Burnout, depression and anxiety levels in mothers of infants with brachial plexus injury and the effects of recovery on mothers’ mental health

doi:10.1016/j.ejogrb.2011.03.001

European Journal of Obstetrics & Gynecology and Reproductive Biology

Volume 157, Issue 1, July 2011, Pages 43-47

https://doi.org/10.1016/j.ejogrb.2011.03.001 Get rights and content

Abstract

Objective

To evaluate depression, anxiety and burnout in mothers of infants with brachial plexus injury and assess the effects of the severity of injury on the mothers’ mental health, as the literature provides no information on this topic.

Study design

The study was based on eighteen mothers without psychiatric antecedents who had infants with perinatal brachial plexus paralysis (PBPP). The severity of the brachial plexus injury was classified according to the Narakas classification system. The recovery rate following conservative treatment was classified according to the Modified Mallet Classification System. The Maslach burnout inventory, Beck depression inventory, and Beck anxiety inventory were administered to the mothers.

Results

The mothers whose infants were in the third Narakas group were mildly depressed and the depression scores of the mothers in Narakas groups II and III were regularly increased. Mothers in the first and second groups reported a minimal level of anxiety scores. There was no statistically significant difference between the depression, anxiety, emotional exhaustion, depersonalization, and personal accomplishment scores of the mothers in relation to the severity of the injury in the child (p = 0.218, p = 0.078, p = 0.149, p = 0.138, and p = 0.246). In addition, the depression and anxiety levels of the mothers whose infants recovered fully or partially showed a statistically significant decrease when compared to the mothers of infants with no recovery (p = 0.003, p = 0.015). There was, however, no statistically significant difference between the emotional exhaustion, depersonalization, and personal accomplishment scores of the mothers of infants with full recovery, partial recovery and no recovery (p = 0.591, p = 0591, p = 0.062).

Conclusion

Infants’ disability may cause psychological distress in their mothers. When brachial plexus injury is predicted in infants, more mothers may become depressed.

Introduction

Approximately 7.7% of children experience difficulties during their developing years and require access to and utilization of extensive health care resources over time [1]. Although caregiving is a normal part of being the parent of a young child, this role takes on an entirely different significance when a child experiences functional limitations. One of the main challenges for parents is to manage their child's chronic health problems effectively. This might be somewhat daunting for caregivers. The provision of such care may prove detrimental to both the physical health and the psychological well-being of parents of children with chronic disabilities [2]. Parents of children with rare diseases experience stress, especially related to lack of competence, social isolation and emotional demands [3]. The presence of a child with a physical disability may be detrimental to maternal mental health [4]. Children with different disabilities cause different levels of stress in their mothers. A disability is a source of various difficulties for the child and his/her parents. The most affected person in the family is usually the mother in such a situation [5]. Mothers of children with disabilities often experience greater stress and emotional demands than do other mothers [6].

Burnout can be defined as the state of physical and emotional depletion. Burnout includes three unique symptoms: emotional exhaustion, depersonalization, and reduced personal accomplishment. Burnout leads to physical and emotional problems in individuals. These are also reflected in their behavior and interfere with their ability to do their jobs and other activities. The individual can also harm other people as a result [5], [7], [8], [9].

Anxiety disorders and depression are the most frequent mental disorders in general population. Women are affected more frequently than men. Lifetime prevalence rates differ depending on how anxiety or depression is defined and assessed [10], [11].

Perinatal brachial plexus palsy (PBPP) is defined as a flaccid paresis of the arm at birth with a larger passive than active range of motion. It affects various nerves of the brachial plexus supplied by C5 to T1, in 0.38–3 infants per 1000 live births [12]. It is generally believed to be the result of trauma to the brachial plexus at birth resulting in stretching, rupture or avulsion of some or all of the cervical and first thoracic nerve roots. Most of these injuries resolve within a year but some persist [13], [14]. The literature provides no information about the mental health of the mothers of children with brachial plexus injury. Our objective therefore was to evaluate depression, anxiety and burnout in the mothers of infants with brachial plexus injury and to compare the effects of the severity of injury and recovery on the mothers’ mental health.

Section snippets

Materials and methods

This prospective study was based on a group of mothers whose infants suffered from PBPP. Ninety-two patients were admitted to our clinic over a two-year period. Only 18 mothers agreed to participate in the study. The psychiatric histories, drug use, and substance dependencies of the mothers were evaluated by the second author. Mothers with a psychiatric background were excluded. The number of births, weight gain during the pregnancy and problems during the labor were queried. The fathers did

Results

There were 13 male and 5 female patients. Three patients were admitted from outside the province. Eight of the patients had right arm palsy. All mothers were under 35 years of age. All patients had been born by normal spontaneous vaginal delivery. Fifteen patients had been born with a vertex presentation, two with a breech presentation and one a vertex-arm presentation. Vacuum instrumentation was not used in any patient. Eight patients had shoulder dystocia. The mean weight gain of the mothers

Discussion

Birth and child rearing can have a detrimental effect on maternal mental health, even when the child has no disability. Mothers of children with disabilities often experience greater stress and emotional demands than do other mothers [6]. The disability causes various hardships for the child and his/her parents [23]. Furthermore, women are assumed to be particularly at risk for the stress of multiple roles [24], and chronic strain related to combining the parent role and work is a predictor of

Conclusion

The needs of parents of children with serious or chronic diseases should be considered. The findings highlight the necessity of paying attention to signs of chronic stress in the psychosocial follow up of these families. Chronic stressors should be identified and reduced or eliminated to prevent psychiatric problems such as psychological exhaustion, anxiety and depression. Parents may need support in this process.

Acknowledgement

This study was performed in Dr. Sami Ulus Pediatric Health and Research Hospital, Ankara, Turkey

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Cited by (32)

Requirements for tele-health in children with obstetric brachial plexus palsy during Covid-19-like situations
2022, Hand Surgery and Rehabilitation
Citation Excerpt :
Difficulties in managing treatment, the responsibility of the home exercise program and having a more-or-less disabled child all affect the parents [8,9]. The family’s social and daily life are deeply affected [9], parents’ emotional reactions are altered, with depression and stress; mothers’ quality of life is impaired, with fatigue and negative perception of life [8,10,11]. Corona virus disease (Covid-19) spread all over the world and was declared a “Public Health Emergency of International Concern” by the World Health Organization (WHO) on January 30, 2020, and a pandemic on March 11.
The purpose of the study was to investigate families’ concerns and service requirements during the Covid-19 lockdown. In case of tele-consultation, we also aimed to assess the effects of this service on coping and the family’s worries. At end of lockdown, we contacted the parents of 67 obstetric brachial plexus palsy patients (0–10 years age) by e-mail. During lockdown, 42 of the families had had a tele-consultation with our team, while 25 reported that not receiving any service. A questionnaire consisting of 6 questions was sent to the families, and data were analyzed according to 4 age-groups. Parents' concerns varied according to the children’s age group (p = 0.001). All families replied that their children should receive remote services during Covid-19-like situations (p = 0.173). Parents of the 42 children who had tele-consultations reported that this had alleviated their worries, independently of age-group (p = 0.160). The usefulness of tele-consultation to manage the lockdown situation differed according to age-group (p = 0.002). The parents of under-3-year-olds experienced more worry during lockdown, but all respondents reported needing remote services. Although the tele-consultation alleviated the worries of almost all families, it was most useful in managing lockdown in families with under-3-year-olds.
Le but de l'étude était d'enquêter sur les préoccupations des familles et les besoins en matière de services pendant le confinement à domicile de la Covid-19. De plus, s’ils avaient bénéficié d’un service de téléconsultation, nous visions à évaluer les effets de ce service sur la gestion des processus et les préoccupations de la famille. À la fin de la période de confinement à domicile, nous avons contacté les parents de 67 patients (âgés de 0 à 10 ans) par e-mail. Au cours de ce processus, 42 des familles avaient reçu un service de téléconsultation de notre équipe, tandis que 25 d'entre elles ont déclaré ne pas avoir reçu de service. Un questionnaire composé de 6 questions ouvertes a été envoyé à ces familles et les données ont été analysées dans 4 groupes d'âge différents. Selon les 67 parents, l'inquiétude des parents variait selon les groupes d'âge des enfants (p = 0,001). Toutes les familles ont déclaré que leurs enfants devraient recevoir des services dans des formats à distance pendant une situation similaire à la Covid-19 (p = 0,173). Les parents de 42 enfants souffrant de paralysie obstétricale du plexus brachial qui avaient reçu un service de téléconsultation ont déclaré que le service qu'ils avaient reçu, quel que soit leur groupe d'âge, réduisait leur inquiétude (p = 0,160). L'utilité du service de téléconsultation différait pour gérer le processus en fonction des groupes d'âge (p = 0,002). Les parents d'enfants de moins de 3 ans ont été les plus préoccupés pendant le processus de Covid-19, mais tous les parents qui ont participé à l'étude ont déclaré qu'ils avaient besoin de services à distance. Bien que le service de téléconsultation ait réduit les inquiétudes de presque toutes les familles, il était plus utile dans la gestion du processus dans les familles avec des enfants de moins de 3 ans.
Who are and are not the burnout moms? A cluster analysis study of French-speaking mothers
2021, Journal of Affective Disorders Reports
Citation Excerpt :
Those results taken together indicate that postpartum depression and parental burnout are different notions, but they can overlap when the symptomatology of parental burnout is very important. As parental burnout was, in the first studies, mainly evaluated among samples of parents of children with special needs (Karadavut and Uneri, 2011; Lindström et al., 2010, 2016), a literature review hypothesized an overlap between burden and parental burnout in parents with children with special needs (Lebert-Charron et al., 2018). The present study did not corroborate this hypothesis given that many mothers can have a severe burden without showing manifestations of parental burnout (see APB cluster in Table 3).
: Chronic stress in parenthood can lead to difficulties for parents, including parental burnout. Parental burnout is defined by four dimensions: emotional exhaustion, emotional distancing, feeling fed-up, and contrast in parental self. The aim of this cross-sectional study is to identify the profiles of at-risk mothers for parental burnout.
: One thousand three hundred and six French-speaking mothers, aged over 18 years with at least one child living regularly at home, completed an online set of questionnaires. The mothers responded to the Parental Burnout Assessment (PBA), the Hospital and Anxiety Depression Scale (HADS), the Edinburgh Postnatal Depression Scale (EPDS), the Brief Burden Interview (BBI), the Triangular Love Scale (TLS), and a sociodemographic questionnaire.
: Cluster analysis revealed five profiles based on the score levels on the four dimensions of parental burnout. Analysis of variance (ANOVA) showed that the five clusters significantly differed on the affective variables (i.e., depression, anxiety, postnatal depression, burden), love in couple relationship, and sociodemographic variables. The results highlighted that all the variables are associated with two extreme groups (Absence of Parental Burnout and Very High Manifestations of Parental Burnout).
: The cross-sectional design did not allow the identification of the directional nature of the association between the independent variables and the five clusters.
: The mothers’ five profiles based on the level of parental burnout manifestations enabled the identification of mothers with greater difficulties, contributing to the design of specific primary prevention and therapeutic interventions for parental burnout.
Depression, anxiety, and guilt in mothers with burnout of preschool and school-aged children: Insight from a cluster analysis
2019, Journal of Affective Disorders
Citation Excerpt :
Thus, a group with severe symptoms on all measures (SDC) group could require psychological treatment given their symptom severity (high levels of stress, anxiety, depression, burnout and guilt) (Van Dam, 2016). These results are in keeping with other studies that showed that parents suffering from parental burnout also often presented with more depressive symptoms (Jaramillo et al., 2016), and higher anxiety (Karadavut et Uneri, 2011). Moreover, the results for this group showed a higher proportion of mothers with post-partum depression antecedents than the other two groups.
The primary objective of this study is to identify the typology of exhausted mothers based on, depressive, anxiety, and guilt symptoms. And, secondarily, evaluate whether these profiles differ on parental stress, environmental stress, and parental burnout.
Five hundred and fifty French-speaking mothers suffering from exhaustion completed several questionnaires assessing parental stress, general perceived stress, maternal guilt, and depressive and anxious symptomology. Results from two hundred and ten mothers with burnout symptoms were explored (mean age [SD] = 33.69 [5.1] years). In order to identify possible subgroups, a hierarchical cluster analysis was performed.
Three profiles were highlighted from the sample (Wilks’ λ = 0.156, p < .0001): the first was characterized by high feelings of guilt (29.52%; n = 62), the second showed a dominance of anxiety symptoms and high feelings of guilt (36.19%; n = 76), and the fourth presented low levels of depression, anxiety, and feelings of guilt (23.3%, n = 49).
These findings suggest different profiles of burned out mothers that vary according to severity of anxiety, depression, and guilt. That suggests that parental burnout, depression and anxiety are distinct disorders. This study also makes it possible to show the aggravating effect of guilt in the experience of burnout. Additional research is warranted as it is important to more carefully consider possible appropriate intervention strategies given the differing experiences of burned out mothers.
Caring for a Child With an Obstetric Brachial Plexus Injury: A Metaphor Analysis
2017, Journal of Pediatric Nursing
Citation Excerpt :
Turkey was the country where the remaining three quantitative studies occurred. Karadavut and Uneri (2011) conducted a prospective study of burnout, depression, and anxiety in 18 mothers of infants with OBPI. At the end of the first year mothers whose infants had either partially or totally recovered had a significant decrease in depression and anxiety levels compared to mothers of infants with no recovery.
The purpose of this study was to examine the metaphors used by mothers to describe their experiences caring for their children with obstetric brachial plexus injuries.
A secondary qualitative data analysis was conducted from the primary data set of a phenomenological study of mothers' experiences caring for their children with obstetric brachial plexus injuries. The type of secondary qualitative data analysis approach used was analytic expansion. Metaphor Identification Procedure was used to analyze the corpus of 132 pages of typed transcription.
This metaphorical analysis yielded seven metaphors mothers used to describe their experiences caring for their children with obstetric brachial plexus injuries. These metaphors portrayed mothers' lives as involving a heavy weight, a maze, a juggling act, a simmering pot, a dagger to the heart, a rollercoaster, and a constant battle.
The seven metaphors helped women express what they could not completely capture using only medical jargon and provide valuable insight for clinicians. Using secondary qualitative data analysis to mine for any metaphors in a primary data set gives researchers another valuable and creative opportunity to discover new knowledge from the data they had previously collected.
Specific interventions can be developed to target each of these seven metaphors to help mothers in their daily care for their children with obstetric brachial plexus injuries.
The impact of pediatric brachial plexus injury on families
2015, Journal of Hand Surgery
Citation Excerpt :
Firat et al found that mothers of children with neonatal BPI perceived disability regardless of severity, contrasting with health care providers’ observations.15 In another study, no statistical significance was found between the mothers’ depression, anxiety, emotional exhaustion, or depersonalization and the BPI severity of their infants.16 BPI severity may not be the strongest factor at play in affecting perception of family impact.
To determine the impact of brachial plexus injuries on families to best meet their clinical and social needs.
Our cross-sectional study included families with children between the ages of 1 and 18 years with birth or non-neonatal brachial plexus injuries (BPIs). The consenting parent or guardian completed a demographic questionnaire and the validated Impact on Family Scale during a single assessment. Total scores can range from 0 to 100, with the higher the score indicating a higher impact on the family. Factor analysis and item-total correlations were used to examine structure, individual items, and dimensions of family impact.
A total of 102 caregivers participated. Overall, families perceived various dimensions of impact on having a child with a BPI. Total family impact was 43. The 2 individual items correlating most strongly with the overall total score were from the financial dimension of the Impact on Family Scale. The strongest demographic relationship was traveling nationally for care and treatment of the BPI. Severity of injury was marginally correlated with impact on the family. Parent–child agreement about the severity of the illness was relatively high.
Caretakers of children with a BPI perceived impact on their families in the form of personal strain, family/social factors, financial stress, and mastery. A multidisciplinary clinical care team should address the various realms of impact on family throughout the course of treatment.
Prognostic II.
Loss of resources and demoralization in the chronically ill
2019, General Hospital Psychiatry
Citation Excerpt :
Additionally, treating chronic diseases and conditions is a substantial expense for the US health care system, consuming 86% of its total yearly expenditure, which equals 17.9% of the US gross domestic product (GDP) [2]. Chronic conditions also tend to demand rich social resources, for instance, family members of a chronically ill patient are the first individuals to experience the distress of being constantly involved in care-taking [4,5]. Demoralization is a syndrome of existential distress that can emerge from living with persistent bodily symptoms [6,7].
The study examined whether the association between the severity of physical symptoms and demoralization is mediated by loss of resources in individuals with chronic conditions including conventional diagnoses, functional somatic syndromes, and medically unexplained symptoms.
This cross-sectional study evaluated N = 194 patients (mean age = 46, 83.5% female) who reported at least 3 months of persistent physical symptoms using the following self-report instruments: PHQ-15 (modified), Loss of Resources Inventory, Psychosocial Questionnaire – Demoralization Subscale, and PHQ-8. The mediation hypothesis was tested by multiple regression analyses controlling for age, race, employment status, income, educational attainment, and depression.
Participants experienced M = 9.3 out of 16 possible health-related losses (SD = 4.4). Average to severe demoralization scores were indicated by 59.1% of individuals, of which only 17.1% experienced high demoralization. Loss of resources fully mediated the effect of symptom severity on demoralization, explaining 56% of the variance of demoralization and inhibiting the initially significant effect of symptom severity on demoralization to nonsignificant levels [from b = 0.67, 95% CI (0.26, 1.07) to b = 0.03, 95% CI (−0.27, 0.32)].
Early recognition of the loss of resources phenomena and interventions to reduce its progression through the introduction of resource gains may diminish, or even prevent, the installation of demoralization in individuals with chronic symptoms.

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Burnout, depression and anxiety levels in mothers of infants with brachial plexus injury and the effects of recovery on mothers’ mental health

Abstract

Objective

Study design

Results

Conclusion

Introduction

Section snippets

Materials and methods

Results

Discussion

Conclusion

Acknowledgement

Am J Obstet Gynecol

Am J Obstet Gynecol

Biol Psychol

J Affect Disord

Pediatr Neurol

Int J Pediatr Otorhinolaryngol

The Health of Canada's Children: a CICH profile

The health and well-being of caregivers of children with cerebral palsy

Pediatrics

Stress and well-being among parents of children with rare diseases: a prospective intervention study

J Adv Nurs

Stress and coping among parents of handicapped children: a multidimensional approach

Am J Ment Retard

Burnout and the academic teaching librarian: an examination of the problem and suggested solutions

J Acad Libr

Depressive symptomatology and interaction behaviors of mothers having a child with disabilities

Psyhol Rep

The client role in staff burn-out

J Soc Issues

The measurement of experienced burnout

J Occup Behav

Burnout: The cost of caring