A Scoping Review of Psychological Distress Outcomes in NICU Healthcare Providers

Abstract

The Neonatal Intensive Care Unit (NICU) is a demanding work environment that provides medical care for acutely ill and premature infants while supporting parents experiencing significant stress and psychological distress. This scoping review is the first to examine quantitative research across a broad range of psychological constructs, including burnout, traumatic stress, moral distress, and other distress outcomes such as mental health, somatic symptoms and physiological indicators, among NICU healthcare providers. Following PRISMA-ScR guidelines, PsycINFO, Ovid via MEDLINE, Embase, and CINAHL were searched. Two searches (2021 and 2024) identified 1889 unique records, with 76 publications from 34 countries meeting inclusion criteria (i.e., original quantitative research assessing work-related psychological consequences with NICU healthcare providers) and exclusion criteria (i.e., intervention studies; qualitative studies; NICU provider data inseparable from aggregate results). Most participants were White, female NICU nurses. Across studies, psychological distress was most often reported in the low-to-moderate range, with considerable variability within and across studies making it difficult to clearly summarize the average levels of distress and associations that best predict psychological distress outcomes. Consistent differences by healthcare profession or sociodemographic characteristics were not identified, largely because these factors were infrequently assessed, or findings were inconsistent. Environmental factors were more frequently assessed and reported to be associated with psychological distress in NICU providers. The current evidence base is constrained by cross-sectional designs, inconsistent practices, and conceptual overlap across psychological constructs. Future research should prioritize longitudinal designs, standardized methodologies, and more representative samples across professions. In the interim, unit-level assessment and targeted interventions may help address modifiable work-related stressors, individual responses to stressors, and support NICU healthcare providers’ well-being.