From Intensive Care to Home Care: Examining the Dynamic of Doctor-Parent Communication, Parental Well-Being, and Preterm Infants' Post-Discharge Behavior

Background/Purpose: Preterm infants (PTIs) defined as infants born before completing 37 weeks of gestation, account for an estimated 15 million births globally each year. PTIs often face severe health challenges, and prompt admission to Neonatal Intensive Care Units (NICU). Despite surpassing the critical NICU phase, discharged PTIs remain vulnerable to infections and potential rehospitalization. It is important to ensure that parents are adequately prepared independently care for PTIs. However, the mechanisms linking doctor-parent communication during NICU stays to long-term parental well-being and PTI behavioral outcomes remain poorly understood. This study tests a sequential mediation model to examine whether effective doctor-parent communication reduces PTIs’ post-discharge behavioral difficulties by first alleviating parental depressive symptoms and subsequently enhancing parental coping abilities.

Methods: In partnership with a national nonprofit supporting PTI families in China, 330 parents of PTIs discharged from NICUs (2019–2022) completed structured telephone interviews. Doctor-patient Communication was measured by a scale adopted from the Health and Retirement Study; difficult child behavior was assessed using the difficulty dimension of the Parenting Stress Index-Short Form; depressive symptoms were assessed using the Patient Health Questionnaire-2; and the parental coping abilities was evaluated using the Parental Coping Abilities Scale for Post-discharge of PTIs. A serial multiple mediator model was conducted using the PROCESS macro in SPSS

Results: High-quality doctor-parent communication predicted fewer parental depressive symptoms (β = -0.47, p < 0.001), which in turn correlated with improved coping abilities (β = 0.22, p < 0.01) and subsequently fewer PTI behavioral difficulties post-discharge (β=-0.08, p <0.05). The indirect pathway (communication → depressive symptoms → coping → child behavior) accounted for 31.5% of the total effect, while the direct effect of communication on child behavior explained 68.5%.

Conclusions and Implications: Effective NICU communication serves as a critical buffer against parental depression, enabling adaptive coping strategies that improve PTI outcomes. Findings advocate for integrating communication training into NICU staff professional development and embedding parental mental health screening into post-discharge care protocols. Healthcare systems should prioritize dyadic interventions that address both infant needs and caregiver psychological resilience. Future research should explore cultural and systemic barriers to communication in NICUs and evaluate tailored interventions for at-risk families.