Associations of cumulative adversity on Hispanic mothers’ perceived stress with infants admitted to the Neonatal Intensive Care Unit (NICU)

BACKGROUND: Mothers with a history of cumulative adversity (adverse experience throughout a lifetime) can face unique challenges in maintaining mental stability when compounded with other stressors during the perinatal period (pregnancy and postpartum). Such stressors can be having infants admitted to the Neonatal Intensive Care Unit (NICU), where stress levels often escalate due to the separation from their newborn and feelings of uncertainty regarding their child’s health. This study assessed cumulative adversity levels among 200 Latina mothers with NICU-admitted infants between 2017 and 2022 in Puerto Rico. METHODS: Mothers were contacted between 1 to 8 weeks after their infants’ NICU admission and interviewed using a structured psychological assessment protocol that included the 6-item Spielberger State Trait Anxiety Index (STAI-6), the Parental Stressor Scale: NICU (PSS: NICU), the Patient Health Questionnaire (PHQ-9) for depression severity, and the Cumulative Stressor Inventory (CSI) for cumulative adversity in the 12 months before childbirth. RESULTS: Most participants were low-income, high school-educated mothers receiving government assistance. While anxiety (STAI-6, M = 6.26, SD = 3.9) and depression levels (PHQ-9, Mean = 5.4, SD = 4.8) were low, moderate NICU-related stress was reported (PSS: NICU, Mean = 90.7, SD = 44.06). Regression analyses revealed that cumulative stress is moderately associated with maternal psychological symptoms, including anxiety, depression, and NICU-related stress (R = 0.47, R2 = 0.22, p < 0.05; f (1,173) = 9.44, p < 0.001). CONCLUSION: Higher cumulative adversity (environmental hazards, economic hardships, unsafe neighborhoods, among others) is associated with NICU-related stress within this population. Early psychological interventions and continuous support are essential to mitigating effects of the NICU experience in mothers that have faced cumulative adversity experiences prior to childbirth and postpartum.