Effects and feasibility of expressive writing intervention on coping among mothers of preterm newborns hospitalised in the neonatal intensive care unit: Insights from a convergent parallel mixed-methods study

Preterm birth disrupts early maternal bonding and increases psychological distress, placing significant demands on maternal coping and adaptation during neonatal intensive care unit (NICU) hospitalisation. This study examined the effects and feasibility of a nurse-led expressive writing intervention on coping, adaptation, and post-traumatic stress among mothers of preterm newborns hospitalised in the NICU, using a convergent parallel mixed-methods design. Sixty mothers were randomly assigned to an intervention group (expressive writing) or a control group (neutral writing). The intervention adapted from the Pennebaker protocol. Coping and adaptation were assessed at baseline and one-week post-intervention using the Coping and Adaptation Processing Scale (CAPS) and the Perinatal Post-Traumatic Stress Disorder Questionnaire (PPQ). After adjustment for baseline differences (ANCOVA), not statistically significant between-group difference was found in post-intervention CAPS scores (β = 0.51, p = .823); adjusted marginal means: intervention 54.62 [95% CI 51.5–57.7] vs. control 54.11 [95% CI 51.04–57.19]). The unadjusted effect size (Cohen's d = −0.60). Significant improvements were observed across all five CAPS factor scores in the intervention group. No significant between-group reduction in post-traumatic stress was found (β = 1.40, p = .248). Five qualitative themes emerged: “Pain in the distance,” “Between weakness and strength,” “Health as a reward,” “Alliance with God,” and “Involved in being a mother.” Expressive writing is a feasible, low-cost, nurse-administered intervention that may selectively strengthen specific coping processes in NICU mothers, as reflected in factor-level CAPS improvements. Qualitative findings enrich these results by revealing emotional, spiritual, and identity-formation processes that standardised measures do not fully capture. Further trials with larger samples and longer follow-up are warranted.