Parenting Stress and Depressive Symptoms Among Parents of Preterm Infants in China: The Mediating Role of Coping Abilities

Background and Purpose:

Preterm infants (PTI) refer to viable neonates delivered before completing 37 weeks of gestation. With 15 million preterm infants occurring each year worldwide, preterm birth is a global epidemic that has significant social and economic consequences. While the survival rate for preterm infants has improved, the number of PTI with comorbidities is increasing, presenting great caregiving challenges to their parents. As a result of the demanding, long-term, and stressful caregiving experience, parents are at risk of developing depression symptoms. This study aimed to investigate the association between parenting stress and depressive symptoms in Chinese PTI parents, and to explore the buffering role of coping abilities.

Methods:

The research team worked with a Chinese non-profit organization that focused on supporting PTI in China to recruit participants nationwide. Parents of PTI, who were discharged from Neonatal Intensive Care Unit between 2019 and 2022 were reached out. Each consented participant was interviewed using a questionnaire via phone calls. Data on parenting stress, depressive symptoms, eight dimensions of coping abilities as well as characteristics of parents, infants, and families, experiences of hospitalization and healthcare seeking were collected. A series of linear regression models was utilized to analyze the statistical association between parenting stress and depressive symptoms relationships, with a particular focus on examining the mediation effect of coping abilities.

Results: A total of 340 parents completed the survey. Among them, a total of 289 samples with discharge status were included in the statistical analysis, comprising 190 single-birth families and 99 multiple-birth families. The average age of the parents is 32.75 years. The average age of the premature infants was 2.13 years. The study found that Parenting stress was positively associated with depression symptoms (β=.332, p<.001). while the total coping ability score was negatively correlated with depressed symptoms (β=-.212, p<.001). The stepwise multivariate regression revealed that the mediating role of total coping ability in the relationship between parenting stress and depressed symptoms (β=-.123, p<.05). The negative coping played a mediating role between parenting stress and depressive mood (β=-.204, p<.001), while the premature infant care skills dimension of coping ability moderated the relationship between parenting stress and depressive mood (β= -.126, p<.05). In other words, the coping ability of the parents of premature infants had a protective impact on depressive mood.

Conclusions and Implications: The findings confirm the positive association between parenting stress and depressive symptoms, high level parenting stress is associated with aggravated depressive symptoms. The coping ability plays a mediating role between post-discharge parenting stress and depressive symptoms, with negative coping similarly acting as a mediator. Preterm infant care skills moderate the relationship between parenting stress and depressive symptoms. This suggests that higher coping abilities, lower negative coping, and better infant care skills are associated with alleviated depressive symptoms among parents. Drawing on stress coping theory, this study not only furnishes novel empirical evidence for this theory, but also informs future policies and targeted interventions.

Keywords：caregiving, pre-mature infants, parenting stress depressive symptoms, coping ability