Depression Contributes to Missed Maternal Visits to NICU

Mothers who miss visitation with their infants in the neonatal intensive care unit (NICU) may be experiencing post-partum depression, according to a new study from Cleveland Clinic Children’s. Specifically, for moms whose infant is in the NICU, missing 3.5 or more visitation days in the first month of life is strongly associated with a diagnosis of maternal depression. The study will be presented at the American Academy of Pediatrics 2019 National Conference & Exhibition.

NICU mothers are an especially vulnerable group

Parents of newborns who require neonatal intensive care unit (NICU) stays are especially vulnerable to developing depression, severe anxiety and stress. Unfortunately, current screening tools may fail to identify mothers experiencing mental health issues. Left untreated, these mental health issues can have a life-long effect on both mother and baby.

“For babies born pre-term, the medical piece is certainly important,” states Barbara Gareau, LISW-S, a social worker at Cleveland Clinic Fairview Hospital’s NICU and co-author on the study. “But we cannot duplicate a parent’s voice or touch. “

Previous studies suggest that maternal mental health issues may mean that a mom is less sensitive to the needs of her infant, and can also contribute to infant feeding and sleeping issues. As a whole, maternal mental health issues may negatively impact neurodevelopmental outcomes.

Strong association between missed visitation days and depression

This new study is part of a quality improvement project to assess and address the unmet needs of NICU parents. As part of this project, licensed independent social workers administer a validated, 21-item Depression, Anxiety and Stress (DASS-21) questionnaire to all mothers of infants admitted to the NICU for at least 12 days. Beginning the fourth day of the NICU stay — when mothers have been discharged — researchers recorded the number of maternal missed days in the first month of life. Among the 18 mothers included in the study, the DASS-21 identified three cases of depression, six cases of anxiety and stress each. While there was no correlation between anxiety or stress and maternal visitation, there was a strong relationship between missing visits for 3.5 days or more and maternal depression.

“This work draws attention to the fact that visitation of mothers in the NICU could be a criterion that may be utilized to look for mental distress in mothers,” states Anirudha Das, MD, a neonatologist with Cleveland Clinic Children’s and senior author on the study. “The study provides a cut-off value of 3.5 days of missed visitation beyond which a highly sensitive and specific prediction could be made about maternal mental distress.”

It’s important to note that this study analyzed a small group of new mothers, and did not consider socioeconomic status or the distance from home to hospital. Additionally, the study did not establish causation.

“While there are times when untreated depression may keep a new mother from visiting, the incidence of depression in this population may have been higher because mom was feeling guilty or disconnected from her baby because she wasn’t able to visit.” says Samantha Bastain, LISW-S, a co-author on the study. “Additionally, we see a lot of barriers to visitation that are not necessarily related to depression, including addiction, financial issues related to jobs, vehicles and the cost of parking and childcare. When we see that a mom hasn’t been in to visit with her baby in a few days, we try to reach out to see what might be keeping her away.”

Cleveland Clinic Children’s caregivers do their best to alleviate stressors that may prevent new mothers from visiting, such as finding convenient parking or a quiet place for pumping breastmilk. Social workers lead a parent advisory committee, encourage peer-to-peer mentoring and support, promote the use of the Ronald McDonald’s room for overnight stays, and screen for depression and other mental health issues.

“I saw a patient recently who was having trouble visiting,” notes Ms. Gareau. “When I checked in with the mother, who was a single woman living in a different county, she mentioned that her family had only one car for three adults. We were happy to be able to send an Uber to pick the mom up and bring her to the hospital visit her baby.”

Dr. Das and the caregiving team at Cleveland Clinic Children’s plan to continue this research by including more mothers and publish the findings. “We also plan to investigate the association of maternal mental distress with long-term neurodevelopmental outcomes in the NICU infants,” Dr. Das says.