Maternal stress and depressive symptoms associated with quality of developmental care in 25 Italian Neonatal Intensive Care Units: A cross sectional observational study

Rosario Montirosso, Claudia Fedeli, Alberto Del Prete, Guido Calciolari, Renato Borgatti, Fabio Mosca, Odoardo Picciolini, Stefano Visentin, Nadia Battajon, Maria Lucia Di Nunzio, Fiorina Ramacciato, Laura Barberis, Emmanuele Mastretta, Rinaldo Zanini, Roberto Bellu, Giovanna Carli, Michela Alfiero Bordigato, Valeria Chiandotto, Cristiana Boiti, Rosangela LittaGiovanna Minelli, Marcello Napolitano, Alessandro Arco, Palma Mammoliti, Cinzia Fortini, Paolo Tagliabue, Lorenzo Quartulli, Giuliana Motta, Paola Introvini, Rosetta Grigorio, Paola Mussini, Giulia Pomero, Carlo Poggiani, Ananda Bauchiero

Research output: Contribution to journalArticlepeer-review


Background: Parents of very preterm infants are at great risk for experiencing stress and depression. The so called developmental care oriented approach used in Neonatal Intensive Care Units have beneficial effects for parents. However the actual level of developmental care may vary among units and little is known about how the routine adoption of developmental care affects maternal stress and depression. Objectives: To investigate the extent to which level of quality of developmental care routinely carried out in 25 tertiary Neonatal Intensive Care Units across Italy affects maternal stress and depression. Participants: 178 mothers of healthy very preterm infants with gestational age ≤29. wk and/or birth weight ≤1500. g and without documented neurologic pathologies were recruited consecutively. 180 full-term mothers were recruited as the control group. Methods: To distinguish the quality of developmental care level, each unit was assessed using a specifically developed questionnaire. We compared negative emotional states of mothers by splitting the 25 Neonatal Intensive Care Units into units with high-care and low-care based on median splits for two main care factors: (1) The Infant Centered Care index (consisting of measures of parent involvement, including ability to room in, frequency and duration of kangaroo care and nursing interventions aimed at decreasing infant energy expenditure and promoting autonomic stability). (2) The Infant Pain Management index (consisting of measures to decrease painful experiences including pharmacologic and nursing care practices). Maternal stress was assessed by the Parental Stressor Scale: Neonatal Intensive Care Unit questionnaire. Maternal depressive symptomatology was assessed by the Edinburgh Postnatal Depression Scale questionnaire. Results: Preterm mothers from low-care units in the Infant Pain Management reported higher scores in their perception of stress associated with behavior and appearance of the infant than mothers from high-care units (p= 0.05). Preterm mothers from high-care units in the Infant Pain Management reported a depressive symptomatology score average similar to that reported by full-term mothers. No significant Infant Centered Care effect was found both for maternal stress and depression. Conclusions: The findings suggest that implementing more practices useful to reduce infants' painful experience can mitigate the stress and depressive symptomatology of the preterm mothers.

Original languageEnglish
Pages (from-to)994-1002
Number of pages9
JournalInternational Journal of Nursing Studies
Issue number7
Publication statusPublished - 2014


  • Developmental care
  • Maternal stress
  • Pain management
  • Postpartum depression
  • Preterm infant

ASJC Scopus subject areas

  • Nursing(all)
  • Medicine(all)


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