DOI: https://doi.org/10.21203/rs.3.rs-1404709/v1
Background: Preterm birth is a worldwide problem that can cause changes in emotions of mothers. This study aimed to evaluate the effect of maternal anxiety and post-traumatic stress disorder symptoms on maternal care responses to preterm infants, and whether there is a mediation effect of maternal distress between preterm clinical status and maternal care responses.
Methods: This hospital-based longitudinal cohort study included 256 mother-preterm infants who came to the outpatient clinic for a follow-up check after being discharged from the neonatal intensive care unit at one month of corrected age. Mothers completed the Post-traumatic Stress Disorder Questionnaire, the Self-rating Anxiety Scale, and four sub-scales of care responses.
Results: Significant post-traumatic stress disorder and anxiety were observed in 29.7% and 15.6%, respectively, of mothers at one month of corrected age and at about 10.83 weeks postpartum. Path analysis results showed that the final model could be fitted well with sample data(c2=33.098, DF =20, P=0.033, CFI=0.992, NFI=0.981, RMSEA=0.051, SRMR= 0.029). Path analysis showed that care responses were directly and indirectly affected by preterm infants’ clinical status, maternal post-traumatic stress disorder, and anxiety. Gestational age significantly influenced maternal care responses.
Conclusion: This study identified maternal anxiety and PTSD symptoms may significant effects on maternal care responses to preterm infants at one month of corrected age. To promote the development of preterm infants after discharge from the neonatal intensive care unit, multiple disciplinary interventions should be developed to improve maternal care responses.
Table 1. Description of maternal demographic information and infants’ clinical status (N=256)
|
Mothers M [P25, P75]/ n(%) |
Infants M [P25, P75]/ n(%) |
||
|
Age(year) |
31 [29, 34] |
Gestational age (week) |
31 [29, 34] |
|
Education |
|
Birth weight(g) |
2072.50 [1551.25, 2343.75] |
|
≤High school |
95 (37.11) |
Gender |
|
|
≥College |
161(62.89) |
Male |
95 (37.11) |
|
Breastfeeding pattern |
|
Female |
161(62.89) |
|
Exclusive breasting feeding |
190 (74.22) |
Delivery model |
|
|
Non- Exclusive breasting feeding |
66 (25.78) |
Caesarean section |
190 (74.22) |
|
Parity |
|
Vaginal delivery |
66 (25.78) |
|
Primipara |
193 (75.40) |
5min Apgar |
193 (75.40) |
|
Multipara |
63 (24.60) |
Length of NICU stay (day) |
63 (24.60) |
Table 2. Descriptive statistics and correlations for infants’ clinical status, maternal emotional distress and care responses (N=256)
|
Variables |
M |
SD |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
|
1.GA |
33.16 |
2.81 |
|
|
|
|
|
|
|
|
|
2.BW |
1962.94 |
546.51 |
0.86** |
|
|
|
|
|
|
|
|
3. LOS |
25.54 |
25.70 |
-0.84** |
-0.78** |
|
|
|
|
|
|
|
4. Anxiety |
41.34 |
8.64 |
-0.53** |
-0.44** |
0.43** |
|
|
|
|
|
|
5. PTSD |
4.42 |
2.08 |
-0.60** |
-0.52** |
0.49** |
0.68** |
|
|
|
|
|
6. CMA |
41.05 |
6.96 |
0.46** |
0.37** |
-0.32** |
-0.50** |
-0.52** |
|
|
|
|
7. FLD |
36.22 |
10.26 |
-0.62** |
-0.54** |
0.48** |
0.61** |
0.60** |
-0.76** |
|
|
|
8. CME |
12.17 |
3.10 |
-0.49** |
-0.45** |
0.42** |
0.46** |
0.50** |
-0.50** |
0.62** |
|
|
9. VCI |
27.10 |
5.90 |
-0.49** |
-0.42** |
0.39** |
0.53** |
0.42** |
-0.63** |
0.76** |
0.58** |
GA, Gestational age; BW, Birth weight, LOS, length of NICU stay, PTSD, post-traumatic stress disorder; CMA, Condition Management Ability; FLD, Family life difficulty; CME, Condition Management Effort; VCI, View of Condition Impact; M = mean; SD = standard deviation. **p < .01.
Table 3. indirect effects for the overall model from infants’ clinical status, maternal emotional distress to care responses
|
|
Point estimate |
Product of coefficient |
Bootstrapping |
||||
|
Percentile 95% CI |
Bias-corrected Percentile 95% CI |
||||||
|
SE |
Z |
Lower |
Upper |
Lower |
Upper |
||
|
GA-->BW-->LOS |
-1.803 |
0.326 |
-5.523 |
-2.449 |
-1.170 |
-2.425 |
-1.145 |
|
GA-->BW-->LOS-->CMA |
-0.094 |
0.040 |
-2.352 |
-0.186 |
-0.028 |
-0.185 |
-0.027 |
|
GA-->BW-->LOS-->CMA-->DIFFICULTY |
0.074 |
0.031 |
2.381 |
0.022 |
0.144 |
0.022 |
0.147 |
|
BW-->LOS-->CMA |
-0.001 |
0.000 |
-2.337 |
-0.001 |
0.000 |
-0.001 |
0.000 |
|
BW-->LOS-->CMA-->DIFFICULTY |
0.000 |
0.000 |
2.362 |
0.000 |
0.001 |
0.000 |
0.001 |
|
LOS-->CMA-->DIFFICULTY |
-0.041 |
0.017 |
-2.453 |
-0.079 |
-0.013 |
-0.078 |
-0.012 |
|
GA-->LOS-->CMA |
-0.305 |
0.139 |
-2.192 |
-0.643 |
-0.087 |
-0.638 |
-0.085 |
|
GA-->LOS-->CMA-->DIFFICULTY |
0.239 |
0.110 |
2.179 |
0.069 |
0.508 |
0.069 |
0.508 |
|
GA-->PTSD-->CMA |
0.362 |
0.121 |
2.999 |
0.128 |
0.607 |
0.132 |
0.611 |
|
GA-->PTSD-->CMA-->DIFFICULTY |
-0.284 |
0.098 |
-2.897 |
-0.487 |
-0.098 |
-0.493 |
-0.105 |
|
PTSD-->CMA-->DIFFICULTY |
0.643 |
0.220 |
2.923 |
0.219 |
1.094 |
0.217 |
1.091 |
|
GA-->PTSD-->Anxiety |
-1.045 |
0.201 |
-5.190 |
-1.450 |
-0.668 |
-1.483 |
-0.700 |
|
GA-->PTSD-->Anxiety-->CMA |
0.189 |
0.064 |
2.965 |
0.068 |
0.321 |
0.080 |
0.333 |
|
GA-->PTSD-->Anxiety-->CMA-->DIFFICULTY |
-0.148 |
0.050 |
-2.962 |
-0.253 |
-0.052 |
-0.269 |
-0.066 |
|
PTSD-->Anxiety-->CMA |
-0.427 |
0.146 |
-2.922 |
-0.729 |
-0.150 |
-0.747 |
-0.170 |
|
PTSD-->Anxiety-->CMA-->DIFFICULTY |
0.335 |
0.115 |
2.910 |
0.116 |
0.573 |
0.134 |
0.597 |
|
Anxiety-->CMA-->DIFFICULTY |
0.142 |
0.049 |
2.874 |
0.051 |
0.242 |
0.050 |
0.241 |
|
GA-->PTSD-->Anxiety-->DIFFICULTY |
-0.264 |
0.064 |
-4.134 |
-0.392 |
-0.144 |
-0.401 |
-0.152 |
|
PTSD-->Anxiety-->DIFFICULTY |
0.596 |
0.136 |
4.381 |
0.339 |
0.867 |
0.349 |
0.882 |
|
GA-->Anxiety-->DIFFICULTY |
-0.143 |
0.056 |
-2.566 |
-0.261 |
-0.044 |
-0.265 |
-0.045 |
|
GA-->Anxiety-->CMA |
0.103 |
0.056 |
1.841 |
0.020 |
0.236 |
0.022 |
0.241 |
|
GA-->Anxiety-->CMA-->DIFFICULTY |
-0.080 |
0.044 |
-1.829 |
-0.183 |
-0.015 |
-0.192 |
-0.018 |
|
GA-->CMA-->DIFFICULTY |
-0.689 |
0.181 |
-3.810 |
-1.108 |
-0.382 |
-1.110 |
-0.383 |