Objective To investigate the clinical characteristics of preterm infants after being discharged from the neonatal intensive care unit (NICU), post-traumatic stress disorder (PTSD), maternal anxiety and the current status of maternal care responses, and to analyze the mediating effects of PTSD and maternal anxiety between the clinical characteristics of preterm infants and maternal care responses. Methods A hospital-based study was conducted at Shanghai First Maternal and Infant Hospital from April 2016 to July 2019 for preterm infants and their mothers who participated in outpatient follow-up after discharge from the NICU. The clinical data from 256 preterm infants and their motherswere retrospectively analyzed using the Post-traumatic Stress Disorder Questionnaire, the Self-rating Anxiety Scale, and four care responses questionnaires.Correlations among variables were analyzed, and the mediating effects were examined using structural equation modeling. Results The prevalence of postnatal PTSD and anxiety among mothers of preterm infants was 29.7% and 15.6%, respectively, and Pearson's correlation analyses showed that gestational age at birth was significantly negatively correlated with PTSD and maternal anxiety (r= -0.598, -0.526, P<0.01), and that PTSD, maternal anxiety and maternal caregiving capacity were significantly negatively correlated (r=-0.516, -0.495, P<0.01) and positively correlated with all dimensions of caregiving difficulties (r= 0.420~0.605, P<0.01). Structural equation modeling showed that in terms of maternal caregiving capacity, maternal PTSD and anxiety had a significant negative direct effect on maternal caregiving capacity (βdirect=-0.245, -0.225), while gestational age at birth had a positive direct effect on maternal caregiving capacity (βdirect=0.356), and a significant positive indirect effect through maternal PTSD and anxiety (effect size of 0.189). In terms of mothers' caregiving difficulties, maternal anxiety had a positive direct effect on mothers' caregiving difficulties (βdirect=0.224), birth gestational age had a negative direct effect on mothers' caregiving difficulties (βdirect=-0.277), and significantly exerted a negative indirect effect through mothers' PTSD, and anxiety (effect size of -0.264). Conclusions This study identified the more severe the mother's PTSD and anxiety, the weaker the mother's caregiving capacity and the more pronounced the perceived difficulties in caring for the preterm infant, and this emotional distress mediates the relationship between the preterm infant's birth gestational age and maternal care response. Healthcare providers can benefit from enhanced mental health support and interventions for mothers of preterm infants, especially prevention and treatment for postpartum PTSD and anxiety, to help mothers improve their caregiving capacity and adverse care responses. |