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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.