title: Maternally administered interventions for preterm infants in the NICU: effects on maternal psychological distress and mother-infant relationship.
abstract: Although studies have examined the effects of interventions focused on preterm infants, few studies have examined the effects on maternal distress (anxiety, depressive symptoms, post-traumatic stress symptoms, parenting stress) or parenting. This study examined the effects of the auditory-tactile-visual-vestibular (ATVV) intervention and kangaroo care (KC) on maternal distress and the mother-infant relationship compared to an attention control group. 240 mothers from four hospitals were randomly assigned to the three groups. Maternal characteristics in the three groups were similar: 64.1% of ATVV mothers, 64.2% of KC mothers, and 76.5% of control mothers were African American; maternal age averaged 26.3 years for ATVV mothers, 28.1 for KC mothers, and 26.6 for control mothers; and years of education averaged 13.6 for ATVV and KC mothers, and 13.1 for control mothers. Mothers only differed on parity: 68.4% of ATVV and 54.7% of KC mothers were first-time mothers as compared to 43.6% of control mothers. Their infants had a similar mean gestational ages (27.0 weeks for ATVV, 27.2 for KC, and 27.4 for control) and mean birthweights (993 g for ATVV, 1022 for KC, and 1023 for control). Mothers completed questionnaires during hospitalization, and at 2, 6 and 12 months corrected age on demographic characteristics, depressive symptoms, state anxiety, post-traumatic stress symptoms, parenting stress, worry about child health, and child vulnerability (only at 12 months). At 2 and 6 months, 45-min videotapes of mother-infant interactions were made, and the HOME Inventory was scored. Behaviors coded from the videotapes and a HOME subscale were combined into five interactive dimensions: maternal positive involvement and developmental stimulation and child social behaviors, developmental maturity, and irritability. Intervention effects were examined using general linear mixed models controlling for parity and recruitment site. The groups did not differ on any maternal distress variable. Kangaroo care mothers showed a more rapid decline in worry than the other mothers. The only interactive dimensions that differed between the groups were child social behaviors and developmental maturity, which were both higher for kangaroo care infants. Change over time in several individual infant behaviors was affected by the interventions. When mothers reported on the interventions they performed, regardless of group assignment, massage (any form including ATVV) was associated with a more rapid decline in depressive symptoms and higher HOME scores. Performing either intervention was associated with lower parenting stress. These findings suggest that as short-term interventions, KC and ATVV have important effects on mothers and their preterm infants, especially in the first half of the first year.
authors.affiliation: School of Nursing, Duke University, Durham, NC 27710, United States. Electronic address: Diane.hd@duke.edu.
authors.forename: Diane
authors.initials: D
authors.lastname: Holditch-Davis
authors.affiliation: Children's Hospital of Wisconsin and the College of Nursing, University of Illinois at Chicago, Chicago, IL 60607, United States.
authors.forename: Rosemary C
authors.initials: RC
authors.lastname: White-Traut
authors.affiliation: School of Nursing, Duke University, Durham, NC 27710, United States.
authors.forename: Janet A
authors.initials: JA
authors.lastname: Levy
authors.affiliation: Wake Forest School of Medicine, Winston Salem, NC 27157, United States.
authors.forename: T Michael
authors.initials: TM
authors.lastname: O'Shea
authors.affiliation: Mount Sinai Children's Hospital, Chicago, IL 60608, United States.
authors.forename: Victoria
authors.initials: V
authors.lastname: Geraldo
authors.affiliation: College of Medicine, University of Illinois at Chicago, Chicago, IL 60607, United States; Stroger Hospital, Chicago, IL 60612, United States.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: David
mesh_terms: D000328:Adult; D001288:Attention; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000523:psychology; D007231:Infant, Newborn; D007234:Infant, Premature / Q000523:psychology*; D007362:Intensive Care Units; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal / Q000523:psychology*; D008137:Longitudinal Studies; D008297:Male; D009034:Mother-Child Relations / Q000523:psychology*; D009035:Mothers; D013315:Stress, Psychological / Q000523:psychology*
keywords: Auditory–tactile–visual–vestibular intervention; Infant massage; Kangaroo care; Maternal psychological distress; Mother–infant interactions; Preterm infants