 hospital in Long Island, NNU level II & IV, study period & length of stay = NR | To investigate whether (PTSD) symptoms exist >1 year after neonatal intensive care unit (NNU) experience and if PTSD symptoms differ across parents of infants of different gestational age | Parents of infants attending a follow-up appointment were eligible regardless of the infant's GA or medical diagnoses | NR | N = 91 mothers and fathers, only 83 individuals identified their race: 41% white, 16% Hispanic/Latino, 15% black, 13% Asian, 6% multiracial, and 9% other, SES = 33% lower than the median, age, parity, education & living with partner = NR | GA < 28 wks 21%, 28 – 31 wks, 33%; 32 – 36 wks 38% and > 36 wks 9%, N & BW= NR |
| 31. Toly 2019, USA | Descriptive correlational design, cohort study, 1 hospital, NNU transitional care unit in a large children's hospital located in the Midwest United States that has approximately 1000 admissions per year, study recruitment took place over a period of 15 months, NNU level= NR, length of stay Low risk = 40.7 (SD, 14.8) days High risk = 67.3 (23.7) days | To examine mothers’ psychological state prior to discharge of their technology-dependent infant from the NNU to home |
Mothers > 18 years, their infant was to be discharged from the NNU to home within 2 to 3 weeks for the first time and was not dependent on medical technology (mechanical ventilation, intravenous medication, supplemental oxygen, tracheostomy, feeding tubes and they were able to read and speak English | Mothers of infants with a terminal diagnosis | N= 19, age range 18-41 years, mean 25.63 (SD, 6.27) yrs, ethnicity = 47.4% African American, 60% single, 58% high school, parity & SES = NR |
N= NR, GA = 23- 39.29, mean 29.78 (6.43) wks, BW range 500-3765g, mean BW 1546.1g |
| 32. Vanderbilt 2009, USA | Cohort, Boston Medical Center; study period, NNU level & length of stay = NR | To evaluate rates of acute posttraumatic stress symptoms and positive acute stress disorder screens among low-income mothers of infants admitted to the NNU compared with those with infants in the well-baby nursery | Mothers were identified from the daily census in the WBN or NNU at Boston Medical Centre and recruited based on availability of the research assistant, a living child, understands English, and having retained custody of the infant | HIV exposure or had pre-existing major mental illness. Infants and their mothers were excluded if the infants had substance withdrawal, major congenital anomalies, chromosomal abnormalities, foetal alcohol syndrome, cerebral palsy, blindness, or deafness to focus on a homogenous sample of NNU admissions with our limited sample size | N = 59 mothers mean age = 29 (SD, 6.8) yrs, ethnicity black = 35 (59%), Hispanic = 13 (22%), white 6 (10%), other 5 (9%), living with partner= 16 (27%), education high school/ below = 36 (61%), SES public insurance = 50 (85%), parity = NR | N = NR, GA mean 34 wks (SD, 3.8); BW= 2357(SD, 1034)g, twin = 3 (5%) |
| 33. Vinall 2018, Canada | Cohorts, 1 tertiary-level NNU in Halifax, Nova Scotia, July 2012 and March 2016, NNU level=NR, length of stay mean 57.89 (SD,35.87) days; | To examine whether the number of invasive procedures together with mother's memory for these procedures were associated with PTSS at discharge from the NNU | mothers of infants < 37 weeks GA | Infants were excluded if they had major congenital anomalies, were receiving opioids, or underwent surgery | N = 36 mothers, age median age (IQR)= 31 (27-36) yrs, education median (IQR) = 5 (4-5) yrs, ethnicity, parity, education, relationship and SES = NR | GA median (IQR) 32 (30-34) wks, N, GA & BW= NR |
| 34. Yaman 2015, Turkey | Cross- sectional, 2 centres, 2 January - 31 June 2012, NNU level=NR, length of stay 14 and 96 days, mean = 55.67 (SD, 28.54), | To examine the posttraumatic stress of mothers and fathers, the differences between their experiences |
Parents of newborn in the NICU for at least 7 days, age > 18 yrs old, no previous experience of the NNU, no history of chronic diseases or psychiatric disorders | Parents who could not participate in the study | N= 66 couples, 40.9% of mothers 21–25-year age, 46.9% of fathers 26–30-year; 39.4% of mothers and 34.8% of fathers high school graduates, SES unemployed= 80.3% mothers vs. 92.4% fathers were working, nulliparous 60.4% |
N= NR, 62.2% GA of 24–37 wks, 50% were age 8–28 days, 37.9% treated in the NICU for 8–28 days, 21.2% congenital anomalies |
| 35. Zerach 2015, Israel | Cohort study, 1 hospital at Tel Hashomer, NNU level = NR, length of stay: NR (but according to hospital policy, the minimum length of stay for 24-27 weeks prematurity was 9 weeks) |
To examine the relationship between extremely low birth weight (ELBW) children and their mother's stress and PTSD symptoms |
Mothers of ELBW <1kg infants born at Tel Hashomer hospital from 1995 to 2006 and admitted at the centre's NNU |
Mothers of infants who had died (N=2) | N= 78 mothers, mean age at data collection 39.53 (SD, 6.73) yrs; age at time of birth 29.89 (SD 5.76) yrs; 82.3% living partner, 53.2% educated to degree or higher, 34.6% above average income, parity = NR |
N = 78 (75 ELBW, 3 VLBW) GA mean 25.5 (SD,0.71 wks), range 24 -27 wks multiple birth = 42.3% ELBW (<1kg): = 96.2% mean 752.67 (SD, 66.59)g, VLBW (<1.5kg) = 3.8% mean 1095.66 (SD, 110.21) |
Abbreviations: PTSD: Post-traumatic stress disorder; NNU: Neonatal unit; GA: Gestational age; BW: Birth weight; SES*: Socio-economic status using Pirrehumbert 4-point scale; wks: weeks; NR: Not reported; HIV: Human immunodeficiency virus, EU: European Union; IQR: interquartile range; ELBW: Extremely low birth weight; SD: Standard deviation; VLBW: Very low birth weight; PT: Preterm, FT: Full term; yrs: Years.
a
Studies included in both anxiety and PTS.