Parent mental health

Authors

Houtzager BA, Huening B, Wolke D, Okay I, Virchez M

Click on the image to read the standard in brief.

Target group

Infants born very preterm or those infants with risk factors (see preamble Follow-up & continuing care), parents and their families

User group

Healthcare professionals, neonatal units, hospitals, follow-up teams, and health services

Statement of standard

Parental mental health is attended to during regular follow-up visits for the child, taking into account the impact on (the context of) child development.

Rationale

The experience of a very preterm birth is a stressful life-event for parents and uniquely contributes to reduced life satisfaction. (1) Mothers may suffer role loss (2–5) and are at increased risk for psychological and parenting stress. (2,6,7) Maternal mental health issues are associated with elevated risk of preterm delivery. (8) During and after hospitalisation, parents may show symptoms of depression and anxiety (8–10), posttraumatic stress (PTSS) (4,7,11–16), or a combination of both. (17–19) Most studies focus on maternal distress (20), however, recent studies show that fathers also suffer from depressive symptoms and anxiety. (21,22)

The impact of preterm birth on parents is most evident during early childhood (5,23) and symptoms tend to decline over time. (10,15) Long-term maternal distress was reported 13 years after preterm birth compared to mothers of term-born children (24), while others report no differences at 5 years (25), normalization (3) or even posttraumatic growth (26) at adolescent or adult age of the child. (27) Adverse effects of maternal mental health problems on survivors of preterm birth were still detected in adulthood. (28)

Parent mental health should be regarded in the context of the child’s developmental progress. It is related to infant development and health, mediating child outcome (2,29–31) and can indirectly affect child development through its impact on parent-child interaction. (2,3,21,33) Parental distress has been associated with infant’s illness severity (2,26,30), lack of maternal role fulfilment and rehospitalisation (5) and concerns about the child’s development. (32,34) Parental distress is buffered under conditions of high social support (26,35), a higher level of education/SES, and in the presence of effective coping strategies and a positive developmental outcome for the child. (3) Low social support in combination with developmental difficulties in the child are risk factors. (26) Post-NICU interventions such as maternal infant transaction programme (MITP) (36,37) and infant behavioural assessment and intervention programme (IBA-IP) (38,39) improve child cognitive development through sensitive parenting and improved parent-child interactions. (40) There are targeted post-NICU interventions (36, 41–43), and a web-based intervention (44), that effectively pay attention to parent mental health.

Benefits

Short-term benefits

N/A

Long-term benefits

Prepares parents for their potential emotional reactions after birth (consensus)
Early identification and prompt treatment of parent mental health problems (13,45,46)
Improved mental health support for at-risk families (see Follow-up & continuing care) (consensus)
Improved parenting confidence (36,37)
Facilitates parents’ capacity to support their child’s development (11,36,37,47)
Optimised neurodevelopmental and social-emotional outcomes (28,38,39,42,48)

Components of the standard

Component

Grading of evidence

Indicator of meeting the standard

For parents and family

Parents are informed by healthcare professionals about normal potential emotional reactions to very preterm birth and the importance of assessment during regular follow-up visits in the first six months after discharge. (2–7,12,13,49,50)

A (High quality)
B (High quality)

Clinical records, patient information sheet¹

Parents are supported by early intervention programmes or receive appropriate mental health support if they are at risk for mental health problems (see Follow-up & continuing care). (42,48,51–53)

A (Moderate quality)

Guideline, parent feedback

For healthcare professionals

A guideline on follow-up including parental mental health assessment is adhered to by all healthcare professionals. (54)

B (High quality)

Guideline

At each regular follow-up visit for the child at six months and at two years after discharge parents are screened for mental health problems, using locally available standardised screening tools such as the Edinburgh Postnatal Depression Scale (EPDS), Hospital Anxiety and Depression Scale (HADS), Psychosocial Assessment Tool (PAT) or Distress Thermometer for Parents (DT-P). (55)

A (Moderate quality)

Guideline

Training on recognition of the clinical signs that are associated with mental health difficulties. (53)

B (High quality)

Training records

Parents with identified mental health problems after discharge are referred for locally available specialised mental health support; information about local mental health support and referral pathways is available.

B (High quality)

Clinical records

For neonatal unit, hospital, and follow-up team

A guideline on follow-up including parental mental health assessment is available and regularly updated.

B (High quality)

Guideline

Training on recognition of the clinical signs that are associated with mental health difficulties is ensured.

B (High quality)

Training documentation

A follow-up team (nurse or paediatrician) is available and trained in addressing mental health issues in parents.

B (High quality)

Training documentation

For health service

A national guideline on follow-up including parental mental health assessment is available and regularly updated.

B (High quality)

Guideline

¹The indicator ‘patient information sheet’ is an example for written, detailed information, in which digital solutions are included, such as web-based systems, apps, brochures, information leaflets, and booklets.

Where to go

Further development

Grading of evidence

For parents and family

N/A

For healthcare professionals

Create awareness about paternal and maternal mental health.

B (High quality)

Improve existing support programmes with extra modules for parent mental health specifically in at-risk/socioeconomically deprived populations. (56)

A (Moderate quality)
B (Moderate quality)

For neonatal unit, hospital, and follow-up team

Establish a continuous chain of psychological support before and after discharge. (23)

A (Moderate quality)

Facilitate home visits of targeted families, home visits after discharge for families at high medical and social risk. (37,42,48)

A (High quality)

For health service

Provide standardised information about parent mental health issues after very preterm birth (written, apps, E-health psychoeducational modules, and instruction videos) in all European countries’ languages. (11)

A (Moderate quality)

Generate a greater understanding of the mental health needs of both parents and in particular the father. (49,57)

A (High quality)

Provide access to information about parent mental health in a child record.

B (High quality)

Getting started

Initial steps

For parents and family

Parents are informed by healthcare professionals about normal potential emotional reactions to very preterm birth.
Parents are asked about their mental health and parenting stress by their paediatrician, health visitor or family doctor at regular follow-up visits after discharge, preferably at least during the first six months.

For healthcare professionals

Attend training on recognition of the clinical signs that are associated with mental health difficulties.
Include inquiries about parent mental health and parental support during regular follow-up visits with doctors or nurses.
Record whether parent mental health difficulties are suspected or detected and need to be monitored or treated.
Inform the parents’ family doctor if mental health screen positive.

For neonatal unit, hospital, and follow-up team

Make a telephone call in the first weeks after discharge to check parental wellbeing, in the absence of a physical follow-up appointment.
Develop and implement a unit guideline on follow-up including parental mental health.
Develop information material about potential emotional reactions to very preterm birth.
Organise information sharing about the family with follow-up team.
Support healthcare professionals to participate in training on recognition of the clinical signs that are associated with mental health difficulties.
Exchange/share information with agreement from parents.

For health service

Develop and implement a national guideline on follow-up including parental mental health.

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