Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Bruce Rybarczyk

Second Advisor

Alyssa Ward

Third Advisor

Paul Perrin

Fourth Advisor

Karen Hendricks-Munoz

Fifth Advisor

Heather Jones


Postpartum mental health is a public health priority, particularly for mothers with infants in the Neonatal Intensive Care Unit (NICU), who may have experienced a precipitous birth, followed by a traumatic NICU hospitalization. However, little research has focused on NICUrelated posttraumatic stress (PTSS), despite its presumed prevalence and ripple effects on infant development, family functioning, and provider burnout during the critical early bonding period. In particular, little research has evaluated: early posttraumatic stress (Acute Stress Disorder symptoms, ASD), index and sequential traumas related to NICU/birth, and relations among preexisting risk factors, and trauma appraisals/ objective trauma characteristics (related to infant health and childbirth). Thus, the present study aimed to: (1) characterize ASD’s prevalence, comorbidities, and index/compounding traumas; (2) evaluate relations between pre-existing risk factors, appraisals of infant health and control during childbirth, objective factors related to infant health or childbirth, and ASD, using descriptive statistics, correlation matrices, three infant health structural equation models (SEMs), and three birth related SEMs. English-speaking mothers were eligible between days 5-31 of their infants’ hospitalizations for this cross-sectional 2 study. Of the 119 mothers (~72% Medicaid) who completed surveys, ~55% scored in the “at risk” range or higher for ASD symptoms. In the ~40% of mothers with diagnosed ASD, commodities of other mental health symptoms were high: ~81% endorsed significant postpartum anxiety and ~66% endorsed postpartum depression. Sequential trauma was pervasive: ~54% endorsed more than one trauma. NICU admission was the most common trauma (~81%), followed by childbirth (~50%), pregnancy (~24%), and a specific NICU incident (~15%). Preexisting risk factors were examined, but only to adverse childhood experiences (ACEs) met criteria for testing in the SEMs. All the infant health SEMs had good fit, indicating that appraisals of infant health mediated the relationships between ACEs and ASD symptoms and between objective infant health and ASD respectively. Childbirth models had poor fit; only appraisals of control during childbirth and ACEs predicted ASD symptoms. The high prevalence of ASD symptoms, multiple traumas, and other mental health comorbidities highlight the unique psychosocial needs of NICU mothers. Additionally, these models suggest that a trauma-informed approach to research and clinical work is needed, which accounts for infant health and birth appraisals in addition to prior trauma.


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