Anxiety and Depression Comorbidityin Preterm Infants Parents: the Effect on Early Interactions

Anxiety and Depression Comorbidityin Preterm Infants’Parents: the effect on early interactions

Theoretical Background

Literature has deeply underlined how a premature birth representsa risk ofperinatal psychopathology and astressful event for the parents (Lasiuk et al., 2013). In the first 4 monthsafter preterm birth,maternal depressionor anxietyhave been estimated from 12 to 30%, significantly higher than those in full-term mothers (Rogers et al., 2013). The assessment of perinatal affective state is needed because postnatal depression and anxiety may negatively influence the quality of earlymother-preterm baby interactions(Korja et al., 2012), specificallyin terms of less synchronyand coordinationcompared to non-depressed or non-anxiousdyads, andto mother-full-term infant interactions (Mertesackeret al., 2004).Difficulties on interactive behaviours should be monitored because they are negatively associated to later baby’s development (Righetti-Veltema et al., 2002; Beebe et al., 2011).

Nevertheless, there is a lack of studies on the specific effects of depression and anxiety comorbidity.Furthermore, the influence of preterm fathers’ affective statewas not yet adequately investigated(Helle et al., 2015). A deeper knowledge on paternal symptomatology is relevant,since fathersplay a buffering role in case of maternal psychopathology andwhen the mother-preterm infant relationship is at risk (Baldoni et al., 2009).

Therefore, the effect on interactive patterns of parents’ comorbidity should be deepened, differentiating the role of parental gender in the context of a preterm birth.

Aim/Hypothesis

Main aimis toinvestigate the prevalence of depression and anxiety comorbidity in preterm babies’parents and the effects on parent-preterm infant interactions at 3 months of infant age, an important step forthedetectionof postnataldepressionand anxiety (Cox et al.,1987; Beebe et al., 2011) and for theonsetofdyadicinteractive patterns (Tronick, 2007).

The first aim is toevaluate,through a logistic regression, if the risk of depression and anxiety comorbidity is increased by specific predictors:birth status (preterm vs full term birth), parental gender (mothers vs fathers) and their interaction. Prevalence of depression and anxiety comorbidity inside parental couple will also be estimated: we hypothesize that the frequency of maternal comorbidity is significantly associated with the presence of paternal comorbidity. Furthermore, we expect that the presence of both maternal and paternal comorbidity is significantly more frequent in preterm parents’ couplesthan in full-term ones.

The second aim is toevaluatetheinfluence of depressive and anxious comorbidity on the quality of early parent-preterm infant interactions. A linear multiple regression will be run, hypothesizing that parents’ sensitivity and control during interactions will be predicted by the presence of depressive/anxious comorbidity, preterm birth, maternal gender and their interactions.

Methods

The study will consist in a quasi-experiment with a between subjects design: the comparisonwill bebetween100 parents(50 mothers, 50 fathers) of preterm infants (PT group)and 100 parents (50 mothers, 50 fathers) of healthy full-term infants (FT Group). The sample size was computed on G*power version 3.1.3. for the linear multiple regression (main analysis of the study).

PTgroup will be recruited in two Italian Neonatal Intensive Care Units (BufaliniHospital, Cesena;Villa Sofia-Cervello Hospital, Palermo). Parents will be included in case of infant’s birth weight-BW <1500 g andgestational age-GA <32 weeks.

FT parents will be recruited in the antenatal classes held in Health Services in Cesena. The parental couples will be contacted again after delivery and will be included in the final FT sample only in case of full-term birth (infant GA >36 weeks, BW >2500 g).

For both groups, inclusion criteria will be the fluency in Italian language, theabsence of pre-existing psychiatric disorders andneonatalneurological diseases or severe complications.

All families will be assessed at 3 months of infant age (corrected for PT group) for the comorbidity and for the quality of parent-infant interactions.

Parental depression and anxiety comorbidity will be evaluated by Edinburgh Postnatal Depression Scale (EPDS; Coxet al., 1987) and State-Trait Anxiety Inventory (STAI; Spielberger e al., 1983), respectively. The EPDS isa self-report questionnaire, including 10-items addressing depression symptoms occurring within the previous 7 days. A 8/9 cut-off score is considered to identify risk for depression, as suggested by Italian validation (Benvenuti et al., 1999).

STAI is a self-report measure foranxiety, including 20 items for assessing state anxiety (STAI-S) and 20 for trait anxiety (STAI-T). The adopted cut-off score is>40, as suggested by the Italian validation (PedrabissiSantinello, 1989).

Parents with both EPDS scores >8 and STAI-S scores >40 will be included in the “Comorbidity Group”, while the “No ComorbidityGroup” will include parents with EPDS scores ≤8 and STAI-S scores ≤40. In order to control confounding effects, all parents with only depressive or anxiety symptoms will be excluded from the study.

The quality of parent–infant interaction will be assessed by Child-Adult Relationship Experimental Index (CARE-Index; Crittenden, 1988). This video-based assessment includes7 scales:3 for parents (Sensitive, Controlling, Unresponsive) and 4 for infants (Cooperative, Compulsive-Compliant, Difficult, Passive). All videos will be evaluated by 2 coders (interrater reliability α=0.74)blind to parents’ clinical condition and birth status.

Moreover,infant clinical data, infant development (evaluated by the Griffiths Mental Development Scales-Griffith, 1996) and parental socio-demographic variables(ad hoc questionnaire) will be collected in order to control for homogeneity of the groups.

Expected Results

According to the firstaim, we expect:

-a higher prevalenceof comorbidity significantly predicted by preterm birth, maternal gender, and their interaction;

-asignificant association between the presence of maternal and paternal comorbidity;

-a higher frequency of both maternal and paternal comorbidity inside the couple of preterm infants’ parents than in full-term ones.

According to the second aim, we hypothesize to find that:

-being a parent with a comorbidity significantly predictsa worse quality of interactive patterns, with low sensitivity and high control;

-the effect of comorbidity on interactive patterns is stronger in case of preterm birth compared to full-term birth and in case of mothers compared to fathers.

Implications

Thestrength of the study is the focus on the depression and anxiety comorbidity in preterm babies’ parents. The deepening of this topic, not yet adequately investigated in literature, could help in identifying and estimating parents’ symptomatology, and improving the specificity of supportive interventions.

Another peculiarity of the study is the focus on both mothers and fathers, as they are both deeply involved in the scenario of transition to parenthood.

Planof Activities

The activities will take place at “Laboratorio di PsicodinamicadelloSviluppo”(Cesena, Department of Psychology, University of Bologna).

Research activities will implicate:

• To update the knowledge ofthe scientificliterature regarding preterm birth, parental depression and anxiety, parent-infant interactions;
• Subjects recruitment and data collection;
• To build a database and data analysis;
• To prepare in itinere and final reportsabout state of research and to present data to multidisciplinary staff involved in the study (Hospital NICUs and Department of Psychology);
• Participation at National and International Congresses to present results of the study;
• Publication of results of the study on international peer-reviewed journals.

References

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