# Maternal Stress, Depression, Anxiety, and Participation in Care in Neonatal Semi-Intensive and Intensive Care Units: Results of a Cross-Sectional Study in Two Sri Lankan Hospitals

## TL;DR

Mothers of infants in neonatal units in Sri Lanka experience high stress, depression, and anxiety, and are often not involved in their care.

## Contribution

This study provides insights into maternal psychological burden and care participation in neonatal units in a resource-limited setting.

## Key findings

- 94.3% of mothers experienced at least one psychological condition, and 59% experienced all three.
- Only 13% of mothers achieved a high level of participation in neonatal care.
- Higher maternal participation was associated with reduced stress and anxiety.

## Abstract

What are the main findings?
We observed high psychological morbidity and limited maternal participation in newborn care among mothers of infants admitted to neonatal units.Anxiety and stress levels were higher among mothers who were less involved in the care of their neonates.

We observed high psychological morbidity and limited maternal participation in newborn care among mothers of infants admitted to neonatal units.

Anxiety and stress levels were higher among mothers who were less involved in the care of their neonates.

What are the implications of the main findings?
Mothers should be encouraged to actively participate in the care of their newborns during neonatal unit admission.In Sri Lankan settings, routine screening for maternal psychological burden, along with policy reforms, is recommended.

Mothers should be encouraged to actively participate in the care of their newborns during neonatal unit admission.

In Sri Lankan settings, routine screening for maternal psychological burden, along with policy reforms, is recommended.

Background/Objectives: Admission of a newborn to a neonatal intensive care unit (NICU) places mothers under considerable psychological strain, yet there is limited research from resource-limited settings regarding this aspect. This study represents the Sri Lankan arm of the multicentre study titled “Empowering Parents in the NICU”. It aimed to determine the prevalence and associated factors of stress, depression, and anxiety among mothers of neonates admitted to neonatal units and to assess mothers’ participation in neonatal care. Methods: A cross-sectional study was conducted in two tertiary neonatal units in Sri Lanka. Maternal stress, depression, and anxiety were measured using the Parental Stressor Scale: NICU, Edinburgh Postnatal Depression Scale, and State–Trait Anxiety Inventory. Maternal involvement in care was assessed using the Index of Parental Participation (IPP-NICU). Univariate and multivariate logistic regression analyses were performed. Results: A total of 300 mothers were enrolled. The prevalence of stress, depression, and state anxiety was 73%, 87%, and 77.7%, respectively. Overall, 94.3% experienced at least one psychological condition, while 59% experienced all three. Only 13% achieved an IPP-NICU score ≥ 20 (maximum: 30). Mothers of infants admitted to NICUs, compared with those in semi-intensive care, showed significantly higher rates of depression. Tamil and Muslim mothers demonstrated lower rates of state anxiety compared to Sinhalese mothers. An IPP-NICU score ≥ 20 was associated with reduced stress and anxiety. Conclusions: High psychological morbidity is observed among mothers of neonates managed in neonatal units, emphasising the need for routine maternal mental health screening and promoting maternal participation in neonatal care.