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Original Investigation |

Evolution of Depression and Anxiety Symptoms in Parents of Very Preterm Infants During the Newborn Period

Carmen C. Pace, PhD1,2,3; Alicia J. Spittle, PhD1,2,4; Charlotte M.-L. Molesworth, MBiostat5; Katherine J. Lee, PhD5,6; Elisabeth A. Northam, PhD3,7; Jeanie L. Y. Cheong, MD1,2,8,9; Peter G. Davis, MD1,8,9; Lex W. Doyle, MD1,2,9; Karli Treyvaud, DPsych1,2,6; Peter J. Anderson, PhD2,6
[+] Author Affiliations
1Newborn Research Centre, Royal Women’s Hospital, Melbourne, Australia
2Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Melbourne, Australia
3Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
4Department of Physiotherapy, University of Melbourne, Melbourne, Australia
5Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Australia
6Department of Paediatrics, University of Melbourne, Melbourne, Australia
7Psychology Service, Royal Children’s Hospital, Melbourne, Australia
8Department of Neonatal Services, Royal Women’s Hospital, Melbourne, Australia
9Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
JAMA Pediatr. 2016;170(9):863-870. doi:10.1001/jamapediatrics.2016.0810.
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Importance  Mothers experience heightened depression and anxiety following very preterm (VPT) birth, but how these symptoms evolve during the first months after birth is unknown. Research on the psychological adjustment of fathers following VPT birth is limited.

Objectives  To describe the trajectory and predictors of distress in parents of VPT infants during the first 12 weeks after birth, and to compare rates of depression and anxiety in parents of VPT infants with those in parents of healthy full-term (FT) infants shortly after birth and at 6 months’ postnatal age.

Design, Setting, and Participants  Longitudinal, prospective, follow-up cohort study of depression and anxiety symptoms in parents of VPT infants (<30 weeks’ gestational age; admitted to the neonatal intensive care unit at the Royal Women’s Hospital, Melbourne, Australia, between January 21, 2011, and December 23, 2013), documented every 2 weeks until age 12 weeks and at age 6 months, as well as in parents of healthy FT infants (≥37 weeks’ gestational age; birth weight >2499 g; born at the Royal Women’s Hospital between August 15, 2012, and March 26, 2014; not admitted to the neonatal nursery) shortly after birth and at age 6 months.

Exposure  Birth of a VPT infant.

Main Outcomes and Measures  Symptoms of depression (Center for Epidemiological Studies Depression Scale) and anxiety (Hospital Anxiety and Depression Scale).

Results  The study included 113 mothers (mean [SD] age at birth, 32.7 [5.3] years) and 101 fathers (mean [SD] age at birth, 34.7 [6.4] years) of 149 VPT infants (49% male; 84 singletons, 65 multiples; mean [SD] birth weight, 1021 [261] g) as well as 117 mothers (mean [SD] age at birth, 32.9 [4.8] years) and 110 fathers (mean [SD] age at birth, 35.9 [5.3] years) of 151 healthy FT infants (50% male; 149 singletons, 2 multiples; mean [SD] birth weight, 3503 [438] g). Mean scores and rates of depression and anxiety reduced over time for parents of VPT infants in the 12 weeks after birth: the mean (95% CI) change in depression score per week was −0.52 (−0.73 to −0.31; P < .001) for mothers and −0.39 (−0.56 to −0.21; P < .001) for fathers; the mean (95% CI) change in anxiety score per week was −0.16 (−0.26 to −0.05; P = .003) for mothers and −0.22 (−0.31 to −0.15; P < .001) for fathers. However, rates never dropped below 20%. Few perinatal or social risk factors predicted longitudinal changes in depression or anxiety. Compared with parents of FT infants, parents of VPT infants had higher rates of depression shortly after birth (mothers: 6% vs 40%; odds ratio [OR] = 9.9; 95% CI, 4.3 to 23.3; P < .001; fathers: 5% vs 36%; OR = 11.0; 95% CI, 4.1 to 29.6; P < .001) and at 6 months (mothers: 5% vs 14%; OR = 2.9; 95% CI, 1.0 to 8.2; P = .04; fathers: 6% vs 19%; OR = 3.4; 95% CI, 1.3 to 9.0; P = .01) as well as anxiety shortly after birth (mothers: 13% vs 48%; OR = 6.5; 95% CI, 3.3 to 12.6; P < .001; fathers: 10% vs 47%; OR = 7.8; 95% CI, 3.7 to 16.8; P < .001) and at 6 months (mothers: 14% vs 25%; OR = 2.1; 95% CI, 1.0 to 4.3; P = .05; fathers: 10% vs 20%; OR = 2.3; 95% CI, 1.0 to 5.3; P = .05).

Conclusions and Relevance  Mothers and fathers of VPT infants had elevated rates of depression and anxiety symptoms that declined over time, although remaining above expected levels throughout the newborn period and at 6 months.

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Figure 1.
Depression Scores in Parents of Very Preterm (VPT) Infants Every 2 Weeks Since Birth

Mean depression scores on the Center for Epidemiological Studies Depression Scale (A) and percentages of parents scoring above the cutoff for clinical depression (B) in mothers and fathers of VPT infants over time since birth. Sample sizes indicate the numbers of respondents at each time point; error bars, 95% confidence intervals.

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Figure 2.
Anxiety Scores in Parents of Very Preterm (VPT) Infants Every 2 Weeks Since Birth

Mean anxiety scores on the Hospital Anxiety and Depression Scale (A) and percentages of parents scoring above the cutoff for clinical anxiety (B) in mothers and fathers of VPT infants over time since birth. Sample sizes indicate the numbers of respondents at each time point; error bars, 95% confidence intervals.

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