Hostname: page-component-8448b6f56d-jr42d Total loading time: 0 Render date: 2024-04-24T07:46:42.345Z Has data issue: false hasContentIssue false

Role alteration predicts anxiety and depressive symptoms in parents of infants with congenital heart disease: a pilot study

Published online by Cambridge University Press:  05 April 2021

Amy J. Lisanti*
Affiliation:
Children’s Hospital of Philadelphia, Nursing and Clinical Care Services, Philadelphia, PA, USA University of Pennsylvania School of Nursing, Philadelphia, PA, USA
Aparna Kumar
Affiliation:
Thomas Jefferson University College of Nursing, Philadelphia, PA, USA
Ryan Quinn
Affiliation:
University of Pennsylvania School of Nursing, Philadelphia, PA, USA
Jesse L. Chittams
Affiliation:
University of Pennsylvania School of Nursing, Philadelphia, PA, USA
Barbara Medoff-Cooper
Affiliation:
Children’s Hospital of Philadelphia, Nursing and Clinical Care Services, Philadelphia, PA, USA University of Pennsylvania School of Nursing, Philadelphia, PA, USA
Abigail C. Demianczyk
Affiliation:
Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
*
Author for correspondence: Amy J. Lisanti, Children’s Hospital of Philadelphia, Nursing and Clinical Care Services, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA. Tel: +1 610-368-4788; Fax: +1 267-426-7385. Email: lisanti@chop.edu

Abstract

Background:

Parents of infants born with critical congenital heart disease are at risk for adverse mental health symptoms. The purpose of this study was to identify infant-, parent-, and environmental-based stressors for mothers and fathers after their infants’ cardiac surgery, and to explore relationships between stressors and mental health symptoms of anxiety and depression.

Methods:

This study enrolled 28 biological mother-father dyads from families admitted to the paediatric cardiac intensive care unit for cardiac surgery at one free-standing children’s hospital in the Northeast. Paired t-tests were used to examine group differences between mothers and fathers on perceived stressors and mental health symptoms, while linear mixed effects modelling was used to explore the predictive relationship between perceived stressors, personal factors, and mental health symptoms.

Results:

Mothers reported higher perceived stressor scores of parental role alteration (t = 4.03, p < 0.01) and infant appearance and behaviour (t = 2.61, p = 0.02), and total perceived stress (t = 2.29 p = 0.03), compared to fathers. Mothers also reported higher anxiety (t = 2.47, p = 0.02) and depressive symptoms (t = 3.25, p < 0.01) than fathers. In multivariable analysis, parental role alteration significantly predicted anxiety (t = 5.20, p < 0.01, d = 0.77) and depressive symptoms (t = 7.09, p < 0.01, d = 1.05) for mothers and fathers. The consensus subscale of the Dyadic Adjustment Scale also significantly predicted depressive symptoms (t = −2.42, p = 0.02, d = 0.04).

Conclusion:

Parents were distressed during their infant’s admission for surgical repair for critical congenital heart disease. Parental role alteration was significantly associated with parental anxiety and depressive symptoms, while poor relationship quality was associated with depressive symptoms, highlighting areas for potential nursing-led psychosocial led interventions.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Suggested tweet: Parental role alteration influences mental health symptoms of both mothers and fathers of critically ill infants with CHD @amyjolisanti @ChildrensPhila @CardiologyYoung @NewbornCardiac @cardiacneuro #pedsICU #CHD #pedscards

References

Virani, SS, Alonso, A, Benjamin, EJ, et al. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation 2020; 141: e139e596.CrossRefGoogle ScholarPubMed
Best, KE, Rankin, J. Long-term survival of individuals born with congenital heart disease: a systematic review and meta-analysis. J Am Heart Assoc 2016; 5: e002846.CrossRefGoogle ScholarPubMed
Marino, BS, Lipkin, PH, Newburger, JW, et al. Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement from the American Heart Association. Circulation 2012; 126: 11431172.CrossRefGoogle ScholarPubMed
Colville, GA, Gracey, D. Mothers’ recollections of the paediatric intensive care unit: associations with psychopathology and views on follow up. Intensive Crit Care Nurs 2006; 22: 4955.CrossRefGoogle ScholarPubMed
Re, JM, Dean, S, Mullaert, J, Guedeney, A, Menahem, S. Maternal distress and infant social withdrawal (ADBB) following infant cardiac surgery for congenital heart disease. World j Pediatr Congenital Heart Surg 2018; 9: 624637.CrossRefGoogle ScholarPubMed
Re, J, Dean, S, Menahem, S. Infant cardiac surgery: mothers tell their story: a therapeutic experience. World J Pediatr Congenital Heart Surg 2013; 4: 278285.CrossRefGoogle ScholarPubMed
Rempel, GR, Ravindran, V, Rogers, LG, Magill-Evans, J. Parenting under pressure: a grounded theory of parenting young children with life-threatening congenital heart disease. J Adv Nurs 2013; 69: 619630.CrossRefGoogle ScholarPubMed
Wernovsky, G, Licht, DJ. Neurodevelopmental outcomes in children with congenital heart disease-what can we impact? Pediatr Crit Care Med 2016; 17 (8 Suppl 1): S232S242.CrossRefGoogle ScholarPubMed
Ryan, KR, Jones, MB, Allen, KY, et al. Neurodevelopmental outcomes among children with congenital heart disease: at-risk populations and modifiable risk factors. World J Pediatr Congenital Heart Surg. 2019; 10: 750758.CrossRefGoogle ScholarPubMed
Lisanti, AJ. Parental stress and resilience in CHD: a new frontier for health disparities research. Cardiol Young 2018; 28: 11421150.CrossRefGoogle ScholarPubMed
Landolt, MA, Ystrom, E, Stene-Larsen, K, Holmstrom, H, Vollrath, ME. Exploring causal pathways of child behavior and maternal mental health in families with a child with congenital heart disease: a longitudinal study. Psychol Med 2014; 44: 34213433.CrossRefGoogle ScholarPubMed
McCusker, CG, Doherty, NN, Molloy, B, et al. A controlled trial of early interventions to promote maternal adjustment and development in infants born with severe congenital heart disease. Child: Care, Health Dev 2010; 36: 110117.Google ScholarPubMed
Franck, L, Mcquillen, A, Wray, J, et al. Parent stress levels during children’s hospital recovery after congenital heart surgery. Pediatr Cardiol 2010; 31: 961968.CrossRefGoogle ScholarPubMed
Lisanti, AJ, Allen, LR, Kelly, L, Medoff-Cooper, B. Maternal stress and anxiety in the pediatric cardiac intensive care unit. Am J Crit Care 2017; 26: 118125.CrossRefGoogle Scholar
Lisanti, AJ, Golfenshtein, N, Medoff-Cooper, B. The pediatric cardiac intensive care unit parental stress model: refinement using directed content analysis. ANS Adv Nurs Sci 2017; 40: 319336.CrossRefGoogle ScholarPubMed
Segre, LS, McCabe, JE, Chuffo-Siewert, R, O’Hara, MW. Depression and anxiety symptoms in mothers of newborns hospitalized on the neonatal intensive care unit. Nurs Res 2014; 63: 320332.CrossRefGoogle ScholarPubMed
Franich-Ray, C, Bright, MA, Anderson, V, et al. Trauma reactions in mothers and fathers after their infant’s cardiac surgery. J Pediatr Psychol 2013; 38: 494505.CrossRefGoogle ScholarPubMed
Helfricht, S, Latal, B, Fischer, JE, Tomaske, M, Landolt, MA. Surgery-related posttraumatic stress disorder in parents of children undergoing cardiopulmonary bypass surgery. Pediatr Crit Care Med 2008; 9: 217223.CrossRefGoogle Scholar
Shaw, RJ, Bernard, RS, Deblois, T, et al. The relationship between acute stress disorder and posttraumatic stress disorder in the neonatal intensive care unit. Psychosomatics 2009; 50: 131137.CrossRefGoogle ScholarPubMed
Sood, E, Karpyn, A, Demianczyk, AC, et al. Mothers and fathers experience stress of congenital heart disease differently: recommendations for pediatric critical care. Pediatr Crit Care Med 2018; 19: 626634.CrossRefGoogle ScholarPubMed
Hoffman, MF, Karpyn, A, Christofferson, J, et al. Fathers of children with congenital heart disease: sources of stress and opportunities for intervention. Pediatr Crit Care Med 2020; 21: e1002e1009.CrossRefGoogle Scholar
Vrijmoet-Wiersma, CM, Ottenkamp, J, van Roozendaal, M, Grootenhuis, MA, Koopman, HM. A multicentric study of disease-related stress, and perceived vulnerability, in parents of children with congenital cardiac disease. Cardiol Young 2009; 19: 608614.CrossRefGoogle ScholarPubMed
Dudek-Shriber, L. Parent stress in the neonatal intensive care unit and the influence of parent and infant characteristics. Am J Occup Ther 2004; 58: 509520.CrossRefGoogle ScholarPubMed
Lawoko, S, Soares, JJ. Psychosocial morbidity among parents of children with congenital heart disease: a prospective longitudinal study. Heart Lung J Acute Crit Care 2006; 35: 301314.CrossRefGoogle ScholarPubMed
Scrimin, S, Haynes, M, Altoe, G, Bornstein, MH, Axia, G. Anxiety and stress in mothers and fathers in the 24 h after their child’s surgery. Child Care Health Dev 2009; 35: 227233.CrossRefGoogle ScholarPubMed
Shaw, RJ, Deblois, T, Ikuta, L, et al. Acute stress disorder among parents of infants in the neonatal intensive care nursery. Psychosomatics 2006; 47: 206212.CrossRefGoogle ScholarPubMed
Pinto, NM, Weng, C, Sheng, X, et al. Modifiers of stress related to timing of diagnosis in parents of children with complex congenital heart disease. J Matern Fetal Neonat Med 2016; 29: 33403346.CrossRefGoogle ScholarPubMed
Utens, EM, Versluis-Den Bieman, HJ, Verhulst, FC, et al. Psychological distress and styles of coping in parents of children awaiting elective cardiac surgery. Cardiol Young 2000; 10: 239244.CrossRefGoogle ScholarPubMed
Hertzog, MA. Considerations in determining sample size for pilot studies. Res Nurs Health 2008; 31: 180191.CrossRefGoogle ScholarPubMed
O’Brien, SM, Clarke, DR, Jacobs, JP, et al. An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg 2009; 138: 11391153.CrossRefGoogle ScholarPubMed
Miles, MS, Brunssen, SH. Psychometric properties of the parental stressor scale: infant hospitalization. Adv Neonat Care 2003; 3: 189196.CrossRefGoogle ScholarPubMed
Lisanti, AJ, Golfenshtein, N, Medoff-Cooper, B. The pediatric cardiac intensive care unit parental stress model: refinement using directed content analysis. ANS Adv Nurs Sci 2017; 40: 319336.CrossRefGoogle ScholarPubMed
Spanier, G. Dyadic Adjustment Scale Manual. North Tonawanda, NY, Multi-Health Systems, 1989.Google Scholar
Wood, ND, Crane, DR, Schaalje, GB, Law, DD. What works for whom: a meta-analytic review of marital and couples therapy in reference to marital distress. Am J Fam Ther 2005; 33: 273287.CrossRefGoogle Scholar
Eddy, ME, Carter, BD, Kronenberger, WG, et al. Parent relationships and compliance in cystic fibrosis. J Pediatr Health Care 1998; 12: 196202.CrossRefGoogle ScholarPubMed
Vinokur, AD, Price, RH, Caplan, RD. Hard times and hurtful partners: how financial strain affects depression and relationship satisfaction of unemployed persons and their spouses. J Pers Soc Psychol 1996; 71: 166179.CrossRefGoogle ScholarPubMed
Spielberger, CD, Gorsuch, RL, Lushene, R, Vagg, PR, Jacobs, GA. Manual for the State-Trait Anxiety Inventory. Palo Alto, CA, Consulting Psychologists Press, 1983.Google Scholar
Rychik, J, Donaghue, DD, Levy, S, et al. Maternal psychological stress after prenatal diagnosis of congenital heart disease. J Pediatr 2013; 162: 302307 e301.CrossRefGoogle ScholarPubMed
Franck, LS, Cox, S, Allen, A, Winter, I. Measuring neonatal intensive care unit-related parental stress. J Adv Nurs 2005; 49: 608615.CrossRefGoogle ScholarPubMed
Melnyk, BM, Alpert-Gillis, L, Feinstein, NF, et al. Creating opportunities for parent empowerment: program effects on the mental health/coping outcomes of critically ill young children and their mothers. Pediatrics 2004; 113: e597e607.CrossRefGoogle ScholarPubMed
Turan, T, Basbakkal, Z, Ozbek, S. Effect of nursing interventions on stressors of parents of premature infants in neonatal intensive care unit. J Clin Nurs 2008; 17: 28562866.CrossRefGoogle ScholarPubMed
Radloff, LS. The CES-D scale: a self report depression scale for research in the general population. Appl Psychol Meas 1977; 1: 385401.CrossRefGoogle Scholar
Lavi, I, Fladeboe, K, King, K, et al. Stress and marital adjustment in families of children with cancer. Psychooncology 2018; 27: 12441250.CrossRefGoogle ScholarPubMed
Woolf-King, SE, Anger, A, Arnold, EA, Weiss, SJ, Teitel, D. Mental health among parents of children with critical congenital heart defects: a systematic review. J Am Heart Assoc 2017; 6: e004862.CrossRefGoogle ScholarPubMed
Bevilacqua, F, Palatta, S, Mirante, N, et al. Birth of a child with congenital heart disease: emotional reactions of mothers and fathers according to time of diagnosis. J Matern Fetal Neonat Med 2013; 26: 12491253.CrossRefGoogle ScholarPubMed
Solberg, O, Dale, MT, Holmstrom, H, et al. Emotional reactivity in infants with congenital heart defects and maternal symptoms of postnatal depression. Arch Womens Ment Health 2011; 14: 487492.CrossRefGoogle ScholarPubMed
Solberg, O, Gronning Dale, MT, Holmstrom, H, et al. Trajectories of maternal mental health: a prospective study of mothers of infants with congenital heart defects from pregnancy to 36 months postpartum. J Pediatr Psychol 2012; 37: 687696.CrossRefGoogle ScholarPubMed
O’Connor, TG, Monk, C, Fitelson, EM. Practitioner review: maternal mood in pregnancy and child development—implications for child psychology and psychiatry. J Child Psychol Psychiatry 2014; 55: 99111.CrossRefGoogle ScholarPubMed
Doherty, N, McCusker, CG, Molloy, B, et al. Predictors of psychological functioning in mothers and fathers of infants born with severe congenital heart disease. J Reprod Infant Psychol 2009; 27: 390400.CrossRefGoogle Scholar
Lisanti, AJ, Demianczyk, AC, Costarino, A, et al. Skin-to-skin care reduces stress, anxiety, and salivary cortisol while supporting attachment in mothers of infants with critical congenital heart disease. J Obstet Gynecol Neonat Nurs In Press.Google Scholar
Lisanti, AJ, Demianczyk, AC, Costarino, A, et al. Skin-to-skin care is a safe and effective comfort measure for infants before and after neonatal cardiac surgery. Pediatr Crit Care Med 2020; 21: e834e841.CrossRefGoogle ScholarPubMed
Uhm, JY, Kim, HS. Impact of the mother-nurse partnership programme on mother and infant outcomes in paediatric cardiac intensive care unit. Intensive Crit Care Nurs 2019; 50: 7987.CrossRefGoogle ScholarPubMed
Puthussery, S, Chutiyami, M, Tseng, PC, Kilby, L, Kapadia, J. Effectiveness of early intervention programs for parents of preterm infants: a meta-review of systematic reviews. BMC Pediatr 2018; 18: 223.CrossRefGoogle ScholarPubMed
Vanderveen, JA, Bassler, D, Robertson, CM, Kirpalani, H. Early interventions involving parents to improve neurodevelopmental outcomes of premature infants: a meta-analysis. J Perinatol 2009; 29: 343351.CrossRefGoogle ScholarPubMed
Misri, S, Kostaras, X, Fox, D, Kostaras, D. The impact of partner support in the treatment of postpartum depression. Can J Psychiatry 2000; 45: 554558.CrossRefGoogle ScholarPubMed
Cohen, J. Statistical Power Analysis for the Behavioral Sciences, 2nd ed. Hillsdale, NJ: Erlbaum, 1988.Google Scholar