Sociodemographic risk factors, parental stress and social support in the neonatal intensive care unit
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Updated: Aug 9, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Tamiko Younge1, Marni Jacobs2,3, Lisa Tuchman4
1Division of Neonatology, Children's National Hospital, Washington, DC, USA tyounge@childrensnational.org.
Insights
Parental demographics like education and gender impact stress in the neonatal intensive care unit (NICU). Social support is key, mitigating stress and reducing disparities for NICU families.
Area of Science:
- Neonatal intensive care unit (NICU) research
- Parental mental health
- Sociology of health
Background:
- Neonatal intensive care unit (NICU) admission presents significant stress for parents.
- Understanding sociodemographic factors influencing parental stress and social support is crucial for targeted interventions.
- Previous research has not fully elucidated the complex interplay between demographics, stress, and support in the NICU context.
Purpose of the Study:
- To investigate the relationships among parental demographic characteristics, perceived stress levels, and social support among parents with infants in a NICU.
- To identify specific sociodemographic factors associated with higher parental stress and lower social support.
- To explore the potential modifying effect of social support on the relationship between demographic factors and parental stress.
Main Methods:
- A cross-sectional observational study was conducted with 300 parents enrolled in the Giving Parents Support trial at a tertiary referral NICU.
- Data were collected using psychometric scales for general, parental, and NICU-specific stress, as well as social support.
- Demographic variables included education, insurance, race, relationship status, age, and gender. Linear regression was used to analyze associations and potential modifying effects, controlling for length of stay.
Main Results:
- Lower parental stress was associated with having less than a college degree and female gender. Older parental age correlated with higher parental stress but lower NICU stress.
- Greater social support was linked to significantly lower general and parental stress scores.
- Lower educational attainment, Medicaid insurance, and Black race were associated with decreased social support scores. Social support moderated the impact of education on parental stress.
Conclusions:
- Sociodemographic risk factors do not always predict parental stress or risk in expected ways.
- Interventions should prioritize identifying and supporting NICU families experiencing high stress and low social support.
- Future research and clinical practice must focus on nuanced approaches to support diverse NICU populations.
Objective:
Investigate relationships among neonatal intensive care unit (NICU) parent demographics, reported stress and social support.
Design:
Cross-sectional observation.
Setting:
Tertiary referral NICU in Mid-Atlantic USA.
Patients:
Parents (n=300) in the Giving Parents Support trial at enrolment.
Measures:
Psychometric scales measured general stress, parental stress, NICU stress and social support. Demographic variables included education level, health insurance type, race, relationship status, age and gender. Length of stay was used to control for illness severity. Associations and potential modifying effects were evaluated using linear regression.
Results:
Having less than a college degree (b=-2.52, SE=0.91) and female parent gender (b=-3.42, SE=1.47) were associated with lower parental stress scores. Older age in years was associated with higher parental stress scores (b=0.21, SE=0.07) but lower NICU stress scores (b=-0.01, SE=0.01). Greater social support scores were associated with lower scores of general (b=-2.76, SE=0.39) and parental stress (b=-1.71, SE=0.47). Less than a college degree (b=-0.26, SE=0.11), Medicaid insurance (b=-0.43, SE=0.11) and black race (b=-0.56, SE=0.12) were associated with decreased social support scores. Level of social support modified the relationship between education and parental stress, with higher social support decreasing education-based differences in parental stress scores (p=0.049).
Conclusion:
Sociodemographic risk factors may not infer stress or risk in the anticipated direction. Practice and future research should focus on identifying and supporting NICU families at high risk for stress and low support.
Trial Registration Number:
NCT02643472.
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