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, χ2(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.
Conclusion: Implementation of COPE could lessen postdischarge maternal anxiety and depression, which may improve outcomes for both mothers and preterm infants.