Discussion
PTSD
RECRUITMENT
Worldwide, approximately 25% of NICU parents report clinically significant PTSD symptoms [Previous studies have tended to focus on specific parent-focused therapies, for example trauma-focused therapy for PTSD [
It is now widely recognized that comprehensive perinatal care must include preventative parental mental health services. For example, the California Law, Assembly Bill (AB) 3032-Maternal Mental Health Conditions Education, Early Diagnosis, and Treatment Act [
Our study had several limitations in design and implementation, including selection bias because of the non-random design, unmeasured participation of families in the usual FCC group and incomplete uptake of the mFICare intervention by all mothers in that group. Selection bias may have also affected recruitment. We note that 59% of eligible FCC participants enrolled and 71% of mFICare participants enrolled; nevertheless, there were few differences in characteristics of the two groups. Timing of the intervention may be important and affected by enrollment later in the admission. Other limitations include mFICare intervention curtailment by the COVID-19 pandemic, further reducing intervention dose for some participants, and the exclusion of non-English-speaking families, limiting generalizability. Strengths of the study include increased generalizability of the findings because of the racially and ethnically diverse participant families as well as populations served by the participating NICUs and use of mobile app technology to increase intervention access.
In conclusion, the mFICare model was not associated with fewer mental health symptoms for mothers than the FCC model overall, but it was associated with fewer mental health symptoms for those experiencing higher levels of stress during the NICU stay. Further research on mFICare is urgently needed to address the prevalent and persistent mental health symptoms experienced by parents of preterm infants.