BACKGROUND:This study investigated factors associated with long-term mental health outcomes of parents of children with a cardiac illness. The objective of the study was to investigate the hypothesis that acute mental health status and psychosocial risk factors (eg, acute stress reactions, quality of life) would be more strongly associated with long-term mental health outcomes than demographic, diagnostic, morphology, or procedure-related factors. METHODS:Participants were 31 parents of children who underwent cardiac operations in a pediatric hospital. Acute mental health status, psychosocial risk, demographic information, morphology, and procedure-related data were collected within the ﬁrst 4 weeks of the child's hospital admission. Mental health outcomes, including symptoms of posttraumatic stress, depression, anxiety, and general stress, were collected at a 2-year follow-up. RESULTS:Acute mental health status and psychosocial risk, specifically acute stress reactions, contributed significantly to parent mental health, explaining 44% of the variance in the parent posttraumatic stress scores (P < .001) and 40% in depression scores (P < .001). Morphology and procedure-related factors (eg, prolonged mechanical ventilation) explained a further 12% of the variance in parent posttraumatic stress scores (P = .015) and a further 13% in depression scores (P = .014). No associations were found with demographic factors. CONCLUSIONS:Results suggest that acute mental health status is more strongly related to parent mental health outcomes than morphology and procedure-related variables in children undergoing neonatal cardiac operations and that demographic variables are not associated with mental health outcomes.