Relationship among Attachment with Mother, Self-Esteem, Home Acceptance, and Suicidal Behavior in a Cohort of Ex-Premature Young Adults Exposed or Not to Kangaroo Mother Care Method during the Neonatal Period

Introduction: There is evidence that adult patients who have been preterm at birth have a lower quality of attachment toward their mother, lower self-esteem, and less control of emotions.

Materials and Methods: This study is part of a clinical trial started 20 years ago with 746 preterm or low-birth-weight newborns comparing kangaroo mother care (KMC) method and conventional care (control). We followed up a cohort of young adults with a history of prematurity and being born with birth weight  < 1,800 g. The objective of this study was to evaluate the relationship between the quality of attachment, the self-esteem score, the HOME environment scale score, number of days of neonatal separation with the mother and antecedent of suicidal behavior in these young adults with a history of prematurity, and who had been exposed either to KMC method or not, and to compare these items between this group of individuals and a control group composed by young adults born at term.

Results: The study cohort was composed of 246 young adults with a history of prematurity with birth weight  <  1,800 g, and the control group was composed of 37 young adults born at term. When comparing patients with or without antecedent of suicidal behavior, the former ones had a lower score of attachment and self-esteem (analysis of variance [ANOVA] 47.2 vs. 63.0, p  <  0.001 and 29.4 vs. 32.2, p = 0.001). The same occurred when comparing formerly preterm born adults exposed to KMC method or not, and young adults born at term. Patients with suicidal behavior also had a lower score of acceptance in the family (ANOVA HOME acceptance subscale score 6.7 vs. 7.7, p = 0.02). This result was similar analyzing formerly preterm born adults with antecedent of being or not exposed to KMC method in the most fragile group, that is, those admitted in the neonatal intensive care unit (NICU) (ANOVA HOME acceptance subscale score 8.2 vs. 7.1, p = 0.02).

Conclusion: A good attachment with the mother from the neonatal stage is fundamental in the generation of a stimulating family environment (HOME) and for the development of an adequate self-esteem, which decreases the risk of suicidal behavior in young adults. KMC increases the acceptance in the family of the most fragile group (NICU) and thus indirectly decreases the risk of suicidal behavior.

Keywords: suicidal behavior, premature kangaroo, mother care