Studies have shown premature birth and infant hospitalization to be associated with increased levels of parental distress. Internal and external psychological resources have been found to mitigate distress among persons coping with stressful medical events. The current study evaluated psychological resources and distress in 87 parents (57 mothers and 30 fathers) to whom an infant was born prematurely and hospitalized in the NICU of a large tertiary medical center. Parents were administered standardized measures of internal (problem-solving skills) and external (total spousal support, adequacy of spousal support) psychological resources and of psychological distress (depression, posttraumatic symptoms, and mood). Findings indicated that higher levels of problem-solving skills and more adequate spousal support, but not total spousal support, were related to lower levels of parental distress. Adequacy of spousal support and parents’ problem-solving skills accounted for 18% of the variance in overall mood and 13.8% of the variance in posttraumatic stress symptoms. A significant two-way interaction was found between adequacy of spousal support and problem-solving skills such that individuals with better problem-solving skills reported better overall mood independent of the adequacy of spousal support they receive. However, for individuals with poor problem-solving skills, the adequacy of the spousal support they receive was a significant factor in determining their overall mood. The theoretical and clinical implications of these findings are discussed in terms of the accessibility of these resources to assessment and their potential for change via existing intervention approaches.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Adler, N. E., Boyce, T., Chesney, M. A., Cohen, S., Folkman, S., Kahn, R. L., & Syme, S. L. (1994). Socioeconomic status and health: The challenge of the gradient. American Psychologist, 49(1), 15–24.
Ahlund, S., Clarke, P., Hill, J., & Thalange, N. K. S. (2009). Post-traumatic stress symptoms in mothers of very low birth weight infants 2–3 years post-partum. Archives of Women’s Mental Health, 12(4), 261–264.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: American Psychiatric Association.
Barry, R. A., Bunde, M., Brock, R. L., & Lawrence, E. (2009). Validity and utility of a multidimensional model of received support in intimate relationships. Journal of Family Psychology, 23(1), 48.
Baum, N., Weidberg, Z., Osher, Y., & Kohelet, D. (2011). No longer pregnant, not yet a mother: Giving birth prematurely to a very-low-birth-weight baby. Qualitative Health Research, 22(5), 1–12.
Beach, S. R. H., & Gupta, M. (2006). Directive and nondirective spousal support: Differential effects? Journal of Marital and Family Therapy, 32(4), 465–477.
Beck, A. T., Steer, R. A., Ball, R., Ciervo, C. A., & Kabat, M. (1997). Use of the Beck anxiety and depression inventories for primary care with medical outpatients. Assessment, 4(3), 211–219.
Beck, S., Wojdyla, D., Say, L., Betran, A. P., Merialdi, M., Requejo, J. H., … Van Look, P. F. (2010). The worldwide incidence of preterm birth: A systematic review of maternal mortality and morbidity. Bulletin of the World Health Organization, 88(1), 31–38.
Bell, A. C., & D’Zurilla, T. J. (2009). Problem-solving therapy for depression: A meta-analysis. Clinical Psychology Review, 29(4), 348–353.
Bielawska-Batorowicz, E., Kossakowska-Petrycka, K., Bielawska Batorowicz, E., & Kossakowska Petrycka, K. (2006). Depressive mood in men after the birth of their offspring in relation to a partner’s depression, social support, fathers’ personality and prenatal expectations. Journal of Reproductive and Infant Psychology, 24(1), 21–29.
Blencowe, H., Cousens, S., Oestergaard, M. Z., Chou, D., Moller, A. B., Narwal, R., Adler, A., … Lawn, J. E. (2012). National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: A systematic analysis and implications. The Lancet, 379(9832), 2162–2172.
Bolger, N., Zuckerman, A., & Kessler, R. C. (2000). Invisible support and adjustment to stress. Journal of Personality and Social Psychology, 79(6), 953–961.
Brannon, L. (2016). Gender: Psychological perspectives. Washington, DC: Taylor & Francis.
Brock, R. L., & Lawrence, E. (2009). Too much of a good thing: Underprovision versus overprovision of partner support. Journal of Family Psychology, 23(2), 181–192.
Brougham, R. R., Zail, C. M., Mendoza, C. M., & Miller, J. R. (2009). Stress, sex differences, and coping strategies among college students. Current Psychology, 28(2), 85–97.
Bugental, D. B., Beaulieu, D. A., & Silbert-Geiger, A. (2010). Increases in parental investment and child health as a result of an early intervention. Journal of Experimental Child Psychology, 106(1), 30–40.
Cacciatore, J., Schnebly, S., & Froen, J. F. (2009). The effects of social support on maternal anxiety and depression after stillbirth. Health & Social Care in the Community, 17(2), 167–176.
Carter, J. D., Mulder, R. T., Bartram, A. F., & Darlow, B. A. (2005). Infants in a neonatal intensive care unit: Parental response. Archives of Disease in Childhood. Fetal and Neonatal Edition, 90(2), F109–F113.
Carter, J. D., Mulder, R. T., & Darlow, B. A. (2007). Parental stress in the NICU: The influence of personality, psychological, pregnancy and family factors. Personality and Mental Health, 1(1), 40–50.
Chinaveh, M. (2010). Training problem-solving to enhance quality of life: Implication towards diverse learners. Procedia Social and Behavioral Sciences, 7(C), 302–310.
Christiansen, D., Elklit, A., & Olff, M. (2013). Parents bereaved by infant death: PTSD symptoms up to 18 years after the loss. General Hospital Psychiatry, 35, 605–611.
Chronister, J., Frain, M., Chin Chou, C., Da silva cardoso, E., Chin, C., & Silva, E. (2008). The relationship between social support and rehabilitation related outcomes: A meta-analysis. Journal of Rehabilitation, 74(2), 16–32.
Clark, L., Dombrovski, A. Y., Siegle, G. J., Butters, M., Shollenberger, C. L., Sahakian, B. J., & Szanto, K. (2011). Impairment in risk-sensitive decision-making in older suicide attempters with depression. Psychology and Aging, 26(2), 321–330.
Collins, N. L., Dunkel-Schetter, C., Lobel, M., & Scrimshaw, S. C. (1993). Social support in pregnancy: Psychosocial correlates of birth outcomes and postpartum depression. Journal of Personality and Social Psychology, 65(6), 1243–1258.
Coppola, G., Cassibba, R., Bosco, A., & Papagna, S. (2013). In search of social support in the NICU: Features, benefits and antecedents of parents’ tendency to share with others the premature birth of their baby. The Journal of Maternal-Fetal & Neonatal Medicine, 26(17), 1737–1741.
Couper, J., Bloch, S., Love, A., Duchesne, G., MacVean, M., & Kissane, D. (2009). Coping patterns and psychosocial distress in female partners of prostate cancer patients. Psychosomatics, 50(4), 375–382..
Cournos, F., & Goldfinger, S. M. (2011). Preventing depression of mothers of preterm infants. Psychiatric Services, 62(1), 101–102.
Cutrona, C. E., Hessling, R. M., & Suhr, J. A. (1997). The influence of husband and wife personality on marital social support interactions. Personal Relationships, 4, 379–393.
D’Zurilla, T. J., & Chang, E. C. (1995). The relations between social problem solving and coping. Cognitive Therapy and Research, 19(5), 547–562.
D’Zurilla, T. J., & Nezu, A. M. (2010). Problem-solving therapy. Handbook of Cognitive-Behavioral Therapies, 3, 197–225.
D’Zurilla, T. J., Nezu, A. M., & Maydeu-Olivares, A. (2002). Social problem-solving inventory—Revised. New York: MHS-Psychological Assessments and Services.
Day, A. L., & Livingstone, H. A. (2003). Gender differences in perceptions of stressors and utilization of social support among university students. Canadian Journal of Behavioural Science, 35(2), 73–83.
De Rouck, S., & Leys, M. (2009). Information needs of parents of children admitted to a neonatal intensive care unit: A review of the literature (1990–2008). Patient Education and Counseling, 76(2), 159–173.
Dehle, C., Larsen, D., & Landers, J. E. (2001). Social support in marriage. American Journal of Family Therapy, 29(4), 307–324.
Dixon-Gordon, K. L., Chapman, A. L., Lovasz, N., & Walters, K. (2011). Too upset to think: The interplay of borderline personality features, negative emotions, and social problem solving in the laboratory. Personality Disorders, 2(4), 243–260.
Dolgin, M. J., Goldman, Y., & Iohan, M. (in press). Hebrew validation of the pediatric parenting stress inventory. Israel Journal of Oncology Nursing.
Dolgin, M. J., Phipps, S., Fairclough, D. L., Sahler, O. J. Z., Askins, M., Noll, R. B., … Katz, E. R. (2007). Trajectories of adjustment in mothers of children with newly diagnosed cancer: A natural history investigation. Journal of Pediatric Psychology, 32(7), 771–782.
Dunbar, M., Ford, G., & Hunt, K. (1998). Why is the receipt of social support associated with increased psychological distress? An examination of three hypotheses. Psychology and Health, 13(3), 527–544.
Engle, W., Tomashek, K. M., & Wallman, C. (2007). “Late-preterm” infants: A population at risk. Pediatrics, 120(6), 1390–1401.
Ensor, R., & Hughes, C. (2010). With a little help from my friends: Maternal social support, via parenting, promotes willingness to share in preschoolers born to young mothers. Infant and Child Development, 19(2), 127–141.
Feeley, N., Zelkowitz, P., Cormier, C., Charbonneau, L., Lacroix, A., & Papageorgiou, A. (2011). Posttraumatic stress among mothers of very low birthweight infants at 6 months after discharge from the neonatal intensive care unit. Applied Nursing Research, 24(2), 114–117.
Field, D. J., Dorling, J. S., Manktelow, B. N., & Draper, E. S. (2008). Survival of extremely premature babies in a geographically defined population: Prospective cohort study of 1994-9 compared with 2000-5. BMJ, 336(7655), 1–4.
Folkman, S., Lazarus, R. S., Gruen, R. J., & DeLongis, A. (1986). Appraisal, coping, health status, and psychological symptoms. Journal of Personality and Social Psychology, 50(3), 571.
Gennaro, S. (1988). Postpartal anxiety and depression in mothers of term and preterm infants. Nursing Research, 37(2), 82–85.
Goldberg, S., & DiVitto, B. (2002). Parenting children born preterm. In M. H. Bornstein (Ed.), Handbook of parenting: Children and parenting, vol 1. New York: Routledge.
Grant, J. S., Elliott, T. R., Giger, J. N., & Bartolucci, A. A. (2001). Social problem-solving abilities, social support, and adjustment among family caregivers of individuals with a stroke. Rehabilitation Psychology, 46(1), 44–57.
Grussu, P., Quatraro, R. M., & Nasta, M. T. (2005). Profile of mood states and parental attitudes in motherhood: Comparing women with planned and unplanned pregnancies. Birth, 32(2), 107–114.
Helgeson, V. S. (2003). Social support and quality of life. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 12(Suppl 1), 25–31.
Hoekstra-Weebers, J. E., Jaspers, J. P., Kamps, W., & Klip, E. C. (2001). Psychological adaptation and social support of parents of pediatric cancer patients: A prospective longitudinal study. Journal of Pediatric Psychology, 26(4), 225–235.
Holditch-Davis, D., Schwartz, T., Black, B., & Scher, M. (2007). Correlates of mother–premature infant interactions. Research in Nursing and Health, 30(3), 333–346..
Hyde, J. S. (2013). Gender similarities and differences. Annual Review of Psychology, 65, 373–398.
Ibarra-Rovillard, M. S., & Kuiper, N. A. (2011). Social support and social negativity findings in depression: Perceived responsiveness to basic psychological needs. Clinical Psychology Review, 31(3), 342–352..
Jackson, K., Ternestedt, B.-M., & Schollin, J. (2003). From alienation to familiarity: Experiences of mothers and fathers of preterm infants. Journal of Advanced Nursing, 43(2), 120–129.
Jaffee, W. B., & D’Zurilla, T. J. (2009). Personality, problem solving, and adolescent substance use. Behavior Therapy, 40(1), 93–101.
Jones, L., Rowe, J., & Becker, T. (2009). Appraisal, coping, and social support as predictors of psychological distress and parenting efficacy in parents of premature infants. Children’s Health Care, 38(4), 245–262.
Keren, M., Tiano, G., & Sirota, L. (2000). Preterm as a model for intervined biological and psychological factors in the formation of infancy psychopatology. Medicine, 139, 425–429. (Hebrew).
Kersting, A., Dorsch, M., Wesselmann, U., Lüdorff, K., Witthaut, J., Ohrmann, P., … Arolt, V. (2004). Maternal posttraumatic stress response after the birth of a very low-birth-weight infant. Journal of Psychosomatic Research, 57, 473–476.
Kim, B., Park, H., & Baek, Y. (2009). Not just fun, but serious strategies: Using meta-cognitive strategies in game-based learning. Computers & Education, 52(4), 800–810.
Ko, C. M., Malcarne, V. L., Varni, J. W., Roesch, S. C., Banthia, R., Greenbergs, H. L., & Sadler, G. R. (2005). Problem-solving and distress in prostate cancer patients and their spousal caregivers. Supportive Care in Cancer, 13(6), 367–374..
Kurlyo, M. F., Elliott, T. R., & Shewchuk, R. M. (2001). Focus on the family caregiver: A problem-solving training intervention. Journal of Counseling and Development, 79, 275–281.
Lawrence, E., Bunde, M., Barry, R. A., Brock, R. L., Sullivan, K. T., Pasch, L. A., … Adams, E. E. (2008). Partner support and marital satisfaction: Support amount, adequacy, provision, and solicitation. Personal Relationships, 15, 445–463.
Lazarus, R. S. (1991). Cognition and motivation in emotion. American Psychologist, 46(4), 352.
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.
Levitt, M. J., Weber, R. A., & Clark, M. C. (1986). Social network relationships as sources of maternal support and well-being. Developmental Psychology, 22(3), 310.
Levy-Shiff, R. (1999). Fathers’ cognitive appraisals, coping strategies, and support resources as correlates of adjustment to parenthood. Journal of Family Psychology, 13(4), 554–567.
Li, X., Sundquist, J., Kane, K., Jin, Q., & Sundquist, K. (2010). Parental occupation and preterm births: A nationwide epidemiological study in Sweden. Paediatric and Perinatal Epidemiology, 24(6), 555–563.
Lindberg, B. (2007). Fathers’ experiences of having an infant born prematurely. Technology. Lulea: Lulea University of Technology.
Maisel, N. C., & Gable, S. L. (2009). The paradox of received social support: The importance of responsiveness. Psychological Science, 20(8), 928–932..
Malcarne, V. L., Banthia, R., Varni, J. W., Sadler, G. R., Greenbergs, H. L., & Celine, M. K. (2002). Problem-solving skills and emtional distress in spouses of men with prostate cancer. Journal of Cancer Education, 17(3), 150–154.
Malouff, J. M., Thorsteinsson, E. B., & Schutte, N. S. (2007). The efficacy of problem solving therapy in reducing mental and physical health problems: A meta-analysis. Clinical Psychology Review, 27(1), 46–57.
Manne, S., Sherman, M., Ross, S., Ostroff, J., Heyman, R. E., & Fox, K. (2004). Couples’ support-related communication, psychological distress, and relationship satisfaction among women with early stage breast cancer. Journal of Consulting and Clinical Psychology, 72(4), 660–670.
Marks, N. F. (1996). Caregiving across the lifespan national prevalence and predictors. Journal of Family Relations, 45, 27–36.
Martin, J. A., Hamilton, B. E., Sutton, P. D., Ventura, S. J., Mathews, T. J., & Osterman, M. J. (2010). Births: Final data for 2008. National Vital Satistics Reports 60(1), 1–70
Matire, L. M., Stephens, M. A. P., Druley, J., & Wojno, W. C. (2002). Negative reactions to received spousal care: Predictors and consequences of miscarried support. Health Psychology, 21(2), 167–176.
McDonald, S. D., Han, Z., Mulla, S., Murphy, K. E., Beyene, J., & Ohlsson, A. (2009). Preterm birth and low birth weight among in vitro fertilization singletons: A systematic review and meta-analyses. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 146(2), 138–148.
McNair, D. M., Lorr, M., & Droppleman, L. F. (1992). Manual for the profile of mood states. San Diego, CA: Educational and Industrial Testing Service.
Miles, M. S., Carlson, J., & Funk, S. G. (1996). Sources of support reported by mothers and fathers of infants hospitalized in a neonatal intensive care unit. Neonatal Network, 15(3), 45–52.
Morera, O. F., Maydeu-Olivares, A., Nygren, T. E., White, R. J., Fernandez, N. P., & Skewes, M. C. (2006). Social problem solving predicts decision making styles among US Hispanics. Personality and Individual Differences, 41(2), 307–317.
Morrow, G. R., Hoagland, A., & Carnrike, C. L. (1981). Social support and parental adjustment to pediatric cancer. Journal of Consulting and Clinical Psychology, 49(5), 763–765.
Prachakul, W., Grant, J. S., & Keltner, N. L. (2007). Relationships among functional social support, HIV-related stigma, social problem solving, and depressive symptoms in people living with HIV: A pilot study. The Journal of the Association of Nurses in AIDS Care, 18(6), 67–76.
Preacher, K. J. (2002, May). Calculation for the test of the difference between two independent correlation coefficients [Computer software]. http://quantpsy.org.
Preacher, K. J., Curran, P. J., & Bauer, D. J. (2006). Computational tools for probing interactions in multiple linear regression, multilevel modeling, and latent curve analysis. Journal of educational and behavioral statistics, 31(4), 437–448..
Rabinowitz, M. (2009). Special Intensive care units in newborns—A current update. The Knesset, Research and Information Center 7, 1–15. (Hebrew).
Rafaeli, E., & Gleason, M. E. (2009). Skilled support within intimate relationships. Journal of Family Theory & Review, 1(1), 20–37.
Reichman, B., Levitsky,O., Boyko, V., & Lerner-Geva, L. (2012). The very low weight preterm infants data base: A summarized report 2010 and trends of 2001–2010. The woman and child’s health research unit, Gertner Institute, Tel Hashomer Sheba Medical Center. (Hebrew).
Reichman, S. R. F., Miller, A. C., Gordon, R. M., & Hendricks-munoz, K. D. (2000). Stress appraisal and coping in mothers of NICU infants. Children’s Health Care, 29(4), 279–293.
Rodrõâ, A., Maydeu-olivares, A., & Rodriguez-Fornells, A. (2000). Impulsive/careless problem solving style as predictor of subsequent academic achievement. Personality and Individual Differences, 28, 639–645.
Rowe, J., & Jones, L. (2010). Discharge and beyond. A longitudinal study comparing stress and coping in parents of preterm infants. Journal of Neonatal Nursing, 16(6), 258–266.
Sahler, O. J., Dolgin, M. J., Phipps, S., Fairlough, D. L., Askins, M. A., Katz, E. R., … Butler, R. W. (2013). Specificity of problem-solving skills training inmothers of children newly diagnosed with cancer: Results of a multisite randomized clinical trial. Journal of Clinical Oncology, 31, 1329–1335.
Sahler, O. J. Z., Fairclough, D. L., Phipps, S., Mulhern, R. K., Dolgin, M. J., Noll, R., … Butler, R. W. (2005). Using problem-solving skills training to reduce negative affectivity in mothers of children with newly diagnosed cancer: Report of a multisite randomized trial. Journal of Consulting and Clinical Psychology, 73(2), 272–283.
Schwarzer, R., & Knoll, N. (2007). Functional roles of social support within the stress and coping process: A theoretical and empirical overview. International Journal of Psychology, 42(4), 243–252.
Shaw, W. S., Feuerstein, M., Haufler, A. J., Berkowitz, S. M., & Lopez, M. S. (2001). Working with low back pain: Problem-solving orientation and function. Pain, 93, 129–137.
Silverstein, M., Feinberg, E., Cabral, H., Sauder, S., Egbert, L., … Beardslee, W. (2011). Problem-solving education to prevent depression among low-income mothers of preterm infants: A randomized controlled pilot trial. Archives of Women’s Mental Health, 14, 317–324.
Singer, L. T., Davillier, M., Bruening, P., Hawkins, S., & Toyoko, S. (1996). Social support, psychological disterss, and parenting strains in mothers of very low birthweight infants. Family Relations, 45(3), 343–350.
Singer, L. T., Fulton, S., Kirchner, H. L., Eisengart, S., Lewis, B., Short, E., … Baley, J. E. (2010). Longitudinal predictors of maternal stress and coping after very low-birth-weight birth. Archives of Pediatrics & Adolescent Medicine, 164(6), 518–524.
Sloan, K., Rowe, J., & Jones, L. (2008). Stress and coping in fathers following the birth of a preterm infant. Journal of Neonatal Nursing, 14(4), 108–115.
Sullivan, K. T., Pasch, L. A., Johnson, M. D., & Bradbury, T. N. (2010). Social support, problem solving, and the longitudinal course of newlywed marriage. Journal of Personality and Social Psychology, 98(4), 631–644.
Tamres, L. K., Janicki, D., & Helgeson, V. S. (2002). Sex differences in coping behavior: A meta-analytic review and an examination of relative coping. Personality and Social Psychology Review, 1(6), 2–30.
Taubman-Ben-Ari, O. (2011). Becoming and developing: Personal growth in the wake of parenthood and grandparenthood. In P. R. Shaver & M. Mikulincer (Eds.) Meaning, mortality, and choice: The social psychology of existential concerns (pp. 163–181). Washington, DC: American Psychological Association
Verhofstadt, L. L., Buysse, A., & Ickes, W. (2007). Social support in couples: An examination of gender differences using self-report and observational methods. Sex Roles, 57(3–4), 267–282.
Weiss, D. S., & Marmar, C. R. (1997). The impact of event scale—Revised. In J. P. Wilson & T. M. Keane (Eds.), Assessing psychological trauma and PTSD. New York: Guilford Press.
Wyrwich, K. W., & Yu, H. (2011). Validation of POMS questionnaire in postmenopausal women. Quality of Life Research, 20(7), 1111–1121.
Zachariah, R. (2009). Social support, life stress, and anxiety as predictors of pregnancy complications in low-income women. Research in Nursing & Health, 32(4), 391–404.
Conflict of interest
Tal Shani-Sherman, Michael J. Dolgin, Leah Leibovitch, and Ram Mazkereth declare that they have no conflict of interests.
All procedures involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
About this article
Cite this article
Shani-Sherman, T., Dolgin, M.J., Leibovitch, L. et al. Internal and External Resources and the Adjustment of Parents of Premature Infants. J Clin Psychol Med Settings 26, 339–352 (2019). https://doi.org/10.1007/s10880-018-9583-6
- Premature infants
- Parental distress
- Problem-solving skills
- Spousal support