Perceived Control in the NICU: Implications for Maternal Mental Health and Parenting in the NICU

We examined whether maternal stress in the Neonatal Intensive Care Unit (NICU) predicts parental involvement, measured as functional parenting (FP) and physical contact (PC), during hospitalization. We hypothesized that higher stress, particularly related to perceived lack of control, would be associated with reduced FP and PC.

A retrospective analysis was conducted on 51 parent-preterm infant dyads from a prospective longitudinal cohort in a level IV NICU. Maternal stress and anxiety were assessed within 2 weeks of birth using a reduced version of the Parental Stressor Scale: NICU (PSS: NICU), the Perceived Stress Scale (PSS), and the State-Trait Anxiety Inventory (STAI). FP and PC were extracted from medical chart logs and adjusted for hospitalization length. Multivariable regression models were tested, with best-fit models determined by Bayesian Information Criterion (BIC), and adjusted for gestational age of infant at delivery, caregiver education, and infant sex.

Maternal stress associated with perceived lack of control over the infant's medical care was significantly related to reduced FP (β = -0.55, p < 0.001, BIC = -10.78) and PC (β = -0.50, p <0.001, BIC = -15.38), when controlling for gestational age at birth and maternal education. PSS and STAI were not associated with FP or PC in unadjusted or adjusted models, p > 0.35.

Elevated maternal stress linked to lack of control in the NICU predicts lower caregiver involvement, placing families at risk for disrupted bonding and poorer long-term outcomes. Findings underscore the need for dyadic interventions that reduce maternal stress, enhance caregiver agency, and promote parent-infant connection in the NICU. Findings are limited by the retrospective design, potential measurement variability in chart-documented parental involvement, small sample size, and single-site setting, which further limit generalizability.