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Patterns of Distress in African-American Mothers of Preterm Infants

Holditch-Davis, Diane PhD, RN, FAAN*; Miles, Margaret Shandor PhD, RN, FAAN; Weaver, Mark A. PhD; Black, Beth PhD, RN; Beeber, Linda PhD, RN, FAAN; Thoyre, Suzanne PhD, RN; Engelke, Stephen MD§

Journal of Developmental & Behavioral Pediatrics: June 2009 - Volume 30 - Issue 3 - p 193-205
doi: 10.1097/DBP.0b013e3181a7ee53
Original Article

Objective: To examine inter-relationships among stress due to infant appearance and behavior in the neonatal intensive care unit (NICU), parental role alteration stress in the NICU, depressive symptoms, state anxiety, posttraumatic stress symptoms, and daily hassles exhibited by African-American mothers of preterm infants and to determine whether there were subgroups of mothers based on patterns of psychological distress.

Method: One hundred seventy-seven African-American mothers completed questionnaires on their psychological distress at enrollment during infant hospitalization and 2, 6, 12, 18, and 24 months after term.

Results: Psychological distress measures were intercorrelated. There were four latent classes of mothers: the low distress class with low scores on all measures; the high NICU-related stress class with high infant appearance and parental role stress and moderate scores on other measures; the high depressive symptoms class with high depressive symptoms and state anxiety and moderately elevated scores on NICU-related stress and posttraumatic stress symptoms; the extreme distress class with the highest means on all measures. Infants in the high stress class were sicker than infants in the other classes. The extreme distress class mothers averaged the lowest educational level. The classes differed on distress measures, worry about the child, and parenting stress through 24 months with the extreme distress class having the highest values.

Conclusion: Although different types of maternal psychological distress were substantially related, there were distinct subgroups of mothers that were identifiable in the NICU. Moreover, these subgroups continued to differ on trajectories of distress and on their perceptions of the infants and parenting through 24 months after term.

From the *School of Nursing, Duke University, Durham, NC; †School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC; ‡Family Health International, Durham, NC; §Division of Neonatology, Department of Pediatrics, School of Medicine, East Carolina University, Greenville, NC.

Received August 2008; accepted February 2009.

This study was supported by Grant R01 NR005263 from the National Institute for Nursing Research, NIH.

Address for reprints: Diane Holditch-Davis, PhD, RN, FAAN, Duke University School of Nursing, 307 Trent Drive, DUMC 3322, Durham, NC 27710; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.