Parental Stress, Depression, and Participation in Care Before and During the COVID-19 Pandemic: A Prospective Observational Study in an Italian Neonatal Intensive Care Unit

Recent studies reported, during the COVID-19 pandemic, increased mental distress among the general population and among women around the childbirth period. COVID-19 pandemic may undermine the vulnerable well-being of parents in Neonatal Intensive Care Units (NICUs). Our study aimed to explore whether parental stress, depression, and participation in care in an Italian NICU changed significantly over three periods: pre-pandemic (T), low (T), and high COVID-19 incidence (T). Enrolled parents were assessed with the Parental Stressor Scale in the NICU (PSS:NICU), Edinburgh Postnatal Depression Scale (EPDS), and Index of Parental Participation (IPP). Stress was the study primary outcome. A sample of 108 parents, 34 for each time period, was estimated to be adequate to detect a difference in PSS:NICU stress occurrence level score (SOL) of 1.25 points between time periods. To estimate score differences among the three study periods a non-parametric analysis was performed. Correlation among scores was assessed with Spearman rank coefficient. Overall, 152 parents were included in the study (62 in T, 56 in T, and 34 in T). No significant differences in the median PSS:NICU, EPDS, and IPP scores were observed over the three periods, except for a slight increase in the PSS:NICU parental role sub-score in T (T 3.3 [2.3-4.1] vs. T 3.9 [3.1-4.3]; = 0.038). In particular, the question regarding the separation from the infant resulted the most stressful aspect during T (T 4.0 [4.0-5.0] vs. T 5.0 [4.0-5.0], = 0.008). The correlation between participation and stress scores ( = 0.19-022), and between participation and depression scores ( = 0.27) were weak, while among depression and stress, a moderate positive correlation was found ( = 0.45-0.48). This study suggests that parental stress and depression may be contained during the COVID-19 pandemic, while participation may be ensured.