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Anxiety, Infant, Maternal age, Premature.



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


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 x 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.