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Parenthood and couple relationship after neonatal care
Dalarna University, School of Health and Welfare, Care Sciences. Dalarna University, School of Health and Welfare, Caring Science/Nursing. Centre for Clinical Research Dalarna, Falun.
2026 (English)Doctoral thesis, comprehensive summary (Other academic)
Description
Abstract [en]

Background: In neonatal intensive care units (NICUs), parents experience stress and trauma related to separation from the infant, uncertain health outcomes, and difficulties finding their parental role. There is a lack of studies describing how NICU experiences affect parents’ mental health and family outcomes long-term, especially in contexts that facilitate rooming-in for both parents. The overall aim of this thesis was to describe mental health, couple relationships, and parenting outcomes in parents from NICUs compared to parents from maternal units (MUs) and to explore NICU parents’ experiences of family relationships up to 3 years postpartum.

Methods: Study 1 (papers I–III) used a comparative longitudinal cohort design in which parents from NICUs and MUs answered four questionnaires during the first 3 years postpartum. Study 2 (paper IV) employed a constructivist grounded theory design where interviews with 20 NICU parents were conducted up to 3 years postpartum. Results: There were no differences between NICU and MU parents regarding symptoms of depression (EPDS) 1 month postpartum (I), the quality of their couple relationships (QDR36) 1 year postpartum (II), and their parenting sense of competence (PSOC) and coparenting (PPC) three years postpartum (III). Rooming-in together as parents with the infant in the NICU and social support were positively associated, and symptoms of depression were negatively associated with the outcomes of the QDR36 and PSOC. QDR36 was also associated with PSOC and PPC outcomes. Study 2 (IV) showed that being together in NICU and having stability and support made parents experience being in a “safe zone,” which strengthened their relationship after discharge. Separation, instability, and a lack of support negatively influenced parents’ well-being and the couple relationship.

Conclusion: In NICU contexts that facilitate family togetherness, parents’ symptoms of depression, the quality of their couple relationship, and their parenting do not differ from MU parents. To optimize long-term family outcomes, the togetherness of parents and infants, and support from staff, family, and friends, should be prioritized during NICU hospitalization. Furthermore, there is a need for better emotional and practical support after discharge for parents at risk for decreased mental health and a strained couple relationship.

Place, publisher, year, edition, pages
Falun: Dalarna University, 2026.
Series
Dalarna Doctoral Dissertations ; 53
Keywords [en]
comparative, couple relationship, mental health, NICU parents, parenting, rooming-in, social support
National Category
Nursing
Identifiers
URN: urn:nbn:se:du-53247ISBN: 978-91-990244-4-8 (print)OAI: oai:DiVA.org:du-53247DiVA, id: diva2:2049683
Public defence
2026-06-05, lecture hall F135, Campus Falun and online, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2026-04-21 Created: 2026-03-30 Last updated: 2026-04-21Bibliographically approved
List of papers
1. NICU parents' mental health: A comparative study with parents of term and healthy infants
Open this publication in new window or tab >>NICU parents' mental health: A comparative study with parents of term and healthy infants
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2023 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 112, no 5, p. 954-966Article in journal (Refereed) Published
Abstract [en]

AIM: To compare mental health in parents of preterm/ill infants and parents of term and healthy infants before birth and 1 month after hospital discharge.

METHODS: A comparative cohort design was used. In total 439 parents from six neonatal intensive care units (NICUs) and 484 parents from four maternity units (MUs) in Sweden answered a survey 1 month after discharge.

RESULTS: Parents in neonatal units experienced significantly more psychologically traumatic births and rated their health and the health of their infants less favourably the first week after delivery than parents in MUs. In the neonatal units, both parents had better possibilities to stay together with the infant during hospital stay. There was no difference between the NICU and MU groups in postpartum depressive symptoms 1 month after discharge. Experiencing a traumatic birth was not related to an increased risk of perinatal depressive symptoms (Edinburgh Postnatal Depression Scale ≥13) for mothers in NICUs. In contrast, the risk of depression increased for mothers in MUs.

CONCLUSION: Family togetherness, parent-infant closeness and emotional support at NICUs may contribute to the positive outcome. Further studies are needed to assess the long-term effects of how family togetherness and closeness influence families long-term.

Keywords
NICU, mental health, neonatal care, parents, preterm infants
National Category
Nursing
Identifiers
urn:nbn:se:du-45612 (URN)10.1111/apa.16735 (DOI)000952489900001 ()36853186 (PubMedID)2-s2.0-85150763413 (Scopus ID)
Available from: 2023-03-09 Created: 2023-03-09 Last updated: 2026-04-21Bibliographically approved
2. Quality of couple relationship and associated factors in parents of NICU-cared infants during the first year after birth
Open this publication in new window or tab >>Quality of couple relationship and associated factors in parents of NICU-cared infants during the first year after birth
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2024 (English)In: Journal of Perinatology, ISSN 0743-8346, E-ISSN 1476-5543, Vol. 44, no 12, p. 1738-1745Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To describe factors associated with quality of couple relationships among parents of infants cared for in neonatal intensive care units (NICUs) 1 year after birth and examine the trajectory of the relationship quality compared to parents from maternity units (MUs).

STUDY DESIGN: Longitudinally comparative cohort design. Parents answered surveys during the first year after discharge about the couple relationship, social support, and depressive symptoms.

RESULTS: Better social support and a hospital stay of 7-14 days were positively associated with the couple relationship in NICU mothers, whereas not having slept together with the partner and infant during hospitalization were negatively associated. Depressive symptoms were negatively associated with the relationship among NICU fathers. There were no differences in trajectory of the relationship quality between NICU and MU parents.

CONCLUSION: To strengthen couple relationships, it could be important to improve social support, facilitate space and time for support, and enable togetherness during hospitalization.

National Category
Nursing
Identifiers
urn:nbn:se:du-49275 (URN)10.1038/s41372-024-02076-1 (DOI)001283483600002 ()39097668 (PubMedID)2-s2.0-85200383804 (Scopus ID)
Available from: 2024-08-26 Created: 2024-08-26 Last updated: 2026-04-21Bibliographically approved
3. Parenthood after neonatal care -parenting sense of competence and coparenting three years after discharge
Open this publication in new window or tab >>Parenthood after neonatal care -parenting sense of competence and coparenting three years after discharge
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2026 (English)In: Early Human Development, ISSN 0378-3782, E-ISSN 1872-6232, Vol. 214, article id 106462Article in journal (Refereed) Published
Abstract [en]

Many parents of infants in neonatal intensive care units (NICUs) experience trauma and a loss of their parental role, which may affect their parenting following discharge. This study aimed to compare parenting competence and coparenting between parents of NICU and non-NICU infants three years postpartum. We also examined factors influencing parenting among NICU parents.

We used a comparative cohort design to collect data from 561 parents who completed a set of questionnaires, including measures of parenting sense of competence, coparenting, dyadic relationship quality, social support, and depressive symptoms.

Three years postpartum, no differences were found in parenting sense of competence or coparenting between NICU parents and non-NICU parents. For both NICU mothers and fathers, a higher parenting sense of competence in satisfaction and efficacy was associated with a higher quality in the couple relationship. Mothers reported higher parenting satisfaction if they had not experienced a traumatic birth. Fathers reported higher parenting satisfaction if they had no depressive symptoms, and higher parenting efficacy if they had a longer couple relationship, received greater social support, had a shorter infant hospital stay, or were rooming-in with their partner and infant during hospitalization. Factors associated with more coparenting problems among NICU parents included lower couple relationship quality, a 7-14-day hospitalization for mothers, and lower social support for fathers.

This study highlights that early possibilities for parents to initiate parenthood together and receive adequate mental and social support during and after NICU hospitalization should be a priority for enhancing parents' sense of competence and coparenting.

Keywords
Coparenting, Discharge, NICU, Neonatal, Parenthood, Parenting
National Category
Nursing
Identifiers
urn:nbn:se:du-52261 (URN)10.1016/j.earlhumdev.2025.106462 (DOI)001645928100001 ()41418379 (PubMedID)2-s2.0-105025002275 (Scopus ID)
Available from: 2026-01-09 Created: 2026-01-09 Last updated: 2026-04-21Bibliographically approved
4. Parental well-being and the couple relationship the first years after experiencing neonatal care: A grounded theory study
Open this publication in new window or tab >>Parental well-being and the couple relationship the first years after experiencing neonatal care: A grounded theory study
(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Identifiers
urn:nbn:se:du-53248 (URN)
Available from: 2026-03-30 Created: 2026-03-30 Last updated: 2026-04-21Bibliographically approved

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1232 of 3
CiteExportLink to record
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Citation style
  • apa
  • ieee
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  • vancouver
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  • Other style
More styles
Language
  • de-DE
  • en-GB
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  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
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Output format
  • html
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