Financial Strain As a Predictor of Maternal Mental Health Among Mothers of Preterm Infants

Background and Purpose: When preterm infants require care in a neonatal intensive care unit (NICU), they are often hospitalized for weeks or months immediately after birth. Since preterm birth is rarely expected, the infant’s prolonged hospital stay can cause unplanned financial distress on the family. However, the impacts of NICU stays on parents’ financial security is rarely studied. Financial strain is a known risk factor for postpartum depression, which in turn can affect mothers’ ability to bond with their newborns. The aim of the study was to understand how financial strain is associated with maternal mental health in a sample of hospitalized preterm infants and their mothers.

Methods: An interdisciplinary team conducted a three-year longitudinal study examining maternal engagement in four Colorado NICUs. The study gathered data using in-hospital surveys, post-discharge surveys, maternal time-use diaries as well as qualitative interviews. In this study, we analyzed many factors related to maternal engagement, maternal mental health, and infant health outcomes. Along with data on mothers’ economic status we included employment status and access to leave, as well as health care coverage and infant health care utilization post-discharge. In measuring financial strain, questions regarding paid/unpaid leave, household income, insurance, employment status, education, and perception of financial security were asked. Logistic regression was used to test the association of these factors with maternal postpartum depression.

Results: Of the mothers (n=168) in this study, 57% (n=94) identified as non-Hispanic White and 83% (n=139) reported being married or living with a partner. In all, 98 mothers (77%) had access to any type of leave, though only 43% (n=58) had any paid leave while a majority had access to unpaid leave (72%, n=86). Mothers’ income was measured categorically and equal numbers had incomes in the highest and lowest categories: under $25,000 (n=39) and over $100,000 (n=39). About 45% (n=75) of mothers had a bachelor’s degree or more, and 55% (n=92) of mothers had an associate’s degree or less. In all, 56% (n=94) of the mothers were covered by private health insurance.

Financial strain among mothers was significantly associated with their likelihood of having postpartum depression symptoms (OR=1.13 [1, 1.27]; p=0.0447). Also, those with no access to unpaid leave were more likely to indicate risk for postpartum depression (OR=2.28 [0.99, 5.29]; p=0.0528). Interestingly, significance was not found when testing the association of access to paid leave and financial strain.

Conclusions and Implications: Financial strain is evident with mothers who are working but have incomes below the median wage. Consistent with other literature, we found that financial strain was associated with risk for postpartum depression in our sample. Additionally, lack of access to leave from work was associated with risk for postpartum depression. Taken together, these findings suggest that lack of financial support for working mothers increases risk for adverse maternal mental health outcomes.