Williams Allison, Parlier-Ahmad Anna Beth, Thompson Erin, Wallace Rachel, Perrin Paul B, Ward Alyssa, Hendricks-Muñoz Karen D
Department of Psychiatry, Virginia Commonwealth University Medical Center, Richmond, VA 23298, USA.
Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA.
Children (Basel). 2023 Aug 30;10(9):1477. doi: 10.3390/children10091477.
Postpartum depression (PPD), postpartum anxiety (PPA), and post-traumatic stress disorder (PTSD) among birthing people have increased substantially, contributing to adverse maternal/infant dyad outcomes, with a high prevalence in the neonatal intensive care unit (NICU). Despite calls for trauma-informed care in the NICU and high rates of post-traumatic stress, little research has examined the rates of or the relationships between peripartum mood and adverse child experiences (ACEs) in NICU mothers or evaluated which peripartum traumas are most distressing. This study employed structural equation modeling (SEM) to explore whether peripartum-related traumas and NICU-related stressors mediated the associations between ACEs and mental health outcomes in 119 lower-income, racially diverse mothers in a Level IV NICU. Mental health concerns were prevalent and highly comorbid, including 51.3% PPA, 34.5% PPD, 39.5% post-traumatic stress, and 37% with ≥4 ACEs. The majority (53.8%) of mothers endorsed multiple peripartum traumas; NICU admission was the most common trauma (61%), followed by birth (19%), pregnancy (9%), and a medical event in the NICU (9%). Our SEMs had good fit and demonstrated that ACEs predicted peripartum distress. Trauma-informed care efforts should employ transdiagnostic approaches and recognize that women commonly present to the NICU with childhood trauma history and cumulative peripartum traumas.
分娩人群中的产后抑郁症（PPD）、产后焦虑症（PPA）和创伤后应激障碍（PTSD）大幅增加，导致母婴二元组出现不良结局，在新生儿重症监护病房（NICU）中患病率很高。尽管呼吁在新生儿重症监护病房提供创伤知情护理，且创伤后应激发生率很高，但很少有研究调查新生儿重症监护病房母亲围产期情绪与不良儿童经历（ACEs）之间的发生率或关系，也没有评估哪些围产期创伤最令人痛苦。本研究采用结构方程模型（SEM），探讨围产期相关创伤和新生儿重症监护病房相关应激源是否介导了119名低收入、种族多样的四级新生儿重症监护病房母亲的不良儿童经历与心理健康结局之间的关联。心理健康问题普遍存在且高度共病，包括51.3%的产后焦虑症、34.5%的产后抑郁症、39.5%的创伤后应激，以及37%有≥4种不良儿童经历。大多数（53.8%）母亲认可多种围产期创伤；入住新生儿重症监护病房是最常见的创伤（61%），其次是分娩（19%）、怀孕（9%）和新生儿重症监护病房的医疗事件（9%）。我们的结构方程模型拟合良好，表明不良儿童经历可预测围产期痛苦。创伤知情护理工作应采用跨诊断方法，并认识到女性通常带着童年创伤史和累积的围产期创伤进入新生儿重症监护病房。
