Recognizing and Screening for Postpartum Depression in Mothers of NICU Infants

Adv Neonatal Care. 2003;3(1) 

In This Article

PPD and Mothers of Multiples and Preterm Infants

Depression and anxiety disorders are more prevalent in mothers of multiples, affecting over 25% of these mothers during the prenatal and postpartum periods.[2] The high incidence of preterm deliveries, sleep deprivation, social isolation, and the constant demands of the twins may contribute to depression in families of multiples. One research team followed mothers of twins 5 years after delivery and reported that 34% of mothers who had 2 living twins and 53% of women who had only 1 living twin were clinically depressed.[23] Another grounded theory study of mothering twins over the first year of life revealed that the most vulnerable time for PPD was the first 3 months postpartum, with 19% of the mothers experiencing PPD compared with the usual rate of 13%.[3,13]

The stress associated with multiple births frequently is compounded by a premature delivery. This is significant because mothers of preterm infants experience a higher level of depression than mothers of full-term infants.[4,5,6,7] Mothers of preterm infants (n = 37) who were assessed for PPD shortly before their infants' neonatal intensive care unit (NICU) discharge and again at their infants' 4 week follow-up visit were frequently depressed at the 1-month visit.[5] Low social support and low self-esteem were predictive. High levels of depression at 1 month and 12 months postpartum were reported in a longitudinal study of 69 Hispanic mothers of very low-birth-weight infants.[7] Social support appeared to buffer the effects of depression in this sample.

Known PPD predictors, such as child care stress, have been examined in parents of NICU infants. In a descriptive study (n = 212 parents of NICU infants), the mothers' perceptions of the severity of their infants' illness was the strongest factor related to their parental stress scores (P = 0.001).[24]

Low social support, another known predictor of PPD, was documented in a descriptive study of 37 mothers of hospitalized preterm infants that examined the types of support mothers expected and received after their infants' discharge from the NICU.[25] These mothers reported less material, emotional, and informational support than they had expected. Based on this work, Davis et al developed a Guide to Helping Women Anticipate Postpartum Social Support Needs, which NICU nurses will find useful in helping prepare their mothers for their infants' discharge from the hospital.[25]

Depressive symptoms at the time of NICU discharge were evaluated in 30 mothers of preterm infants.[6] Maternal depressive symptoms were predicted by less accurate knowledge of infant development. These investigators suggest that educating mothers of preterm infants about infant development may provide protection against the development of PPD.

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