This study investigated the relationship between mothers’ dispositional mindfulness and the level of parental stress of mothers with newborns admitted in the NICU and the relationship between mothers’ dispositional mindfulness and mother-infant bonding.
Design and participants
A cross-sectional study design was used with anonymous questionnaires that were completed between April 9, 2019 and September 11, 2019. The participants of the study were mothers of the neonates admitted in the NICUs in three governmental, academic hospitals in Qom city in IRAN. Purposeful and sequential sampling was performed until the sample size was completed. Mothers of all infants who met inclusion criteria (birth gestational age < 35 weeks, expected length of stay in NICU at least 10 days, mother Persian-speaking and have not specific illnesses and were not admitted to another ward, having at least one baby meeting in the NICU), and confirmed the informed consent were offered the opportunity to participate.
Ethical approval for this study was obtained from Ethical Committee of Qom University of Medical Sciences, Qom. Iran (IR.MUQ.REC.1398.006).
To obtain data, the researcher (who had no previous contact) approached the mothers at a time when they were visiting but not holding their baby, and when not involved with other NICU person and provided the qquestionnaires and was available for any explanation.
General Demographic and infant clinical data Form: A researcher created infant clinical data collection form (birth gestational age, birth weight, delivery type, apgar scores, diagnoses, length of stay) and parental demographic data form (age, educational level, job, insurance, presence of other children, history of depression/anxiety, perception of support) completed by mother.
Parental Stressor Scale: NICU (PSS:NICU) : Sources of parents’ stress were measured by using the Parental Stressor Scale: Neonatal Intensive Care Unit(PSS:NICU, 2002), a well-established self-report survey in which parents rated sources of stress by using a Likert scale (1 = not at all stressful, 5 = extremely stressful) within 3 domains: Infant Behavior and Appearance (17 items), Sights and Sounds (6 items), and Parental Role Alterations (11 items) (20). The higher score in this questionnaire, show the greater experience of stress.
Construct validity of the PSS: NICU has been demonstrated through correlation with measures of state anxiety (r = 0.46-0.61, P <.001) (21). Internal consistency of the PSS: NICU is reported as α greater than 0.70 for all domain scales and α equal to 0.89 to 0.90 for the entire instrument (20). The validity and reliability of the instrument have been previously confirmed in a study by Hosseini et al in Iran (22) In the present study, the Cronbach's alpha for 30 mothers was reported to be 88%.
Five Facets of Mindfulness Questionnaire(FFMQ): Five Facets of Mindfulness Questionnaire (15) is a 39-item self-report measure based on a factor analytic study of five independently developed mindfulness questionnaires. Analysis of these five mindfulness questionnaires yielded five factors that capture core aspects of mindfulness: (1) observing, (2) describing, (3) acting with awareness, (4) non-judging of inner experience, and (5) non-reacting to inner experience. Items were rated on a 5-point Likert scale ranging from 1 (never or very rarely true) to 5 (very often or always true). The scales may be combined for an overall level of dispositional Mindfulness with a sum score ranging from 39 to 195. Prior work has established that the subscales demonstrate good internal consistency ranging from .75 to .91(15). The Cronbach’s alpha for the full scale for this study was 0.84.
The Postpartum Bonding Questionnaire (PBQ): (PBQ) is a 25-item scale reflecting a mother’s feelings or attitudes towards her baby (e.g. ‘‘I feel close to my baby’’, ‘‘My baby irritates me’’) (23). Participants rated how often they agreed with these statements on a 6-point Likert scale ranging from always (score=0) to never (score=5) When the statement reflects a negative emotion or attitude, the scoring is reversed, so low scores denoting good bonding. The PBQ has four subscales which reflect impaired bonding (Scale 1) (12 items, ranging from 0 to 60), rejection and anger (Scale 2) (7 items, scores ranging from 0 to 35), anxiety about care (Scale 3) (4 items, scores ranging from 0 to 20) and risk of abuse (Scale 4) (2 items, scores ranging from 0 to 10). Brockington et al. (2001) suggest cut-off scores to identify problematic bonding of 12 for Scale 1, 17 for Scale 2, 10 for Scale 3 and 3 for Scale 4 and for the entire scale 38(23). In previous studies in Iran the validity and reliability of this instrument were reported as acceptable(24,25). In the present study, the Cronbach's alpha for the whole instrument was calculated 0.87, and for the components of impaired bonding 0.63, rejection and anger0.75, anxiety about care 0.73 and risk of abuse0.70, respectively.
Multivariate regression model was used to examine the relationships between variables by moderating the effect of independent variables, Multi collinearity analysis of variance inflation factor was used, all cases had a VIF <2. Residual plots versus predicted values were used to evaluate the regression models. The above analyzes were performed in R 3.6.1 at 95% confidence level. Based on the regression results, variables of maternal age, maternal education, and length of stay in the NICU were estimated as demographic factors related to the graft variable, in order to modify their effect, the relationship between the other variables with the linkage variable was examined further by modifying the effect of these three variables.