Evaluating the effect of Family Integrated Care on maternal stress and anxiety in neonatal intensive care units

ABSTRACT

Objective: To identify how Family Integrated Care (FICare) affected maternal stress and anxiety.

Study Design: This secondary analysis of the FICare cluster randomised controlled trial included infants born between 1 April 2013 and 31 August 2015 at ≤33 weeks’ gestation. Mothers completed the PSS:NICU and STAI questionnaires at enrolment and study day 21.

Results: 1383 mothers completed the surveys at one or both time-points. The mean PSS:NICU and STAI scores at day 21 were significantly lower in the FICare mothers than controls (PSS:NICU mean [standard deviation] FICare 2.32 [0.75], control 2.48 [0.78], p = 0.0005; STAI FICare 70.8 [20.0], control 74.2 [19.6], p = 0.0004). The sights and sounds, looks and behaviour, and parental role PSS:NICU subscales and the state and trait STAI subscales were all significantly different between FIC are and controls at day 21. The magnitude of change in all stress and anxiety subscales was greater in the FICare group than controls. These differences remained significant after adjustment for confounders with the greatest change in the parental role (least-squares mean [95% confidence interval] FICare −0.65 [−0.72, 0.57], control −0.31 [−0.38, −0.24], p < 0.0001) and state anxiety subscales.

Conclusion: FICare is effective at reducing NICU-related maternal stress and anxiety.

KEYWORDS:

• Preterm infant
• NICU
• stress
• anxiety
• FICare

Acknowledgments

The authors would like to thank the Mount Sinai FICare Steering Committee for their tireless efforts in developing and implementing the pilot FICare programme, as well as the site investigators, NICU educators, NICU staff, veteran parents, and study coordinators across Canada and Australia and New Zealand for their dedication to the trial. We would also like to thank the staff from the Maternal-Infant Care Research Centre (MiCare) for assistance with the data management. MiCare is supported by a team grant from the Canadian Institutes of Health Research (CIHR, FRN87518) and in-kind support from Mount Sinai Hospital.

Disclosure statement

No potential conflict of interest was reported by the authors.

FICare Study Group and Parent Advisors

Site Investigators/Representatives

Canada: Karel O’Brien, Shoo K Lee, Marianne Bracht, Mount Sinai Hospital, Toronto, Ontario; Georges Caouette, Centre Hospitalier Universitaire de Quebec-Laval, Québec City, Québec; Eugene Ng, Sunnybrook Health Sciences Centre, Toronto, Ontario; Douglas McMillan, IWK Health Centre, Halifax, Nova Scotia; Linh Ly, Hospital for Sick Children, Toronto, Ontario; Kimberly Dow, Kingston General Hospital, Kingston, Ontario; Richard Taylor, Victoria General Hospital, Victoria, British Columbia; Luis Monterrosa, Saint John Regional Hospital, Saint John, New Brunswick; Roderick Canning, The Moncton Hospital, Moncton, New Brunswick; Koravangattu Sankaran, William Bingham, Royal University Hospital, Saskatoon, Saskatchewan; Amuchou Soraisham, Foothills Medical Centre, Calgary, Alberta; Salhab el Helos, Hamilton Health Sciences Centre, Hamilton, Ontario; Ruben Alvaro, St Boniface General Hospital, Winnipeg, Manitoba; Michael Narvey, Health Sciences Centre, Winnipeg, Manitoba; Orlando da Silva, London Health Sciences Centre, London, Ontario; Horacio Osiovich, BC Women’s & Children’s Hospital, Vancouver, British Columbia; Julie Emberley, Janeway Children’s Health and Rehabilitation Centre, St. John’s, Newfoundland; Celine Catelin, Centre Hospitalier Universitaire de Sherbrooke, Fleurimont, Quebec City; Lucia St. Aubin, Tammy Warkentin, Windsor Regional Hospital, Windsor, Ontario; Zarin Kalapesi, Jaya Bodani, Regina General Hospital, Regina, Saskatchewan;

Australia: Kei Lui, Royal Hospital for Women, Sydney, New South Wales; Guan Kho, The Townsville Hospital, Townsville, Queensland; Zsuzsoka Kecskes, Hazel Carlisle, The Canberra Hospital, Canberra, Australian Capital Territory; Jacqueline Stack, Ian Callander, Liverpool Hospital, Liverpool, New South Wales; Peter Schmidt, Gold Coast University, Queensland; Mary Paradisis, Royal North Shore Hospital, Sydney, New South Wales.

New Zealand: Roland Broadbent, Dunedin Hospital, Dunedin, Otago.

Site Coordinators

Canada: Clare Raiman, Charlene Wong, Mount Sinai Hospital, Toronto, Ontario; Michele Cabot, Anne Marie Roy, Maryse L’Herault, Marie-Andree Gignac, Marie-Helene Marquis, Mylene Leblanc, Centre Hospitalier Universitaire de Quebec-Laval, Québec City, Québec; Cathy Travell, Sunnybrook Health Sciences Centre, Toronto, Ontario; Marlene Furlong, IWK Health Centre, Halifax, Nova Scotia; Annette Van Bergen, Hospital for Sick Children, Toronto, Ontario; Maryanne Ottenhof, Heather Keron, Clare Bowley, Kingston General Hospital, Kingston, Ontario; Shannon Cross, Gillian Kozinka, Victoria General Hospital, Victoria, British Columbia; Valerie Cobham-Richards, Kelly Northrup, Cindy Gilbert-Rogers, Saint John Regional Hospital, Saint John, New Brunswick; Norma Leger, Pat Pidgeon, Kim McDuff, The Moncton Hospital, Moncton, New Brunswick; Cindy Thiel, Shannon Willard, Royal University Hospital, Saskatoon, Saskatchewan; Evelyn Ma, Linda Kostecky, Foothills Medical Centre, Calgary, Alberta; David Pogorzelski, Sherin Jacob, Hamilton Health Sciences Centre, Hamilton, Ontario; Kim Kwiatkowski, Valerie Cook, St Boniface General Hospital, Winnipeg, Manitoba; Naomi Granke, Health Sciences Centre, Winnipeg, Manitoba; Nicola Geoghegan-Morphet, London Health Sciences Centre, London, Ontario; Hannah Bowell, Jennifer Claydon, BC Women’s & Children’s Hospital, Vancouver, British Columbia; Nicole Tucker, Janeway Children’s Health and Rehabilitation Centre, St. John’s, Newfoundland; Thomas Lemaitre, Myriam Doyon, Centre Hospitalier Universitaire de Sherbrooke, Fleurimont, Quebec City; Candace Ryan, Windsor Regional Hospital, Windsor, Ontario.

Australia: Joanne Sheils, Elizabeth Siddons, Royal Hospital for Women, Randwick, New South Wales; Anne-Marie Feary, Gold Coast University Hospital, Gold Coast, Queensland; Ian Callander, Robyn Richard, Liverpool Hospital, Liverpool, New South Wales; Jennifer Orbeso, Townsville Hospital, Townsville, Queensland; Margaret Broom, Allana Carter, Canberra Hospital, Canberra, Australian Capital Territory; Alexis Fox, Royal North Shore Hospital, St Leonard, New South Wales.

New Zealand: Jan Seuseu, Dunedin Hospital, Dunedin, Otago

Veteran Parents

Canada: Jack Hourigan, Cynthia Schaeffer, Melanie Lataigne, Mount Sinai Hospital, Toronto, Ontario; Ginette Mantha,Préma-Québec and Centre Hospitalier Universitaire de Quebec-Laval, Québec City, Québec; Kate Robson, Sunnybrook Health Sciences Centre, Toronto, Ontario; Leah Whitehead, Natasha Skinner, IWK Health Centre, Halifax, Nova Scotia; Rita Visconti, Deedee Crosland, Hospital for Sick Children, Toronto, Ontario; Kate Griffin, Brandon Griffin, Lisa Collins, Kirsten Meyer, Ian Silver, Kingston General Hospital, Kingston, Ontario; Britt Burnham, Rachel Freeman, Kristi Muralt, Victoria General Hospital, Victoria, British Columbia; Cara Ramsay, Saint John Regional Hospital, Saint John, New Brunswick; Pawulina McGrath, Heather Johnson, The Moncton Hospital, Moncton, New Brunswick; Michelle Munroe, Toronto East General Hospital.

Australia: Denise Hales, Royal Hospital for Women, Randwick, New South Wales; Corrine Henderson, Annabell Fenton, The Canberra Hospital, Canberra, Australian Capital Territory

Additional information

Funding

This work was supported by the Canadian Institutes of Health Research Partnerships for Health System Improvement (CIHR-PHSI) under Grant # PHE122173 and the Ontario Ministry of Health and Long-Term Care under Grant # 06465.