Families of very low-birth-weight infants more likely to use mental health care
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Key takeaways:
- Seeking mental health care is more common among parents of very low-birth-weight infants.
- Parents of newborns who died sought help sooner, the study found.
Parents of very low-birth-weight premature infants are more likely to use mental health care in the first year after discharge from the NICU than families who do not have a premature infant, according to a study.
“There is a very well-established body of literature that looks at the fact that having an infant hospitalized in the NICU has significant impacts on the family members — not just the infant who is hospitalized, but the parents and the siblings,” Katherine E. Schwartz, MD, a neonatologist at Cohen Children’s Medical Center in New York, told Healio.
“We know from prior research that this can manifest as increased rates of mental health issues, both for parents and for siblings, so we wanted to look a little bit more closely at the NICU population to see what we could learn about when they are in most need,” Schwartz said.
Schwartz and colleagues reviewed insurance claims filed from July 1, 2015, to June 30, 2016, for families of neonates born at 30 weeks’ gestational age or sooner with a birth weight less than 1,500 g. They used a sample of families that did not have exposure to a child hospitalized in the NICU for prematurity as a control group, matching each case with four controls.
“We basically looked at proportions of family members who accessed mental health care resources in the year during the hospitalization of their child if they were a case family, or in the year afterward,” Schwartz said. “We looked at those proportions on a month-by-month basis, and created curves to display the trends and proportions over time to look at their utilization compared to again those control families.”
The authors initially thought there would be an underutilization of mental health care during the hospitalization of the NICU patient, “just because of all of the competing stresses that we thought we'd be present in the family,” according to Schwartz, but the results showed otherwise.
The final study population included 1,209 premature babies, who had 2,003 parents and 884 siblings. The control arm included 1,884 neonates with 3,336 parents and 1,878 siblings.
Overall, more parents of very low-birth-weight (VLBW) children used mental health care over the first year after their newborn was discharged from the hospital than parents in the control group, Schwartz and colleagues found. Use was even higher among parents of the 11.1% of neonates who died.
Mental health care use among female parents of VLBW preemies steadily increased from the birth until approximately the time of their child’s discharge, followed by a plateau and then a decline, the researchers reported. The largest proportion of mental health care usage among female parents occurred immediately after the death of a newborn, although Schwartz and colleagues found that the proportion of each group of female parents using mental health care — including parents in the control group — was converging by the end of the first postpartum year.
Among male parents, mental health care use rose steadily in the first year after birth in the control group, whereas it remained uniform throughout the first year among male parents of VLBW preemies who survived. Among male parents of newborns who died, there was a steady increase in use in the months after the death, which peaked at around 7 months and declined to a proportion similar to the other two groups, according to the researchers.
“The thing that was most surprising to me was how much of an underutilization phenomenon we saw for the bereaved siblings of a NICU patient,” Schwartz said.
She said it is crucial for providers to be aware of the “resiliency of these families.”
“Celebrate that resilience, but also, especially in the background of the pediatric mental health crisis in the post-pandemic era, know that children who have a sibling who has been in the NICU or who died in the NICU really are a population that need special attention,” Schwartz said. “When we look at outcomes of families after having a child in the NICU, it really shouldn't be stratified by bereavement status because there are there are very particular needs for the bereaved population.”
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