Predictors of maternal state anxiety one month after a late-preterm delivery
Design and Methods: This was a longitudinal observational study of 41 infant/mother dyads recruited from a level 3 NICU. Mothers completed the self-administered 20-item 4-point Likert S-Anxiety scale (STAI Form Y-1) one month post NICU discharge. The STAI provides information on how the participant may have felt at a defined time in the recent past, how he or she anticipates feeling if a hypothetical situation occurs in the future, and evaluates feelings of apprehension, tension, nervousness, and worry that the participant experiences “ right now.” Higher scores are associated with increased psychological stress. Participants rated each item-statement that best describes the intensity of their feelings: (1) not at all, (2) somewhat, (3), moderately, (4) very much so. The range of possible scores is 20-80. A score between 40 and 59 is defined as moderate anxiety and a score between 60 and 80 is defined as severe anxiety. Demographic and other mother and infant covariates were extracted from medical records. We used the Vulnerable Baby Scale (VBS), the Pictorial Assessment of Temperament (PAT), and the Maternal Attitude Questionnaire to measure maternal perception of infant vulnerability, maternal perception of infant temperament, and maternal expectations and attitudes towards motherhood.
The Stability of the Cardiorespiratory System in Preterm Infants (SCRIP) score was used to measure infant physiological stability.
Results: Anxiety scores were in the moderate range. The lowest score was 21 and the highest score was 57 [Mean (34.2) SD (9.7)]. In bivariate analysis STAI scores negatively correlated with the 5-minutes Apgar scores (r=0.009, r=-0.63), availability of family support (p=0.02, r=-0.53) and SCRIP score (p=0.03, r=-0.55) and positively correlated with length of stay (p=0.05, r=47) and parent role alteration (p=0.02, r=0.51). Apgar and MAQ scores were the most significant predictors of maternal anxiety one month post hospital discharge when adjusting for significant infant and mother covariates in multiple regression models.
Implications: The stress associated with an eventful pregnancy that have ended with a LP birth may persist beyond the NICU period. Infant’s severity of illness and maternal cognitions concerning expectations of her infant and expectations of herself as a mother present significant vulnerability for increased anxiety during transition to motherhood. Screening for moderate to severe anxiety prior to NICU discharge could identify those at increased risk. Future studies are needed to evaluate the relationship between the identified risk factors and whether early identification and intervention in the NICU reduces the risk and duration of state anxiety.
This study was supported by a foundation grant from the investigator’s institution