Melbourne School of Psychological Sciences - Theses
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ItemParental psychological distress following very preterm birth: impact on infant social-emotional development and parent-child interaction( 2014)It is known that there are high rates of psychological distress in parents of very preterm infants, but previous researchers examining parental mental health after preterm birth have usually assessed mental health at one point in time. As such, little is known about the evolution of parental distress, particularly during the inpatient period in the Neonatal Intensive Care Unit (NICU). Parental distress can negatively impact parent-child relationships, which can then affect longer term child social-emotional development. Furthermore, children born very preterm have higher rates of early social-emotional difficulties, and are more likely to experience suboptimal parent-child interaction. These problems are likely to be compounded by parental mental health difficulties. Understanding these issues in the first year of life is vital to guide appropriate intervention, both for the wellbeing of mothers and fathers during this difficult period, and for the optimal development of their very preterm infants. This study aimed to describe the trajectory of psychological distress (depression, anxiety and post-traumatic stress symptoms) in mothers and fathers of very preterm infants at several key time points from birth to 12 months corrected age. It also investigated how this distress influenced parent-child interaction and the infant’s social-emotional development at 12 months corrected age. Finally, it examined whether parent-child interaction explained the relationship between maternal psychological distress during the first 12 months and infant social-emotional development at 12 months corrected age. Participants included 96 mothers and 86 fathers of 127 infants (99 families including 26 sets of twins and one set of triplets) born prior to 30 weeks gestational age and admitted to the Royal Women’s Hospital NICU in Melbourne, Australia. A subset of families of 55 infants were followed up at 12 months corrected age. Mothers and fathers completed measures assessing depression (The Centre for Epidemiological Studies Depression Scale) and anxiety (The Hospital Anxiety and Depression Scale) fortnightly from birth until the infant reached term equivalent age, and at three, six and 12 months corrected age. In addition, parents completed the Post-traumatic Stress Disorder Checklist Specific Version at term equivalent age and 12 months corrected age to assess post-traumatic stress symptoms. At 12 months corrected age the mothers and infants participated in the Emotional Availability Scales, an observational task assessing parent-child interaction, and mothers completed the Infant-Toddler Social and Emotional Assessment to assess infant social-emotional development. Overall, results showed that symptoms of depression, anxiety and post-traumatic stress were initially high for both mothers and fathers, and reduced in severity over time between the birth of their infant and 12 months corrected age. However, rates of clinically significant symptoms of depression remained above levels that would be expected in the general population at 12 months corrected age. Psychological distress in parents at various time points was predictive of certain infant social-emotional development and parent-child interaction outcomes. When these associations were examined more closely, it was found that the relationships between maternal mental health predictors and infant social-emotional development could not be explained by the influence of parent-child interaction. The findings of this study represent a substantial advance in the understanding of parental mental health following very preterm birth, especially in fathers. Additionally, the results may help identify the optimal timing of assessment and intervention to improve mothers’ and fathers’ wellbeing, and thus their infants’ development.