Prevalence of anxiety and post-traumatic stress (PTS) among the parents of babies admitted to neonatal units: A systematic review and meta-analysis

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Study Justification:
This systematic review and meta-analysis aimed to investigate the prevalence of anxiety and post-traumatic stress (PTS) among parents of babies admitted to neonatal units (NNU). The study is important because parents of babies in NNUs often experience distressing situations, which can lead to mental health symptoms. Understanding the prevalence of anxiety and PTS among these parents is crucial for identifying the need for early diagnosis and effective intervention.
Highlights:
– The review included 56 studies involving 6,036 parents of babies in NNUs.
– The pooled prevalence of anxiety among parents up to one month after birth was 41.9%, and for PTS it was 39.9%.
– Prevalence of anxiety decreased to 26.3% and PTS to 24.5% between one month and one year after birth.
– More than one year after birth, PTS prevalence remained high at 27.1%.
– The study found high heterogeneity between studies, and some evidence that study characteristics contributed to the variation in prevalence estimates.
Recommendations:
– Implement routine screening for anxiety and PTS among parents of babies in NNUs to enable early diagnosis and effective intervention.
– Provide support and resources for parents experiencing anxiety and PTS, both during and after their baby’s stay in the NNU.
– Conduct further research to better understand the factors contributing to the high prevalence of anxiety and PTS among these parents, and to develop targeted interventions.
Key Role Players:
– Researchers and clinicians specializing in neonatal care and mental health.
– Policy makers and government officials responsible for healthcare policies and funding.
– Healthcare providers in neonatal units, including doctors, nurses, and psychologists.
– Parent support groups and organizations advocating for the mental health of parents with babies in NNUs.
Cost Items for Planning Recommendations:
– Development and implementation of routine screening protocols in NNUs.
– Training for healthcare providers on identifying and addressing anxiety and PTS in parents.
– Provision of mental health resources and support services for parents.
– Research funding for further studies on the prevalence and factors contributing to anxiety and PTS among parents in NNUs.
– Public awareness campaigns to reduce stigma and increase understanding of mental health issues in this population.

Background: Parents of babies admitted to neonatal units (NNU) are exposed to a range of potentially distressing experiences, which can lead to mental health symptoms such as increased anxiety and post-traumatic stress (PTS). This review aimed to describe how anxiety and PTS are defined and assessed, and to estimate anxiety and PTS prevalence among parents of babies admitted to NNU. Method: Medline, Embase, PsychoINFO, Cumulative Index to Nursing and Allied Health literature were searched to identify studies published prior to April 14, 2021. Included studies were assessed using Hoy risk of bias tool. A random-effects model was used to estimate pooled prevalence with 95% CIs. Potential sources of variation were investigated using subgroup analyses and meta-regression. The review is registered with PROSPERO (CRD42020162935). Findings: Fifty six studies involving 6,036 parents met the review criteria; 21 studies assessed anxiety, 35 assessed PTS, and 8 assessed both. The pooled prevalence of anxiety was 41.9% (95%CI:30.9, 53.0) and the pooled prevalence of PTS was 39.9% (95%CI:30.8, 48.9) among parents up to one month after the birth. Anxiety prevalence decreased to 26.3% (95%CI:10.1, 42.5) and PTS prevalence to 24.5% (95%CI:17.4, 31.6) between one month and one year after birth. More than one year after birth PTS prevalence remained high 27.1% (95%CI:20.7, 33.6). Data on anxiety at this time point were limited. There was high heterogeneity between studies and some evidence from subgroup and meta-regression analyses that study characteristics contributed to the variation in prevalence estimates. Interpretation: The prevalence of anxiety and PTS was high among parents of babies admitted to NNU. The rates declined over time, although they remained higher than population prevalence estimates for women in the perinatal period. Implementing routine screening would enable early diagnosis and effective intervention. Funding: This research is funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Maternal and Neonatal Health and Care, PR-PRU-1217-21202. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

The review was prospectively registered with PROSPERO (CRD42020162935). NNU: This review includes parents of all babies admitted to NNUs for any level of care. Anxiety and PTS: Throughout this review, the term ‘anxiety’ is used to describe anxiety symptoms, which can vary from mild to severe17 or the presence of an anxiety disorder, such as generalised anxiety disorder. The term ‘PTS’ is used to describe PTS symptoms, which occur in response to an extremely negative or traumatic event, or the presence of acute stress disorder (from three days to one month after the event) or post-traumatic stress disorder (PTSD) (more than one month after the event). A search strategy was developed using a combination of free-text (title/abstract) keywords and MeSH (subject terms) to describe the key concepts of anxiety and PTS, parents, NNUs and prevalence. Medline, Embase, PsychoINFO, Cumulative Index to Nursing and Allied Health literature, Web of Science, ResearchGate and Google Scholar were searched (Appendix A). No date or language restrictions were applied. A search of grey literature was conducted using British Library EThOS, Open Grey and ProQuest Dissertations & Theses Global and studies. The websites of not-for-profit organisations Bliss and March of Dimes were also searched for relevant studies. In addition, the reference lists of all included studies were used to identify further relevant publications. The final search was conducted on April 14th 2021. Studies were included if they: 1) were cohort (prospective or retrospective) or cross-sectional in design; 2) assessed prevalence of anxiety and/or PTS at any time after birth; 3) included mothers, fathers, parents or other primary carers of babies admitted to a NNU. Two of three reviewers (RM, SH, FA) independently screened the titles and abstracts of all studies identified by the search. Full texts were independently screened by two of four reviewers applying the review eligibility criteria (RM, SH, HB, FA). Screening was performed using Covidence software.18 Disagreements regarding study eligibility were resolved through discussion and consensus within the review team. Study authors were contacted if cut-off points were not reported, if anxiety and/or PTS data were reported as mean scores or combined with prevalence of depression, or if the study was available as an abstract only. Additional information was provided by 14 study authors. Where no data were obtained from authors, missing data were recorded as not reported and subsequently excluded from meta-analyses and meta-regressions. The following data were extracted for each included study: year and country of publication, study objective, study design, study period, NNU level, infant length of NNU stay, study inclusion/exclusion criteria, demographics of parents and babies, assessment tool, cut-off point, time of assessment and prevalence. Risk of bias was assessed using the Hoy risk of bias tool (Appendix B).19 The tool consists of ten items: items one to four assess external validity (selection bias (items 1-3) and non-response bias (item 4), items five to ten assess internal validity (measurement bias (items 5-9)) and analysis bias (item 10). Appraisal of each item provides a subjective assessment of risk of bias as low, high or unclear. All data were extracted and independently cross-checked by at least two authors (RM, SH, HB, FA). Pooled prevalence estimates of anxiety and PTS were calculated by combining estimates from each study. Meta-analysis was conducted using the “Metaprop” function in STATA 15.9.20 A random-effects model was applied and the results were reported as proportions with 95% confidence intervals (CI). The data were analysed by time of assessment: up to one month after birth; from one month to one year after birth; and more than one year after birth. If studies reported more than one assessment of anxiety/PTS in the time period, the time point with most participants was included. Subgroup analyses were pre-specified and conducted across the following study characteristics: setting (high vs. middle income countries), design (cohort vs. cross-sectional), sample representativeness (low vs. high risk of selection bias on item one of the quality assessment vs. no on item one), anxiety measurement tool (self-report vs. clinical interview), sex of parents (male vs. female), self-report scale (State Trait Anxiety Inventory (STAI) state scale vs. others for anxiety; Perinatal Post-Traumatic Stress Disorder Questionnaire (PPQ) vs. others for PTS) and prematurity level (< 33 vs. ≥ 33 weeks gestation). Planned subgroup analyses by birthweight, neonates that had surgical procedures, level of NNU, and length of stay were not feasible due to insufficient data. Sensitivity analysis based on study quality was also planned but could not be performed because no study was low risk of bias on all items. Evidence of variation in anxiety/PTS prevalence due to between-study heterogeneity was assessed using the I2 statistic, which describes the percentage of variation not due to sampling error. An I2 value above 50% indicates moderate heterogeneity and above 75% indicates high heterogeneity.21 Where there was evidence of high heterogeneity and there were sufficient numbers of studies, meta-regression was performed to investigate whether any variation in prevalence estimates was explained by study characteristics. Patient and public involvement (PPI): A voluntary group of parents, whose babies received care in a neonatal unit and a representative from Bliss provided the PPI input for this review. Parents provided a personal insight from their experience of having a baby cared for in a NNU and worked collaboratively with the team to improve the readability of the scientific language used in the review and interpreting the findings to a wider dissemination of the findings. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Based on the provided information, it seems that the text is a detailed description of a systematic review and meta-analysis on the prevalence of anxiety and post-traumatic stress (PTS) among parents of babies admitted to neonatal units (NNUs). The review aimed to estimate the prevalence of anxiety and PTS among parents at different time points after birth and to identify potential sources of variation in prevalence estimates.

The review included 56 studies involving 6,036 parents. The pooled prevalence of anxiety was found to be 41.9% among parents up to one month after birth, decreasing to 26.3% between one month and one year after birth. The pooled prevalence of PTS was 39.9% among parents up to one month after birth, decreasing to 24.5% between one month and one year after birth. More than one year after birth, the prevalence of PTS remained high at 27.1%.

The review suggests that implementing routine screening for anxiety and PTS among parents of babies admitted to NNUs could enable early diagnosis and effective intervention. This could help improve access to maternal health by identifying and addressing mental health symptoms in parents, ultimately supporting their well-being during the perinatal period.

It is important to note that this information is based on the description provided and does not include any specific innovations or recommendations for improving access to maternal health.
AI Innovations Description
The recommendation to improve access to maternal health based on the described review is to implement routine screening for anxiety and post-traumatic stress (PTS) among parents of babies admitted to neonatal units (NNUs). The review found that the prevalence of anxiety and PTS was high among parents of babies in NNUs, and implementing routine screening would enable early diagnosis and effective intervention.

By screening parents for anxiety and PTS, healthcare providers can identify those who may be at risk and provide appropriate support and treatment. This can help prevent the long-term negative effects of anxiety and PTS on parents’ mental health and well-being.

Additionally, routine screening can also help healthcare providers identify any gaps in the current system and develop targeted interventions to address the specific needs of parents in NNUs. This can include providing access to counseling services, support groups, and resources to help parents cope with the challenges they may face during their baby’s hospitalization.

Overall, implementing routine screening for anxiety and PTS among parents of babies in NNUs can contribute to improving access to maternal health by ensuring that parents receive the necessary support and interventions to promote their well-being during this challenging time.
AI Innovations Methodology
The provided text is a detailed description of a systematic review and meta-analysis on the prevalence of anxiety and post-traumatic stress (PTS) among parents of babies admitted to neonatal units (NNUs). The review aimed to estimate the prevalence of anxiety and PTS among parents of babies admitted to NNUs and investigate potential sources of variation in prevalence estimates.

To improve access to maternal health, it is important to address the mental health needs of parents, particularly those with babies admitted to NNUs. Implementing routine screening for anxiety and PTS can enable early diagnosis and effective intervention. This can help identify parents who may require additional support and provide appropriate mental health services.

In terms of methodology to simulate the impact of recommendations on improving access to maternal health, the following steps can be considered:

1. Identify the recommendations: Based on the findings of the systematic review and meta-analysis, identify specific recommendations that can improve access to maternal health for parents of babies admitted to NNUs. These recommendations can include interventions such as routine screening, mental health support programs, and targeted interventions for high-risk populations.

2. Define the simulation model: Develop a simulation model that represents the maternal health system and its various components. This model should capture the key factors that influence access to maternal health, such as availability of services, healthcare infrastructure, and patient characteristics.

3. Input data: Gather relevant data to populate the simulation model. This can include data on the prevalence of anxiety and PTS among parents of babies admitted to NNUs, healthcare utilization patterns, resource availability, and other relevant parameters.

4. Implement the recommendations: Incorporate the identified recommendations into the simulation model. This can involve modifying the model to reflect the impact of the recommendations on access to maternal health services. For example, the model can simulate the increase in the number of parents identified with anxiety or PTS through routine screening and the subsequent provision of mental health support.

5. Simulate the impact: Run the simulation model to simulate the impact of the recommendations on improving access to maternal health. This can involve running multiple scenarios to assess the potential outcomes under different conditions or assumptions. The simulation can provide estimates of the expected changes in access to maternal health services, such as the number of parents receiving mental health support or the reduction in wait times for services.

6. Evaluate the results: Analyze the simulation results to evaluate the impact of the recommendations on improving access to maternal health. This can involve comparing the outcomes of different scenarios or assessing the changes in key performance indicators, such as the proportion of parents accessing mental health services or the reduction in prevalence of anxiety and PTS.

7. Refine and iterate: Based on the evaluation of the simulation results, refine the recommendations and the simulation model as needed. Iteratively improve the model and recommendations to optimize access to maternal health services.

By following this methodology, policymakers and healthcare providers can gain insights into the potential impact of recommendations on improving access to maternal health for parents of babies admitted to NNUs. This can inform decision-making and resource allocation to effectively address the mental health needs of this population.

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