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Psychological distress in parents of children with autism spectrum disorder: A cross-sectional study based on 683 mother-father dyads

  • Author Footnotes
    1 Fēi Li (ORCID: https://orcid.org/0000-0002-6260-1907) and Yun Tang have contributed equally to this work.
    Fēi Li
    Footnotes
    1 Fēi Li (ORCID: https://orcid.org/0000-0002-6260-1907) and Yun Tang have contributed equally to this work.
    Affiliations
    School of Nursing, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Department of Developmental and Behavioral Pediatric & Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, MOE-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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  • Author Footnotes
    1 Fēi Li (ORCID: https://orcid.org/0000-0002-6260-1907) and Yun Tang have contributed equally to this work.
    Yun Tang
    Footnotes
    1 Fēi Li (ORCID: https://orcid.org/0000-0002-6260-1907) and Yun Tang have contributed equally to this work.
    Affiliations
    Faculty of Education, Yunnan Normal University, Kunming, China

    Department of Developmental and Behavioral Pediatric & Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, MOE-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
    Search for articles by this author
  • Fei Li
    Correspondence
    Correspondence to: F Li, Developmental and Behavioral Pediatric Department & Child Primary Care Department, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, and MOE-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
    Affiliations
    Department of Developmental and Behavioral Pediatric & Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, MOE-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
    Search for articles by this author
  • Shuanfeng Fang
    Affiliations
    Department of Child Health, Zhengzhou Children's Hospital, Zhengzhou, China
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  • Xin Liu
    Affiliations
    Department of Developmental and Behavioral Pediatric & Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, MOE-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
    Search for articles by this author
  • Minyi Tao
    Affiliations
    Department of Developmental and Behavioral Pediatric & Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, MOE-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
    Search for articles by this author
  • Danping Wu
    Affiliations
    Department of Developmental and Behavioral Pediatric & Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, MOE-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
    Search for articles by this author
  • Liping Jiang
    Correspondence
    Correspondence to: LP Jiang, Nursing Department, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
    Affiliations
    Department of Nursing, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
    Search for articles by this author
  • Author Footnotes
    1 Fēi Li (ORCID: https://orcid.org/0000-0002-6260-1907) and Yun Tang have contributed equally to this work.
Published:March 03, 2022DOI:https://doi.org/10.1016/j.pedn.2022.02.006

      Highlights

      • The gender difference in psychological distress for parents of children with ASD depends on the severity of children's autistic symptoms.
      • Mothers of children with severe autistic symptoms reported higher levels of psychological distress than fathers.
      • Child social impairment predicted maternal distress, and the psychological distress of fathers moderated their relationship.
      • Children’s social interventions and parents’ stress management are directions to promote parental psychological well-being.

      Abstract

      Purpose

      This study aimed to assess psychological distress and its gender difference in parents of children with ASD. Predictive factors for parental psychological distress and interaction effects between parents were also explored.

      Design and methods

      A cross-sectional study was conducted for parents of children with ASD and 683 mother-father dyads were included in the analyses.

      Results

      Mothers of children with severe autistic symptoms reported significantly higher levels of stress, anxiety, and depression than fathers. The prevalence of moderate-to-severe anxiety and depression for mothers was 13.8% and 13.1%, respectively. The corresponding prevalence for fathers was 9.9% and 8.0%, respectively. A college education or above protected against maternal stress and an only child predicted paternal stress. Child social impairment predicted maternal but not paternal psychological distress. Stress was a significant predictor of anxiety and depression for both parents. Paternal stress and anxiety moderated the relationship between child's social impairment and maternal stress, and paternal anxiety moderated the relationship between child's social impairment and maternal depression.

      Conclusions

      The gender difference in the parental psychological distress depends on the severity of children's autistic symptoms. Child social impairment exerts significant effects on mothers' psychological distress and parental stress contributes to anxiety and depression for both parents. The psychological distress of fathers moderates the relationship between child social impairment and maternal psychological distress.

      Implications

      Health-care professionals should pay special attention to parents who are susceptible to psychological distress. Social skill interventions for children and stress reduction programs for parents are recommended to promote parental psychological well-being.

      Keywords

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      References

        • Al-Oran H.M.
        • Al-Sagarat A.Y.
        Parenting stress of children with autistic disorder.
        Open Access Library Journal. 2016; 3: 1-10
        • Ang K.Q.P.
        • Loh P.R.
        Mental health and coping in parents of children with autism spectrum disorder (ASD) in Singapore: An examination of gender role in caring.
        Journal of Autism and Developmental Disorders. 2019; 49: 2129-2145
        • Association A.P.
        Diagnostic and statistical manual of mental disorders: DSM-V.
        American Psychiatric Publishing, Arlington2013
        • Benson P.R.
        The impact of child symptom severity on depressed mood among parents of children with ASD: The mediating role of stress proliferation.
        Journal of Autism and Developmental Disorders. 2006; 36: 685-695
        • Bian C.
        • He X.
        • Qian J.
        The reliability and validity of a modified patient health questionnaire for screening depressive syndrome in general hospital outpatients.
        Journal of Tongji University (Medical Science). 2009; 30 (doi:CNKI:SUN:TJIY.0.2009-05-038): 136-140
        • Brei N.G.
        • Schwarz G.N.
        • Klein-Tasman B.P.
        Predictors of parenting stress in children referred for an autism spectrum disorder diagnostic evaluation.
        Journal of Developmental and Physical Disabilities. 2015; 27: 617-635
        • Chen K.
        • Lin C.
        • Yu T.
        • Huang C.
        • Chen Y.
        Differences between the childhood autism rating scale and the social responsiveness scale in assessing symptoms of children with autistic spectrum disorder.
        Journal of Autism and Developmental Disorders. 2018; 48: 3191-3198
        • Chen Q.
        The revision and application of social responsiveness scale: A preliminary study.
        (Master’s thesis) Sun Yat-sen University, Guangdong2009
        • Chiarotti F.
        • Venerosi A.
        Epidemiology of autism spectrum disorders: A review of worldwide prevalence estimates since 2014.
        Brain Sciences. 2020; 10
        • Cohen S.
        • Kamarck T.
        • Mermelstein R.
        A global measure of perceived stress.
        Journal of Health and Social Behavior. 1983; 24: 385-396
        • Constantino J.
        • Gruber C.
        The social responsiveness scale (SRS) manual.
        Western Psychological Services, Los Angeles2005
        • Crowell J.A.
        • Keluskar J.
        • Gorecki A.
        Parenting behavior and the development of children with autism spectrum disorder.
        Comprehensive Psychiatry. 2019; 90: 21-29
        • Feinberg E.
        • Augustyn M.
        • Fitzgerald E.
        • Sandler J.
        • Suarez Z.F.-C.
        • Chen N.
        • Silverstein M.
        Improving maternal mental health after a child’s diagnosis of autism spectrum disorder: Results from a randomized clinical trial.
        JAMA Pediatrics. 2014; 168: 40-46
        • García-López C.
        • Sarriá E.
        • Pozo P.
        Multilevel approach to gender differences in adaptation in father-mother dyads parenting individuals with autism spectrum disorder.
        Research in Autism Spectrum Disorders. 2016; 28: 7-16
        • Gerstein E.D.
        • Crnic K.A.
        • Blacher J.
        • Baker B.L.
        Resilience and the course of daily parenting stress in families of young children with intellectual disabilities.
        Journal of Intellectual Disability Research. 2009; 53: 981-997
        • Halstead E.
        • Ekas N.
        • Hastings R.P.
        • Griffith G.M.
        Associations between resilience and the well-being of mothers of children with autism spectrum disorder and other developmental disabilities.
        Journal of Autism and Developmental Disorders. 2018; 48: 1108-1121
        • Hartley S.L.
        • Mihaila I.
        • Otalora-Fadner H.S.
        • Bussanich P.M.
        Division of labor in families of children and adolescents with autism spectrum disorder.
        Family Relations. 2014; 63: 627-638
        • Hayes A.F.
        Introduction to mediation, moderation, and conditional process analysis: A regression-based approach.
        2nd ed. The Guilford Press, New York, England2018
        • He X.
        • Li C.
        • Qian J.
        Reliability and validity of a generalized anxiety disorder scale in general hospital outpatient.
        Shanghai Archives of Psychiatry. 2010; 22: 200-203
        • Hobson J.A.
        • Tarver L.
        • Beurkens N.
        • Hobson R.P.
        The relation between severity of autism and caregiver-child interaction: A study in the context of relationship development intervention.
        Journal of Abnormal Child Psychology. 2016; 44: 745-755
        • Jariwala-Parikh K.
        • Barnard M.
        • Holmes E.R.
        • West-Strum D.
        • Bentley J.P.
        • Banahan B.
        • Khanna R.
        Autism prevalence in the medicaid program and healthcare utilization and costs among adult enrollees diagnosed with autism.
        Administration and Policy in Mental Health and Mental Health Services Research. 2019; 46: 768-776
        • Kim H.-Y.
        Statistical notes for clinical researchers: Assessing normal distribution (2) using skewness and kurtosis.
        Restor Dent Endod. 2013; 38: 52-54
        • Leadbitter K.
        • Macdonald W.
        • Taylor C.
        • Buckle K.L.
        Parent perceptions of participation in a parent-mediated communication-focussed intervention with their young child with autism spectrum disorder.
        Autism. 2020; 24: 2129-2141
        • Maenner M.J.
        • Shaw K.A.
        • Baio J.
        • Washington A.
        • Patrick M.
        • DiRienzo M.
        • Hewitt A.
        Prevalence of autism spectrum disorder among children aged 8 years - autism and developmental disabilities monitoring network, 11 sites, United States, 2016.
        MMWR Surveillance Summary. 2020; 69: 1-12
        • Mcstay R.L.
        • Dissanayake C.
        • Scheeren A.
        • Koot H.M.
        • Begeer S.
        Parenting stress and autism: The role of age, autism severity, quality of life and problem behaviour of children and adolescents with autism.
        Autism. 2014; 18: 502-510
        • Nomaguchi K.M.
        • Brown S.L.
        Parental strains and rewards among mothers: The role of education.
        Journal of Marriage and the Family. 2011; 73: 621-636
        • Ozturk Y.
        • Vivanti G.
        • Uljarevic M.
        • Dissanayake C.
        • Victorian A.T.
        Treatment-related changes in children’s communication impact on maternal satisfaction and psychological distress.
        Research in Developmental Disabilities. 2016; 56: 128-138
        • Rankin J.A.
        • Paisley C.A.
        • Tomeny T.S.
        • Eldred S.W.
        Fathers of youth with autism spectrum disorder: A systematic review of the impact of fathers’ involvement on youth, families, and intervention.
        Clinical Child and Family Psychology Review. 2019; 22: 458-477
        • Rayan A.
        • Ahmad M.
        Effectiveness of mindfulness-based intervention on perceived stress, anxiety, and depression among parents of children with autism spectrum disorder.
        Mindfulness. 2017; 8: 677-690
        • Scherer N.
        • Verhey I.
        • Kuper H.
        Depression and anxiety in parents of children with intellectual and developmental disabilities: A systematic review and meta-analysis.
        PLoS One. 2019; 14e0219888
        • Schnabel A.
        • Youssef G.J.
        • Hallford D.J.
        • Hartley E.J.
        • McGillivray J.A.
        • Stewart M.
        • Austin D.W.
        Psychopathology in parents of children with autism spectrum disorder: A systematic review and meta-analysis of prevalence.
        Autism. 2020; 24: 26-40
        • Schopler E.
        • Reichler R.J.
        • Renner B.R.
        The childhood autism rating scale (CARS).
        Western Psychological Services, Los Angeles1988
        • Seymour M.
        • Giallo R.
        • Wood C.E.
        The psychological and physical health of fathers of children with autism spectrum disorder compared to fathers of children with long-term disabilities and fathers of children without disabilities.
        Research in Developmental Disabilities. 2017; 69: 8-17
        • Spitzer R.L.
        • Kroenke K.
        • Williams J.B.W.
        Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study.
        Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. Jama. 1999; 282: 1737-1744
        • Spitzer R.L.
        • Kroenke K.
        • Williams J.B.W.
        • Löwe B.
        A brief measure for assessing generalized anxiety disorder: The GAD-7.
        Archives of Internal Medicine. 2006; 166: 1092-1097
        • Tsai C.-H.
        • Chen K.-L.
        • Li H.-J.
        • Chen K.-H.
        • Hsu C.-W.
        • Lu C.-H.
        • Huang C.Y.
        The symptoms of autism including social communication deficits and repetitive and restricted behaviors are associated with different emotional and behavioral problems.
        Scientific Reports. 2020; 10: 20509
        • Wang H.
        • Hu X.
        • Han Z.R.
        Parental stress, involvement, and family quality of life in mothers and fathers of children with autism spectrum disorder in mainland China: A dyadic analysis.
        Research in Developmental Disabilities. 2020; 107: 1-13
        • Zhen W.
        • Jue C.
        • Boyd J.E.
        • Haiyin Z.
        • Xiuzhen J.
        • Jianyin Q.
        • Xiao Z.
        Psychometric properties of the Chinese version of the perceived stress scale in policewomen.
        PLoS One. 2011; 6e28610
        • Zhou H.
        • Xu X.
        • Yan W.
        • Zou X.
        • Wu L.
        • Luo X.
        • Ding D.
        Prevalence of autism spectrum disorder in China: A nationwide multi-center population-based study among children aged 6 to 12 years.
        Neuroscience Bulletin. 2020; 36: 961-971