Promoting Maternal Mental Health and Wellbeing in Neonatal Intensive Care Through Mindfulness

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Mothers of infants with medical issues requiring neonatal intensive care – an estimated 400,00-480,000 infants born per year – are at increased risk for mental health problems, which also have negative effects on parenting and child outcomes. The experience of having an infant in the neonatal intensive care unit (NICU) is often overwhelming and traumatic for parents, particularly mothers, who are more likely than fathers to be primary caretakers and are more frequent NICU visitors. NICU mothers are at high risk for depressive, anxiety, and trauma symptoms, which have been shown to persist following NICU discharge, to impair maternal-infant attachment, and to negatively impact child development. The NICU stay represents a critical window for offering evidence-based preventive interventions to mothers. However, there are few NICU-based programs to promote maternal mental health and wellbeing, their evidence base is limited, and they are generally delivered face-to-face. Our pilot research suggests face-to-face program delivery poses significant feasibility issues, including lack of acceptability for busy parents and financial and staffing challenges for NICU staff. Found to improve depression, anxiety, and trauma in adults, mindfulness has not yet been evaluated for mothers in the NICU. Mindfulness skills promote non-judgmental awareness of present-moment realities and enhance capacities for accepting painful emotions and situations. Our team developed a mindfulness-based NICU intervention delivered via video and audio modalities. Our pilot research indicates that the intervention significantly reduced maternal depressive, anxiety, and trauma symptoms and improved stress management, sleep, and coping. The proposed R34 project will enable us to further develop the intervention and prepare for a future R01 efficacy trial. In Year 1 of this project, we will develop additional mindfulness practices to address the family's transition home from the NICU, and we will develop an active control condition. In Years 2-3, we will conduct a pilot randomized study in two NICU sites to assess feasibility of our study design, program content, and measures and a preliminary evaluation of program benefits. Our pilot RCT will assess maternal psychological symptoms and heart rate variability as a measure of physiological stress reactivity, a potential mechanism for how mindfulness practices may improve stress management, which we will evaluate more fully in the future R01. Our team of experts in mindfulness interventions, perinatal mental health, neonatal health, physiologic stress response, and prevention trials has a history of productive collaboration and strong partnerships with the NICU study sites. Our proposed research is innovative in its focus on prevention in the NICU, adaptation of mindfulness strategies for a new population, use of video and audio modalities to optimize program feasibility, and inclusion of a physiological index of maternal stress. The research is significant in its focus on a critical understudied public health problem, emphasis on a potentially scalable intervention model, and promise for positively impacting an estimated 10-12% of mothers of infants born each year