Early intervention program reduces stress in parents of preterms during childhood, a randomized controlled trial

Inger Pauline Landsem, Bjørn Helge Handegård, Jorunn Tunby, Stein Erik Ulvund, John A Rønning, Inger Pauline Landsem, Bjørn Helge Handegård, Jorunn Tunby, Stein Erik Ulvund, John A Rønning

Abstract

Background: It is well documented that heightened levels of parenting stress have a negative influence on children's socio-emotional and behavioral development. Parenting stress may therefore be regarded as an outcome variable in its own right. This study investigated whether a sensitizing intervention influences stress reported by parents of prematurely born children until the children were age nine.

Methods: Preterm infants (N = 146, birth weight <2,000 g) were randomized to intervention (N = 72) with the Mother-Infant Transaction Program (MITP) or a preterm control group (N = 74) that received standard hospital care. A term reference group comprised 75 healthy, full-term neonates. Parents reported on the Parenting Stress Index (PSI) when the children were 6 months, 1, 2, 3, 5, 7 years old and on the PSI-Short Form (PSI-SF) at age 9. Main outcomes were the mother's and father's reports of total, child and parent-related stress. Cross-sectional and longitudinal analyses were performed using linear mixed models (LMM), taking dependency in the data caused by twin pairs and repeated measures into account. Response rates were high across all follow-ups, and still reached 85% from mothers and 72% from fathers at 9 years.

Results: Mothers in the intervention group reported better longitudinal development of child-related stress than mothers of preterm controls, as they perceived their children as being more adaptable and less moody throughout childhood until the age of seven. Less stress in the intervention group was revealed by cross-sectional analysis of maternal reports at all ages, while fathers reported similar differences at ages three and five. Parents in the intervention group reported stronger agreement on several stress scores on several occasions. Fathers with high interventional participation (mean 54%) reported significantly less stress at age nine than those who participated less. Both parents in the intervention group reported levels of stress similar to those experienced by the term reference group at all follow-ups, while differences between the preterm control and term reference groups increased.

Conclusions: This early intervention reduces stress among parents of prematurely born children to a level reported by parents of term-born children and enhances agreement between parents.

Trial registration: Clinical Trials Gov identifier NCT00222456, 05.09.2005.

Figures

Figure 1
Figure 1
Study flow and parents’ reports on Parenting Stress Index (PSI) from 6 months to 9 years of age. At age 9, two mothers in the TR group reported on PSI but their child did not attend the follow-up session.
Figure 2
Figure 2
Parenting Stress Index (PSI), Total Stress reported by mothers and fathers in the preterm intervention (PI), preterm control (PC) and term control (TR) groups from 6 months until 7 years.
Figure 3
Figure 3
Mothers’ reports on Parenting Stress Index (PSI)-Child Domain from age 6 months until 7 years.

References

    1. Singer LT, Fulton S, Kirchner L, Eisengart S, Lewis B, Short E, Min OM, Satayathum S, Kercsmar C, Baley JE. Parenting very low birth weight children at school age: maternal stress and coping. J Pediatr. 2007;151:463–469. doi: 10.1016/j.jpeds.2007.04.012.
    1. Singer LT, Fulton S, Kirchner L, Eisengart S, Lewis B, Short E, Min OM, Satayathum S, Kercsmar C, Baley JE. Longitudinal predictors of maternal stress and coping after very low-birth-weight birth. Arch Pediat Adolesc Med. 2010;164:518–524.
    1. Aarnoudse-Moens CSH, Weisglas-Kuperus N, van Goudoever JB, Oosterlaan J. Meta-analysis of neurobehavioral outcomes in very preterm and/or very low birth weight children. [Review Article] Pediatrics. 2009;124(No.2):717–728. doi: 10.1542/peds.2008-2816.
    1. Rauh VA, Nurcombe B, Achenbach T, Howell C. The mother-infant transaction program. The content and implications of an intervention for the mothers of low-birthweight infants. Clin Perinatol. 1990;17(1):31–45.
    1. Deater-Deckard K. Parenting stress and child adjustment: some old hypotheses and new questions. Clin Psychol: Science and Practice. 1998;3(2):314–332.
    1. Abidin RR. Parenting Stress Index, Professional Manual, Third Edition. Odessa, USA: PAR Psychological Assessment Resources, Inc; 1995.
    1. Morgan J, Robinson D, Aldridge J. Parenting stress and externalizing child behavior. Child Fam Soc Work. 2002;7:219–225. doi: 10.1046/j.1365-2206.2002.00242.x.
    1. Schappin R, Wijnroks L, Uniken Venema MMAT, Jongmans MJ. Rethinking stress in parents of preterm infants: a meta-analysis. PLoS One. 2013;8(2):e54992. doi: 10.1371/journal.pone.0054992.
    1. Treyvaud K, Lee KJ, Doyle LW, Anderson PJ. J Pediatr. 2014. Very preterm birth influences parental mental health and family outcomes seven years after birth.
    1. Pihlakoski L, Sourander A, Aromaa M, Rønning JA, Rautava P, Helenius H, Silanpää M. Child Psychiatr Hum Dev. 2012. Do antenatal and postnatal parental psychological distress, and recognized need of help predict preadolescent’s psychiatric symptoms? The Finnish Family Competence Cohort Study.
    1. Theule J. PhD thesis. University of Toronto: Ontario Institute for Studies in Education; 2010. Predicting parenting stress in families of children with ADHD.
    1. Feldman R. From biological rhythms to social rhythms: physiological precursors of mother-infant synchrony. Dev Psychol. 2006;42(1):175–188. doi: 10.1037/0012-1649.42.1.175.
    1. Korja R, Latva R, Lehtonen L. The effects of preterm birth on mother-infant interaction and attachment during the infant’s first two years. Acta Obstet Gynecol Scand. 2012;91:164–173. doi: 10.1111/j.1600-0412.2011.01304.x.
    1. van Bakel HJ, Maas AJB, Vreeswijk CM, Vingerhoets AJ. Pictorial representation of attachment: measuring the parent-fetus relationship in expectant mothers and fathers. BMC Pregnancy Childbirth. 2013;13:138. doi: 10.1186/1471-2393-13-138.
    1. Walsh J. Definitions matter: if maternal-fetal relationships are not attachment, what are they? Arch Wom Ment Health. 2010;13:449–451. doi: 10.1007/s00737-010-0152-8.
    1. Willinger U, Diendorfer-Radner G, Willnauer R, Jörgl G, Hager V. Parenting stress and parental bonding. Behav Med. 2005;31(2):63–69. doi: 10.3200/BMED.31.2.63-72.
    1. Yarcheski A, Mahon NE, Yarcheski TJ, Hanks MM, Cannella BL. A meta-analytic study of predictors of maternal-fetal attachment. Int J Nurs Studies. 2009;46:708–715. doi: 10.1016/j.ijnurstu.2008.10.013.
    1. Benzies KM, Magill-Evans JE, Hayden KA, Ballantyne M. Key components of early intervention programs for preterm infants and their parents: a systematic review and meta-analysis. BMC Pregnancy & Childbirth. 2013;13(suppl 1):S10. doi: 10.1186/1471-2393-13-S1-S10.
    1. Bakermans-Kranenburg MJ, van Ijzendoorn MH, Juffer F. Less is more: meta-analyses of sensitivity and attachment interventions in early childhood. Psychol Bull. 2003;129(2):195–215. doi: 10.1037/0033-2909.129.2.195.
    1. Gray PH, Edwards DM, O’Callaghan MJ, Cuskelly M, Gibbons K. Early Hum Dev. 2013. Parenting stress in mothers of very preterm infants - Influence of development, temperament and maternal depression.
    1. Halpern LF, Brand KL, Malone AF. Parenting stress in mothers of very-low -birth-weight (VLBW) and full-term infants: a function of infant behavioral characteristics and child-rearing attitudes. J Pediatr Psychol. 2001;26(2):93–104. doi: 10.1093/jpepsy/26.2.93.
    1. Kaaresen PI, Rønning JA, Ulvund SE, Dahl LB. A randomized, controlled trial of the effectiveness of an early-intervention program in reducing parenting stress after preterm birth. Pediatrics. 2006;118(1):e9–e19. doi: 10.1542/peds.2005-1491.
    1. Kaaresen PI, Rønning JA, Tunby J, Nordhov SM, Ulvund SE, Dahl LB. A randomized controlled trial of an early intervention program in low birth weight children: outcome at 2 years. Early Hum Dev. 2008;84(3):201–209. doi: 10.1016/j.earlhumdev.2007.07.003.
    1. Nordhov SM, Rønning JA, Ulvund SE, Dahl LB, Kaaresen PI. Early intervention improves behavioral outcomes for preterm infants: randomized controlled trial. Pediatrics. 2012;129:9–16. doi: 10.1542/peds.2011-0248.
    1. Landsem IP, Handegård BH, Ulvund SE, Tunby J, Kaaresen PI, Rønning JA. Does an early intervention influence behavioral development until age nine of children born prematurely? 2014.
    1. Crnic KA, Gaze C, Hoffman C. Cumulative parenting stress across the preschool period: relations to maternal parenting and child behavior at age 5. Inf Child Dev. 2005;14:117–132. doi: 10.1002/icd.384.
    1. Abidin RR. Bibliography for the parenting stress index. 2011.
    1. Haskett ME, Ahern LS, Ward CS, Allaire JC. Factor structure and validity of the parenting stress index-short form. J Clin Child & Adoles Psychol. 2006;35(2):302–312. doi: 10.1207/s15374424jccp3502_14.
    1. Twisk JWR. Applied Multilevel Analysis. Cambridge: Cambridge University Press; 2006.
    1. Alsawalmeh YM, Feldt LS. Test of the hypothesis that the intraclass reliability coefficient is the same for two measurement procedures. Appl Psych Meas. 1992;16:195–205. doi: 10.1177/014662169201600208.
    1. Hedges LV, Olkin L. Statistical Methods for Meta-Analysis. Orlando, FL: Academic Press; 1985.
    1. Eckerman CO, Hsu H, Molitor A, Leung EHL, Goldstein RF. Infant arousal in an en-face exchange with a new partner; Effects of prematurity and perinatal biological risk. Dev Psychol. 1999;35(1):283–297. doi: 10.1037/0012-1649.35.1.282.
    1. Evans T, Whittingham K, Boyd RN. What helps the mother of a preterm infant become securely attached, responsive and well-adjusted? Infant Behav Dev. 2012;35:1–11. doi: 10.1016/j.infbeh.2011.10.002.
    1. Laucht M, Esser G, Schmidt MH. Differential development of infants at risk for psychopathology: the moderating role of early maternal responsivity. Dev Med Child Neurol. 2001;43:292–300. doi: 10.1017/S0012162201000561.
    1. Olafsen KS, Kaaresen PI, Handegard BH, Ulvund SE, Dahl LB, Rønning JA. Maternal ratings of infant regulatory competence from 6 to 12 months: influence of perceived stress, birth-weight, and intervention: a randomized controlled trial. Infant Behav Dev. 2008;31(3):408–421. doi: 10.1016/j.infbeh.2007.12.005.
    1. Coppola G, Cassibba R, Costatini A. What can make the difference? Premature birth and maternal sensitivity at 3 months of age: the role of attachment organization, traumatic reaction and baby’s medical risk. Infant Behav Dev. 2007;30:679–684. doi: 10.1016/j.infbeh.2007.03.004.
    1. Poehlmann J, Fiese BH. The interaction of maternal and infant vulnerabilities on developing attachment relationships. Dev Psychopatlol. 2001;13:1–11. doi: 10.1017/S0954579401001018.
    1. Borghini A, Pierrehumbert B, Miljkovictch R, Muller-Nix C, Forcada-Guex M, Ansermet F. Mothers attachment representations of their premature infant at 6 and 18 months after birth. Infant Mental Health Journal. 2006;27(5):494–508. doi: 10.1002/imhj.20103.
    1. Jones KM, Champion PR, Woodward LJ. Social competence of preschool children born very preterm. Early Hum Dev. 2013;89:795–802. doi: 10.1016/j.earlhumdev.2013.06.008.
    1. Sameroff AJ, Fiese B. Transactional regulation: the developmental ecology of early intervention. In: Shonkoff J, Meisel S, editors. Handbook of Early Childhood Intervention. Cambridge: Cambridge University Press; 2000. pp. 135–159.
    1. Feldman R, Greenbaum CW, Yirmaya N. Mother-infant affect synchrony as an antecedent of the emergence of self-control. Dev Psychol. 1999;35:223–231. doi: 10.1037/0012-1649.35.1.223.
    1. Hauser-Cram P, Warfield ME, Shonkoff JP, Krauss MW, Sayer A, Upshur CC, Hodapp RM. Children with disabilities: a longitudinal study of child development and parent well-being. Source: Monographs of the Society for Research in Child Development. 2001;66(3):1–114.
    1. Goyal NK, Teeters A, Ammerman RT. Home visiting and outcomes of preterm infants: a systematic review. Pediatrics. 2013;132(3):502–516. doi: 10.1542/peds.2013-0077.
    1. Ong L, Chandran V, Boo N. Comparison of parenting stress between Malaysian mothers of four-year-old very low birthweight and normal birthweight children. Acta Paediatr. 2001;90:1464–1469. doi: 10.1111/j.1651-2227.2001.tb01614.x.
    1. Choe DE, Olson SL, Sameroff AJ. Effects of maternal distress and parenting on the development of children’s self-regulation and externalizing behavior. Dev Psychopathol. 2013;25:437–453. doi: 10.1017/S0954579412001162.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner