European Journal of Cardiovascular Medicine

The psychological well-being of parents plays a critical role in the overall health and development of their children, particularly when those children are undergoing medical procedures such as surgery1,2. Neonates requiring general surgery present a unique set of challenges for parents, who may experience significant stress and anxiety during this period3. While the emotional impact of such events is universally high, the presence of psychiatric comorbidities in parents can complicate their ability to cope with the situation effectively4.

Coping strategies, the cognitive and behavioral responses individuals use to manage stress, are known to vary significantly based on individual characteristics, including mental health status5. Previous studies have highlighted the important role coping mechanisms play in moderating the effects of stress and mental health challenges. In particular, avoidance behaviors (such as denial, withdrawal, or distraction) and the seeking of professional help (e.g., therapy, counseling) are two key strategies that can greatly influence the emotional and psychological outcomes of stressful experiences6,7.

However, less is known about how psychiatric comorbidities specifically impact the choice of coping strategies in parents dealing with the stress of having a neonate undergo general surgery. Parents with existing psychiatric conditions may have a heightened vulnerability to stress and may engage in maladaptive coping strategies, such as avoidance, that can hinder their mental well-being. Conversely, parents without psychiatric comorbidities may demonstrate more adaptive coping behaviors, including seeking professional counseling or support.

This study aims to explore these differences by comparing the coping strategies employed by parents with and without psychiatric comorbidities in the context of their neonate’s surgery. Through a cross-sectional survey, this research seeks to provide a deeper understanding of how psychiatric conditions may shape coping responses and to identify potential areas for targeted interventions to support parents facing such challenges.

Study Design: This study employs a cross-sectional design to explore the coping strategies of parents of neonates undergoing general surgery. The study is observational in nature, aiming to compare coping behaviors in parents with and without psychiatric comorbidities.

Study Setting: The study will be conducted at the RVM Institute of Medical Sciences, Laxmakkapalli, Telangana. The study will take place over a period from January 2024 to December 2024, ensuring a sufficient sample size from the parents attending the neonatal surgical ward during this period.

Participants: The study will include parents of neonates who are undergoing general surgery. Parents will be divided into two groups:

Group 1 (Parents with Psychiatric Comorbidities): Parents who have been previously diagnosed with any psychiatric disorder, such as depression, anxiety, PTSD, or other mental health conditions.

Group 2 (Parents without Psychiatric Comorbidities): Parents who do not have a history of psychiatric disorders and do not report symptoms consistent with mental health issues.

Inclusion Criteria:

Parents of neonates undergoing general surgery at the institute.

Parents who consent to participate in the study.

Exclusion Criteria:

Parents with severe cognitive impairments that may interfere with the ability to complete the survey.

Parents who are unwilling to participate.

Sampling Technique: A convenience sampling method will be used to recruit participants during the study period. Parents attending the neonatal surgery ward will be approached and invited to participate in the study.

Data Collection: Data will be collected through self-administered surveys and clinical interviews. The survey will be designed to assess:

Demographic Information: Age, gender, education level, socioeconomic status, and marital status.

Psychiatric History: Information about past or current psychiatric conditions (e.g., diagnosed mental health disorders such as depression, anxiety, etc.).

Coping Strategies: The Coping Strategies Inventory (CSI) will be used to assess different coping behaviors, particularly avoidance strategies and seeking professional help. Items related to avoidance (e.g., avoidance of discussing the child's condition, denial, withdrawal) and seeking professional counseling or therapy will be specifically focused on.

Survey Tool:

The Coping Strategies Inventory (CSI): A validated tool to assess coping strategies and behaviors. This includes subscales to measure both avoidant and approach-based coping mechanisms such as seeking professional support, prayer, problem-solving, and social support seeking.

Data Analysis:

Descriptive Statistics: Frequencies and percentages will be used to summarize the coping strategies employed by parents with and without psychiatric comorbidities.

Comparative Analysis: Chi-square tests will be conducted to compare the proportions of coping strategies used by both groups. A significance level of p<0.05 will be used for all statistical analyses.

Statistical Software: Data will be analyzed using SPSS (Statistical Package for the Social Sciences) version 25.

Ethical Considerations:

Informed Consent: All participants will be provided with a detailed explanation of the study’s purpose, and written informed consent will be obtained prior to participation.

Confidentiality: All data will be stored securely, and personal information will be kept confidential.

Ethical Approval: The study will be approved by the IEC at RVM Institute of Medical Sciences to ensure that it meets the ethical standards for research involving human participants.

The study comprised a total of 100 participants, evenly split between mothers and fathers (Table 1). The mean age of the participants was 32.5 years, with 85% of the participants being married, and 75% having secondary education or higher.

Table 1. Participants Data

Neonatal Cohort Data

Of the 100 neonates included in the study, 60% were male. The most common surgical procedures performed were gastrointestinal malformations (45%) and congenital heart defects (30%) (Table 2).

Table 2. Neonatal Cohort Data

Psychiatric Comorbidities

A notable prevalence of psychiatric comorbidities was observed among the parents. Specifically, 30% of participants were diagnosed with anxiety disorders, 25% with depression, and 10% with post-traumatic stress disorder (PTSD). Furthermore, 15% of participants were found to have multiple psychiatric comorbidities (Table 3).  

Table 3.Psychiatric Comorbidities Data

Anxiety related to the child's surgery was the most common type of anxiety disorder, affecting 60% of parents, while 40% had pre-existing anxiety diagnoses (Table 4).

Table 4.Anxiety Disorders Data

Psychiatric Comorbidities by Parent Gender

The prevalence of psychiatric comorbidities was significantly higher in mothers (55%) compared to fathers (35%), with a p-value of 0.02, indicating a statistically significant difference (Table 5).

Table 5.Psychiatric Comorbidities by Parent Gender

Psychiatric Comorbidities by Neonatal Surgical Condition

Parents of neonates with gastrointestinal malformations exhibited a higher prevalence of psychiatric comorbidities (60%) compared to those whose children had congenital heart defects (30%), with a statistically significant p-value of 0.03 (Table 6).

Table 6.Psychiatric Comorbidities by Neonatal Surgical Condition

Social Support

Social support was another key factor examined. A striking 70% of parents with psychiatric disorders reported insufficient emotional support, compared to only 40% of parents without psychiatric disorders. This difference was statistically significant with a p-value of 0.04 (Table 7).

Table 7.Social Support Data

Coping Mechanisms

Coping strategies varied between parents with psychiatric comorbidities and those without. Among parents with psychiatric disorders, 50% employed avoidance strategies, while only 20% of parents without psychiatric disorders did so. In contrast, 40% of parents without psychiatric comorbidities sought professional counseling or therapy, whereas only 20% of parents with psychiatric disorders used this coping mechanism (Table 8).

Table 8.Coping Mechanisms Data

This study provides valuable insights into the coping strategies of parents with and without psychiatric comorbidities, particularly in the context of stressors associated with having a neonate undergoing general surgery. The findings highlight significant differences in coping mechanisms, with particular emphasis on avoidance behaviors and the utilization of professional counseling or therapy.

A key observation from this study is the higher tendency of parents with psychiatric disorders to engage in avoidance strategies compared to their counterparts without psychiatric comorbidities. Approximately 50% of parents with psychiatric conditions used avoidance as a coping mechanism, a significantly higher percentage than the 20% reported by parents without psychiatric comorbidities8. Avoidance coping, in which individuals withdraw or deny the stressor, has been consistently linked with poor mental health outcomes. This finding aligns with prior research suggesting that individuals with mental health conditions may be more prone to engage in maladaptive coping mechanisms, such as avoidance, to manage stress9. The increased reliance on avoidance may reflect an underlying struggle with managing the emotional burden of caring for a critically ill child while simultaneously coping with psychiatric symptoms. These avoidance behaviors can potentially exacerbate existing mental health conditions and delay seeking appropriate support or treatment10.

On the other hand, parents without psychiatric disorders were more likely to seek professional counseling or therapy (40% compared to 20% in parents with psychiatric comorbidities). This finding is consistent with the broader literature, which suggests that individuals without psychiatric comorbidities are often more open to seeking formal psychological support in times of crisis11. The lower utilization of counseling services by parents with psychiatric disorders could reflect several barriers, including stigma, limited access to services, or a perceived lack of effectiveness of professional support12. These barriers may prevent parents with psychiatric conditions from actively seeking help, which could ultimately hinder their ability to effectively cope with the stressors associated with their child's surgery.

The differences in coping mechanisms between these two groups underscore the importance of considering parents’ mental health history when designing interventions to support families facing pediatric surgeries. Health care providers and support organizations should recognize that parents with psychiatric comorbidities may be more likely to require targeted interventions that address avoidance behaviors and promote adaptive coping strategies13. Tailored support, such as psychoeducation on the benefits of seeking professional help and providing accessible mental health resources, could enhance coping outcomes for these parents. Furthermore, creating a non-judgmental environment where parents feel comfortable discussing their mental health struggles could encourage greater engagement with professional counseling services.

The findings also suggest that interventions aimed at reducing the reliance on avoidance and increasing the use of active coping strategies, including seeking counseling, could be beneficial for parents facing such stressful experiences. Future research should focus on understanding the specific barriers to accessing professional support for parents with psychiatric comorbidities and develop strategies to overcome these challenges14. Longitudinal studies could also help clarify whether the coping strategies employed by parents influence long-term mental health outcomes for both the parents and their children.

This study contributes to the understanding of coping strategies in parents with psychiatric comorbidities during a high-stress period in their lives. By recognizing the distinct patterns of coping employed by parents with and without psychiatric conditions, we can better inform interventions aimed at improving mental health outcomes and providing more effective support for families navigating the complexities of pediatric surgery.

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