Post-Traumatic Symptomatology in Parents with Premature Infants: A Systematic Review of the Literature
Karatzias, Thanos, Chouliara, Zoë, Maxton, Fiona, Freer, Yvonne, Power, Kevin, Journal of Prenatal & Perinatal Psychology & Health
ABSTRACT: The emotional distress resulting from the experience of giving birth to a preterm infant (gestational age < 37 weeks) and the subsequent neonatal unit hospitalisation may be a traumatic experience for parents. In the present systematic literature review, studies on parental posttraumatic symptomatology following birth of a premature infant were reviewed. A total of 5 studies were identified. All studies reviewed found that posttraumatic symptomatology is quite common in parents or primary caregivers of premature infants. However, methodological weaknesses of relevant studies (e.g. use of convenience samples, lack of pre - delivery assessments) make it difficult to draw consistent conclusions regarding prevalence of posttraumatic symptomatology in this population group or whether the experience of a premature birth could be responsible for the development of PTSD. Directions for future research are discussed.
KEY WORDS: premature infants, PTSD, post - traumatic symptomatology, literature review.
"Premature" or "preterm" defines infants born <37 weeks of gestation. Prematurity is on the increase in the western countries. In the USA, for example, premature births were 12.1% of all births in 2002 indicating a 29% increase since 1981 (Martin, Hamilton, Sutton, Ventura, et al, 2003). According to the leading charity "Tommy's," UK has the highest rate of premature birth in Europe with 5 infants born prematurely every hour. In total, more than 45,000 infants are born prematurely in the UK each year and prematurity accounts for 75% of all deaths in the first month of life and 50% of long-term disability (http://www.tommys.org). Although from 32 weeks onwards most infants are able to survive with the help of medical technology, 1 in 10 premature infants will develop a permanent disability such as lung disease, cerebral palsy, blindness or deafness. In a UK based study, 62% (n = 314) of premature infants, when they had reached the equivalent of full term (i.e. 40 weeks), presented with one or more of the following conditions, cerebral parenchymal cysts, hydrocephalus, retinopathy of prematurity or continuing need for oxygen treatment (Costeloe, Gibson, Marlow, & Wilkinson, 2000).
The high rates of infant morbidity arising from preterm births impose an immense burden on infants, families and finite health care resources (Campbell & Fleischman, 2001; Petrou, Mehta, Hockley, Cook-Mozaffari, Henderson, & Goldacre, 2003) as well as, social and educational services (Petrou, Sach, & Davidson, 2001). Although the medical and economic sequelae of preterm birth are well documented in the literature, relatively little is known about the parental traumatic aspects of the experience. 'Traumatic' is defined the experience of a threatening situation that goes beyond the bounds of the individual coping strategies and is accompanied by a sense of helplessness and defenseless abandonment (Yehuda, 2002). Post-traumatic stress disorder (PTSD), the clinical manifestation of post-traumatic stress, involves the threat of death or serious injury to the individual or another that is accompanied by intense feelings of fear, helplessness or horror (APA, 2000). PTSD can significantly impair the function and well-being of individuals as it involves re-experiencing the trauma, avoidance of reminders, and persistent increased arousal (Holditch-Davis, Bartlett, Blickman, & Shandor Miles, 2003).
The emotional distress resulting from the experience of having a preterm infant and the subsequent neonatal unit hospitalization may contribute towards post-traumatic stress responses for various reasons, outlined as follows. Having a premature baby may result in parents experiencing a sense of loss of personal control over events, particularly those related to the survival of the infant (Meek, Fowler, Caflin, & Rasmussen, 1995). Parents may also experience a loss of their role as decision makers and care givers of their child (Campbell & Fleischman, 2001) that could be resulted from parent-infant separation brought about by hospitalisation (Moehn & Rossetti, 1996). …