Eligibility criteria for articles employed in this review include original articles, free full-text and open-access papers published in English from 2019 to 2024, articles applying quantitative and qualitative methodologies, articles from developing countries based on the World Bank, articles discussing parents’ involvement with preterm and LBW infants in developing countries, articles that discuss the psychological well-being of preterm and LBW infants’ parents in developing countries, and articles that discuss the factors associated with the parents’ psychological conditions with preterm and LBW infants in developing countries.

Three databases implemented in this scoping review are PubMed, Wiley Online Library, Taylor & Francis, and gray literature, namely, research rabbit published from January 2019 to December 2024 in English. Expanded keywords with MeSH, Boolean, and truncation used in this study have received team approval. The keywords are as follows: paren* OR mother OR father OR women AND low birth weight OR infant with low birth weight OR preterm birth OR premature infant OR premature neonat* OR preterm neonat* AND psychological wellbeing OR parental stress OR psychosocial health AND developing countr* OR low-income countr* OR middle-income countr*

There are three authors in this scoping review who work together to develop the article from theme to publication. The first author (DW) plays a role in designing the theme or topic of the review, collecting evidence, selecting articles, writing manuscripts, and revising them until publication of manuscripts to the destination journal. The second author (CSP) plays a role in helping to find keywords, select articles, and review the preparation of manuscripts until the publication stage. Then, the third author (EKS) plays a role in determining the topic and the criteria in the manuscript. After identifying which articles were relevant, the reviewers collaborated to extract them into a Microsoft Excel spreadsheet. Three separate reviewers (DW, CSP, and EKS) independently extracted the data.

The article's findings demonstrated that the study implemented a qualitative method in three of the articles and a quantitative design in six of the articles. One study was carried out at home, while eight Studies concluded in hospital intensive care units. According to the World Bank, the publications that were assessed came from developing countries, including Malaysia (45%), Ghana (22%), Ethiopia (11%), Kenya (11%), and Nepal (11%). According to World Bank data, Malaysia was still a developing country at the time of this review, despite being designated as a developed country in 2025.

Data charting was carried out on 9 relevant articles, employing tables to describe significant points such as title, author, year of publication, country, objective, subjects, methodology, and study outcomes.

The Joanna Briggs Institute (JBI) Critical Appraisal Tools, which include the Checklist for Analytical Cross-Sectional Studies and Qualitative Research, are used to evaluate the quality of the nine publications that were discovered. The quantitative critical appraisal (cross-sectional studies) is classified as A (19-24), B (9-18), and C (≤8). Qualitative critical appraisals can be graded as A (21-30 points), B (11-20 points), or C (≤10). The critical appraisal's overall findings indicated that while article A2 had good quality (grade B), articles A1, A3, A4, A5, A6, A7, A8, and A9 had very good quality (grade A). Cross-sectional methods are typically used in high-quality papers; research methodologies, criteria, samples, and sampling strategies are thoroughly explained; data collection techniques are used; and data analysis is done correctly. Even though article A2 employed a cross-sectional research design, the instruments employed had not been validated, and there was no explanation of confounding variables or how to account for them.

The authors used narrative summaries to present major topics in a thematic format. Three main themes emerged from the study, all of which align with the scoping review's goals about the psychological circumstances of parents of LBW and preterm infants in developing countries. The outcomes of this review's theme and sub-theme analysis are as follows:

Theme 1: Quality of Life, Psychological Problems and Disorders

Quality of Life in Parents with Premature and LBW Infants in Developing Countries

The average total life quality score of mothers with preterm and LBW infants was moderate. Young mothers show better marital quality and psychological well-being. This is supported by Malay cultural traditions that provide enough support so that postpartum mothers do not experience many difficulties. Social support from sharing information and experiences during the postpartum period can improve quality of life. Mothers working in governmental areas are risking having a good quality of life due to longer paid leave so that the economy is stable (A3). On the other hand, the low quality of life of mothers is caused by sleep disturbances, activity limitations, premature gestation, low education level, and history of cesarean section (A3, A7).

Symptoms of Problems and Disorders in Parents with Premature and LBW Infants in Developing Countries

The stress condition of mothers with preterm and LBW infants based on PSS scores was high at 43.5%; DASS-21 scores showed low at 22.3%, moderate at 11.5%, and higher at 4.6% (A2, A9). Mothers with preterm infants experienced higher stress levels (85.5%); the main causes were changes in the mother's role due to separation from the baby, inability to breastfeed, and prolonged care of the baby (A1, A3, A4, A6). Islamic cultural traditions dictate that mothers must stay at home for 40 days after giving birth, which makes it difficult for moms to see their children. As a result, Muslim mothers reported higher rates of stress than non-Muslim mothers. In addition, delaying PNC adds to the psychological burden because in the management of high-risk pregnancies (A2). The instability of the baby's condition also increases stress as parents feel worried (A6). Fathers also experience stress as they have to provide emotional support and physical care and are unable to work, adding to the economic burden (A1).

In the NICU, mothers of preterm infants expressed 67.8% anxiety about circumstances and 85.5% anxiety about conditions (A4). The incidence of anxiety in mothers with preterm infants was 75.6% (A5). Based on the DASS-21 scale assessment, the percentage of mothers with premature infants in the mild category was 8.5%, moderate 30%, severe 10.8%, and very severe 9.2% (A9). Risk factors that increase anxiety in mothers are when they are separated from their infants (A6). In addition, anxiety will increase due to situational factors, especially when the mother first visits the NICU; new and unfamiliar environments will increase anxiety symptoms (A4, A6).

Mothers with preterm and LBW infants experienced postpartum depression (PPD) with a percentage of 76% in the minimal category, 20% mild PDD, 2% moderate PDD, and 2% severe PDD. Risk factors for postpartum depression are PNC visits; mothers who regularly attend PNC because of complications during pregnancy will increase anxiety and depression. Mothers with preterm births are also at risk of PPD, as preterm and LBW infants increase the incidence of mortality and smaller physical appearance of the baby (A2). In addition, premature birth causes the mother to be unprepared for childbirth, the baby's condition is vulnerable, and the mortality rate is high. There are domestic violence and the environment in the NICU is frightening, increasing psychological distress, which will raise the prevalence of anxiety and depression (A5). Maternal age and stress and anxiety are significantly correlated; mothers under 30 years old are more likely to experience depression than mothers over 31 (A9).

Theme 2: Instruments Used to Measure Psychosocial Conditions of Parents with Premature and LBW Infants in Developing Countries

Stress Measurement Instrument

Four questions on feelings and thoughts over the previous month are asked as part of the PSS-4 (Perceived Stress Scale-4), a test designed to measure stress levels. A Likert scale with a range of 0 (never) to 4 (very often) is used to score responses. An elevated stress level is indicated by a final score of at least 6; if it exceeds 6, it will be referred to a counselor (A2). The NICU PSS was revised by Miles (1993) and consists of 26 questions related to sight & sound (5 questions), newborn behavior and appearance (14 questions), and maternal role change (7 questions). Measurement was on a 5-point Likert scale that ranged from 1 (not stressed at all) to 5 (extremely stressed) and 0 (no experience or not applicable). PSS scores were classified into high (4-5), medium (3-3.99), and low (1-2.99) (A3, A4). The Depression Anxiety Stress Scales (DASS-21) is a tool to assess depression, anxiety, and stress conditions by Lovibond (1995). There are 7 questions to assess stress, namely questions number 1, 6, 8, 11, 12, 14, and 18. The final score is by summing the values of the questions and multiplying by 2. The DASS 21 scale divides stress scores into five categories: mild (15–18), moderate (19–25), severe (26–33), and extremely severe (37+) (A9).

Anxiety Measurement Instruments

Spielberg and Gorsuch (1983) created the State-Trait Anxiety Inventory (STAI), a tool that is used to measure anxiety, including overwhelm, terror, and difficulty relaxing. 40 questions about state anxiety (20) and trait anxiety (20) make up the instrument. A four-point Likert scale is used to calculate scores, which add up to a total between 20 and 80. Higher scores correspond to higher anxiety levels (A4). Charles R. Kesler created the Kessler-10 (K-10) in 1956 as a tool for measuring anxiety and depression symptoms over a 4-week period. There are fourteen questions about depression and anxiety symptoms. Five points are awarded for filling in 1 to 5 constantly. The K-10 score is low (10–15), moderate (16–21), high (22–29), and extremely high (>30). Lovibond developed the Depression Anxiety Stress Scales (DASS-21) to scale psychological disorders such as stress, anxiety, and depression (1995). Questions 2, 4, 7, 9, 15, 19, and 20 indicate the seven questions used to quantify anxiety. The results are calculated by adding together all of the question scores and then multiplying the total by two. The DASS 21 scale divides anxiety scores into five categories: mild (8–9), moderate (10–14), severe (15–19), and very severe (20+) (A9).

Depression Measurement Instrument

The PHQ-9, which consists of nine questions given over the course of the previous two weeks, is a tool used to measure depression levels. A four-point Likert scale is used to score responses: 0 means "not at all," 1 means "some days," 2 means "more than half the days," and 3 means "almost every day." Depression is categorized into minimal (0–4), mild (5–9), moderate (10–14), fairly severe (15–19), and severe (20–27) categories based on the score in total, ranging from 0 to 27 (A2). In addition to the PHQ-9, there is a PHQ-4 measuring scale to measure anxiety and depression simply by Kroenke, Spitzer, Williams, & Löwe (2009). The evaluation process involves the score addition and classification as normal (0–2), moderate (3–5), and severe (9–12). Cox, JL, Holden, JM, and Sagovsky, R. (1987) created the 10-item Edinburgh Postnatal Depression Scale (EPDS), a measure for screening for postnatal depression within the last seven days. A score of more than 13 on the EPDS, which ranges from 0 to 30, denotes sadness (A5). Lovibond developed the Depression Anxiety Stress Scales (DASS-21) to scale psychological disorders such as stress, anxiety, and depression (1995). Questions 3, 5, 10, 13, 16, 17, and 21 are among the seven items used to measure depression. The scores of the marked questions are added up, and the result is then multiplied by two. The DASS 21 scale divides stress scores into five categories: normal (0–9), mild (10–13), moderate (14–20), severe (21–27), and very severe (28+) (A9).

Quality of Life Measurement Instrument

The WHOQOL-BREF questionnaire, which was recommended by the World Health Organization (1998), was used to measure quality of life. There were 24 questions divided into four categories: environment (8 questions), social interactions (3 questions), psychological (6 questions), and physical (7 questions). Each component's score is calculated on an ascending scale. Elements 3, 4, and 26 were recoded, and the elements were averaged for each domain. To match the ratings on the original WHOQOL-100, the resultant scores were transformed to 4-20 (multiplied by 4). Each domain's quality of life is positively correlated with higher domain scores (A3, A7).

Theme 3: Factors Associated with Psychological Well-Being of Parents with Premature and LBW Infants in Developing Countries

Social Support for Parents with Premature and LBW Infants

Social support for parents who have premature and LBW infants is very important to reduce anxiety and increase resilience. The type of support needed includes informational support. This support is provided by health workers related to the care and condition of premature infants. Nurses provide information through electronic media that can be accessed anytime and anywhere. Mothers will receive assistance in caring for their infants from husbands, parents, friends, family, and health professionals in addition to financial, emotional, and physical support. In order to foster resilience in the care of premature infants, health professionals, spouses, families, and religious leaders provide psychosocial support in the form of empathy, consolation, encouragement, and a sense of security. Additionally, the mother's resistance will be strengthened by spiritual assistance like prayers (A1, A7, A8).

Socioeconomics for Parents with Premature and LBW Infants

Parents in the NICU struggle with financial limitations because of the length of their child's stay, which can be expensive, as well as extra expenses for food, transportation, and medication. Additionally, parents expressed dissatisfaction with the length of their treatment period and the frequency of their NICU visits, citing the lengthy drive from their homes to the healthcare facility (A6). When LBW and preterm newborns were admitted to the NICU, their fathers would take time from work to care for their infants. This exacerbates the financial strain of being unable to work, leading to financial difficulties (A1).