Parental Uncertainty in Illness of an Infant and Perinatal Post-traumatic Stress Disorder in the NICU

Abstract

Varying and conflicting risk factors for perinatal post-traumatic stress disorder (PPTSD) have been reported in the literature in parents after having an infant in the neonatal intensive care unit (NICU). Furthermore, relationships between feelings of parental uncertainty in illness of an infant in the NICU and PPTSD in parents have not been established. The purpose of this study was to (a) investigate the factor structure underlying parental perception of uncertainty scale (PPUS) in a sample of parents in the NICU; (b) describe how parental uncertainty in illness changes throughout the NICU course and after discharge; (c) evaluate if infant illness severity correlates with higher scores of perceptions of uncertainty in illness at three points in time; (d) assess if parental and/or infant clinical characteristics correlate with screening positive for PPTSD three months after NICU discharge; and (e) explore if more parents who experience high levels of uncertainty about their infant’s illness screen positive for PPTSD. The Uncertainty in Illness Theory guided this research. A sample of 176 parent-infant dyads participated in this prospective, longitudinal, correlational study. The confirmatory factor analysis of the PPUS demonstrated that the four-factor structure and a shorter, two factor model, fits in the sample. Parental uncertainty in illness decreased over time for most parents, though less decrease was associated with social determinants of health and gestational age of infant. Screening positive for PPTSD was associated with both parental and infant characteristics. In the final regression, history of mental health illness (p = 0.015; 95% CI 0.05-0.45), elevated postpartum depression screening scores (p = 0.003; 95% CI 0.096-0.436), and uncertainty after discharge (p = 0.05; 95% CI 0.00-0.13), were associated with screening positive for PPTSD. Healthcare providers in the NICU need to assess parental mental health and assist in development of healthy coping strategies.