UC Irvine

Infant neonatal intensive care unit (NICU) hospitalization is known to increase maternal risk for psychological distress, including symptoms of post-traumatic stress disorder (PTSD). However, no universal screening standard has been established and predicting maternal risk remains challenging. While the psychosocial support needs of individual mothers are likely complex and may vary from family to family, reconceptualizing maternal distress in relation to differences between parenting expectations and NICU experiences may illuminate commonalities across a range of experiences. This mixed methods study explored parenting expectation-experience differences (EEDs) among NICU mothers and assessed correlations between mothers’ EED scores and psychological outcomes 1 – 5 years post-NICU hospitalization. A 3-phase explanatory sequential mixed methods design was employed. In Phase one, Pearson’s correlation coefficients were used to measure relationships between EED scores and maternal psychological outcomes (n = 128). Significant inverse correlations in the mild to moderate range were found between EED scores and maternal psychological outcomes (r = -0.25 to -0.41). In Phase two, reflexive thematic analysis of one-on-one, semi-structured interviews contextualized EED scores (n = 13). In Phase three, quantitative-qualitative data synthesis contextualized EED scores and revealed key differences in meaning ascribed to unmet parenting expectations.

Subsequent focused analysis of cross-sectional questionnaire data (n = 128) tested the association between EED scores and maternal PTSD symptoms using multiple linear regression. The moderating role of parenting self-efficacy was also examined. After adjusting for eight significant covariates in the main effects model, a negative association was found between EED scores and PTSD symptoms (B = -1.5, p < 0.001). Perceived parenting self-efficacy was found to moderate (weaken) this association (B = -0.141, p = 0.015).

Subsequent focused analysis of qualitative interview data (n = 13) explored needs identified by mothers of NICU-hospitalized children in relation to the principles of Trauma-Informed Care (TIC). Mothers’ care needs were found to align with TIC principles.

Findings suggest that interventions and NICU care practices aimed at better aligning parents’ expectations with NICU experiences and at promoting parenting self-efficacy among NICU mothers may improve delivery of supportive NICU care and suggest that implementation of TIC principles in NICU settings may support parental presence, participation in infant care, and mental health.