Stress in mothers of preterm infants in Bangladesh: associations with family, child and maternal factors and children's neuro-development

Background   The aim of this paper was to ascertain stress experienced by mothers of prospectively followed up preterm infants, and associations with family, child and maternal factors and children's neuro-development.
Methods   Within a follow-up study of preterm infants <33 weeks gestational age at a Child Development Center in Dhaka Shishu Hospital, mothers were interviewed with the Self-Report Questionnaire (SRQ) at each visit. Association between SRQ scores and child, family and maternal variables at first and final visit and children's neuro-developmental outcomes was determined.
Results   Low income mothers were more compliant (54%) compared with the defaulters (31%) ( P  = 0.0001) among the 159 mothers enrolled. Of the 88 mothers who were followed up until a mean age of 22 months of their child, 29.3% were at high risk for psychiatric morbidity at first visit compared with 23.9% on their last visit. Use of abortifacients ( P  = 0.026) and higher maternal age ( P  = 0.040) were significantly associated with maternal stress at first visit; while at last follow-up, total number of visits had the most significant association ( P  = 0.041). Twenty-five per cent and 19% of mothers were at risk for psychiatric morbidity in children developing normally and those with neuro-developmental impairments respectively.
Conclusions   Mothers at risk for psychiatric morbidity can be helped through follow-up support within public hospitals close to their homes, which is most availed by low income families. Neuro-developmental monitoring of high-risk infants closer to homes may be more feasible in resource poor countries than reliance on hospital visits, which increase stress. Biological markers of stress and coping strategies need further research.     

注意缺陷多动障碍与孤独症患儿母亲养育压力差异的研究

目的探讨注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)与孤独症患儿母亲养育压力的差异及影响因素。方法采用父母压力指数量表(Parenting Stress Index,PSI)对ADHD患儿(n=150,7~12岁)及孤独症患儿(n=131,7~12岁)母亲进行评定。结果孤独症组母亲每个分量表得分及父母、儿童方面总分均高于ADHD组(P0.05)。多元回归分析结果表明放任自流的教养方式可能是孤独症患儿母亲父母领域总分和压力总分的影响因素。结论孤独症患儿母亲较ADHD患儿母亲承受着较高的压力。     

孤独症患儿父母压力和情绪变化及相关因素

【目的】 探讨孤独症患儿父母压力和情绪变化及其相关因素。 【方法】 采用父母压力指数量表(PSI)、孤独症行为量表(ABC)、孤独症评定量表(CARS)、抑郁自评量表(SDS)和焦虑自评量表(SAS)对孤独症患儿父母进行评定;采用PSI、SDS和SAS量表对正常儿童父母进行评定。 【结果】 1)孤独症患儿父母PSI总分及各分量表分均显著高于正常儿童父母(P=0.000);2)患儿父、母亲SDS和SAS分均显著高于正常儿童父母(P= 0.000)。患儿母亲SDS和SAS分均高于患儿父亲得分(P=0.000),患儿母亲抑郁发生率高于父亲(P=0.000);3)患儿父母的压力与患儿症状严重度正相关(P<0.01);4)多元回归结果表明孤独症患儿ABC量表分、孤独症患儿母亲的焦虑以及患儿年龄影响孤独症儿童父母压力,解释了总变异的54.9%。 【结论】 孤独症患儿父母承受着较高的压力、焦虑和抑郁水平,孤独症患儿母亲比患儿父亲及正常儿童父母更易发生抑郁,患儿行为问题是父母压力的主要影响因素。     

What causes stress for mothers of children with MBD?

Adapting the paradigm developed by Richard Lazarus, parenting stress and coping were studied among mothers of 6-9-year-old children (n = 42) with different symptoms of Minimal Brain Dysfunction (MBD) (hyperkinesis, perceptual or motor deficits, learning disabilities or speech disorders) and among mothers of non-disabled children (n = 42) matched for age, sex, social status of the family and marital status. Mothers of children with MBD were found to experience more parenting difficulties and more negative cognitive appraisals of their stakes in parenting than their matched controls. The mothers of children with hyperkinesis and perceptual or motor deficits considered their mastery lower and experienced less positive affects than their matched controls. The mothers of children with speech disorders experienced less positive affects than their matched controls. Mothers of children with both few and several symptoms experienced more parenting difficulties in the child domain than their matched controls. Mothers of children with several symptoms considered their mastery lower and experienced less positive affects; mothers of children with few symptoms appraised their stakes in parenting more negatively than their matched controls. No significant differences were found between mothers of children with MBD with few and several symptoms.     

农村遭受性侵儿童家庭亲密度与适应性研究

  目的  了解农村儿童性侵害发生状况及其与家庭亲密度和适应性的关系，分析可能影响受害儿童家庭功能的因素，为该类人群的创伤后干预提供科学依据。  方法  采用分层整群抽样方法, 在湖北省汉川市和郧西县抽取1 666名农村中学生进行问卷调查，应用多因素Logistic回归分析受害儿童家庭功能的影响因素。  结果  有175人(10.50%)遭受过非接触性性侵，44人(2.64%)遭受过接触性性侵。与正常儿童相比，受害儿童的家庭亲密度(F=8.97)和适应性均较低(F=4.09)(P均 < 0.05)。在性侵害受害儿童中，母亲离家(OR=0.20)与家庭亲密度较差呈正相关，看护人文化水平较高以及恰当的教育方式与家庭亲密度和适应性较低呈负相关(P均 < 0.05)。  结论  农村性侵害儿童的家庭功能不容乐观，其中母亲离家、看护人文化水平较低和采用不合理教育方式家庭中的受害者家庭功能显著较差。应加强对此类儿童的重视，尽可能减小性侵等负性事件对孩子造成的影响。     

Parenting Stress,Social Support,and Mother‐Child Interactions in Families of Multiple and Singleton Preterm Toddlers

The study investigated family support as a buffer of stress in 153 mothers and preterm toddlers. Data were collected regarding maternal depressive symptoms, parenting stress, and family support; infant health; and videotaped mother‐child interactions. Although more parenting stress related to less optimal child play, only information support functioned as a protective factor. Information support predicted positive play under high, but not low, maternal stress. Mothers of multiples reported more parenting stress than mothers of singletons.     

Effects of combining public assistance and employment on mothers and their young children

One goal of recent welfare reform legislation is to move welfare-dependent mothers with young children into the paid labor force. However, prior to the new legislation, many welfare-dependent women were already engaged in employment activities. In this paper we examine whether child or maternal well-being is influenced by a mother's strategy of combining work and public assistance receipt in the late 1980s. Measures of well-being include children's cognitive test scores and behavior problems, parenting behavior, and maternal mental health, social support, and coping strategies collected when children were 2 1/2 to 3 years of age. Data from the Infant Health and Development Program (a sample of low birthweight, premature infants born in 8 sites in 1985) were used to identify low-income families (incomes under 200% of the poverty threshold; N = 525). Comparisons were made among mothers in the following groups: (a) Work Only, (b) Some Work-Some Welfare, (c) Some Work-No Welfare, (d) No Work-No Welfare, and (e) Welfare Only. Mothers in the Some Work-Some Welfare group had children with cognitive and behavioral scores similar to children whose mothers were in the Work Only group; these two groups also had similar mental health, social support, and coping scores. However, not working and receiving welfare (Welfare Only) was associated with negative cognitive and behavioral outcomes for children, with less stimulating home learning environments, lower maternal mental health, less social support, and more avoidant coping strategies. We discuss the proposition that welfare and work may be complementary rather than opposing strategies, in terms of putting together a family income package.     

A comparison of mothers' and fathers' experience of parenting stress and attributions for parent child interaction outcomes

Parents of children with disabilities are vulnerable to parenting stress, which may place them at physical and psychological risk. However, it is not clear whether fathers experience stress differently to mothers, or whether their experiences are reported less frequently. Additionally, there is little reported on the relationships and gender differences between mothers' and fathers' attributions for parent child interaction outcomes. Parenting stress was assessed in this study using Abidin's (1990) Parenting Stress Index (PSI), and parenting attributions were assessed using the original (Bugental et al., 1989; Bugental and Shennum, 1984), and modified versions of the Parenting Attribution Test, also known as the Child Interaction Survey (CIS) (M-CIS: Esdaile and Greenwood, 1995b). Participants were 53 mothers and 25 fathers of children with disabilities. Having a child with a disability was associated with elevated scores on the PSI; some gender differences were found. Only one significant outcome was found on the assessment of parenting attributions. Thus, the findings suggest that further research is indicated to explore differences in mothers' and fathers' experiences of parenting stress, and the assessment of parenting attributions. The fact that having a child with a disability was associated with elevated scores on the PSI for both mothers and fathers indicates the importance of considering stress management as an integral part of occupational therapy programmes that involve parents of children with special needs. Therapists also need to consider possible gender differences when planning stress management programmes including both mothers and fathers of children with disabilities.     

Effects of Combining Public Assistance and Employment on Mothers and Their Young Children

SUMMARY

One goal of recent welfare reform legislation is to move welfare-dependent mothers with young children into the paid labor force. However, prior to the new legislation, many welfare-dependent women were already engaged in employment activities. In this paper we examine whether child or maternal well-being is influenced by a mother's strategy of combining work and public assistance receipt in the late 1980s. Measures of well-being include children's cognitive test scores and behavior problems, parenting behavior, and maternal mental health, social support, and coping strategies collected when children were 2 ½ to 3 years of age. Data from the Infant Health and Development Program (a sample of low birthweight, premature infants born in 8 sites in 1985) were used to identify low-income families (incomes under 200% of the poverty threshold; N = 525). Comparisons were made among mothers in the following groups: (a) Work Only, (b) Some Work-Some Welfare, (c) Some Work-No Welfare, (d) No Work-No Welfare, and (e) Welfare Only. Mothers in the Some Work-Some Welfare group had children with cognitive and behavioral scores similar to children whose mothers were in the Work Only group; these two groups also had similar mental health, social support, and coping scores. However, not working and receiving welfare (Welfare Only) was associated with negative cognitive and behavioral outcomes for children, with less stimulating home learning environments, lower maternal mental health, less social support, and more avoidant coping strategies. We discuss the proposition that welfare and work may be complementary rather than opposing strategies, in terms of putting together a family income package.     

Stress in parents of children with cerebral palsy: what sources of stress are we talking about?

Background Parents of children with cerebral palsy (CP) often experience high levels of stress. Little is known however on the different sources of stress parents experience. The purpose of the present study was to explore the relation between aspects of parental distress in the parenting role and the child's limitations in functional skills and the child's behavioural difficulties, in parents of children with CP. Methods A cross‐sectional study among 42 parents of ambulatory children with CP (age 3–8 years; GMFCS levels I–III) was performed, using the Parenting Stress Index (PSI), the Paediatric Evaluation of Disability Inventory (PEDI) and the Vineland Adaptive Behaviour Scales (VABS). Results Regression analysis revealed that the PEDI Functional Skills and VABS Maladaptive behaviour scores explained 27% of the total variance in the PSI Parent domain total stress score. Maladaptive behaviour did significantly contribute to parental stress scores for the Parent domain subscales Attachment, Relationship with spouse, Depression, and, in particular, Sense of competence. Conclusions Parents' functioning can be affected by behavioural aspects of the child with CP, and sense of competence could be an important variable in this relation. This emphasizes the importance of the development of specific interventions that support the family as a whole.     

大动脉调转术后儿童母亲亲职压力和心理状态的对照研究

【目的】 探讨大动脉调转术后儿童与正常儿童母亲的亲职压力和心理状况,为术后儿童的全面康复提供数据。 【方法】 采用亲职压力指标简表(Parenting Stress Index Short Form, PSI/ SF)、状态-特质焦虑量表(State-Trait Anxiety Inventory, STAI)对135例大动脉调转术后儿童的母亲和142例正常儿童的母亲进行调查。 【结果】 大动脉调转术后儿童的母亲亲职压力量表总分、亲职愁苦及亲子互动失调分量表得分高于正常对照组[总分(93.49±15.10)vs(74.71±16.55),P< 0.05 ],状态焦虑得分高于正常对照组[(43.19±7.07)vs(39.67±7.45),P< 0.05],亲职压力量表总分及亲职愁苦分量表得分与状态焦虑得分呈正相关。 【结论】 大动脉调转术后儿童母亲存在较高水平的亲职压力和状态焦虑,值得专业人员关注和实施干预。     

Psychosocial Resources Predicting Maternal and Paternal Positive Parenting and Lower Child Abuse Risk

Young children have the highest victimization rates of physical abuse in their first year of life, making up nearly half of all child abuse–related fatalities. More effective prevention is needed to reduce child victimization, yet many risk reduction models rely on problematic inclusion criteria, only intervene after maltreatment has occurred, or focus only on mothers. More proactive prevention models that promote positive parenting practices early in the transition to parenthood could be key to reducing child maltreatment. The current study sought to assess how both mothers’ and fathers’ psychosocial resources (e.g., emotion regulation, coping, and social support) and empathy can predict positive parenting and predict lower child abuse risk across time in a cross-lagged model. Parenting and abuse risk were examined prenatally, through the transition into parenthood, until children were 4 years old. First time mothers and their partners were recruited in the third trimester of pregnancy and assessed again when children were 6 months, 18 months, and 4 years old. Separate path models for mothers and fathers analyzed whether psychosocial resources and empathy at earlier timepoints predicted their positive parenting and lower abuse risk by the time children were age 4. Findings demonstrated that mothers’ earlier empathy predicted later positive parenting and earlier positive parenting predicted later empathy. Fathers’ lower prenatal abuse risk predicted greater subsequent empathy. Both mothers’ and fathers’ psychosocial resources and empathy at earlier timepoints predicted later positive parenting. Parents’ psychosocial resources can be integral assets in positive, effective parenting approaches both concurrently and longitudinally. Mothers’ and fathers’ resources are an important point of intervention prior to and during the transition into parenthood to support healthier families that would confer benefits to child functioning.

     

Home programmes in paediatric occupational therapy for children with cerebral palsy: Where to start?

Aim:  Home programmes are used extensively for children with cerebral palsy. Even though there is consensus about the importance of home programme intervention, there is little evidence of efficacy and scant information regarding programme characteristics that might affect family participation. Instead, research to date has focussed on parental compliance with prescribed programmes and parent–child interactions.
Methods:  Based on reviewed literature, this article proposes a model to guide development of home programmes for children with cerebral palsy. It is a starting point for therapists to consider the way in which they focus and structure their home programmes for children who have cerebral palsy.
Results and Conclusions:  The paper identifies an urgent need to develop clinical guidelines for home programmes through rigorous formal processes and to evaluate the impact of occupational therapy home programmes.     

An expanded Transactional Stress and Coping Model for siblings of children with sickle cell disease: family functioning and sibling coping, self-efficacy and perceived social support

Aim   To investigate the application of an expanded Transactional Stress and Coping Model for the psychological adjustment of non-chronically ill, African-American siblings of children with sickle cell disease (SCD).
Methods   Ninety-seven siblings (M = 11.24 years) from 65 families who care for a child with SCD participated. Primary caregivers completed the Coping Health Inventory for Parents, the Family Relations Scale and the Child Behaviour Checklist, while siblings completed the Kidcope, the Children's Self-Efficacy for Peer Interaction Scale, and the Social Support Scale for Children.
Results   Family processes were predictive of sibling adjustment, revealing that family coping, expressiveness and support improved adjustment, while family conflict predicted poor adjustment.
Conclusion   Findings suggest that family-centered interventions stressing family expressiveness and support, while minimizing conflict, will contribute to sibling psychological adjustment.     

Web-Based Prevention of Parenting Difficulties in Young,Urban Mothers Enrolled in Post-Secondary Education

Research consistently indicates that young mothers are at elevated risk for adverse social and economic risks. Recent attention has been paid to the value of maternal educational attainment for their children’s economic and social outcomes. Pursuit of post-secondary education requires mothers to balance multiple roles, potentially stressing the parent–child relationship. Yet, almost no studies have addressed parenting and associated stress in young mothers enrolled in post-secondary education, and no preventive intervention trials have been conducted. We screened young mothers (<25 years at child’s birth) pursuing post-secondary education in an urban, inner city college for study inclusion based on elevated parenting stress, and participated in a randomized controlled trial to assess the efficacy of a web-based parenting intervention (Triple P Online) in reducing parenting stress and dysfunctional discipline (N = 52). Mothers were randomly assigned to the web-based parenting program condition or to a waitlist control condition. Mothers who completed at least the first four core modules of the online program had lower scores on the Parenting Scale’s subscales (Overreactivity, Verbosity, and Laxness), compared to those who did not complete four or more modules. No intervention effects were obtained for parenting stress. The current study provides preliminary evidence of the efficacy of this online parenting program for reducing risk for dysfunctional discipline in student mothers. Future research is warranted to replicate these findings, and to test whether provision of supplemental support for implementation, or briefer program formats may promote both program compliance and outcomes related to reducing parenting stress.     

Division of Household Labor and Family Functioning in Off‐Reservation Navajo Indian Families*

The division of household labor and family functioning of mothers and fathers was examined in 28 off‐reservation Navajo Indian families. Mothers invested significantly more time in cleaning, food, and child‐related tasks than fathers, but mothers and fathers equally participated in household maintenance. In their perception of how they and their family functioned, mothers and fathers reported similar zzlevels of coping and competence, but mothers demonstrated significantly more commitment, cohesion, and communication skills than fathers. Overall, fathers showed high levels of involvement in household labor and family functioning. Findings are discussed with respect to family functioning and gender roles in 2‐parent Navajo families.     

孤独症谱系障碍儿童母亲亲职压力及影响因素研究

目的 探讨孤独症谱系障碍(autism spectrum disorders,ASD)儿童母亲亲职压力及其影响因素。 方法 采用亲职压力指标简表(PSI-SF),焦虑自评量(SAS),流调用抑郁自评量表(CES-D),简易应对方式量表(SCSQ),领悟社会支持量表(PSSS),孤独症行为量表(ABC),以及自拟的儿童和家庭基本情况调查表对150例ASD儿童的母亲进行调查。 结果 不同抑郁和焦虑水平的儿童母亲在亲职总压力及三个维度得分差异均有统计学意义(P<0.05);除亲职愁苦维度外,不同ABC得分组间母亲亲职总压力得分及另外两个维度有差异(P<0.05);除困难儿童维度外,其他各维度及总压力得分均与积极应对呈负相关(P<0.05);除亲子互动失调维度外,其他各维度及总压力得分均与消极应对呈正相关(P<0.05);朋友支持、其他人支持与亲子互动失调呈负相关;社会总支持与亲职愁苦呈负相关(P<0.05);多元线性回归显示:亲职总压力与患儿严重程度、母亲的焦虑和抑郁状态以及政府资助显著相关。 结论 母亲的亲职压力受多种因素影响,提高ASD康复服务水平,改善患儿症状及家长心理状态并给予更多的政府和社会支持是缓解母亲亲职压力的重要途径。     

Coping efficacy and perceived family support: potential factors for reducing stress in premedical students

Objective  This study investigated the relationship between perceived family support and coping efficacy in premedical (i.e. prior to entering medical school) students, an understudied subset of undergraduate students who are particularly at risk for academia- related stress. The relationships between students' perceived academic coping abilities and their academic behaviours and experiences of stress have been considered within the vocational literature. However, an understanding of factors that inform coping efficacy beliefs is lacking.
Methods  A total of 238 premedical students provided demographic information regarding themselves and their parents. Students also completed a paper questionnaire containing a coping efficacy scale and items assessing their level of family support.
Results  Correlational analyses revealed significant positive relationships between family support and students' perceived abilities to cope with anticipated academic barriers as hypothesised. Bivariate comparisons of mean coping efficacy scores revealed that racial or ethnic minority students reported significantly higher coping efficacy beliefs than did White students. Students with doctor mothers also reported significantly higher coping efficacy than students with mothers employed in other health-related fields. No significant differences in coping efficacy were found when those with doctor fathers versus those with fathers in other health-related fields were compared.
Conclusions  Findings from the present study indicate that perceived family support plays a key role in establishing premedical students' confidence in their ability to cope with the challenges of academic life. These findings have important implications for further studies on coping and stress in premedical students.     

Mothers of undernourished Jamaican children have poorer psychosocial functioning and this is associated with stimulation provided in the home

OBJECTIVES: To compare mothers of undernourished children with mothers of adequately nourished children on maternal depression, parenting self-esteem, social support and exposure to stressors and to determine if these variables are independently related to undernutrition and stimulation provided in the home after controlling for socio-economic status. DESIGN: A case control study. SETTING: Children and their mothers were recruited from 18 government health centres in the Kingston, St Andrew and St Catherine parishes of Jamaica. SUBJECTS: One hundred and thirty-nine mothers of undernourished children (WAZ< or =-1.5z scores) aged 9 - 30 months and 71 mothers of adequately nourished children (WAZ > -1z scores) matched for sex and age group were enrolled into the study. RESULTS: Mothers of undernourished children came from poorer homes but had similar social support to mothers of adequately nourished children. They were more depressed, had lower levels of parenting self-esteem (both P<0.01), reported higher levels of economic stress (P<0.001) and provided a less stimulating home environment (P<0.05). However, after controlling for social background variables there was no independent relationship between either psychosocial function or home stimulation and nutritional status. Undernutrition was found to be mainly explained by economic factors. The mothers' self-esteem was independently associated with the level of stimulation provided to the child. CONCLUSIONS: When caring for undernourished children attention should be paid to the psychosocial status of the mother as well as the physical condition of the child. SPONSORSHIP: Thrasher Research Fund; Campus Research and Publication Fund, UWI, Jamaica.     

Relationships of parenting strain and mental health with family needs in mothers of severely handicapped school-aged children suffering from cerebral palsy

OBJECTIVE: The study was designed to clarify relationships of family needs of mothers of school-aged children suffering from cerebral palsy with the parenting strain and mental health. METHODS: The subjects were 249 mothers of cerebral palsy children from schools for the physically handicapped in Japan. The survey item consisted of sex and age of the children and age, family needs, parenting strain, and mental health of the mothers. Family needs of the mothers were determined according to "The Family Needs Survey". Parenting strain was assessed according to the "Parenting Strain Index for Parents with Disabled Children". Mental health was measured according to "General Health Questionaire-12". In the statistical analysis, an indirect model, with the parenting strain and family needs as the primary and secondary factor, respectively was postulated for mother's mental health, and fit of the model to the data was investigated. RESULTS: The Comparative Fit Index (CFI) was 0.962, the Tucker-Lewis Index (TLI) was 0.977, and the Root Mean Square Error of Approximation (RMSEA) was 0.058; these indices were statistically within the tolerance range. The path coefficient of correlation of the parenting strain with the family needs was 0.656, and the path coefficient of the parenting strain with mental health was 0.406; both were statistically significant. CONCLUSION: Relationships between family needs of mothers of cerebral palsy children from schools for the physically handicapped children and the mothers' parenting strain and mental health were indicated. The findings suggested that in order to develop and implement social intervention strategies for reducing mothers' parenting strain and providing solutions, it is imperative to extensively consider what family needs are and what solutions are required to resolve those needs.