title: A model for the development of mothers' perceived vulnerability of preterm infants.
abstract: OBJECTIVE
  Some mothers of preterm infants continue to view them as vulnerable after their health has improved. These exaggerated perceptions of vulnerability lead to poor parent-child interactions and, subsequently, to adverse child outcomes. However, there is no theoretical model to explain why these exaggerated perceptions develop in only some mother-child dyads.
  
  
  METHODS
  Data for this study come from a randomized trial of an intervention to reduce distress in mothers of preterm infants. A total of 105 mothers older than 18 years of infants aged 25-34 weeks, weighing >600 g and with clinically significant anxiety, depression, or trauma symptoms, were recruited and randomized. Women were assessed at baseline, after intervention, and at 6 months after birth. The outcome for these analyses was perceptions of infant vulnerability as measured by the Vulnerable Baby Scale (VBS) at 6 months after birth. A theoretical model developed from the extant literature was tested using the MacArthur Mediator-Moderator Approach.
  
  
  RESULTS
  A dysfunctional coping style, high depression, anxiety, or trauma symptoms in response to the preterm birth, and low social support were related to 6-month VBS scores. Maternal response to trauma was directly related to VBS, and an important precursor of maternal response to trauma was a dysfunctional coping style.
  
  
  CONCLUSIONS
  This model suggests that maternal responses to trauma are critical in the formation of exaggerated perceptions of vulnerability as are dysfunctional coping styles and low social support. Women with these characteristics should be targeted for intervention to prevent poor parenting practices that result from exaggerated perceptions of vulnerability.
authors.affiliation: *Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY; †Statistical Research Consultants, LLC, Schaumburg, IL; ‡Nathan Kline Institute for Psychiatric Research, Orangeburg, NY; §Division of Population Sciences, Prevention Research Center, University of New Mexico, Albuquerque, NM; ‖PGSP-Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, CA; ¶Lucile Packard Children's Hospital Stanford, Palo Alto, CA; #Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA.
authors.forename: Sarah McCue
authors.initials: SM
authors.lastname: Horwitz
authors.forename: Amy
authors.initials: A
authors.lastname: Storfer-Isser
authors.forename: Bonnie D
authors.initials: BD
authors.lastname: Kerker
authors.forename: Emily
authors.initials: E
authors.lastname: Lilo
authors.forename: Ann
authors.initials: A
authors.lastname: Leibovitz
authors.forename: Nick
authors.initials: N
authors.lastname: St John
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Shaw
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology*; D001294:Attitude to Health; D019052:Depression, Postpartum / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000523:psychology*; D008960:Models, Psychological; D009034:Mother-Child Relations / Q000523:psychology*; D016487:Parenting / Q000523:psychology; D011644:Puerperal Disorders / Q000175:diagnosis / Q000523:psychology*; D012307:Risk Factors; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology*