The risk factors of post-traumatic stress disorder among parents of neonatal intensive care unit infants: a systematic review

Aim
The aim of this review is to identify the risk factors for post-traumatic stress disorder (PTSD) in parents of infants admitted to the neonatal intensive care unit (NICU).

Design
A This study is a systematic review of articles examining PTSD risk factors in parents of NICU-admitted infants. PTSD diagnoses were made using the DSM-IV, DSM-5, ICD-11, or DSM-IV-TR A1 criteria. This review does not address PTSD risk factors in the general population, other family members, or NICU patients. Regardless of the child's gestational age or gender, the focus is exclusively on NICU parents or primary caregivers. All other family members are excluded from the review.

Methods
A comprehensive literature review was conducted using multiple search algorithms to identify all relevant studies. The databases PTSDpubs, CINAHL, PsycINFO, and Web of Science were systematically searched. The study selection process was documented using the PRISMA flow diagram. Each study was independently assessed using the Critical Appraisal Skills Programme (CASP) framework. The selected articles were critically evaluated, and data were extracted and synthesised for analysis.

Results
A total of 286 previously published papers met the inclusion and exclusion criteria. Of these, eight studies were included in the systematic evaluation of PTSD risk factors among parents of NICU-admitted infants. Five key risk factors were identified: (1) Being female, (2) Having, or perceiving to have, a sick newborn, (3) Parents with previous obstetric problems, (4) Having mental health-related problems/diagnosis, and (5), Lack of psychological Support in the NICU.

Discussion
The synthesis of the selected studies reveals a multifaceted risk landscape. Being female was the most commonly reported risk factor, consistent with broader research indicating that women are generally at higher risk of developing PTSD. The presence of a sick newborn significantly heightened parental risk, likely due to the acute stress associated with managing a child's severe health challenges. A history of obstetric complications also emerged as a significant predictor, with past traumas compounding the emotional burden of the NICU experience. Pre-existing mental health conditions further increased susceptibility to PTSD, underscoring the importance of addressing underlying psychological vulnerabilities. Crucially, the lack of psychological support in NICU settings was identified as a systemic deficiency, exacerbating parental stress. This finding highlights gaps in family-centred and family-integrated care strategies, which fail to sufficiently address parents' psychological needs during critical periods of their child's hospitalisation.

Conclusion
This review underscores the complex interplay of factors contributing to PTSD in NICU parents and offers important clinical insights for developing targeted interventions. Healthcare systems must prioritise comprehensive psychosocial support for all NICU parents, not solely primary caregivers, to alleviate the immense stress that can lead to PTSD. The findings advocate for policy changes and the integration of robust psychological support structures within NICUs to bolster parental resilience during and after their infants’ hospitalisation.