Fathers' Heightened Stress Responses to Recounting their NICU Experiences Months after Discharge: A Mixed Methods Pilot Study

Abstract

Objective The acute and traumatic events associated with having a newborn who requires admission to the neonatal intensive care unit (NICU) may elicit long-term concerns for parents postdischarge. Cognitive processing of taxing events influences recurring stress responses, which can be inferred via biomarkers such as salivary cortisol (sCort) and skin conductance (SC). In addition, personal narratives provide an important insight into individual perceptions and coping strategies. The current pilot study aimed to (1) test the hypotheses that fathers' sCort and SC would peak in response to stress induction and decrease during recovery, (2) examine associations among stress biomarkers and stress perceptions, (3) explore fathers' narratives using thematic analysis, and (4) integrate fathers' narrative themes with their stress responsivity.

Study Design Using a convergent mixed methods approach, we enrolled 10 fathers of infants formerly cared for in NICU who underwent a Trier Social Stress Test including recounting their NICU experience months postdischarge. Stress responsivity was measured via sCort and SC, while stress perceptions were identified by using the Perceived Stress Scale and Distress Thermometer-Parent. Personal narratives were explored by using thematic analysis.

Results The significant rise in fathers' sCort and SC in response to stress induction was reflected in narrative themes including loss, worry, and role strain. Subsequently, fathers' sCort and SC returned to baseline, which was illustrated by themes such as role strength, coping, and medical staff interactions. Fathers' stress measured by PSS was lower than that required for mental health referral, and did not correlate with stress biomarkers.

Conclusion Salivary cortisol and skin conductance are useful biomarkers of paternal stress responsivity and recovery. Thematic analysis identified fathers' NICU stressors and coping strategies that mirrored their stress responsivity patterns. Further studies are needed to more broadly examine the sociodemographic variables that influence stress reactivity and perceptions in parents of infants formerly cared for in NICU.

Key Points

• Stress associated with NICU stay is impactful on fathers and may have long-term implications.

• Salivary cortisol and skin conductance are useful noninvasive stress biomarkers.

• Fathers' coping strategies included infant bonding, partner relationship, and trust building.

Keywords

coping - fathers - thematic analysis - convergent mixed methods - neonatal intensive care unit - salivary cortisol - skin conductance - stress biomarkers - stress perceptions

Authors' Contributions

B.F. contributed to the qualitative data analysis, wrote the first draft of the manuscript, and reviewed and revised the manuscript. S.A. contributed to qualitative data analysis and writing, revising, and review of the manuscript. F.G. participated in execution of the study, conducted data analysis, contributed to the writing, review, and revision of the manuscript. A.H. participated in the execution of the study and contributed to the qualitative analysis and writing and review of the manuscript. G.B. made important scientific contributions to protocol development and reviewing and approving the manuscript. K.D. had primary responsibility for scientific oversight and fidelity of the research study protocol, data analysis, writing, review, and revision of the manuscript. All authors approved the final version of the manuscript prior to submission and agree to be accountable for all aspects of the work.

Publikationsverlauf

Eingereicht: 24. November 2020

Angenommen: 30. April 2021

Artikel online veröffentlicht:
15. Juni 2021

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