Previous research has shown that having a child in the Neonatal Intensive Care Unit (NICU) is stressful for parents and that parents of NICU infants exhibit higher levels of stress compared to parents of healthy infants (Carter, Mulder, & Darlow, 2007; MacDonald, 2007; Treyvaud et al., 2010). As a result of these high levels of stress, NICU parents are at risk for developing psychopathology. Studies have found correlations between parental psychopathology and lower scores on measures of psychological well-being such as self-acceptance and autonomy (Bhullar, Hine, & Phillips, 2014; Valiente et al., 2013). Additionally, research has indicated that some well-being characteristics, such as autonomy and increasing perception of control, may be a key buffer in preventing the development of psychopathology (Bhullar et al., 2014). Moreover, findings suggest that both parental psychopathology and well-being have implications for child development. Poor parental mental health has been associated with adverse child social-emotional development and increased negative affect (Gao et al., 2007; Halligan, Murray, Martins, & Cooper, 2007; Treyvaud et al., 2010). In contrast, parental psychological well-being has been linked to positive reciprocal maternal-infant interactions, parental warmth and control, positive parenting, parental responsiveness, and parental involvement and monitoring of adolescents, all of which are conducive to positive outcomes in children (Hill & Bush, 2001; Izzo, Weiss, Shanahan, & Rodriguez-Brown, 2000; Shumow & Lomax, 2002). The purpose of this dissertation was to conduct three separate investigations of parental mental health in the NICU, each building on the results of the other. The first investigation examined the effects of parental well-being on the changes in parental psychopathology symptoms in the NICU. The second study investigated how these well-being variables as well as parental psychopathology, specifically depression and acute stress disorder (ASD) symptoms, related to the course of infant illness severity in the NICU. Lastly, indicators of both parental psychopathology and well-being were investigated in relation to indicators of infant neurobehavioral status. Mental health questionnaires were administered to 97 parents of infants admitted to the NICU at Loma Linda University Children’s Hospital at two time points. NICU nurses collected measures of infant severity and neurobehavioral status. Results of the investigation showed that specific well-being variables (i.e., personal growth, purpose in life, and environmental mastery) predicted change in depression and ASD symptoms over time. In addition, findings revealed that negative mental health variables were strongly related to the course of infant health compared to well-bing factors. Lastly, results also provide information about parent factors that influence early stages of cognitive development. Findings from this dissertation will inform researchers about aspects of risk and resiliency in parents of this population as well as areas that should be targeted in future interventions to help parents of infants admitted to the NICU. Additionally, results may be used to better inform health care practitioners in the NICU about ways to improve infant outcomes as well as to improve the experience and well-being of both parents and infants in the NICU.

LLU Discipline

Clinical Psychology




School of Behavioral Health

First Advisor

Neece, Cameron L.

Second Advisor

Ballinger, Rebecca

Third Advisor

Schellinger, Kriston

Fourth Advisor

Tagge, Edward P.

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Parenting - Psychology; Quality of Life - Psychology; Intensive Care Units; Neonatal; Stress; Psychological; Infant Welfare

Subject - Local

Infant Illness Severity Score; Parental Psychopathology; Psychological Well-being; Child social-emotional development; Maternal-infant interactions



Page Count


Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives