Am J Perinatol
DOI: 10.1055/a-2353-0993
Original Article

Mental Health Support and Screening for Mood Disorders for Caregivers in the Neonatal Intensive Care Unit: Is the Call to Arms Being Answered?

1   Division of Neonatology, Department of Pediatrics, Feinberg School of Medicine, Northwestern University and the Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
,
Lamia Soghier
2   Division of Neonatology, Department of Pediatrics, George Washington University School of Medicine, Children's National Hospital, Washington, District of Columbia
,
Joanne Lagata
3   Division of Neonatology, Department of Pediatrics, Emory University, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
,
Miller Shivers
4   Division of Psychiatry and Behavioral Health, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
,
Erin Sadler
5   Division of Psychology & Behavioral Health, Department of Pediatrics, George Washington University School of Medicine, Children's National Hospital, Washington, District of Columbia
,
Elizabeth Fischer
6   Division of Pediatric Psychology and Behavioral Medicine, Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
,
Adrienne Borschuk
7   Division of Psychiatry and Behavioral Sciences, Department of Pediatrics, SUNY Upstate Medical University Upstate Golisano Children's Hospital, Syracuse, New York
,
Melissa House
8   Division of Neonatology, Department of Pediatrics, Emory University of School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
,
Children's Hospitals Neonatal Consortium Perinatal Mood Anxiety Disorder Focus Group › Author Affiliations

Abstract

Objective Perinatal mood and anxiety disorders (PMADs) affect many neonatal intensive care unit (NICU) parents and are a significant risk factor for maternal suicide. Lack of screening and treatment interferes with infant development and bonding, compounding risks in fragile infants. We aim to describe PMAD screening in level IV NICUs across the Children's Hospitals Neonatal Consortium (CHNC) and to determine the relationship between standardized screening and mental health professionals (MHPs) presence.

Study Design We surveyed experts at 44 CHNC NICUs about PMADs screening practices and presence of NICU-specific MHPs. Kruskal–Wallis test was used to examine relationships.

Results Of 44 centers, 34 (77%) responded. Fourteen centers (41%) perform screening with validated tools. Thirteen (38%) centers have NICU-dedicated psychologists. Formally screening centers tend to have higher cumulative MHPs (p = 0.089) than informally screening centers. Repeat screening practices were highly variable with no difference in the number of cumulative MHPs.

Conclusion Screening practices for PMADs vary across CHNC centers; less than half have additional MHPs beyond social workers. Creating a sustainable model to detect PMADs likely requires more MHPs in NICUs.

Key Points

  • PMADs affect many NICU parents.

  • Systematic screening for PMADs is limited in level IV children's hospital NICUs.

  • Additional MHPs may contribute to enhanced screening and support of parents.

  • Hospitals should prioritize funds for NICU-specific MHPs to optimize outcomes.

Supplementary Material



Publication History

Received: 07 March 2024

Accepted: 20 June 2024

Accepted Manuscript online:
26 June 2024

Article published online:
29 July 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Wisner KL, Sit DK, McShea MC. et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry 2013; 70 (05) 490-498
  • 2 McKee K, Admon LK, Winkelman TNA. et al. Perinatal mood and anxiety disorders, serious mental illness, and delivery-related health outcomes, United States, 2006-2015. BMC Womens Health 2020; 20 (01) 150
  • 3 Rao WW, Zhu XM, Zong QQ. et al. Prevalence of prenatal and postpartum depression in fathers: a comprehensive meta-analysis of observational surveys. J Affect Disord 2020; 263: 491-499
  • 4 Fletcher RJ, Feeman E, Garfield C, Vimpani G. The effects of early paternal depression on children's development. Med J Aust 2011; 195 (11–12): 685-689
  • 5 Bitsko RH, Holbrook JR, Robinson LR. et al; EdS. Health care, family, and community factors associated with mental, behavioral, and developmental disorders in early childhood - United States, 2011-2012. MMWR Morb Mortal Wkly Rep 2016; 65 (09) 221-226
  • 6 Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum. Screening and diagnosis of mental health conditions during pregnancy and postpartum: ACOG clinical practice guideline no. 4. Obstet Gynecol 2023; 141 (06) 1232-1261
  • 7 Earls MF, Yogman MW, Mattson G, Rafferty J. Committee on Psychosocial Aspects of Child and Family Health. Incorporating recognition and management of perinatal depression into pediatric practice. Pediatrics 2019; 143 (01) e20183259
  • 8 Barry MJ, Nicholson WK, Silverstein M. et al; US Preventive Services Task Force. Screening for depression and suicide risk in adults: US Preventive Services Task Force Recommendation Statement. JAMA 2023; 329 (23) 2057-2067
  • 9 Hynan MT, Mounts KO, Vanderbilt DL. Screening parents of high-risk infants for emotional distress: rationale and recommendations. J Perinatol 2013; 33 (10) 748-753
  • 10 Garfield CF, Lee YS, Warner-Shifflett L, Christie R, Jackson KL, Miller E. Maternal and paternal depression symptoms during NICU stay and transition home. Pediatrics 2021; 148 (02) e2020042747
  • 11 Pace CC, Spittle AJ, Molesworth CM. et al. Evolution of depression and anxiety symptoms in parents of very preterm infants during the newborn period. JAMA Pediatr 2016; 170 (09) 863-870
  • 12 Hynan MT, Steinberg Z, Baker L. et al. Recommendations for mental health professionals in the NICU. J Perinatol 2015; 35 (Suppl. 01) S14-S18
  • 13 Toly VB, Blanchette JE, Liu W. et al. Maternal stress and mental health prior to their technology-dependent infant's discharge home from the NICU. J Perinat Neonatal Nurs 2019; 33 (02) 149-159
  • 14 Grunberg VA, Geller PA, Bonacquisti A, Patterson CA. NICU infant health severity and family outcomes: a systematic review of assessments and findings in psychosocial research. J Perinatol 2019; 39 (02) 156-172
  • 15 Obeidat HM, Bond EA, Callister LC. The parental experience of having an infant in the newborn intensive care unit. J Perinat Educ 2009; 18 (03) 23-29
  • 16 Perazzo SI, Hoge MK, Shaw RJ, Gillispie-Bell V, Soghier L. Improving parental mental health in the perinatal period: a review and analysis of quality improvement initiatives. Semin Perinatol 2024; 48 (03) 151906
  • 17 Hynan MT, Hall SL. Psychosocial program standards for NICU parents. J Perinatol 2015; 35 (suppl 1, Suppl 1): S1-S4
  • 18 Hall SL, Cross J, Selix NW. et al. Recommendations for enhancing psychosocial support of NICU parents through staff education and support. J Perinatol 2015; 35 (Suppl. 01) S29-S36
  • 19 Purdy IB, Craig JW, Zeanah P. NICU discharge planning and beyond: recommendations for parent psychosocial support. J Perinatol 2015; 35 (Suppl. 01) S24-S28
  • 20 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
  • 21 Harris PA, Taylor R, Minor BL. et al; REDCap Consortium. The REDCap consortium: building an international community of software platform partners. J Biomed Inform 2019; 95: 103208
  • 22 Johnson Rolfes J, Paulsen M. Protecting the infant-parent relationship: special emphasis on perinatal mood and anxiety disorder screening and treatment in neonatal intensive care unit parents. J Perinatol 2022; 42 (06) 815-818
  • 23 Brown M, Yamamoto T. Society for Social Work Leadership in Health Care Standards for Social Work Practice and Staffing in Children's Hospitals. Society for Social Work Leadership in Health Care; 2018
  • 24 Bloyd C, Murthy S, Song C, Franck LS, Mangurian C. National cross-sectional study of mental health screening practices for primary caregivers of NICU infants. Children (Basel) 2022; 9 (06) 793
  • 25 Jarvis L, Long M, Theodorou P, Barclay Hoffman S, Soghier L, Beers L. Perinatal mental health task force: integrating care across a pediatric hospital setting. Pediatrics 2021; 148 (06) e2021050300
  • 26 Grunberg VA, Geller PA, Hoffman C, Njoroge W, Ahmed A, Patterson CA. Parental mental health screening in the NICU: a psychosocial team initiative. J Perinatol 2022; 42 (03) 401-409
  • 27 Paulson JF, Bazemore SD. Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. JAMA 2010; 303 (19) 1961-1969
  • 28 Soghier LM, Kritikos KI, Carty CL. et al. Parental depression symptoms at neonatal intensive care unit discharge and associated risk factors. J Pediatr 2020; 227: 163-169.e1
  • 29 Discenza D. “Mental health” in the NICU: time to catch up and provide trauma-informed care for families and pros. Neonatal Netw 2017; 36 (05) 318-320
  • 30 Jarde A, Morais M, Kingston D. et al. Neonatal outcomes in women with untreated antenatal depression compared with women without depression: a systematic review and meta-analysis. JAMA Psychiatry 2016; 73 (08) 826-837
  • 31 Howard LM, Kirkwood G, Latinovic R. Sudden infant death syndrome and maternal depression. J Clin Psychiatry 2007; 68 (08) 1279-1283
  • 32 Paul IM, Downs DS, Schaefer EW, Beiler JS, Weisman CS. Postpartum anxiety and maternal-infant health outcomes. Pediatrics 2013; 131 (04) e1218-e1224
  • 33 Luca DL, Margiotta C, Staatz C, Garlow E, Christensen A, Zivin K. Financial toll of untreated perinatal mood and anxiety disorders among 2017 births in the United States. Am J Public Health 2020; 110 (06) 888-896