The mental health of mothers of infants with life-threatening bronchiolitis: what is the role of hormones?

Background

Infant life-threatening events represent a significant stressor affecting mental health of new borns’ mothers. Of note, bronchiolitis represents a paradigm of acute maternal stress. Different hormones such as those belonging to hypothalamic–pituitary–adrenal axis (HPA) as well as vasopressin and neurophysin 1 demonstrated to have a role in behavioural responses to stressful events [1]. Purpose of this study is to compare mental health and hormonal profile of mothers of infants affected or not by bronchiolitis.

Methods

This is a case-control study for which we enrolled mothers of infants with bronchiolitis (N=56) and mothers of healthy infants (N=52). All infants had to be younger than 1 year. Mothers’ mental health was assessed by the following rating scales: Edinburgh Postnatal Depression Scale (EPDS), State Trait Anxiety Inventory (STAI-S, STAI-T), Barkin Index of Maternal Functioning (BIMF), The Connor-Davidson Resilience Scale 10 items (CD-RISC). A blood sample in late morning was collected withing 3 days of infants’ hospitalization and the following hormones were analyzed: cortisol, dehydroepiandrosterone sulfate (DHEA-S), antidiuretic hormone (vasopressin-ADH), adrenocorticotropic hormone (ACTH) and neurophysin 1 (an indicator of brain ossitocin level). DHEA-S/cortisol ratio was calculated as a biomarker of chronic stress and burnout [2]. To evaluate differences in mean scores of the psychological scales completed by mothers at enrollment, analysis of variance (ANOVA) models were applied, comparing cases and controls. Differences in maternal hormone levels between cases and controls were assessed using analysis of covariance (ANCOVA) models. Linear regression models were subsequently used to evaluate associations between maternal hormone levels and rating scale scores.

Results

Mothers of infants affected by bronchiolitis presented worse symptoms of anxiety and depression (p<0.01), less residual resilience (p<0.01) and poorer functioning (p<0.01). Women with ill children resulted to have lower cortisol, DHEA-S, DHEA-S/cortisol, ACTH levels than the counterpart (all p<0.01). Higher DHEA-S/cortisol ratios were associated with higher BIMF scores (p=0.05), indicating a positive effect of this parameter on maternal functioning. ACTH levels resulted to be directly associated with severity of depressive symptoms (EPDS scores) (p=0.02), while ADH with anxiety (STAI-S scores) (p=0.03). Finally ADH levels were inversely associated with BIMF scores (p<0.01), highlighting a negative effect of this hormone on maternal care.

Conclusions

Mothers of infants affected by bronchiolitis show an imbalance of DHEA-S/cortisol systems that is indicative of the detrimental effects of prolonged stress. DHEA-S/cortisol ratio is confirmed to be a valuable parameter for evaluating biological dysfunction associated with stress. This aspect affects maternal functioning as showed by the relation between DHEA-S/cortisol ratio and BIMF scores. Mental health assistance that integrates the abilities of a variety of professionals is necessary for women who undergo trauma during the postpartum period. This leads to improved maternal health and functioning, with positive repercussions on the infant’s health. Further studies are necessary to confirm the results of the present study.

References

1. Chen, X., Hackett, P.D., DeMarco, A.C., Feng, C., Stair, S., Haroon, E., Ditzen, B., Pagnoni, G., Rilling, J.K. Effects of oxytocin and vasopressin on the neural response to unreciprocated cooperation within brain regions involved in stress and anxiety in men and women. Brain Imaging Behav. 2016;10(2):581-93.
2. Andrisani, A., Sabbadin, C., Minardi, S., Favaro, A., Donà, G., Bordin, L,, Ambrosini, G,, Armanini, D. Persistent amenorrhea and decreased DHEAS to cortisol ratio after recovery from anorexia nervosa. Gynecol Endocrinol. 2017;33(4):311-314.