Graduation Date

Spring 5-7-2022

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Kathleen Hanna

Second Advisor

Tiffany Moore


Maternal distress in the NICU is a common and potentially harmful phenomenon for mothers with a sick infant. The overall purpose of this dissertation was to describe maternal distress and to examine maternal distress among mothers who have infants greater than or equal to 34 weeks of gestation at birth in the NICU. This was accomplished by first conducting a concept analysis of maternal distress in the NICU. Next, an integrative review of the literature was done to assess maternal distress and associated variables in response to infant hospitalization in the NICU. Finally, a mixed methods study was done to investigate the perceptions and experiences of distress in mothers of infants born ³ 34 weeks of gestation in the NICU. Major findings include the conceptual definition of maternal distress in the NICU, characterized by symptoms of depression, anxiety, and traumatic stress experiences that occur on a spectrum of severity. The integrative review found that maternal distress in the NICU is a prevalent experience associated with difficulties in the postpartum period and influenced by maternal and infant characteristics and the NICU environment. The literature review also exposed a gap in studying mothers of infants born after 34 weeks gestation. Finally, major findings in the mixed methods study were that maternal distress in the NICU is prevalent in mothers of infants born ≥ 34 weeks gestation. The NICU experience was characterized by descriptions of changes in perspectives based on context and considering past and future losses. There was some divergence between quantitative and qualitative assessments of depression and anxiety; both assessments of posttraumatic stress symptoms were convergent. The cumulative findings support that maternal distress in the NICU is a valid and useful concept to address psychological experiences in mothers of infants in the NICU. Mothers of infants born ≥ 34 weeks gestation who did not know of the impending NICU hospitalization before birth experience similar distress as the larger population of NICU mothers, with a higher incidence of posttraumatic stress symptoms. This dissertation has implications for research and clinical practice, particularly with measurement of maternal distress in the NICU and preventing posttraumatic stress experiences after NICU discharge.