Self-Compassion and Mental Distress Among Mothers of Hospitalized Preterm Infants

1. Self-Compassion and Mental Distress Among Mothers of Hospitalized Preterm Infants Lois C. Howland, DrPH, MS, RN Nancy Jallo, PhD, RN Rita Pickler, PhD,RN Cynthia D. Connelly, PhD, RN Dale Glaser, PhD, RN

2. Acknowledgments • Funding and collaborative support: • Faculty Incentive Award, Hahn School of Nursing, University of San Diego • Center for Biobehavioral Clinical Research (P30 NR011403, R. Pickler, Principal Investigator), School of Nursing, Virginia Commonwealth University • Neonatal Intensive Care Unit,Sharp Mary Birch Hospital for Women and Newborns

3. Background Incidence of preterm birth remains high at ~550,000 annually (Mathews, et al., 2011) Mothers of preterm infants have high levels of postpartum mental distress (stress, anxiety, depression) (Vigod, et al., 2010, Lefkowitz, Baxt, & Evans, 2010) Perinatal stress and anxiety linked to postpartum depression (Drewett, et al., 2004) High levels of maternal postpartum distress can impair a mother’s ability to care of her infant ((Kingston, Tough, & Whitefield, 2012) Higher levels of self-compassion have been associated with lower levels of depression, and better well-being (Allen & Leary, 2010)

4. Defining Self-Compassion “Self-compassion….entails three basic components: (1) extending kindness and understanding to oneself rather than harsh self-criticism and judgment; (2) seeing one’s experiences as part of the larger human experience rather than as separating and isolating; and (3) holding one’s painful thoughts and feelings in balanced awareness rather than over-identifying with them…..can be viewed as useful emotional self-regulation strategy…”(Neff, 2003)

5. Study Aims • To evaluate the relationship of reported self-compassion level with: • Maternal mental distress measures: stress, anxiety, and depressive symptoms • Maternal-infant responsiveness • Sleep quality • Amount of RGI intervention exposure

6. Data Source: The Maternal Relaxation Study Theoretical framework: psychoneuroimmunology (PNI) Design: non-randomized, repeated measures intervention study Number of participants: 20 Number of study visits: 3 visits over 8 weeks Recruitment: recruited between April and September, 2010 Location of study visit: private area adjacent to NICU, at the infant’s bedside, or in the participant’s home by preference of the mother

7. Participant Eligibility • Inclusion criteria • > 18 years old • One or more neonates currently in NICU • Infant gestational age 23-32 weeks • Exclusion criteria • Unable to read/write English • Current use of systemic steroids • Current treatment for chronic illness • Current treatment for psychiatric disorders (not including postpartum depression) • Currently using GI techniques

8. Study Procedures • Data collection: • Completion of 6 questionnaires at each visit • Last visit includes interview on mother’s opinion of GI plus a self-reported measure of maternal-infant responsiveness • Compensation: • $20 cash or gift card for Visits 1 and 2, $40 cash or gift card for last visit, keeps CD and CD player

9. Self-Reported Behavioral Measures

10. Intervention Procedures • Relaxation guided imagery intervention • Mind-body intervention using mental images to produce a relaxed mental state • Daily listening to 20-minute RGI recording • Set of 3 CD tracks that focus on specific outcomes: • Relaxation • Working with difficult feelings • Increasing feelings of self-compassion • Change CD tracks every 2 weeks for 6 weeks then whichever CD track preferred for remainder of study

11. Measurement of Intervention • Weekly scripted phone call to mother to capture average number of times she used the CD • Weekly averages from the 8 weeks on study were aggregated to establish an overall “average listening frequency” • Mean # times RGI used per week = 4.46 (SD = 1.77, range 1.7-7.4)

12. Study Sample (N=20) • Mean maternal age = 27.3 years (SD 6.38, range 18-37) • Race/ethnicity = 60% white, 50% Hispanic • Education level = 100% HS grad or above (4/20 > college grad) • Marital status = 50% not married • Family income = 50% <$40,000/year • Parity = 35% one or more children • Breast-feeding status = 100% breastfeeding at baseline • Mean infant LOS = 62.3 days (SD 22.3, range 26 - 99) • Mean GA = 29.2 weeks (SD 4.1, range 23-35) • Mean Neonatal Morbidity Index score = 4 (SD 1.1, range 2-5)

13. Self-Report Measures

14. Pearson correlations of self-compassion score with biobehavioral outcomes and weekly RGI use *p-value 0.05 level **p-value 0.01 level

15. Summary of Results • Lower self-compassion scores at Week 0 and Week 8 associated with higher scores in reported: • Stress • Anxiety • Depressive symptoms • Sleep quality (poorer) • Higher self-compassion scores at Week 8 positively correlated • Greater RGI use • Higher maternal-infant responsiveness.

16. Study Implications Mothers of hospitalized preterm infants can experience high levels of mental distress and lower levels of self-compassion Identifying effective strategies to enhance self-compassion in mothers of preterm infants may reduce mental distress, enhance sleep quality, and improve the mother-infant relationship

17. Study Limitations Missing data: incomplete self-report data on two participants for Week 8 Overall sample size small No control comparison group Intervention fidelity – self-report Varying infant medical conditions and length of stay (i.e., varying stress levels over time) Intervention not available for mothers not fluent in English

18. With appreciation to our study participants and…. • NICU nurse sub-investigators: • Sara Peterson, RN • Kathryn Sondreal-Evans, RN • Catheline Seigmund, ALS, RN • Anna Rickel, RN • SMBHWN Study Coordinator: • Kathy Arnell, RNC • USD research assistants • Heather Warlan, MSN, RN • Linda Schaffer, PHD, RN • Elizabeth Light, BSN, RN