466 - Theme-coded qualitative analysis to understand parental perceived stress and depression in the neonatal intensive care unit

Poster Number: 466
Publication Number: 466.130

Claire R. Ressel, Georgetown University School of Medicine, Washington, DC, United States; Jessica Wolfe, Georgetown University School of Medicine, Washington, DC, United States; Deborah F. Perry, Georgetown University, WASHINGTON, DC, United States; Lewis P. Rubin, Georgetown University Medical Center, Washington, DC, United States

Background: Parents of infants admitted to NICUs often experience significant psychosocial stress and have higher risks for depression, anxiety, and disturbed parent-child bonding. Analyses of parental stress often use either a predominantly biomedical or qualitative approach. The current study integrates these domains, using parental demographic and psychosocial assessments, stress-related salivary biomarkers, measures of illness severity, and open-ended question interviews for a more complete assessment of parental NICU experience and stressors.

Objective: We detail a novel use of theme-coded qualitative analysis of open-ended interviews to explore parents' perceptions of the NICU experience, sources of stress and well-being, and associations with stress/depression measurements.

Design/Methods: Inclusion criteria: parents of infants admitted to a Level IV NICU born ≤34 weeks gestation or having a predicted length of stay >2 weeks. At weeks 1 and 6 and before discharge, we collected parental salivary cortisol and α-amylase (AM, PM) and the Edinburgh Postpartum Depression Scale, Perceived Stress Scale, and Social Provisions Scale. Infant data and the Neonatal Acute Physiology Perinatal Extension-II and Neonatal therapeutic Intervention Scoring System were recorded. Parents individually participated in recorded open-ended question interviews. Interviews were transcribed and annotated using qualitative content analysis based on a grounded theory approach. Investigators affixed codes (with inter-rater checks) to transcripts using an iterative approach, highlighting common phrasing and themes. Transcripts were entered into NVivo qualitative data analysis software to sort and label categories and themes.

Results: Results are available for 15 interviews. We identified patterns, themes, subgroup differences, and common phrasing to develop an interactive model of the complex interplay among social supports, NICU environment, COVID-19-related stressors, and parental experience [Figure]. The model facilitates evaluating multiple components which influence parental experience and clarifies parental-perceived barriers and facilitators. Voiced resiliency was compared to subjects' stress and depression salivary biomarkers and the validated scales.Conclusion(s): Parent interviews revealed feelings of isolation, fear, and resilience among NICU parents. Textual analysis of open-ended interviews informed construction of a conceptual model describing the NICU experience. Integration of biomedical and qualitative methods more comprehensively reveals experiences of parents and points to strategies for fostering support and resilience.
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