More than one-third of mothers and 1 in 6 fathers of very preterm babies experience symptoms severe enough to potentially indicate post-traumatic stress disorder (PTSD), according to a nationwide study. “If we know which parents are struggling, we can provide them with targeted support in time. That is better for both the parents and the child,” says researcher Lotte Haverman.

“Preterm birth and admission to a neonatal intensive care unit are not only major medical events, but can also leave deep emotional scars on many parents. This nationwide study shows that we need to take their symptoms seriously,” emphasizes psychologist Lotte Haverman, professor at the Emma Children’s Hospital at Amsterdam UMC.

Mental health problems
The researchers followed 446 very preterm babies, born before 29 weeks of pregnancy. Parents from 217 families completed questionnaires about their mental well-being shortly after the birth, one month later, and around the baby’s expected due date. “Although fortunately most parents are doing well, we found that a significant proportion experience mental health problems,” says Kirsten Muller, psychologist and researcher at Amsterdam UMC and Erasmus MC. She worked on the study on behalf of both university medical centers, with all Dutch intensive care units for preterm babies participating.

Actual figures likely higher
Mothers reported more symptoms on average than fathers. Around the expected due date, more than one-third of mothers experienced symptoms consistent with PTSD. Among fathers, this was approximately 1 in 6. The actual figures are likely even higher. Researcher Gerbrich van den Bosch, a neonatologist at Erasmus MC, explains: “Not all parents participated in the study. For example, parents who were not proficient in Dutch or English were unable to complete the questionnaires. We also deliberately stopped sending questionnaires to parents whose son or daughter had died. In addition, we have indications that parents experiencing the highest levels of stress did not complete the questionnaires.”

Traumatic event
Almost 40 percent of mothers showed clear signs of depression during the first weeks after birth, compared with around 20 percent of fathers. Depressive symptoms among mothers decreased somewhat over time. PTSD symptoms, however, remained strikingly high among many parents.

PTSD can develop following a highly distressing event, such as violence or a life-threatening situation. Symptoms can include reliving the event, avoidance, negative feelings, and heightened arousal or tension. These symptoms not only affect the parents’ lives, but may also affect their prematurely born child. Muller says: “We know that children’s development is influenced by how their parents are doing.”

Risk of more severe symptoms
The researchers also examined which factors increased the risk of mental health problems. Previous traumatic life events, having received psychological support in the past, high levels of stress during pregnancy, and severe stress during the baby’s hospital stay were associated with more symptoms in both parents. Among fathers, the baby’s condition, the number of children in the family, and the amount of support they perceived also played a role.

Monitoring parents’ well-being
According to the researchers, monitoring parents’ mental health should become a standard part of care surrounding preterm birth. The Emma Children’s Hospital has developed the KLIK PROM portal for this purpose: a digital system in which parents complete online questionnaires about their well-being, symptoms, and experiences. This allows healthcare professionals to immediately see during consultations how parents are doing and where additional support may be needed.

EMDR
“By identifying symptoms early, support and treatment can begin in time. That is better for both parents and their child,” says Lotte Haverman. “If we know which parents are struggling, we can offer targeted help and prevent symptoms from continuing unnecessarily for a long time.”

The study results make clear that it is important to minimize the stress experienced by parents during and after their child’s intensive care admission.

In addition, a therapy such as Eye Movement Desensitization and Reprocessing (EMDR) could potentially be offered as a standard part of care. The researchers therefore want to assess the effectiveness of EMDR for parents of preterm children. If it proves effective, it could become a routine part of their care.

HIPPO study
This research is part of the nationwide HIPPO study (Happiness for the Improvement of Premature and Parental Outcome). It is a collaboration between Amsterdam UMC, Erasmus MC, UMC Utrecht, the Neonatology Network Netherlands, and the parent and patient organization Care4Neo, with support from the VriendenLoterij. The research was carried out in all Dutch intensive care units for preterm babies.

The results were published today in the journal Pediatrics.

Read the original Dutch version on the Amsterdam UMC website.

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