THE FEASIBILITY AND EFFECT OF SUPPORTIVE COUNSELING ON THE PSYCHOLOGICAL WELLBEING OF MOTHERS IN THE NEONATAL WARDS OF THE UNIVERSITY COLLEGE HOSPITAL, IBADAN

Abstract

Background: Current evidence indicates that admission of a baby into the neonatal care unit after delivery can predispose a woman to different kinds of psychological distress. The psychological distress that occurs during this period might be transient or can last for a longer time depending on the type of interventions given to them. Among mothers in the neonatal unit, the mental health challenges they could encounter include postpartum blues, depression, anxiety, post-traumatic stress disorder, adjustment disorder and parent-infant interaction problems. Psychological interventions have been shown to be effective in improving the mental health of mothers in the neonatal care unit. However, there is a paucity of studies assessing the feasibility of these types of in interventions amongst mothers in neonatal care in Nigeria. Methodology: This was a quasi-experimental study design involving an intervention group as well as a control group at University College Hospital. The 20 mothers in the intervention group received 2 sessions of supportive counseling a week apart while the 20 mothers in the control received no intervention apart from the regular care of their baby. The outcome measures, Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU), Edinburg Post Natal Depression Scale (EPDS) and Impact Event Scale-Revised (IES-R) were administered by a blinded assessor to both groups at baseline and immediately after the second session (1 week after baseline). A Client Satisfaction Questionnaire was also administered separately to the intervention group after obtaining the post-intervention outcome measures. Data were analyzed using Statistical Package for Social Sciences (SPSS 22). Sociodemographic variables were presented using frequency tables. The difference in sociodemographic characteristics between the intervention group and control group was examined using a t-test for continuous variables and chi-square for categorical variables. Difference in mean scores between groups at baseline and at post-intervention was examined with a student t-test. The treatment effect was determined with Analysis of covariance (ANCOVA) to compare mean post-intervention outcomes between the groups while controlling for baseline scores and other confounders. Results: The intervention group and the control group were well matched on socioeconomic and background medical factors. Within-group analysis at baseline and post-intervention for the intervention group showed a statistically significant reduction in mean scores of EPDS (p<0.001), IES-R (p< 0.001) and PSS: NICU (p < 0.001). Similarly, within-group analysis at baseline and post-intervention for the control group showed a statistically significant reduction in the EPDS score (p=0.004), IES-R score (p=0.008) and PSS: NICU (p=0.018). However, after controlling for baseline scores with ANCOVA, a significant intervention effect was identified for only EPDS and IESR but not for PSS: NICU. The treatment effect sizes Cohen’s d was 2.0 for EPDS and 0.7 for IES-R respectively. All the mothers were either satisfied (70%) or very satisfied (30%) with the intervention using the client satisfaction questionnaire (CSQ). Further qualitative feedback looking at the greatest worries of mothers in the neonatal care unit showed that the mothers were also stressed by other practical difficulties such as the physical navigation of the activity of the Hospital environment including having to climb several flights of stairs and financial difficulties. Conclusion: This supportive counseling intervention for mothers in the neonatal unit showed a significant treatment effect by reducing their depressive and post-traumatic stress symptoms with large to moderate effect sizes. If these findings are confirmed by larger Randomized Controlled Trials, the type of brief psychological intervention programs like the current study should be offered to mothers in neonatal units in Nigeria to help reduce their depressive and post-traumatic symptoms. Training or Organization of the workshop for neonatal care health workers will also assist in scaling up services for maternal mental health