Biopsychosocial risks of parental care for high-risk neonates: implications for evidence-based parental counseling

Objective: Provide an evidence base for counseling parents of high-risk neonates about the biopsychosocial impact of providing long-term care. Study Design: A review of the effects of long-term care on families of high-risk neonates. Our search was limited to 1993–2010. We used the terms ‘long-term care,’ ‘family,’ ‘neonate’ and ‘technology dependence.’ Results were organized based on Engel's biopsychosocial model. Result: Physical—parental caregivers reported more health problems, had fewer health-promoting behaviors and lower vitality. Psychological—parental caregivers had higher rates of post-traumatic stress disorder and depressive symptoms, although some improved with time. Siblings reported greater stress and depression. Social—parental caregivers achieved fewer years of education, higher unemployment and lower incomes. Couples reported greater family strain. The effect on divorce was mixed. Siblings reported disruption in their academic and social lives. Conclusion: Providing long-term care involves biopsychosocial risks. Counseling of parents should identify them and advocate strategies for prevention.