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Forgotten Parent: NICU Paternal Emotional Response

Mackley, Amy B. MSN, PCNS-BC, RNC-NIC, CCRC; Locke, Robert G. DO; Spear, Michael L. MD; Joseph, Rachel MSN

Section Editor(s): Catlin, Anita

doi: 10.1097/ANC.0b013e3181e946f0
Ethical Issues In Newborn Care

PURPOSE: To evaluate and compare the presence of perceived paternal stress and depressive symptomatology in fathers of preterm infants over time.

SUBJECTS: Fathers of NICU infants born before 30 weeks of gestation.

DESIGN: Prospective convenience sample.

METHODS: Consenting fathers were given 2 self-report questionnaires: Center for Epidemiologic Studies-Depression Scale (CES-D) and Parent Stressor Scale: Infant Hospitalization (PSS:IH) on 7th (time 1), 21st (time 2), and 35th (time 3) days of life. Objective measurement of illness severity was quantified by Score for Neonatal Acute Physiology. Statistical methods included generalized linear estimating equation and mixed linear modeling.

MAIN OUTCOME MEASURES: Stress and depressive symptomatology in fathers of preterm infants.

RESULTS: Stress scores (PSS:IH) were unchanged over time (P = .62) indicating that fathers (n = 35) remain significantly stressed. Individual subcomponents of stress (parent role alteration, infant appearance/behavior, NICU sights/sounds) also remained constant over the study period (P = .05 for each). Stress scores over time were not modified by demographic characteristics (marriage, education, insurance). Mean depressive symptomatology scores (CES-D) decreased over time (P = .04). The percentage of fathers with elevated CES-D scores (>16) decreased from a baseline 60% but did not diminish between times 2 (39%) and 3 (36%). Parent Stressor Scale: Infant Hospitalization stress scores were correlated with CES-D depressive symptomatology scores (P < .01). Socioeconomic factors influenced initial CES-D scores, but only marriage ameliorated subsequent changes in measurements. Objective measurement of infant illness (Score for Neonatal Acute Physiology) did not influence paternal CES-D or PSS:IH scores.

CONCLUSION: Fathers of premature infants in a medical NICU demonstrated elevated levels of stress that persisted across time for all domains of measured stress. Paternal self-reported stress and depressive symptomatology was independent of infant illness. One third of fathers had persistently elevated CES-D scores. If these findings are representative of general NICU population, then the emotional needs of our fathers are not being fully addressed.

Division of Neonatology, Christiana Care Health Systems, Newark (Ms Mackley and Messrs Locke and Spear), Division of Neonatology, Alfred .I duPont Hospital for Children, Wilmington (Messrs Locke and Spear and Ms Joseph), Delaware; and Department of Pediatrics, Thomas Jefferson University, Jefferson Medical College, Philadelphia (Mr Locke and Mr Spear).

Correspondence: Amy B. Mackley, MSN, PCNS-BC, RNC-NIC, CCRC, Division of Neonatology, Christiana Care Health Systems, 4745 Ogletown-Stanton Rd, MAP-1, Ste 217, Newark, DE 19713 (

This research was conducted at Christiana Hospital, Christiana Care Health System in Newark, Delaware.

© 2010 National Association of Neonatal Nurses