Post-traumatic stress disorder, anxiety, and care responses among mothers of preterm infants at one month of corrected age after discharge from the neonatal intensive care unit

doi:10.21203/rs.3.rs-1404709/v1

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Post-traumatic stress disorder, anxiety, and care responses among mothers of preterm infants at one month of corrected age after discharge from the neonatal intensive care unit

https://doi.org/10.21203/rs.3.rs-1404709/v1

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Background: Preterm birth is a worldwide problem that can cause changes in emotions of mothers. This study aimed to evaluate the effect of maternal anxiety and post-traumatic stress disorder symptoms on maternal care responses to preterm infants, and whether there is a mediation effect of maternal distress between preterm clinical status and maternal care responses.

Methods: This hospital-based longitudinal cohort study included 256 mother-preterm infants who came to the outpatient clinic for a follow-up check after being discharged from the neonatal intensive care unit at one month of corrected age. Mothers completed the Post-traumatic Stress Disorder Questionnaire, the Self-rating Anxiety Scale, and four sub-scales of care responses.

Results: Significant post-traumatic stress disorder and anxiety were observed in 29.7% and 15.6%, respectively, of mothers at one month of corrected age and at about 10.83 weeks postpartum. Path analysis results showed that the final model could be fitted well with sample data(c2=33.098, DF =20, P=0.033, CFI=0.992, NFI=0.981, RMSEA=0.051, SRMR= 0.029). Path analysis showed that care responses were directly and indirectly affected by preterm infants’ clinical status, maternal post-traumatic stress disorder, and anxiety. Gestational age significantly influenced maternal care responses.

Conclusion: This study identified maternal anxiety and PTSD symptoms may significant effects on maternal care responses to preterm infants at one month of corrected age. To promote the development of preterm infants after discharge from the neonatal intensive care unit, multiple disciplinary interventions should be developed to improve maternal care responses.

Anxiety

Care responses

Preterm infants

Post-traumatic stress disorders

Table 1. Description of maternal demographic information and infants’ clinical status (N=256)

Mothers M [P25, P75]/ n(%)		Infants M [P25, P75]/ n(%)
Age(year)	31 [29, 34]	Gestational age (week)	31 [29, 34]
Education		Birth weight(g)	2072.50 [1551.25, 2343.75]
≤High school	95 (37.11)	Gender
≥College	161(62.89)	Male	95 (37.11)
Breastfeeding pattern		Female	161(62.89)
Exclusive breasting feeding	190 (74.22)	Delivery model
Non- Exclusive breasting feeding	66 (25.78)	Caesarean section	190 (74.22)
Parity		Vaginal delivery	66 (25.78)
Primipara	193 (75.40)	5min Apgar	193 (75.40)
Multipara	63 (24.60)	Length of NICU stay (day)	63 (24.60)

Table 2. Descriptive statistics and correlations for infants’ clinical status, maternal emotional distress and care responses (N=256)

Variables	M	SD	1	2	3	4	5	6	7	8
1.GA	33.16	2.81
2.BW	1962.94	546.51	0.86**
3. LOS	25.54	25.70	-0.84**	-0.78**
4. Anxiety	41.34	8.64	-0.53**	-0.44**	0.43**
5. PTSD	4.42	2.08	-0.60**	-0.52**	0.49**	0.68**
6. CMA	41.05	6.96	0.46**	0.37**	-0.32**	-0.50**	-0.52**
7. FLD	36.22	10.26	-0.62**	-0.54**	0.48**	0.61**	0.60**	-0.76**
8. CME	12.17	3.10	-0.49**	-0.45**	0.42**	0.46**	0.50**	-0.50**	0.62**
9. VCI	27.10	5.90	-0.49**	-0.42**	0.39**	0.53**	0.42**	-0.63**	0.76**	0.58**

GA, Gestational age; BW, Birth weight, LOS, length of NICU stay, PTSD, post-traumatic stress disorder; CMA, Condition Management Ability; FLD, Family life difficulty; CME, Condition Management Effort; VCI, View of Condition Impact; M = mean; SD = standard deviation. **p < .01.

Table 3. indirect effects for the overall model from infants’ clinical status, maternal emotional distress to care responses

	Point estimate	Product of coefficient		Bootstrapping
		Product of coefficient		Percentile 95% CI		Bias-corrected Percentile 95% CI
		SE	Z	Lower	Upper	Lower	Upper
GA-->BW-->LOS	-1.803	0.326	-5.523	-2.449	-1.170	-2.425	-1.145
GA-->BW-->LOS-->CMA	-0.094	0.040	-2.352	-0.186	-0.028	-0.185	-0.027
GA-->BW-->LOS-->CMA-->DIFFICULTY	0.074	0.031	2.381	0.022	0.144	0.022	0.147
BW-->LOS-->CMA	-0.001	0.000	-2.337	-0.001	0.000	-0.001	0.000
BW-->LOS-->CMA-->DIFFICULTY	0.000	0.000	2.362	0.000	0.001	0.000	0.001
LOS-->CMA-->DIFFICULTY	-0.041	0.017	-2.453	-0.079	-0.013	-0.078	-0.012
GA-->LOS-->CMA	-0.305	0.139	-2.192	-0.643	-0.087	-0.638	-0.085
GA-->LOS-->CMA-->DIFFICULTY	0.239	0.110	2.179	0.069	0.508	0.069	0.508
GA-->PTSD-->CMA	0.362	0.121	2.999	0.128	0.607	0.132	0.611
GA-->PTSD-->CMA-->DIFFICULTY	-0.284	0.098	-2.897	-0.487	-0.098	-0.493	-0.105
PTSD-->CMA-->DIFFICULTY	0.643	0.220	2.923	0.219	1.094	0.217	1.091
GA-->PTSD-->Anxiety	-1.045	0.201	-5.190	-1.450	-0.668	-1.483	-0.700
GA-->PTSD-->Anxiety-->CMA	0.189	0.064	2.965	0.068	0.321	0.080	0.333
GA-->PTSD-->Anxiety-->CMA-->DIFFICULTY	-0.148	0.050	-2.962	-0.253	-0.052	-0.269	-0.066
PTSD-->Anxiety-->CMA	-0.427	0.146	-2.922	-0.729	-0.150	-0.747	-0.170
PTSD-->Anxiety-->CMA-->DIFFICULTY	0.335	0.115	2.910	0.116	0.573	0.134	0.597
Anxiety-->CMA-->DIFFICULTY	0.142	0.049	2.874	0.051	0.242	0.050	0.241
GA-->PTSD-->Anxiety-->DIFFICULTY	-0.264	0.064	-4.134	-0.392	-0.144	-0.401	-0.152
PTSD-->Anxiety-->DIFFICULTY	0.596	0.136	4.381	0.339	0.867	0.349	0.882
GA-->Anxiety-->DIFFICULTY	-0.143	0.056	-2.566	-0.261	-0.044	-0.265	-0.045
GA-->Anxiety-->CMA	0.103	0.056	1.841	0.020	0.236	0.022	0.241
GA-->Anxiety-->CMA-->DIFFICULTY	-0.080	0.044	-1.829	-0.183	-0.015	-0.192	-0.018
GA-->CMA-->DIFFICULTY	-0.689	0.181	-3.810	-1.108	-0.382	-1.110	-0.383

No competing interests reported.

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Post-traumatic stress disorder, anxiety, and care responses among mothers of preterm infants at one month of corrected age after discharge from the neonatal intensive care unit

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