Middle Range Theory of Parental Postadoption Depression

Contributor: Karen Foli
June 23, 2019

Karen Foli, PhD, RN, FAAN

Year First Published – 2010

Copyright 2019 Karen J. Foli

Major Concepts

Expectations: Unmet and unrealistic

Dimensions of Expectations: Of Self as Parent, Of Child, Of Family/Friends, and Of Society/Others

Depressive Symptoms Pre- and Post-Placement


Middle range theory: associations of concepts to depressive symptoms

Brief Description

Foli’s (2010) mid-range theory of parental postadoption depression formed as a result of a grounded theory study, which used triangulation of data sources and collection methods, and has been subsequently tested in several empirical studies. The common theme of parental expectations is salient to depressive symptoms post-placement. Four dimensions of expectations are identified: expectations of themselves as parents; expectations of the adopted child; expectations of family and friends, and expectations of society. Each dimension for the adoptive parent is unique. Expectations of themselves as parents appears to be the most resistant to being perceived as met. Parents often hold high expectations of themselves as caregivers, which may be formed as they undergo the home study, comprised of multiple, and at times, invasive components (physical, financial, social). Expectations of the child may vary based on how much information is given to the prospective parents about the child, parental education and preparation, and whether the child’s needs are known and understood. Instantaneous bonding between parent and child may be assumed; oftentimes, attachment and bonding develop with time.

Social support is reflected in the expectations of family and friends. Family and friends may not fully appreciate the need for support surrounding placement. Often parents expect such support once the child is placed in the home. Understanding birth parent motivation becomes more salient and complex after placement as may be the case in open adoptions. Last, parents may form expectations of how society will view them as a family. Especially, transracial/trans-ethnic parents may be startled to realize that members of society may not accept them as a family unit as they interface with public arenas. Intrusive questions and negative non-verbal communications indicate that parental expectations of society have not been met.

Foli (2010) concluded that the process of adoption contributed to the formation of expectations; if the parent subsequently experienced a disconnect between what was expected and what was realized (or affirmed), the parent was vulnerable to experiencing depressive symptoms. In subsequent studies, findings supported the theoretical relationship between expectations and depressive symptoms for both adoptive mothers and fathers.  Risk factors are those which pose risks to developing depressive symptoms while contributors are those risk factors which have become actualized. Buffers, as with depression in general, are also important. These include social support, resiliency, feeling rested, and optimism. Parental postadoption depression is critical to assess for as the literature describes negative outcomes for children who are exposed to parental depression (birth and adoptive parents).

Primary Sources

Foli, K. J., Lim, E., & South, S. C. (2017). Longitudinal analyses of adoptive parents’ expectations and depressive symptoms. Research in Nursing and Health, 40(6), 564-574. doi: 10.1002/nur.21838

Foli, K. J., Hebdon, M., Lim, E., & South, S. C. (2017). Transitions of adoptive parents: A longitudinal mixed methods analysis. Archives of Psychiatric Nursing, 31(5), 483-492. doi: https://doi.org/10.1016/j.apnu.2017.06.007

Foli, K. J., South, S. C., Lim, E., & Jarnecke, A. (2016). Post-adoption depression: Parental classes of depressive symptoms across time. Journal of Affective Disorders, 200, 293-302. doi: 10.1016/j.jad.2016.01.049

Foli, K. J., South, S. C., Lim, E., & Hebdon, M. (2016). Longitudinal course of risk for parental post-adoption depression using the Postpartum Depression Predictors Inventory-Revised. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 45(2), 210-226. doi:10.1016/j.jogn.2015.12.011

Foli, K. J., Lim, E., South, S. C., & Sands, L. P. (2014). “Great expectations” of adoptive parents: Theory extension through structural equation modeling. Nursing Research, 63(1), 14-25. doi: 10.1097/NNR.0000000000000006

Foli, K.J., South, S.C., & Lim, E. (2014). Maternal postadoption depression: Theory refinement through qualitative content analysis. Journal of Research in Nursing, 19(4), 303-327. doi: 10.1177/1744987112452183

South, S. C., Foli, K. J., & Lim, E. (2013). Predictors of relationship satisfaction in adoptive mothers. The Journal of Social and Personal Relationships, 30(5), 545-563. doi: 10.1177/0265407512462681

Foli, K. J., Schweitzer, R., & Wells, C. (2013). The personal and professional: Nurses’ lived experiences of adoption. The American Journal of Maternal/Child Nursing, 38(2), 79-86. doi: 10.1097/NMC.0b013e3182763446

Foli, K. J. South, S. C., Lim, E., & Hebdon, M. (2013). Depression in adoptive fathers: An exploratory mixed methods study. Psychology of Men & Masculinity, 14(4), 411-422. doi: 10.1037/a0030482

Foli, K. J., South, S. C., Lim, E., & Hebdon, M. (2012). Maternal postadoption depression, unmet expectations, and personality traits. Journal of the American Psychiatric Nurses Association, 18(5), 267-277. doi: 10.1177/1078390312457993

Foli, K. J. (2012). Nursing care of the adoption triad. Perspectives in Psychiatric Care, 48(4), 208-217. doi: 10.1111/j.1744-6163.2012.00327.x

Foli, K. J., South, S. C., & Lim, E. (2012). Rates and predictors of depression in adoptive mothers: Moving toward theory. Advances in Nursing Science, 35(1),
51-63. doi:10.1097/ANS.0b013e318244553e

Foli, K. J., & Gibson, G. C. (2011[a]). Training ‘adoption smart’ professionals. Journal of Psychiatric and Mental Health Nursing, 18(5), 463-467. doi:

Foli, K. J. & Gibson, G. C. (2011[b]). Sad adoptive dads: Paternal depression in the post-adoption period, International Journal of Men’s Health, 10(2), 153-
162. doi: 10.3149/jmh.1002.153

Foli, K.J. (2010). Depression in adoptive parents: A model of understanding through grounded theory. Western Journal of Nursing Research, 32, 379-400. doi: 10.1177/0193945909351299

Foli, K. J. (2009). Postadoption depression: What nurses should know. American Journal of Nursing, 109, 11. doi: 1097/01.NAJ.0000357144.17002.d3

About the author

Karen J. Foli ( 1959 – )

Dr. Foli is a fellow in the American Academy of Nursing (AAN) in recognition for her work with adoption and kinship families. Her research is bound together by the theme of care rendered through the lens of psychological trauma. With this thread, she has received funding from the National Institute of Food and Agriculture (trauma-informed parenting for kinship parents), the National Council of State Boards of Nursing: Center for Regulatory Excellence (relationships between trauma and substance use in nurses), and private foundations (exploring parental postadoption depression). Dr. Foli’s work has uncovered adoptive parents’ trajectories of depressive symptoms prior to and after placement of a child. As a nurse theorist, Dr. Foli conceptualized and disseminated a middle-range theory of parental postadoption depression, a theory now being used by other nurse researchers.

She is author or coauthor of five, well-received, health-related books. One of these, Nursing Care of Adoption and Kinship Families: A Clinical Guide for Advanced Practice Nurses, received the American Psychiatric Nurses Association (APNA) Award for Media in 2018. Her most recent book, The Influence of Psychological Trauma in Nursing, co-authored by John R. Thompson, MD (Sigma, 2019), is intended to build resiliency and post-traumatic growth in student and new nurses who face considerable firsthand and secondary trauma.

Dr. Foli is also the recipient of numerous research and teaching awards, including the Charles B. Murphy Outstanding Undergraduate Teaching Award from Purdue University, which is the highest award bestowed for undergraduate teaching at the university. For her work as an educator, Dr. Foli was inducted into the Purdue University Book of Great Teachers in 2018. She also received the Sigma Theta Tau Honorary Society of Nursing, Delta Omicron Chapter Award for Outstanding Mentoring in 2017.

Currently, Dr. Foli is an Associate Professor and the Director of the PhD Program at Purdue University, School of Nursing, West Lafayette, Indiana. She received her nursing degrees from Indiana State University and Indiana University School of Nursing, Indianapolis, and her PhD in Communications Research from the University of Illinois, Urbana/Champaign.