Parental Well-being Research Articles

EQ-5D-5L or EQ-HWB-S: Which is the Better Instrument for Capturing Spillover Effects in Parental Carers of Children with COVID-19?

'Caregiver health spillovers' refer to the broader impacts of an individual's illness and interventions on informal caregivers' health and well-being. This study focuses on the spillover effects experienced by parental carers of children with coronavirus disease 2019 (COVID-19), aiming to compare the psychometric properties of the EQ-5D-5L and the experimental EQ Health and Wellbeing Short version (EQ-HWB-S) in capturing these effects. A longitudinal study was conducted with 861 parental carers of children aged 0-18 years with COVID-19 and 231 parents of healthy children as the control group. The EQ-5D-5L and EQ-HWB-S were used to assess parental health and well-being. Analyses included known-groups validity (multivariable regression), test-retest reliability (Gwet's AC1, intraclass correlation coefficient) and responsiveness to health improvement (Glass' Δ effect size). Parents of infected children reported more problems than those of healthy controls. The EQ-HWB-S better discriminated between sub-groups defined by the child's COVID-19 presence, caring time and work impact. Test-retest reliability was fair to good for EQ-HWB-S dimensions (Gwet's AC1: 0.33-0.79), moderate to good for EQ-5D-5L (Gwet's AC1: 0.40-0.76), and good for index scores and EQ VAS (intraclass correlation coefficient: 0.70-0.77). Parental health and well-being improved as children recovered, with the EQ-5D-5L showing slightly higher responsiveness (effect size: 0.77-0.87) than EQ-HWB-S (effect size: 0.62-0.74). Both EQ-HWB-S and EQ-5D-5L are valid, reliable and responsive for measuring parental spillover effects related to a child's COVID-19 infection. EQ-HWB-S outperformed in distinguishing social and emotional impacts of caregiving, while EQ-5D-5L better captured physical health improvements. The choice between tools may depend on study objectives.

Emotional Reactivity and Behavioral Problems in Preschoolers: The Interplay of Parental Stress, Media-Related Coping, and Child Screen Time

Background/Objectives: Excessive screen time has been linked to poorer developmental outcomes in preschool years, with the impact depending on context. Parents of emotionally reactive children, in particular, may use screens to manage their child’s emotions, especially when experiencing distress themselves. This reliance on screens can hinder the development of self-regulation, leading to behavioral difficulties. Our study aimed to explore how emotional reactivity, parental distress, screen time, and media-related coping interact while contributing to externalizing (behavioral) problems in preschool-aged children. Methods: The study included 754 children (49.1% girls), aged 2–5 years (M = 44.6 months, SD = 13.7). Parents reported children’s emotional reactivity and externalizing problems using the Child Behavior Checklist and provided data on daily screen time and media-related coping behaviors. Bivariate correlations, group comparisons, and structural equation modeling were employed to analyze the data. Results: Children averaged 111.86 min of daily screen time (SD = 83.94), with 35.2% of parents using screens as a coping strategy. Emotional reactivity was the strongest predictor of externalizing problems, while the role of screen time was weak, yet significant. Parental distress was positively associated with child emotional reactivity and screen time. Structural equation modeling showed that child emotional reactivity related to behavioral problems both directly and indirectly via parental distress, media-related coping, and increased screen time. Conclusions: The findings highlight emotional reactivity as a key factor in child behavioral problems, emphasizing the cumulative risks posed by parental distress and screen use. The results suggest interventions promoting healthier screen habits and supporting parental well-being.

Parental singing during kangaroo care: parents' experiences of singing to their preterm infant in the NICU

IntroductionSinging fosters emotional connections, attachment, bonding, and language development in infants. Prematurely born infants, however, are at risk of missing this vital communication, impacting neurodevelopment and family wellbeing, especially during prolonged hospital stays. Kangaroo care provides physiological and emotional support, while Creative Music Therapy (CMT) has demonstrated positive effects on neurodevelopment, parental wellbeing, and attachment. The Singing Kangaroo project, a Swedish-Finnish multi-center randomized controlled trial (RCT), investigated the impact of parental singing during kangaroo care. This qualitative follow-up study explores these findings through the lens of Antonovsky's Sense of Coherence (SOC) model.MethodSemi-structured interviews were conducted with 28 families (20 intervention group, eight control group) at their infant's 5-month corrected age. The intervention group received CMT twice weekly during kangaroo care for 4 weeks in the NICU, while the control group received standard care. Data were analyzed inductively, followed by deductive categorization within the SOC framework, focusing on its three core components: Manageability, Comprehensibility, and Meaningfulness.ResultsParents in the intervention group reported enhanced understanding of how singing fosters attachment and boosts their self-esteem, aligning with increased manageability and comprehensibility. Control group parents also experienced joy in singing, which positively influenced family wellbeing, albeit less extensively. Across both groups, singing was described as a meaningful activity that strengthened parent-infant bonding and promoted emotional connection within the family.ConclusionParental singing during kangaroo care, particularly when supported by a trained music therapist, enhances parents' sense of coherence by fostering comprehensibility, manageability, and meaningfulness. This study highlights the long-term benefits of integrating CMT into family-centered NICU care to support both infants' neurodevelopment and family wellbeing.

Holistic Family-Centered Interventions for Autism Spectrum Disorder: Enhancing Child and Parental Well-Being: A Case Study

This case study underscores the critical need for comprehensive family-centered interventions for autism spectrum disorder (ASD), particularly in resource-constrained settings like rural India. Raja, the subject of this case, displayed atypical communicative and social behaviors around 18 months of age. Despite early diagnosis, the coronavirus disease 2019 (COVID-19) lockdown delayed therapeutic interventions, exacerbating challenges for Raja and his family. Initial therapies, including speech and occupational therapy, were ineffective, leading to increased irritability and distress in Raja and further straining the family dynamics. At three years of age, Raja remained uncommunicative, cried frequently, was socially passive, and had poor eating and sleeping habits. His parents, overwhelmed and frustrated, experienced frequent arguments and blamed each other for their child’s behavior, avoiding social gatherings and feeling hopeless about the future. The intervention implemented in this case study has its conceptual underpinning in Roy’s adaptation model. Calista Roy’s model is based on the assumption that every individual is a biopsychosocial being and, when confronted with a focal stimulus, strives to adapt to a challenging situation through various modes like interdependence, physical, and self-concept. This leads the individual either toward positive or negative maladaptive behavior. The goal of the intervention was to promote the adaptation of Raja’s parents in a positive direction. The intervention was implemented in two phases over six months through 25 online sessions, each lasting between 1 and 1.5 hours. The intervention significantly improved Raja’s behavior and the overall family well-being, highlighting the effectiveness of involving the entire family in ASD interventions. This case study provides empirical support for the RAM framework’s conceptual assumption that support and care facilitate the adoption of positive adaptation strategies. The findings demonstrate that interventions targeting familial support and adaptive behaviors not only benefit the child but also enhance the overall well-being of the parents, underscoring the broader impact of holistic approaches in managing ASD.

Redefining Parental Dynamics: Exploring Mental Health, Happiness, and Positive Parenting Practices.

This study investigated how mental health, subjective happiness, and positive parenting interrelate among 489 Greek parents (76% mothers, 20% fathers) of children aged 7-13 years. We aimed to clarify whether these constructs converge strongly or remain relatively compartmentalized. Using a network analytic framework, we first estimated a graphical LASSO partial correlation network (38 nodes) and found 257 nonzero edges out of 703 possible (37% connectivity). The mean edge weight was 0.024, and centrality metrics were robust (Correlation Stability > 0.59 at r = 0.70). We then constructed a Directed Acyclic Graph (DAG) via Bayesian network modeling (1000 bootstrap samples, edge retention ≥ 85%) to infer directional paths. Mental health items (MHC-SF) correlated strongly within their domain (partial correlations up to r = 0.50), as did subjective happiness items (SHS) and positive parenting items (NPP). However, cross-domain links were notably weaker, with partial correlations between NPP items and mental health or happiness rarely exceeding r = 0.20. One bridging link emerged from MH_11 ("warm and trusting relationships") to N_16 ("good relationship with extended family"), r = 0.23, highlighting only a modest cross-construct relationship. The DAG similarly showed that mental health variables exerted moderate directional influence on happiness but minimal influence on parenting nodes. Contrary to assumptions of broad reciprocity, these constructs operated in largely discrete clusters. Interventions should thus treat parental well-being and parenting skills as partially distinct targets, emphasizing more tailored, context-sensitive strategies for Greek families.

Impact of Work-Life Balance Policies on Family Relationships in Canada

Purpose: The aim of the study was to analyze the impact of work-life balance policies on family relationships in Canada. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: Work-life balance policies in Canada, such as flexible working hours, parental leave, and telecommuting, have significantly improved family relationships. Research indicates that employees with access to these policies report higher satisfaction in their family roles, with 72% noting improved communication and quality time with family members (Statistics Canada, 2021). Flexible scheduling allows parents to actively participate in child-rearing and household responsibilities, fostering stronger bonds. Additionally, extended parental leave benefits have positively influenced early childhood development and parental well-being. However, challenges persist, as some employees feel pressured to maintain high productivity while working remotely, potentially blurring the boundaries between work and family life. Unique Contribution to Theory, Practice and Policy: Role theory, conservation of resources (COR) theory & work-family border theory may be used to anchor future studies on analyze the impact of work-life balance policies on family relationships in Canada. Organizations should prioritize the implementation of flexible work policies that go beyond merely offering remote work options or paid leave, ensuring that these policies are designed to accommodate the diverse needs of employees. Policymakers should consider expanding and standardizing work-life balance policies across sectors and regions to ensure that all workers have equitable access to family leave, flexible working arrangements, and affordable childcare.

The adolescent Internet Adaptability Scale: Development and psychometric properties

This study presents the development and validation of the Adolescent Internet Adaptability Scale (AIAS), designed to assess adolescents’ adaptive capacities in Internet use. The scale development encompassed multiple phases with diverse sample sizes: item pool generation through interviews (n = 15), scale structure analysis via Exploratory Factor Analysis (EFA, n = 553) and Confirmatory Factor Analysis (CFA, n = 4,637), along with reliability (n = 4,637) and validity (n = 4,637) analyses. The reliability phase included alpha, composite reliability, and retest reliability (n = 132), while the validity phase covered structural, convergent, discriminant, criterion-related validity, and measurement invariance tests. The AIAS, comprising eight dimensions—Internet curiosity, Internet self-efficacy, Internet learning ability, Internet socialization ability, Internet information search ability, Internet information protection ability, Internet self-control ability, and Internet positive coping ability—demonstrates strong reliability and validity. It shows positive correlations with Internet use—parental active help, well-being, and meaning in life, and negative correlations with Internet addiction and depression, with stronger associations observed with positive indicators. These findings highlight the Internet’s potential as a platform for strength acquisition. The AIAS, with its comprehensive nature, is promising for tailoring adolescent support from a positive psychology perspective, enabling holistic assessment and targeted interventions. It also advances understanding of youth development in the digital era, proving valuable for clinical and research applications. Ongoing evaluation, cross-cultural validation, and longitudinal research are essential for realizing its full potential. This multidimensional scale significantly advances the assessment of adolescent Internet use, equipping stakeholders to effectively address adolescents’ digital behaviors for enhancing well-being.

Revitalising strong cultural connections and resilience: Co-designing a pilot Elder-led mentorship program for Indigenous mothers in a remote northern community in Alberta, Canada

ABSTRACT Connecting with traditional knowledge and culture promotes the well-being of Indigenous parents and creates healthy environments for child development. Community Elders in a remote northern community in Alberta, Canada, collaborated with researchers to design a pilot Elders Mentoring Program. The programme aims to support young Indigenous mothers(-to-be), bringing back cultural traditions and teachings. Twelve workshops for Indigenous mothers(-to-be) focused on cultural activities and passing down traditional knowledge from Elders. Nine mothers(-to-be) completed a survey about their perinatal and postpartum experiences and care needs. Sharing circles with Elders and individual debriefings with mothers were conducted to understand their experiences in the workshops. Survey responses showed limited childcare services and transportation availability as barriers to accessing perinatal and postpartum support. Four themes emerged from qualitative data analysis: (1) the meaningful role of Elder mentorship for Indigenous mothers(-to-be); (2) Weekly workshops provided a safe space to share and develop relationships; (3) Participation in workshop activities fostered positive coping and improved self-esteem; (4) Elder-led workshops encouraged cultural connection and transference of traditional knowledge to younger generations. Cultural workshops led by Elders enhanced the connection to culture and resilience for Indigenous mothers and expectant mothers in a remote northern community.

2-Brain Regulation for Improved Neuroprotection during Early Development (2-BRAINED): a translational hyperscanning research project

IntroductionVery preterm (VPT) birth is a major risk condition for child development and parental wellbeing, mainly due to multiple sources of stress (e.g., separation and pain exposure) during the neonatal intensive care unit (NICU) stay. Early video-feedback (VF) interventions proved effective in promoting VOT infants’ development and parental wellbeing. Electroencephalography (EEG) hyperscanning allows the assessment of brain-to-brain co-regulation during live interaction between infants and parents, offering promising insights into the mechanisms behind the interactive benefits of early VF interventions.GoalsThis study aimed to compare indices of brain-to-brain co-regulation between dyads of full-term (FT) and VPT infants interacting with their mothers and investigate the effect of an early post-discharge VF intervention on the brain-to-brain co-regulation indices of VPT dyads.Methods and analysisVPT and FT dyads will be enrolled at birth, and the former will be randomly allocated to one of two arms: VF intervention or care as usual. Short-term effectiveness will be assessed through ratings of mother–infant interaction videotaped before and after the VF intervention or care as usual. Mothers of VPT and FT infants will report on their mental state, parenting stress and bonding, and infant temperament and sensory profile at 3 and 6 months (corrected age, CA). At 9 months CA, all dyads will participate in a lab-based EEG-hyperscanning paradigm to assess brain-to-brain co-regulation through phase-locking value (PLV) and other explorative indices.Ethics and disseminationThis study was funded by the Italian Ministry of Health and received approval by the Ethics Committee of Pavia (Italy) and participating hospitals. Research findings will be reported in scientific publications, presented at international conferences, and disseminated to the general public.Study registration numberGR-2021-12375213 (Italian Ministry of Health registry).

Facilitators and barriers to parental involvement in neonatal pain management in the NICU: a scoping review

ObjectivesNeonatal pain prevention is not only a humanistic but also an ethical imperative. Fitting with the principles of family-centred care, parental involvement in neonatal pain management plays an active role...

Health-promoting activities among Saudi Arabian parents of children with disabilities: A cross-sectional study.

Engaging in health-promoting activities is crucial for maintaining overall well-being. However, parents of children with disabilities often face unique challenges that can impact their ability to engage in such activities. These challenges may include increased caregiving responsibilities, limited access to resources, and emotional and physical burdens, which may hinder their involvement in health-promoting behaviors. This study aimed to assess and compare health-promoting activities among parents of children with and without disabilities, with a focus on identifying key differences and associated factors that influence their health and well-being. A quantitative cross-sectional study was conducted with 118 parents of children aged 3 to 18 years recruited via social media and centers for children with disabilities in the Kingdom of Saudi Arabia. Data were collected using the eight-item Health-Promoting Activities Scale (HPAS) and demographic variables. The study utilized descriptive statistics, chi-square test, t-test, and ANOVA for data analysis, conducted using SPSS version 25. The results showed that parents of children with disabilities had significantly lower HPAS scores (31.73 ± 10.21) compared to parents of children without disabilities (34.83 ± 8.05), although this difference was not statistically significant (p = 0.082). Parents of children with disabilities reported significantly lower frequencies of spiritual or rejuvenating personal time (p = 0.032) and social activities (p = 0.011). Additionally, higher education (p = 0.023) and better health status (p = 0.005) were positively associated with higher HPAS scores among parents. This study's findings highlight the significant impact that caring for a child with a disability can have on parents' health-promoting behaviors. Factors such as education and health status were found to play a crucial role in shaping these behaviors. The results suggest the need for tailored interventions and support programs by nurses and healthcare providers to enhance the well-being of parents of children with disabilities.

Lived experiences of empowerment in parents of trans children and adolescents.

The construct of empowerment is associated with beneficial outcomes in numerous populations with well-being across multiple domains. Within families, empowerment has been found to be related to both parent and child well-being. As such, empowerment appears to be a promising concept to support parents of young (< 18 years) trans and gender diverse children and adolescents; however, what empowerment means for parents of trans children and adolescents is not known. This study aimed to characterize empowerment for parents of trans and gender diverse children and adolescents from their lived experiences. To accomplish this, a qualitative design was implemented using reflexive thematic analysis to describe what the lived experience of empowerment is for N = 18 (12 mothers and six fathers) Australian parents of trans children and adolescents under 18 years of age. Four primary themes best described the accounts offered by the participants, with empowerment consisting of (1) having knowledge and information, (2) advocating for their child or adolescent, (3) experiencing a sense of belonging to an accepting community, and (4) experiencing support and help from professionals and systems. These findings support establishing high-quality, easy-to-access, and understandable informational resources for parents and better education and training of professionals and organizations to enhance the empowerment of parents of trans children and adolescents. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Stressful but Not Unhappy: A Review of the Positive Aspects of Parenting a Child with Autism Spectrum Disorder.

This review aimed to identify and synthesise the evidence for the positive aspects of parenting a child with autism spectrum disorder (ASD). To date, ASD parental research has predominantly focused on the negative aspects; parents and carers are left uninformed of how to strengthen their positive mental wellbeing. Three electronic databases-PubMed, Scopus, and Web of Science -were searched for literature reporting positive aspects of parenting a child with ASD, published between January 2013 and December 2023. The PRISMA 2020 checklist was used for reporting. Two hundred and fifty-four articles were retrieved from the databases. After title/abstract screening (n = 213) and full-text reviews (n = 32), six papers were included (n = 6). Sixteen positive aspects of parenting a child with ASD were identified and grouped into three themes: joyful moments, journey to resilience, and social connection. These three themes are eudaimonic wellbeing constructs and often under-represented in ASD parental studies. Focusing on joyful moments, building resilience through the parenting journey, and finding support and connection with others in similar situations can support the mental wellbeing of parents and carers of children with ASD. Future research is needed to further evaluate the positive aspects of parenting a child with ASD.

Uncovering the Links Between Problematic Smartphone Usage and Subjective Vitality: The Role of Mindful Parenting and Parenting Stress.

In recent years, scientific research has increasingly focused on the relationship between parents' mobile phone usage and parenting. As smartphones have become pervasive among parents, concerns have arisen regarding how this usage might influence parenting practices and well-being. Therefore, studies that examine the relationship between parents' technology usage-particularly smartphone usage-and their well-being and parenting practices are of significant value. Such research can provide deeper insights into how technology shapes family dynamics and parental roles over time. Our research aimed to investigate the relationships among problematic smartphone usage, mindful parenting, parenting stress, and subjective vitality. The study involved a cross-lagged panel design with two waves of longitudinal research, and parents with at least one child between the ages of 1 and 14 participated. The results revealed that problematic smartphone use has a negative correlation with mindful parenting and subjective vitality, while it has a positive correlation with parenting stress. Serial mediation analysis showed that mindful parenting and parenting stress, both longitudinally and sequentially, mediate the relationship between problematic smartphone usage and subjective vitality. These findings suggest that problematic smartphone use adversely affects parents' well-being by increasing stress and reducing mindful engagement in parenting. Interventions focusing on reducing problematic smartphone use and enhancing mindful parenting practices may improve parental well-being and reduce stress.

Parent-focused online video intervention for promoting parenting sense of competence: a randomized controlled trial.

Apart from child behavioral problems which were ameliorated by increasing parenting skills, parental well-being is one of the important components for development of parenting sense of competence (PSOC), which subsequently affects parenting style and child outcomes. This randomized controlled trial study aims to determine whether a brief asynchronous parent-focused online video intervention (POVI) that was easily accessible would be effective in increasing PSOC and parental well-being. One hundred and twenty parents, with a poor Thai Mental Health Indicators-15 score or mild-moderate depression/anxiety, of children aged 3-10 years, were randomized into two parallel groups, intervention and control groups (1:1). The intervention group received six online, weekly, parent-focused sessions. Parent and child outcomes were measured at baseline, 6, and 10 weeks. The Generalized Estimating Equations model was used for the analysis. At 10 weeks, the intervention group reported a higher PSOC (p = 0.005), particularly on the parenting satisfaction subscale, and mental health indicator. Both groups experienced reduced depression and anxiety from baseline, and child behaviors remained unchanged. POVI improved PSOC and parental well-being among parents with mild to moderate mental health problems. POVI may be used as a primary tool to promote parental well-being in general pediatric practice. This study demonstrates the efficacy of a parent-focused online video intervention (POVI) in enhancing parenting sense of competence and parental well-being. It addresses the gap in interventions that focus primarily on parental well-being, particularly for those who face mild to moderate mental health challenges. The findings contribute valuable insights for healthcare professionals, highlighting the potential of POVI, an easy-to-access and less time-consuming intervention, as a primary tool to promote parental well-being in general pediatric practice settings.

Implications of state policy context for the well-being of immigrant families with young children.

There is notable variation in state-level social policy exclusions for immigrant parents and their children. Little research has investigated how these exclusions impair the well-being of immigrant families. This study examined how state-level social policy exclusions for immigrants are associated with the well-being of immigrant parents and development of their children. A mixed methods approach guided by the transformative framework was used with quantitative analyses among a subsample of low-income immigrant parents from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B; N = 1550) and qualitative focus groups with immigrant parents of young children from two states with differing social policy contexts: California (n = 18) and New Hampshire (n = 17). Results indicated that low-income immigrant parents with young children experienced greater parenting-related stressors in states with more restrictive policies toward immigrants. Quantitative findings revealed that children born in more exclusionary states had lower reading skills at age 4 and kindergarten. Findings from the qualitative focus groups identified a core category centered on humanity being at the hands of the state, with the following themes: (1) salience of immigrant limitations; (2) state climate toward immigrants; and (3) social programs reduce stress, but access is variable and filled with barriers. Policy and practice implications are discussed.

How Parental Identity and Behaviors Contribute to the Well-being of Parents in an Ultra-Orthodox Society

AbstractThe Ultra-Orthodox (Haredi) sector is religiously conservative, insular, strictly adheres to Judaism, and considers raising children a central value. This study broadens the research on this sector by examining how conservativeness, parental identity, and parenting behaviors predict parental well-being. Parenting behaviors were assessed by the Parenting Pentagon Model (PPM), which includes five constructs that provide a comprehensive picture of parenting: Partnership, Leadership, Love, Independence, and Rules. Participants were 355 Haredi parents (279 mothers, 76 fathers), who completed questionnaires addressing primary study variables. The parents reported being more conservative than open, having a fairly strong parental identity, more optimal behaviors on the PPM, and fairly high levels of well-being. A regression analysis showed that having a child with a disability, conservativeness, parental identity, and the PPM all explained significant variance in parental well-being. A greater understanding of this sector can lend insight into other insular, conservative sectors around the world.

The Grief of Older Parents Over the Loss of a Child: A Scoping Review.

Aging brings physical, psychological, and social changes, often accompanied by significant life events like the death of a loved one. One of the most devastating losses is the death of a child, which profoundly impacts older parents. This scoping review examines 47 studies on the effects of such grief, highlighting increased death anxiety, elevated mortality risk, psychological distress, and the role of social isolation in intensifying grief. Cultural factors, including stigma, further complicate the mourning process. The findings reveal that prolonged grief, social withdrawal, and declining health are common among bereaved older parents. These results underscore the urgent need for tailored interventions and support networks to mitigate the psychological and social consequences of this profound loss. Addressing this critical issue can improve the well-being of older parents, making it a vital area for further research and intervention.

Parental stress and mental health among transgender parents

Background Parental stress impacts individual health and the development of the next generation, but there is a lack of comprehensive research on parental stress among transgender parents in China. This study is the first to investigate parental stress and mental health among transgender parents and identify potential influencing factors. Methods We designed a cross-sectional survey that recruited a representative sample of 647 transgender parents. A validated questionnaire was used to investigate parental stress, depression, anxiety, and their associated factors, including parent factors (gender dysphoria, time of coming out, depression, and anxiety) and situational factors (family violence, partner violence, relationship with partner, discrimination and family income). Linear regression models were used to explore the influencing factors of parental stress among transgender parents, a structural equation model (SEM) was established to explore the possible pathways between these factors and parental stress, and network analysis was conducted to determine primary symptoms and central risk factors. Results The average parental stress score was 50.4 ± 8.02. 92.7% of participants exhibited depressive tendencies and 73.7% showed anxiety tendencies. Lower family income (p < 0.001), coming out after having a child (Coefficient (Coef.) = 2.6, 95% confidential interval (CI) = 1.174 ∼ 4.027), family violence (Coef. = 3.582, 95%CI = 2.372 ∼ 4.791), partner violence (Coef. = 4.199, 95%CI = 2.998 ∼ 5.401), being discriminated during seeking of childbearing health care (Coef. = 3.29, 95%CI = 2.054 ∼ 4.526), poor relationship with partner (fair relationship: coef. = −3.205, 95%CI = −4.86∼−1.551; good relationship: coef. = −5.372, 95%CI = −6.886∼−3.858), depression (Coef. = 5.873, 95%CI = 3.557 ∼ 8.189), and anxiety (Coef. = 5.705, 95%CI = 4.368 ∼ 7.042) were significantly associated with higher parental stress. Through the pathway analysis, the direct or indirect effects of parent factors and situational factors on parental stress were observed. Additionally, network analysis revealed that gender dysphoria, family violence, psychological abuse, and various anxiety types as central risk factors, with two gender dysphoria symptoms showing the strongest direct relationship to stress. Conclusions Transgender parents experience significant parental stress influenced by mental health, sociodemographic, transgender-specific, family, and socio-environmental factors. Enhanced family support and a more inclusive social environment are crucial for reducing stress and improving the well-being of transgender parents and their children.

Outcomes Following Close Collaboration With Parents Intervention in Neonatal Intensive Care Units

Family-centered care (FCC) in neonatal intensive care units (NICUs) is critical for parental involvement and infant well-being, yet few studies have evaluated the impact of FCC interventions on practice or examined how implementation fidelity may affect these outcomes. To evaluate the association between the Close Collaboration With Parents intervention and FCC practices and how implementation fidelity may modify these outcomes. This nonrandomized clinical trial had a before-and-after design. It was conducted between March 2021 and June 2023 at 6 NICUs in Estonia and included the parents of all newborns and all staff. Close Collaboration With Parents is an educational intervention for multiprofessional NICU staff including e-learning and bedside practices combined with reflection sessions. It aims to improve FCC culture by developing staff skills in communication and collaboration with parents and parenting support. The quality of FCC was assessed using a 1-time questionnaire for the parents with 9 questions from the Digi Family-Centered Care-Parent version tool, and daily questions for the staff using Digi Family-Centered Care-Nurse version tool. The association between implementation fidelity, defined as the proportion of staff who completed the full education, and the quality of FCC was also analyzed. A total of 186 infants (with responses from 186 mothers and 22 fathers) were included in the preintervention period. The median (IQR) gestational age was 37.4 (34.0-39.9) weeks, 94 infants (50.5%) were male, and the median (IQR) parental age was 32 (28-36) years. A total of 208 infants (with responses from 208 mothers and 55 fathers) were included in the postintervention period. The median (IQR) gestational age was 38.1 (35.4-39.9) weeks, 114 infants (55.1%) were male, and median (IQR) parental age was 32 (27-35) years. From the staff, 7448 and 6717 daily responses were analyzed in the preintervention and postintervention periods, respectively. The total rating was significantly higher after the intervention than before, by both the parents (r = 0.07; P < .001) and the staff (r = 0.10; P < .001). The median ratings did not, however, change: the parents' median (IQR) overall rating before and after was 7.0 (6.0-7.0), and the staff's median (IQR) overall rating was 6.0 (5.0-7.0) before and 6.0 (6.0-7.0) after. Implementation fidelity ranged from 4 of 30 health care professionals (13.3%) to 37 of 45 (82.2%) at the NICUs. The NICUs with high fidelity, as opposed to low fidelity, had significantly greater improvement in FCC ratings by the staff after the intervention (β = 2.1 [95% CI, 0.8-3.4]; P = .002). In this nonrandomized clinical trial, FCC practices were rated higher by the staff and parents after the Close Collaboration With Parents intervention. Implementation fidelity was identified as an important factor. ClinicalTrials.gov Identifier: NCT06258655.