Parent-infant closeness after preterm birth and depressive symptoms: A longitudinal study

Liisa Lehtonen; Siri Lilliesköld; Kris De Coen; Liis Toome; Ana Gimeno; Sylvia Caballero; Rasa Tameliene; Sabine Laroche; Jana Retpap; Hege Grundt; Marie-Rose Van Hoestenberghe; Caryl Skene; Bernd Pape; Anna Axelin; Separation, Closeness Experiences in Neonatal Environment (SCENE) research group

doi:10.3389/fpsyg.2022.906531

Parent-infant closeness after preterm birth and depressive symptoms: A longitudinal study

Front Psychol. 2022 Jul 22:13:906531. doi: 10.3389/fpsyg.2022.906531. eCollection 2022.

Authors

Liisa Lehtonen^{1

2}, Siri Lilliesköld^{3

4}, Kris De Coen⁵, Liis Toome⁶, Ana Gimeno⁷, Sylvia Caballero⁸, Rasa Tameliene⁹, Sabine Laroche^{10

11}, Jana Retpap¹², Hege Grundt¹³, Marie-Rose Van Hoestenberghe¹⁴, Caryl Skene¹⁵, Bernd Pape^{16

17}, Anna Axelin^{18

19}; Separation, Closeness Experiences in Neonatal Environment (SCENE) research group

Affiliations

¹ Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland.
² Department of Clinical Medicine, University of Turku, Turku, Finland.
³ Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden.
⁴ Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
⁵ Department of Neonatal Intensive Care, Ghent University Hospital, Ghent, Belgium.
⁶ Department of Neonatal and Infant Medicine, Tallinn Children's Hospital, Tallinn, Estonia.
⁷ Neonatal Intensive Care Unit, La Fe Hospital, Valencia, Spain.
⁸ Department of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
⁹ Department of Neonatology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
¹⁰ Neonatal Intensive Care Unit, University Hospital Antwerp, Antwerp, Belgium.
¹¹ University of Antwerp, Antwerp, Belgium.
¹² Tartu University Hospital, Tartu, Estonia.
¹³ Department of Paediatrics, Haukeland University Hospital, Bergen, Norway.
¹⁴ Department of Neonatal Intensive Care, Ziekenhuis Oost-Limburg, Genk, Belgium.
¹⁵ Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
¹⁶ Turku Clinical Research Center, Turku University Hospital, Turku, Finland.
¹⁷ School of Technology and Innovations, University of Vaasa, Vaasa, Finland.
¹⁸ Department of Nursing Science, University of Turku, Turku, Finland.
¹⁹ Department of Women's and Children's Health, University of Uppsala, Uppsala, Sweden.

Abstract

Background: Preterm birth increases the risk for postpartum depression in both mothers and fathers, calling for strategies to alleviate and prevent depressive symptoms in parents of preterm infants. The aim of this study was to assess the association between early parent-infant closeness and later depressive symptoms among parents of preterm infants. We hypothesized that longer duration of closeness associate with fewer depressive symptoms in both parents.

Methods: This prospective cohort study included 23 neonatal intensive care units (NICUs) from 15 countries in 2018 to 2020. Each unit recruited families with preterm infants aiming to 30 families. The total duration of parents' presence in the NICU, and separately parent-infant skin-to-skin contact and holding, were measured using a Closeness Diary up to 14 days. The Edinburgh Postnatal Depression Scale (EPDS) was used at discharge and at 4 months corrected age of the infant.

Results: The study included 684 mothers and 574 fathers. The median presence was 469 min (Q1 258 and Q3 1,087) per 24 h for the mothers and 259 min (Q1 100 and Q3 540) for the fathers; mean EPDS scores were 9.2 (SD 5.0) and 6.3 (SD 4.4) at discharge and 6.6 (4.7) and 4.3 (4.2) at 4 months, respectively. Parents' presence and depressive symptoms varied greatly between the units. Parents' presence as the total measure, or skin-to-skin contact and holding separately, did not associate with depressive symptoms in either mothers or fathers at either time point (adjusted).

Conclusion: No association was found between the duration of parent-infant closeness in the neonatal unit and parents' depressive symptoms. The beneficial effects of family-centered care on parents' depression seem to be mediated by other elements than parent-infant physical closeness. More research is needed to identify the critical elements which are needed to alleviate parents' depression after NICU stay.

Keywords: neonatal intensive care unit; parenting; postpartum depression; preterm birth; skin-to-skin contact.