Xu F, Shi LL, Gao L. Analysis of anxiety and depression status and related factors among mothers of children in neonatal intensive care unit. World J Psychiatry 2025; 15(3): 101748 [DOI: 10.5498/wjp.v15.i3.101748]
Corresponding Author of This Article
Ling-Ling Shi, Department of Neonatology, Suzhou Ninth Hospital Affiliated to Soochow University, No. 2666 Ludang Road, Taihu New Town, Wujiang District, Suzhou 215200, Jiangsu Province, China. 1832441574@qq.com
Research Domain of This Article
Pediatrics
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Fen Xu, Ling-Ling Shi, Li Gao, Department of Neonatology, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou 215200, Jiangsu Province, China
Author contributions: Xu F and Shi LL performed research and wrote the manuscript; Xu F, Shi LL, and Gao L conceived the research, analyzed data, and provided guidance for the research; and all authors reviewed and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethic Committee of Suzhou Ninth Hospital affiliated to Soochow University.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ling-Ling Shi, Department of Neonatology, Suzhou Ninth Hospital Affiliated to Soochow University, No. 2666 Ludang Road, Taihu New Town, Wujiang District, Suzhou 215200, Jiangsu Province, China. 1832441574@qq.com
Received: November 13, 2024 Revised: December 23, 2024 Accepted: January 6, 2025 Published online: March 19, 2025 Processing time: 104 Days and 20.6 Hours
Abstract
BACKGROUND
Newborns are immediately admitted to the neonatal intensive care unit (NICU) after birth, and thus mothers suffer from the pain of mother-infant separation. Some mothers worry about alterations in their child’s condition and the uncertainty and high medical costs of possible sequelae, which frequently cause anxiety, depression, and other adverse emotions.
AIM
To investigate the anxiety and depression status of mothers of children in the NICU and its related factors.
METHODS
A convenient sampling method is adopted. The research objects included the mothers of 191 children in the NICU of Suzhou Ninth Hospital Affiliated with Suzhou University from January 2023 to July 2024. The general information questionnaire, personal control scale, self-rating anxiety scale, and self-rating depression scale were utilized for investigation. Anxiety and depression status in mothers of children in the NICU and its related factors were analyzed.
RESULTS
The incidences of maternal anxiety and depression among 191 hospitalized children in the NICU were 32.98% (63/191) and 23.56% (45/191), respectively. Single-factor analysis reveals that family monthly income, individual sense of control, gestational age of the child, and the number of diseases in the child are associated with the anxiety and depression experienced by the mother of the child in the NICU (P < 0.05). Multivariate logistic regression analysis revealed that family monthly income of < 5000 yuan (RMB), poor individual control, gestational age of < 32 weeks, and the number of diseases of ≥ 3 kinds are all related factors for anxiety and depression in mothers of children admitted to the NICU (P < 0.05).
CONCLUSION
Mothers of children admitted to the NICU demonstrated high anxiety and depression incidences. The nursing staff in the neonatal department established intervention measures for each related factor, strengthened communication and communication with the mother of the child, and did a good job in psychological counseling.
Core Tip: The closed management of the neonatal intensive care unit can protect newborns, but it causes mothers to feel the pain of separation and increase negative emotions such as anxiety and depression. This study revealed that family economic income, poor individual control, young gestational age of the child, and the number of diseases in the child are all factors that increase maternal anxiety and depression. This provides good guidance for clinical nursing to establish corresponding nursing measures according to related factors, strengthen communication and interaction with the mother of the child, provide psychological counseling, and reduce maternal anxiety and depression.
Citation: Xu F, Shi LL, Gao L. Analysis of anxiety and depression status and related factors among mothers of children in neonatal intensive care unit. World J Psychiatry 2025; 15(3): 101748
The neonatal intensive care unit (NICU) is an important place for monitoring and treating the condition of high-risk newborns. Newborns are easy to be infected with pathogenic bacteria due to their low immunity. Most NICUs in our country implement a fully enclosed management model[1]. Therefore, the mother needs to bear the pain of mother-to-child separation during the monitoring and treatment of newborns in the NICU. Some mothers are concerned about the changes in the child’s condition and the uncertainty of the child’s possible sequelae, particularly high medical costs[2]. Mothers frequently demonstrate inner uneasiness, irritability, fear, and tension. The increase in anxiety and depression affects postpartum recovery[3]. Anxiety refers to negative emotions that develop during the struggle between humans and their environment, as well as in the adaptation process to negative life events. One may demonstrate inner anxiety and fear in the absence of obvious objective factors. It is also the most prevalent emotional response that people experience when facing difficulties, challenges, or negative life events. Serious anxiety is frequently difficult to self-control, and concentrating on things is challenging. Depression is a mental illness with typical symptoms such as depression, low emotion, and slow thinking. Depression evolves from melancholy to grief-stricken, numb, and even pessimistic, attempting to commit suicide. Therefore, once the mother of children in the NICU has anxiety and depression, it not only affects postpartum physical recovery but also has adverse effects on the development of offspring, family, and society[4]. However, the current research on the anxiety and depression of mothers of children in the NICU is to determine the reasons for the medical expenses of the children, the severity of the children’s condition, etc. The investigation of the mother’s sense of self-control in encountering life events is lacking. This study examined the current situation of anxiety and depression in mothers of children in the NICU and combined with the self-control of mothers to explore the related factors of anxiety and depression to provide a reference for the formulation and implementation of nursing intervention programs for mothers of children in the NICU.
MATERIALS AND METHODS
Research object
This study selected the mothers of 191 children who were admitted to the NICU of Suzhou Ninth Hospital Affiliated with Soochow University in Jiangsu Province as the research objects using the convenience sampling method, from January 2023 to July 2024.
Inclusion and exclusion criteria
Inclusion criteria are as followed: (1) Mothers of singleton pregnancy and newborns born in our hospital; (2) Newborns admitted to the NICU for the first time at birth, with a hospitalization time of ≥ 48 hours; (3) Mothers aged ≥ 18 years; (4) Mothers with reading, writing, and communication skills; and (5) Mothers informed of this study and signed an informed consent form.
Exclusion criteria are as followed: (1) Mothers of children with a history of severe mental illness and personality disorder; (2) Mothers with chronic diseases; (3) Mothers of the child with serious complications after childbirth, such as postpartum hemorrhage, postpartum infection, etc.; (4) Mothers who have medical disputes with hospitals; and (5) Mothers who are unable to complete the questionnaire for various reasons.
Research methods
General information collection: The information of the mothers of children, including age, education level, residence, family monthly income, medical reimbursement type, presence of pregnancy complications (such as pregnancy-induced hypertension, pregnancy-induced diabetes, etc.), any planned pregnancies, delivery methods, child’s sex, child’s birth weight, number of diseases of the child (such as jaundice, asphyxia, pneumonia, premature delivery, meningitis, etc.), were collected by creating general information collection form.
Self-control assessment: The personal sense of control scale was used to assess the perceived level of control over personal and life events by mothers of children in the NICU[5]. The personal sense of control scale is a single-dimension scale, consisting of seven items in total: (1) I feel helpless when dealing with problems in life; (2) I can hardly change many important issues in my life; (3) I feel that my life is beyond my control; (4) I am almost unable to control what happened to me; (5) I am unable to solve the problems encountered in one’s own life; (6) I can almost do anything I want to do; and (7) What I mainly depend on myself. All items were scored by a 5-point Likert scale (1-5 points), with a total score of 7-35 points. The higher the score, the higher the degree of self-control of mothers of children in the NICU. Scores of ≤ 25 and > 25 points indicate a poor and good sense of self-control, respectively[6].
Anxiety assessment: The self-rating anxiety scale (SAS)[7] was used to evaluate whether mothers of children in the NICU have anxiety. The scale consists of 20 items, of which 15 have positive ratings and 5 have negative ratings. A four-level scoring method was utilized. The positive scoring questions were scored from 1 to 4 points from “no or very little time” to “most or all of the time,” reverse scoring questions are worth 1-4 points. The sum of scores for each item represents the total gross score, whereas the standard score is equal to the gross score multiplied by 1.25 times and taken as an integer. SAS scores of ≥ 50 points in mothers of children in the NICU indicate the presence of anxiety, with 50-59, 60-69, and ≥ 70 points denoting mild, moderate, and severe anxiety, respectively.
Depression assessment: The self-rating depression scale (SDS)[8] was used to evaluate whether mothers of children in the NICU have depression. The scale consists of 20 items, with 10 items being positive rating questions and 10 items being negative rating questions. Using a 4-point scoring system, positive scoring questions are scored 1-4 points from “no or very little time” to “most or all time”, whereas negative scoring questions are scored 1-4 points. The sum of scores for each item represents the total gross score, whereas the standard score is equal to the gross score multiplied by 1.25 times and taken as an integer. SDS scores of the mother of a child in the NICU of ≥ 53 points indicate the presence of depression, with 53-62, 63-72, and ≥ 73 points denoting mild, moderate, and severe depression, respectively.
Statistical analysis
Statistical Package for the Social Sciences software (version 25.0) was used for data analysis, the utilization rate and composition ratio of count data is expressed, and the comparison between the two groups was conducted with the χ2-tests. Through multiple logistic regression analysis, the related factors of anxiety and depression in mothers of children in the NICU were analyzed, with P values of < 0.05 indicating that the difference is statistically significant.
RESULTS
Status and univariate analysis of anxiety and depression in mothers of children in the NICU
The incidence of maternal anxiety in 191 children admitted to the NICU assessed with the SAS scale was 32.98% (63/191). Among them, 20, 28, and 15 cases were mild, moderate, and severe anxiety, respectively. The incidence of maternal depression in 191 hospitalized children in the NICU was assessed with the SDS scale to be 23.56% (45/191). Among them, 24, 13, and 8 cases were mild, moderate, and severe anxiety, respectively. Single-factor analysis reveals that family monthly income, individual sense of control, gestational age of the child, and the number of diseases in the child are associated with the anxiety and depression experienced by the mother of children in the NICU (P < 0.05, Table 1).
Table 1 Univariate analysis of maternal anxiety and depression in neonatal intensive care unit hospitalized children, n (%).
Characteristics
Total
Has anxiety (n= 63)
No anxiety (n= 128)
Anxiety, χ2
Anxiety, P value
Has depression (n= 45)
No depression (n= 146)
Depression, χ2
Depression, P value
Age
1.187
0.276
1.540
0.215
< 35
137
42 (66.67)
95 (74.22)
29 (64.44)
108 (73.97)
≥ 35
54
21 (33.33)
33 (25.78)
16 (35.56)
38 (26.03)
Degree of education
0.505
0.477
2.877
0.090
High school or below
81
29 (46.03)
52 (40.63)
24 (53.33)
57 (39.04)
College degree or above
110
34 (53.97)
76 (59.37)
21 (46.67)
89 (60.96)
Place of residence
0.884
0.347
0.124
0.725
Cities and towns
85
25 (39.68)
60 (46.88)
19 (42.22)
66 (45.21)
Rural district
106
38 (60.32)
68 (53.12)
26 (57.78)
80 (54.79)
Family monthly income
6.830
0.033
7.247
0.027
< 5000 yuan· (RMB)
40
18 (28.57)
22 (17.19)
13 (28.89)
27 (18.49)
5000-8000 yuan· (RMB)
86
31 (49.21)
55 (42.97)
24 (53.33)
62 (42.47)
> 8000 yuan· (RMB)
65
14 (22.22)
51 (39.84)
8 (17.78)
57 (39.04)
Medical insurance type
3.520
0.172
4.635
0.099
Urban and rural medical insurance
73
30 (47.62)
43 (33.59)
23 (51.11)
50 (34.25)
Employee medical insurance
72
20 (31.75)
52 (40.63)
15 (33.33)
57 (39.04)
Other
46
13(20.63)
33(25.78)
7 (15.56)
39 (26.71)
Pregnancy complications
1.512
0.219
2.740
0.098
Have
94
35 (55.56)
59 (46.09)
27 (60.00)
67 (45.89)
Not have
97
28 (44.44)
69 (53.91)
18 (40.00)
79 (54.11)
Planned pregnancy
1.222
0.269
1.323
0.250
Yes
140
43 (68.25)
97 (75.78)
30 (66.67)
110 (75.34)
No
51
20 (31.75)
31 (24.22)
15 (33.33)
36 (24.66)
Delivery method
1.273
0.259
1.522
0.217
Spontaneous labor
96
28 (44.44)
68 (53.13)
19 (42.22)
77 (52.74)
Cesarean section
95
35 (55.56)
60 (46.87)
26 (57.78)
69 (47.26)
Sense of self-control
10.820
0.001
8.968
0.003
Worse
86
39 (61.90)
47 (36.72)
29 (64.44)
57 (39.04)
Good
105
24 (38.10)
81 (63.28)
16 (35.56)
89 (60.96)
Child’s gestational age
10.818
0.001
10.655
0.001
< 32 weeks
24
15 (23.81)
9 (7.03)
12 (26.67)
12 (8.22)
≥ 32 weeks
167
48 (76.19)
119 (92.97)
33 (73.33)
134 (91.78)
Sex of child
0.275
0.601
0.263
0.608
Male
104
36 (57.14)
68 (53.13)
26 (57.78)
78 (53.42)
Female
87
27 (42.86)
60 (46.87)
19 (42.22)
68 (46.58)
Birth weight
2.594
0.107
2.865
0.091
≥ 2.5 kg
130
38 (60.32)
92 (71.88)
26 (57.78)
104 (71.23)
< 2.5 kg
61
25 (39.68)
36 (28.12)
19 (42.22)
42 (28.77)
Number of diseases in children
8.478
0.014
8.279
0.016
1 kind
29
7 (11.11)
22 (17.19)
5 (11.11)
24 (16.44)
2 kinds
57
12 (19.05)
45 (35.15)
7 (15.56)
50 (34.25)
≥ 3 kinds
105
44 (69.84)
61 (47.66)
33 (73.33)
72 (49.31)
Multivariate logistic regression analysis of anxiety and depression in mothers of children in the NICU
The dependent variable was whether the mothers of hospitalized children in NICU had anxiety and depression (0 = no, 1 = yes). Statistically significant features in univariate analysis (monthly household income, sense of self-control, gestational age of the child, and number of diseases in the child) were independent variables, with Table 2 showing the assigned values. Multivariate logistic regression analysis revealed that family monthly income of < 5000 yuan (RMB), poor sense of self-control, gestational age of < 32 weeks, and the number of diseases of ≥ 3 kinds are all related factors for anxiety and depression in mothers of children in the NICU (P < 0.05, Tables 3 and 4).
Table 3 Results of multivariate logistic regression analysis on maternal anxiety of hospitalized children in neonatal intensive care unit.
Variable
β
SE
Wald χ2
P value
OR (95%CI)
Family monthly income < 5000 yuan (RMB)
0.784
0.291
7.258
0.007
2.190 (1.239-3.873)
Poor sense of self-control
1.268
0.452
7.870
0.005
3.554 (1.465-8.619)
Child’s gestational age < 32 weeks
0.919
0.319
8.299
0.004
2.507 (1.342-4.683)
Number of diseases in children ≥ 3 kinds
1.675
0.509
10.829
0.001
5.339 (1.968-10.507)
Table 4 Results of multivariate logistic regression analysis of depression in mothers of hospitalized children in neonatal intensive care unit.
Variable
β
SE
Wald χ2
P value
OR (95%CI)
Family monthly income < 5000 yuan (RMB)
0.632
0.274
5.320
0.021
1.881 (1.099-3.219)
Poor sense of self-control
1.085
0.415
6.835
0.009
2.959 (1.313-6.673)
Child’s gestational age < 32 weeks
1.128
0.411
7.532
0.006
3.089 (1.379-6.917)
Number of diseases in children ≥ 3 kinds
1.391
0.450
9.554
0.002
4.019 (1.664-9.708)
DISCUSSION
Newborns are the hope and continuation of a family. However, the mother went through a long pregnancy period and experienced physical pain during childbirth. The mother of the newborn has just experienced the physical pain of childbirth and has to accept the reality that the newborn is admitted to the NICU, which undoubtedly causes the mother to have a bad mood. This study revealed that the incidence of maternal anxiety and depression in mothers of children in the NICU was 32.98% and 23.56%, respectively, within the scope of literature reports[9,10]. Multiple studies have demonstrated that the occurrence of anxiety and depression symptoms in mothers of children in the NICU is caused by various factors[11-13]. Therefore, relevant related factors of maternal anxiety and depression symptoms need to be identified so that nursing staff can take corresponding nursing interventions and reduce the incidence of anxiety and depression symptoms in mothers of sick children.
The results of this study indicated that family monthly income of < 5000 yuan (RMB), poor individual self-control, gestational age of < 32 weeks, and the number of diseases of ≥ 3 are all related factors for anxiety and depression in mothers of children in the NICU. Reason analysis are as followed: (1) The cost of raising childbirth is relatively high, specifically newborns after birth, and it is easy to perceive the economic pressure of raising children for low-income families[14]. Northrup et al[15] revealed that low income increases the depressive mood of mothers of children in the NICU, which is consistent with the results of this study. A newborn needs to be transferred to the NICU for treatment due to certain factors after birth, making the family have to bear a large amount of medical expenses and increasing the burden on the family. This will undoubtedly affect the mother of the child’s psychology, resulting in the mother of the child being prone to anxiety, depression, and other negative emotions; (2) Self-control refers to an individual’s perceived degree of control over their life and surrounding environment. Belonging to a part of resilience resources, it demonstrates a positive effect on maintaining individual physical and mental health[16]. Contrary, a poor sense of self-control easily causes stress and negative emotions due to life events[17]. Bian et al[18] have confirmed that poor personal self-control is positively correlated with the occurrence of anxiety and depression. NICU implemented a completely closed management model, the mothers of NICU hospitalized children face the pressure of maternal separation after delivery, causing them to worry about the health of the child, and their body is still in recovery. Dealing with various pressures takes a lot of energy and time. Producing negative emotional cognitive experience and self-denial, generating a sense of powerlessness, and reducing the sense of self-control is easy. Mothers of children with a worse sense of self-control often demonstrate a lack of security, excessive worry, lack of self-confidence, and suspicion, and are prone to tension and irritability, which in turn induces anxiety and depression; (3) The younger the gestational age of a child at birth, the worse their developmental condition appears. Jackson et al[19] revealed that parents have a high level of psychological pressure when the gestational age is 25-30 weeks. This may be because of the small gestational age at birth, the physiological organ development is not mature. Various serious complications, such as necrotizing enterocolitis, retinopathy of prematurity, and bronchopulmonary dysplasia, are prone to occur during NICU monitoring[20-22]. Further, the risk of death is high, bringing great mental and psychological pressure to the mother. Alkozei et al[23] have confirmed that the greater the pressure on the mothers of children in the NICU, the more prone to anxiety and depression. The smaller the gestational age at birth, the lower the birth weight, the higher the risk of disease, and the worse the prognosis[24]. Mothers of sick children may worry about changes in their condition and disease prognosis, which easily causes negative emotions such as anxiety or depression[25]; and (4) The greater the number of diseases (such as low birth weight, jaundice, asphyxia, pneumonia, premature delivery, hypoxic-ischemic encephalopathy, etc.) in children in the NICU[26], the more serious the condition and higher the required medical expenses. At present, not all medical items in China’s newborn medical insurance system can be reimbursed 100%. The various costs of the NICU are relatively high. Therefore, the mother of the child is not only worried about the severity of the child’s condition and the treatment results and prognosis but also worried about whether the economic problems will affect the treatment and rescue of the child, which greatly increases the risk of anxiety and depression in the mother of the child.
The aforementioned influencing factors inspire healthcare professionals in neonatology. Neonatal medical staff is reminded to pay more attention to the psychological state of the mother of the child. First, the needs of the mother of the child were assessed. Personalized guidance and support were provided to the mother of the child according to the different groups and the gestational age and family of the child, and the needs of the mother of the child were met through nursing support services. Concurrently, departments are encouraged to establish a support system for families of sick children, with medical staff as the main body, to provide treatment-related information support, and enable mothers to promptly understand the condition of their children. Further, we should strengthen humanistic care, such as emphasizing the humanization of communication, treatment, and environment, paying attention to individual differences and individual needs, and providing active comfort and encouragement. Moreover, under the premise of management permission, increase the visitation time and the opportunity for mother-to-child contact, to alleviate the mother’s anxiety, depression, and other negative emotions.
This study has limitations. This study is a cross-sectional survey research and only analyzed the anxiety and depression status and related factors of parents of children in the NICU. Corresponding measures were proposed following the related factors, but they were not implemented. We hope to actively implement this work in future medical and nursing work, striving to establish a comprehensive and effective psychological intervention model, thereby reducing the incidence of anxiety and depression among parents of children in the NICU and improving the quality of medical and nursing care.
CONCLUSION
In summary, mothers of hospitalized children in the NICU have a high incidence of anxiety and depression. Among them, low family economic income, poor sense of self-control, young gestational age of the child, and multiple diseases of the child are all related factors for anxiety and depression in mothers of children in the NICU. Therefore, neonatal nursing staff should formulate intervention measures based on various related factors, strengthen communication and communication with the mother of the child, and do a good job in psychological counseling.
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Psychiatry
Country of origin: China
Peer-review report’s classification
Scientific Quality: Grade B, Grade C
Novelty: Grade B, Grade C
Creativity or Innovation: Grade B, Grade B
Scientific Significance: Grade C, Grade C
P-Reviewer: Insel PS; Mends-Brew E S-Editor: Wei YF L-Editor: A P-Editor: Yu HG
Group of Neonatology; Society of Pediatrics; Chinese Medical Association; Neonatal Professional Committee, Chinese Association of Medical Education. [Guidelines for family integrated care in neonatal intensive care unit].Zhonghua Er Ke Za Zhi. 2023;61:292-300.
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