NICU Fellow, PGY-4 Brown University North Kingstown, Rhode Island, United States
Background: Mothers of preterm infants are at high risk for postpartum depression. For low income parents especially, the stress of having an infant in the NICU is compounded by the stress of obtaining meals, transportation, or childcare to visit the NICU. Over time, the accumulation of these stressors may impact mood. However, few studies quantify the short term financial burden of NICU hospitalization or its impact postpartum depression. Objective: To determine if the short term financial burden of NICU hospitalization is associated with a change in depression scores at two months postpartum in low income mothers. Design/Methods: We conducted a secondary analysis of data collected in a multi-center randomized clinical trial in four level III NICUs that tested the effect of a problem solving intervention on depression in Medicaid-eligible, 26-34 week gestation mother-infant dyads. We asked mothers about transportation to the NICU (total trips, mileage, and cost), meals purchased out of the home, number of days of leave, and the amount and cost of household or childcare help. Maternal depression was measured using the Quick Inventory of Depressive Symptomatology (QIDS). We examined the association between these factors and change in QIDS from 0 to 2 months postpartum using Spearman’s rank correlation coefficients and linear regression models, adjusted for length of stay and site. A post hoc analysis examined the effect modification of high or low baseline QIDS. Results: Among 294 mother-infant dyads, mean maternal age was 30 (SD 6), mean gestational age was 32 weeks (SD 2), and median length of stay was 33 days (IQR 20-53). Mothers had mild baseline depression (mean QIDS 6.4 ,SD 3.8). Participants reported a substantial financial burden, with median total mileage of 488 miles (IQR 151-1254), parking cost of $102 (IQR 17-254), and cost of meals of $193 (IQR 100-411). For women with a baseline QIDS of 6 or higher only, each additional day of leave taken by a partner was associated with a 0.11 unit improvement in QIDS from 0 to 2 months, adjusted for length of stay and site. Mothers who had any paid help with childcare had worsening QIDS (1.0, IQR -0.50-3.00) from 0-2 months than women without help. Total mileage and total number of trips to the NICU exhibited a weak negative correlation with change in maternal depression from 0-2 months, but was not significant after adjustment.
Conclusion(s): Partner leave may have a greater impact on postpartum depression for women who are more depressed at baseline. Similarly, mothers who seek more childcare help may have less support, leading to worsening depression scores.
