Depression, low self‐esteem, and their children’s limitations in mobility and communication can impact the parenting stress of mothers caring for sons or daughters with cerebral palsy, a study suggests.
The findings call attention to the importance of watching for the emotional and cognitive well-being of parents — especially mothers — whose children have cerebral palsy and adjusting healthcare interventions and policies accordingly.
The study, “Activity Limitation in Children with Cerebral Palsy and Parenting Stress, Depression, and Self‐esteem: A Structural Equation Model,” was published in the journal Pediatrics International.
Cerebral palsy (CP) is a group of disorders that seriously affects a child’s ability to move, and maintain balance and posture, which strongly limits physical activity. Many people with CP also have intellectual disabilities and problems with hearing, vision, and speech.
Parenting a child with such disabilities can be both physically and psychologically challenging. For that reason, having a child with CP has been associated with greater stress in parent-child interactions — basically, increased parenting stress. Correlations have been found between the child’s level of disability, parental depression, and parenting stress. But how these factors interconnect, and how each one affects the other, remains unclear.Gathering more information about these correlations could help health care professionals to provide more appropriate services to these children and their parents.
To provide insight, two Korean researchers set out to identify what factors can influence parental stress, as well as parents’ emotional and cognitive well-being in the context of their children’s cerebral palsy. Specifically, the pair wanted to determine the relationships between mothers’ self-esteem, depression, and parental stress, and their children’s medical disabilities.”Parents of children with CP often perceive themselves as advocates for ensuring that their children receive optimal services and more than 60% are vulnerable to parenting stress,” the researchers said.According to the investigators, the first factors to be considered when thinking about parental stress are child-related factors, particularly the severity of their illness.To measure the relationship between their children’s disability and the mothers’ stress, the researchers used a structural equation model. This allowed the team to understand the connection between the children’s activity limitations — as measured by gross and fine motor, as well as communication skills — and the magnitude of their mothers’ depressive symptoms, specifically self‐esteem and parenting stress. All data were collected through self-report questionnaires.
A structural equation model includes a diverse set of mathematical models, as well as computer algorithms, and statistical methods. Together, they allow researchers to analyze relationships between sets of data based on several different variables.
In total, 217 children with cerebral palsy — 123 boys, 94 girls; all under age 12, with a mean age of 6.61 years — were included in the study. Among them, 77 (35.5%) had quadriplegia, with both arms and both legs affected; 11 (5.1%) had triplegia, in which three limbs are affected; and 87 (40.1%) had diplegia, which affects two limbs, usually the two legs. There were 42 children (19.42%) with hemiplegia, in which the arm and leg of one side of the body are affected.
Most children had the spastic form of the disease (71.0%), characterized by increased muscle tone, with a few children having dyskinetic/athetotic (7.8%), ataxic (4.6%), or mixed (5.5%) cerebral palsy.
The proposed model had “excellent fit indices,” meaning that it conformed well with the children’s and mothers’ data. From this model, the researchers could understand that both a child’s limitations and a mother’s depressive symptoms played a part in the mothers’ self-esteem. Further, the children’s activity limitations were found to have an indirect effect on self-esteem in the mothers, with depression having a direct effect on them.
Parenting stress could be explained by the children’s activity limitations as well as by the mothers’ depression and self-esteem. While the children’s disabilities and the mothers’ depression had both direct and indirect effects, a mother’s self‐esteem directly impacted on her own parenting stress.
“The results highlight the importance of identifying parental depression and self‐esteem as predictive variables for parenting stress among parents of children with CP, as well as children’s activity limitation,” the researchers said.
These findings may serve to alert health care providers to be watchful of “prevention and treatment programs dealing with self-esteem and depression affecting parental stress caused by caring for children with cerebral palsy,” they said.
“Interventions for decreasing parenting stress could include support for caregiving demands as well as techniques to improve stress management and self-esteem,” the researchers concluded. They said these concerns should be taken into account by policy makers to provide better support for families living with cerebral palsy.