Original Research Reports 206 http://psy.psychiatryonline.org Psychosomatics 47:3, May-June 2006 Acute Stress Disorder Among Parents of Infants in the Neonatal Intensive Care Nursery RICHARD J. SHAW, M.B.B.S., THOMAS DEBLOIS, M.D. LINDA IKUTA, M.N., R.N., KARNI GINZBURG,PH.D. BARRY FLEISHER, M.D., CHERYL KOOPMAN,PH.D. The authors examined the prevalence of acute stress disorder (ASD) in parents of infants hospi- talized in the neonatal intensive care unit (NICU). Forty parents were assessed after the birth of their infants. Parents completed self-reportmeasures of ASD, parental stress, family environment, and coping style: 28% of parents developed symptoms of ASD. ASD was associated with female gender, alteration in parental role, family cohesiveness, and emotional restraint. Family environ- ment and parental coping style are significantly associated with the development of trauma symp- toms. Results from this study suggest potential interventions to help minimize psychological dis- tress in parents. (Psychosomatics 2006; 47:206–212) Received, accepted January 26, 2005. From the Department of Psychiatry and Behavioral Sciences and Department of Pediatrics, Stanford Univer- sity School of Medicine, and Lucile Packard Children’s Hospital, Palo Alto, CA. Address correspondence and reprint requests to Dr. Richard Shaw, Dept. of Psychiatry and Behavioral Sciences, Stanford Univ. School of Medicine, 401 Quarry Rd., Palo Alto, CA 94305-5719. e-mail: rjshaw@Stanford.edu Copyright  2006 The Academy of Psychosomatic Medicine H aving a newborn infant hospitalized in the neonatal intensive care unit (NICU) is an unexpected and trau- matic event. 1 Considerable research has examined sources of parental stress in the NICU. Miles et al. 2 have developed a framework for identifying specific domains of stress that occur in the neonatal ICU, and they emphasize the impor- tance of the alteration in the expected parental role. Pre- vious studies suggest a relationship between parental stress and symptoms of anxiety and depression. 3–6 Recently, researchers have identified posttraumatic stress disorder (PTSD) as a model to describe and explain the psychological reaction of parents to their NICU expe- rience. 7–10 The model of a NICU hospitalization as a trau- matic event has many parallels with the literature describ- ing PTSD in parents of children with cancer and other pediatric medical conditions. 11,12 Acute stress disorder (ASD), the form of traumatic stress that is experienced in the first weeks after a traumatic event, is considered to be a precursor to PTSD. However, although ASD seems par- ticularly relevant as a specific model for consideration in the context of traumatic stress in parents of NICU infants, there have been no previous studies that have examined this phenomenon among parents of NICU infants. In this study, we examined ASD among parents of NICU infants and explored its relationship with ratings of parental stress as well as sociodemographic and medical variables. We also examined the relationship of two vari- ables that have been shown in previous studies to influence the development of trauma symptoms, specifically, quality of family environment and parental coping style. 13 In re- search relating distress among cancer survivors to their coping style, the use of suppression has been associated with greater development of PTSD, whereas repression ap- pears to be related to less risk of psychological distress. 14 On the basis of these previous studies, we developed the following specific hypotheses: 1) Parents of NICU in- fants will be at risk for developing symptoms of ASD; 2) Symptoms of ASD will be positively related to ratings of severity of parental stress; 3) Symptoms of ASD are