with theory-based reproducible intervention programs is urgently needed due to the host

of adverse negative physical and mental health outcomes associated with prematurity.

The purpose of this study was to test a theoretical model examining the processes through

which an evidence-based educational-behavioral intervention program (COPE)

influences maternal anxiety and depression 2 months following discharge of their

premature infants from the neonatal intensive care unit (NICU).

Methods:  Mothers of 246 low-birth-weight (LBW) infants were randomized to COPE or

control conditions. Maternal measures included parental beliefs, trait and state anxiety,

stress in the NICU, and depression. Observers blind to study group rated maternal-infant

interaction in the NICU.

Results: Structural equation modeling suggested the model tested provided a reasonable

fit of the model to the data (c2 (64 df) = 97.67; p = .004; RMSEA = .046; CFI = .97). 

Participation in the COPE program was both directly and indirectly, via associations with

parental beliefs and maternal depression/anxiety in the NICU, related to mothers’ post-

hospital depression/anxiety.  Participation in the COPE program was also directly

associated with higher mother-infant interaction scores.  Maternal levels of stress in the

NICU, however, were not related to participation in the COPE intervention nor to

mother-infant interaction or to maternal post-hospital depression/anxiety.  Implications,

limitations, and future directions of the study are discussed.

Conclusions and Implications: Implementation of COPE could lessen post-discharge

anxiety and depression for mothers of LBW premature infants, which in turn, could

improve outcomes for a high risk population of infants. Understanding the processes

through which interventions work is necessary for the effective translation of efficacious

interventions into clinical practice settings.