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Infant, Maternal, and Neighborhood Predictors of Maternal Psychological Distress at Birth and Over Very Low Birth Weight Infants' First Year of Life

Greene, Michelle M. PhD*; Schoeny, Michael PhD; Rossman, Beverly PhD, RN; Patra, Kousiki MD; Meier, Paula P. PhD, RN; Patel, Aloka L. MD

Journal of Developmental & Behavioral Pediatrics: October/November 2019 - Volume 40 - Issue 8 - p 613–621
doi: 10.1097/DBP.0000000000000704
Original Article

Objective: To use a social-ecological conceptualization to analyze change of maternal distress, defined as depression, anxiety, and perinatal-specific post-traumatic stress (PPTS), across very low birth weight (VLBW) infants' first year of life and to identify infant, maternal, and neighborhood predictors of these changes over time.

Methods: Mothers of VLBW infants (n = 69) completed psychological distress questionnaires 2 to 4 weeks after infant birth, 2 weeks before infant discharge from neonatal intensive care unit, and at infants' 4- and 8-month corrected age (age adjusted for prematurity). Infant and maternal sociodemographic data were collected from medical chart review. Neighborhood data were obtained through US census data. Multilevel linear growth modeling was used to (1) predict unstandardized estimates of mothers' initial levels of depression, anxiety, and PPTS at the time of infant's birth and the rate of change of these markers of distress over time and (2) model unstandardized estimates of infant, maternal, and neighborhood as predictors of distress at infants' birth and change over time.

Results: Unstandardized estimates from multilevel linear growth modeling revealed depression (−2.8), anxiety (−1.4), and PPTS (−0.7) declined over infants' first year of life (<0.001). Mothers residing in lower-income homes and neighborhoods, respectively, reported lower anxiety (−11.2, p = 0.03) and PPTS (−31.1, p = 0.01) at infant birth. Greater infant birth weight predicted both lower anxiety (−0.02, p = 0.02) and lower PPTS (−0.02, p = 0.005).

Conclusion: Mothers psychologically recover over VLBW infants' first year of life. Results add to a building literature about socioeconomically disadvantaged mothers of preterm infants, reporting lower distress; this warrants additional research.

*Department of Pediatrics and Behavioral Sciences, Rush University Medical Center, Chicago, IL;

College of Nursing, Rush University Medical Center, Chicago, IL;

Department of Pediatrics, Rush University Medical Center, Chicago, IL.

Address for reprints: Michelle M. Greene, PhD, Department of Pediatrics and Behavioral Sciences, Rush University Medical Center, 1653 W Congress Parkway, Kellogg 1200, Chicago, IL 60612; e-mail:

This manuscript was supported by a grant from the National Institutes of Health (#NR010009) awarded to the fifth author, a grant from the National Institutes of Child Health and Human Development (#R03HD081412) awarded to the senior author, and a grant from Rush University Medical Center's Departments of Adult Health and Gerontologic Nursing and Women, Children and Family Nursing awarded to the first and third authors. For the remaining authors, no other sources of support were declared.

Disclosure: The authors declare no conflict of interest.

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Received December 13, 2018

Accepted April 24, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.