McGowan Elisabeth C, Du Nan, Hawes Katheleen, Tucker Richard, O'Donnell Melissa, Vohr Betty
Division of Neonatology, Department of Pediatrics, Women & Infants Hospital, Providence, RI.
Yale New Haven Children's Hospital, New Haven, CT.
J Pediatr. 2017 May;184:68-74. doi: 10.1016/j.jpeds.2017.01.052. Epub 2017 Feb 22.
To evaluate associations between maternal mental health disorders (MHDs) and discharge readiness for mothers of infants born preterm (<37 weeks). We hypothesized that mothers with a history of MHDs would report decreased perceptions of neonatal intensive care unit (NICU) discharge readiness compared with mothers without a history.
Mothers of infants born preterm in the NICU >5 days between 2012 and 2015 and participating in a transition home program completed a discharge readiness questionnaire measuring perceptions of staff support, infant well-being (medical stability), maternal well-being (emotional readiness/competency), and maternal comfort (worry about infant). Greater scores are more optimal (range 0-100). Social workers obtained a history of MHDs. Group comparisons and regression analyses were run to predict decreased scores and maternal discharge readiness.
A total of 37% (315/850) of mothers reported a MHD. They were more likely to be white (64% vs 55% P = .05), single (64% vs 45% P ≤ .001), on Medicaid (61% vs 50% P = .002), and less likely to be non-English speaking (10% vs 22%, P ≤ .001). Mothers with MHD perceived less NICU support (92 ± 13 vs 94 ± 12, P = .005), less emotional readiness for discharge (78 ± 17 vs 81 ± 14, P = .04), and lower family cohesion (81 ± 24 vs 86 ± 19, P = .02) compared with mothers without MHD. Regression modeling (OR; CI) indicated that maternal history of MHDs predicted mother's decreased perception of infant well-being (1.56; 1.05-2.33) and her own well-being (1.99; 1.45-2.8) at discharge.
One-third of mothers reported a history of MHDs. This vulnerable group perceive themselves as less ready for discharge home with their infant, indicating an unmet need for provision of enhanced transition services.
评估母亲心理健康障碍（MHDs）与早产（<37周）婴儿母亲出院准备情况之间的关联。我们假设，与无MHDs病史的母亲相比，有MHDs病史的母亲对新生儿重症监护病房（NICU）出院准备情况的认知会降低。
2012年至2015年间在NICU住院超过5天且参与家庭过渡计划的早产婴儿母亲完成了一份出院准备情况调查问卷，该问卷测量对 staff support、婴儿健康状况（医疗稳定性）、母亲健康状况（情绪准备/能力）和母亲舒适度（对婴儿的担忧）的认知。得分越高越好（范围0 - 100）。社会工作者获取了MHDs病史。进行组间比较和回归分析以预测得分降低情况和母亲的出院准备情况。
共有37%（315/815）的母亲报告有MHDs。她们更可能是白人（64%对55%，P = 0.05）、单身（64%对45%，P≤0.001）、参加医疗补助计划（61%对50%，P = 0.002），且不太可能说非英语（10%对22%，P≤0.001）。与无MHDs的母亲相比，有MHDs的母亲感觉NICU的支持更少（92±13对94±12，P = 0.005）、出院时情绪准备更不足（78±17对81±14，P = 0.04）、家庭凝聚力更低（81±24对86±19，P = 0.02）。回归模型（OR；CI）表明，母亲的MHDs病史可预测母亲在出院时对婴儿健康状况（1.56；1.05 - 2.33）和自身健康状况（1.99；1.45 - 2.8）的认知降低。
三分之一的母亲报告有MHDs病史。这一弱势群体认为自己不太准备好带着婴儿出院回家，表明在提供强化过渡服务方面存在未满足的需求。
