The Incidence and Risk Factors Associated with Posttraumatic Stress Disorders among Parents of NICU Hospitalized Preterm Neonates

Document Type : Original Article


1 Maternal, Fetal, and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Neonatology, Yas Women Hospital, Tehran University of Medical Sciences, Tehran, Iran

3 Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran


Background: Parents of preterm neonates are exposed to great stress that can lead to posttraumatic stress disorder. The current study aimed to assess the incidence of posttraumatic stress disorders (PTSD) in both mothers and fathers of preterm infants.
Methods: A prospective cohort study was done at two Iranian hospitals in 2016. One hundred and sixty parents of preterm neonates entered the study. A questionnaire related to acute stress disorder (ASD) was completed for parents at days 3-5 after birth. One month later, the parents were asked for the second interview. Prenatal posttraumatic stress questionnaire (PPQ) for mothers and posttraumatic stress disorder checklist (PCL) for fathers were completed. Prevalence of PTSD among the mothers and fathers was compared.
Results: According to the results, 32.5% of all mothers and 4% of all fathers showed ASD. After a month, 40% of the mothers and 21.5% of the fathers showed PTSD. A significant correlation was seen between PPQ and PCL scores (P<0.001). There were also significant correlations between both father’s and mother’s ASD scores with mother’s PPQ score (P=0.019, P<0.001). The PPQ scores among employed mothers and mothers with unemployed husbands were significantly higher than others (P=0.038, OR=2.46; P=0.02, OR=0.436). A history of an accident during recent years for mother could change both mother's ASD and PPQ scores (P=0.002, OR=0.133; P=0.002, OR=0.15). Both PPQ and PCL scores also increased by father's history of an accident during recent years (P=0.02, OR=0.541; P=0.01, OR=0.325).
Conclusion: The ASD and PTSD among mothers were more frequent than in fathers. Fathers indicated delayed onset of PTSD in comparison with mothers.


1. Ghorbani M, Dolatian M, Shams J, Alavi-Majd H. Anxiety, post-traumatic stress disorder and social supports among parents of premature and full-term infants. Iran Red Crescent Med J. 2014; 16(3): e13461.
2. Ghorbani M, Dolatian M, Shams J, Alavi-Majd H, Tavakolian S. Factors associated with posttraumatic stress disorder and its coping styles in parents of preterm and full-term infants. Glob J Health Sci. 2014; 6(3):65-73.
3. Mandy GT. Incidence and mortality of the preterm infant. Massachusetts: UpToDate; 2017.
4. Wilson-Costello D, Payne A. Long-term neurodevelo-pmental outcome of preterm infants: epidemiology and risk factors. Massachusetts: UpToDate; 2017.
5. Holditch-Davis D, Santos H, Levy J, White-Traut R, O'Shea TM, Geraldo V, et al. Patterns of psychological distress in mothers of preterm infants. Infant Behav Dev. 2015; 41:154-63.
6. Gondwe KW, Holditch-Davis D. Posttraumatic stress symptoms in mothers of preterm infants. Int J Afr Nurs Sci. 2015; 3:8-17.
7. Shaw RJ, Lilo EA, Storfer-Isser A, Ball MB, Proud MS, Vierhaus NS, et al. Screening for symptoms of postpartum traumatic stress in a sample of mothers with preterm infants. Issues Ment Health Nurs. 2014; 35(3):198-207.
8. Misund AR, Nerdrum P, Diseth TH. Mental health in women experiencing preterm birth. BMC Pregnancy Childbirth. 2014; 14:263.
9. Greene MM, Rossman B, Patra K, Kratovil AL, Janes JE, Meier PP. Depression, anxiety, and perinatal-specific posttraumatic distress in mothers of very low birth weight infants in the neonatal intensive care unit. J Dev Behav Pediatr. 2015; 36(5):362-70.
10. Habersaat S, Borghini A, Nessi J, Pierrehumbert B, Forcada-Guex M, Ansermet F, et al. Posttraumatic stress symptoms and cortisol regulation in mothers of very preterm infants. Stress Health. 2014; 30(2):134-41.
11. Gangi S, Dente D, Bacchio E, Giampietro S, Terrin G, De Curtis M. Posttraumatic stress disorder in parents of premature birth neonates. Proc Soc Behav Sci. 2013; 82:882-5.
12. Borghini A, Habersaat S, Forcada-Guex M, Nessi J, Pierrehumbert B, Ansermet F, et al. Effects of an early intervention on maternal post-traumatic stress symptoms and the quality of mother-infant interaction: the case of preterm birth. Infant Behav Dev. 2014; 37(4):624-31.
13. The Australian Psychological Society, The Royal Australian College of General Practitioners, The Royal Australian and New Zealand College of Psychiatrists. Australian guidelines for the treatment of acute stress disorder & posttraumatic stress disorder. Australia: National Health and Medical Research Council; 2015. 14. Shaw RJ, St John J, Lilo EA, Jo B, Benitz W, Stevenson DK, et al. Prevention of traumatic stress in mothers with preterm infants: a randomized controlled trial. Pediatrics. 2013, 132(4):886-94.
15. Aftyka A, Rybojad B, Rosa W, Wróbel A, Karakuła-Juchnowicz H. Risk factors for the development of post-traumatic stress disorder and coping strategies in mothers and fathers following infant hospitalisation in the neonatal intensive care unit. J Clin Nurs. 2017; 26(23-24):4436-45.
16. Chang HP, Chen JY, Huang YH, Yeh CJ, Huang JY, Su PH, et al. Factors associated with post-traumatic symptoms in mothers of preterm infants. Arch Psychiatr Nurs. 2016; 30(1):96-101.
17. Feeley N, Hayton B, Gold I, Zelkowitz P. A comparative prospective cohort study of women following childbirth: mothers of low birth weight infants at risk for elevated PTSD symptoms. J Psychosom Res. 2017; 101:24-30.
18. Van Vliet IM, De Beurs E. The MINI-International Neuropsychiatric Interview. A brief structured diagnostic psychiatric interview for DSM-IV en ICD-10 psychiatric disorders. Tijdschr Psychiatr. 2007; 49(6):393-7.
19. Santana MR, Zatti C, Spader ML, Malgarim BG, Salle E, Piltcher R. Acute stress disorder and defense mechanisms: a study of physical trauma patients admitted to an emergency hospital. Trends Psychiatry Psychother. 2017; 39(4):247-56.
20. Shelby RA, Golden-Kreutz DM, Andersen BL. Mismatch of posttraumatic stress disorder (PTSD) symptoms and DSM-IV symptom clusters in a cancer sample: exploratory factor analysis of the PTSD checklist-civilian version. J Trauma Stress. 2005; 18(4):347-57.
21. Abedian Z, Soltani N, Mokhber N, Esmaily H. Comparing post-traumatic stress disorder in primiparous and multiparous women with preeclampsia. J Midwifery Reprod Health. 2013; 1(1):13-8.
22. Mirzamani M, Mohammadi MR, Besharat MA. Application of the PTSD symptoms scale (PSS) for Iranian PTSD patients. Med J Islamic Republic Iran. 2006; 19(4):345-8.
23. Goutaudier N, Lopez A, Séjourné N, Denis A, Chabrol H. Premature birth: subjective and psychological experiences in the first weeks following childbirth, a mixed-methods study. J Reprod Infant Psychol. 2011; 29(4):364-73.
24. Shaw RJ, Bernard RS, Deblois T, Ikuta LM, Ginzburg K, Koopman C. The relationship between acute stress disorder and posttraumatic stress disorder in the neonatal intensive care unit. Psychosomatics. 2009; 50(2):131-7.
25. Lefkowitz DS, Baxt C, Evans JR. Prevalence and correlates of posttraumatic stress and postpartum depression in parents of infants in the Neonatal Intensive Care Unit (NICU). J Clin Psychol Med Settings. 2010; 17(3):230-7.
26. Le Gouëz M, Alvarez L, Rousseau V, Hubert P, Abadie V, Lapillonne A, et al. Posttraumatic stress reactions in parents of children esophageal atresia. PloS One. 2016; 11(3):e0150760.
27. Shaw RJ, Deblois T, Ikuta L, Ginzburg K, Flisher B, Koopman C. Acute stress disorder among parents of infants in the neonatal intensive care nursery. Psychosomatics. 2006; 47(3):206-12.
28. Candelori C, Trumello C, Babore A, Keren M, Romanelli R. The experience of premature birth for fathers: the application of the Clinical Interview for Parents of High-Risk Infants (CLIP) to an Italian sample. Front Psychol. 2015; 6:1444.
29. Carter JD, Mulder RT, Bartram AF, Darlow BA. Infants in a neonatal intensive care unit: parental response. Arch Dis Child Fetal Neonatal Ed. 2005; 90(2):109-13.
30. Brandon DH, Tully KP, Silva SG, Malcolm WF, Murtha AP, Turner BS, et al. Emotional responses of mothers of late‐preterm and term infants. J Obstet Gynecol Neonatal Nurs. 2011; 40(6):719-31.
31. Verreault N, Da Costa D, Marchand A, Ireland K, Banack H, Dritsa M, et al. PTSD following childbirth: a prospective study of incidence and risk factors in Canadian women. J Psychosom Res. 2012; 73(4):257-63. 32. Shaban Z, Dolatian M, Shams J, Alavi-Majd H, Mahmoodi Z, Sajjadim H. Post-traumatic stress disorder (PTSD) following childbirth: prevalence and contributing factors. Iran Red Crescent Med J. 2013; 15(3):177-82.