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Reducing Anxiety Among Children Born Preterm and Their Young Mothers

Oswalt, Krista L. PhD; McClain, Darya Bonds PhD; Melnyk, Bernadette PhD, RN, CPNP/PMHNP, FAAN

MCN: The American Journal of Maternal/Child Nursing: May/June 2013 - Volume 38 - Issue 3 - p 144–149
doi: 10.1097/NMC.0b013e318286140c

Purpose: To examine the efficacy of COPE on maternal and child anxiety associated with younger mothers of premature infants. The COPE program provides instruction and practice in parenting behaviors specific to the NICU, in combination with information that reduces ambiguity about their infant's appearance and behaviors.

Study Design and Methods: Secondary data analysis was conducted on data obtained from a larger randomized controlled trial with 253 mothers of low birthweight premature infants to examine the efficacy of the Creating Opportunities for Parent Empowerment (COPE) program, an educational–behavioral parent intervention in the NICU, on maternal and child anxiety based on maternal age. For these analyses, child and maternal anxiety were assessed using the Child Behavior Checklist for Ages 2 to 3 and the State-Trait Anxiety Inventory collected at 24 months and 2 to 4 days postintervention, respectively. To test study hypotheses, we conducted multiple regression models using the structural equation modeling approach to path analysis.

Results: Multiple regression results for the full model indicated that there was a significant COPE × mothers' age interaction effect on both mothers' anxiety and child anxiety. Participation in the COPE program significantly predicted lower levels of mothers' anxiety at postintervention as well as lower levels of child anxiety at 24 months for younger mothers (18-21 years old), but not for mothers over 21 years old.

Clinical Implications: Participating in COPE was associated with more favorable mental health outcomes for younger mothers and their children than mothers over 21 years old. Participation in the COPE program may help close the health disparities gap by improving behaviors in infants of younger mothers to rates similar to those of children of mothers over 21 years old.

Parents of infants in the neonatal intensive care unit may find information about their infants' physical and behavioral characteristics to be helpful in planning for what to expect in the future.Supplemental Digital Content is available in the text.

Krista L. Oswalt is a Research Assistant Professor, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ. She can be reached via e-mail at

Darya Bonds McClain is a Research Associate Professor, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ.

Bernadette Melnyk is an Associate Vice President for Health Promotion, University Chief Wellness Officer, Dean and Professor, College of Nursing, Professor of Pediatrics & Psychiatry, College of Medicine, College of Nursing, Ohio State University.

The third author has received honoraria/consulting fees from various healthcare facilities as a result of her role as co-owner of a company called COPE for HOPE that markets the COPE NICU program. The third author is a speaker on evidence-based practice and intervention research and receives honoraria and travel expenses for speaking engagements, and is also a co-author of four books for which she receives honoraria. The third author is currently receiving a grant (#R01NR012171-04) from NIH/NINR. For the remaining authors, no conflicts were declared.

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Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved