title: Maternal anxiety and depression after a premature infant's discharge from the neonatal intensive care unit: explanatory effects of the creating opportunities for parent empowerment program.
abstract: BACKGROUND
  Understanding the processes through which interventions work for mothers of premature infants is necessary for the advancement of science and the translation of efficacious interventions into clinical practice settings.
  
  
  OBJECTIVE
  To test a theoretical model examining the processes through which an educational-behavioral intervention program (Creating Opportunities for Parent Empowerment [COPE]) influences mothers' anxiety and depression 2 months after discharge of their premature infants from the neonatal intensive care unit (NICU).
  
  
  METHODS
  A secondary analysis was conducted using data from a randomized controlled trial with 246 mothers of low-birth-weight preterm infants who were assigned randomly to COPE or placebo control conditions. Measures included mothers' stress in the NICU, mothers' anxiety and depression, and mothers' beliefs about their infants and their role. Observers blind to study group condition also rated the quality of mother-infant interaction in the NICU.
  
  
  RESULTS
  Structural equation modeling suggested that the model tested provided a reasonable fit to the data, chi2(64) = 97.67, p = .004, root mean square error of approximation = .046, comparative fit index = .97. Participation in COPE was both directly and indirectly, via associations with increased maternal beliefs and less maternal depression and anxiety in the NICU, related to mothers' decreased posthospital depression and anxiety. Participation in the COPE program also was associated with higher mother-infant interaction scores.
  
  
  CONCLUSIONS
  Implementation of COPE could lessen postdischarge maternal anxiety and depression, which may improve outcomes for both mothers and preterm infants.
authors.affiliation: College of Nursing & Healthcare Innovation, Arizona State University, Phoenix 85004, USA. bernadette.melnyk@asu.edu
authors.forename: Bernadette Mazurek
authors.initials: BM
authors.lastname: Melnyk
authors.forename: Hugh F
authors.initials: HF
authors.lastname: Crean
authors.forename: Nancy Fischbeck
authors.initials: NF
authors.lastname: Feinstein
authors.forename: Eileen
authors.initials: E
authors.lastname: Fairbanks
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control / Q000523:psychology*; D001294:Attitude to Health; D016009:Chi-Square Distribution; D019052:Depression, Postpartum / Q000209:etiology / Q000517:prevention & control / Q000523:psychology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008960:Models, Psychological; D009034:Mother-Child Relations; D009035:Mothers / Q000193:education / Q000523:psychology; D015999:Multivariate Analysis; D009518:New York; D015403:Nursing Evaluation Research; D010351:Patient Discharge; D010353:Patient Education as Topic / Q000458:organization & administration*; D011209:Power, Psychological; D016037:Single-Blind Method; D055815:Young Adult