The role of coping strategies in predicting change in parenting efficacy and depressive symptoms among mothers of adolescents with developmental disabilities

Background Parents of children with developmental disabilities (DD) face greater caregiving demands than parents of children without DD. There is considerable variability in parents' adjustment to raising a child with DD, however. In line with a strengths‐based approach, this study explores coping strategies as potential mechanisms of resilience among mothers of adolescents with DD. This study examines the frequency with which mothers use various coping strategies and the extent to which those strategies moderate the relationship between adolescent behaviour problems and aspects of maternal well‐being. Both positive and negative dimensions of well‐being are explored, with maternal depressive symptoms and perceived parenting efficacy examined as outcomes cross‐sectionally and longitudinally. Methods The present study focuses on 92 mothers and their adolescents with DD. The adolescents had a wide range of diagnoses, all with continuing special needs. Data were collected from mothers through interviews and self‐administered questionnaires when their adolescents were aged 15 and aged 18. A structured assessment of the adolescent was completed during home visits at age 15. Results Mothers reported frequently using strategies of denial and planning but rarely using strategies of mental and behavioural disengagement to cope with recent stressful situations. Adolescent behaviour problems were found to contribute to greater symptoms of depression and lower feelings of parenting efficacy as well as increases in depressive symptoms over time. Mothers of sons, but not daughters, reported increases in parenting efficacy across their child's adolescent period. Above and beyond adolescent factors, several coping strategies emerged as significant predictors of mothers' symptoms of depression and perceived parenting efficacy. Moreover, use of Active Coping/Planning, Positive Reinterpretation/Growth, and Behavioural/Mental Disengagement as coping strategies moderated the impact of adolescent behaviour problems on maternal depressive symptoms. Conclusions This study extends previous findings by focusing on both positive and negative dimensions of parent well‐being during their child's adolescent period. Adolescence can be a stressful time for parents, with typical developmental tasks entailing additional strains for parents of adolescents with DD. The present findings point to several coping strategies that may reduce the impact of challenging behaviours during this period on mothers' symptoms of depression and feelings of parenting efficacy. Certain coping strategies were found to exert a greater impact on maternal well‐being for parents of adolescents with higher levels of behaviour problems, suggesting that interventions may benefit from an increased focus on this group of mothers with heightened caregiving demands.     

Families of adolescents and adults with autism spectrum disorders in Taiwan: The role of social support and coping in family adaptation and maternal well-being

In this study we examined differences in social support and coping between mothers of adolescents and adults with an autism spectrum disorder (ASD) in Taiwan and the United States and to investigate the effects of social support and coping strategies on family adaptation and maternal well-being. Participants were 76 Taiwanese mothers who had at least one son or daughter with an ASD (10 years old and older), and a comparison group of 325 mothers in the United States matched on the age range of the child with an ASD. Mothers completed self-administered, written questionnaires and participated in an interview. Taiwanese mothers reported significantly greater use of problem-focused and emotion-focused coping strategies than did mothers in the United States. For Taiwanese families, greater use of problem-focused coping strategies was associated with lower levels of depressive symptoms and anxiety. Emotion-focused coping mediated the relationships between ethnicity/culture and several outcome measures: family adaptability, family cohesion, and maternal depressive symptoms. The higher levels of emotion-focused coping in Taiwanese mothers appeared to account for their lower levels of family adaptability and cohesion and higher levels of maternal depressive symptoms. The results from this cross-cultural study helped determine the role of social support and coping strategies in family adaptation and maternal well-being in families of individuals with an ASD in each culture. Implications for service delivery are discussed.     

Maternal stress,well-being,and impaired sleep in mothers of children with developmental disabilities: A literature review

Having children with developmental disabilities (DDs) requires a high level of caregiving responsibilities, and existing studies support that mothers of children with DDs experience high levels of maternal stress as well as poor sleep and well-being. Given the fact that the number of children with DDs has increased, an up-to-date literature review is necessary to identify factors associated with maternal stress, sleep, and well-being. In addition, understanding these factors and their relationships may provide better strategies in designing effective interventions that can reduce the burden in mothers of children with DDs. This review summarized 28 scientific research papers that examined maternal stress, sleep, and well-being in mothers of children with DDs in past 12 years. The study findings indicate that mothers of children with DDs experience higher levels of stress than mothers of typically developing children, and it remains high over time. In addition, these mothers often encounter depressive symptoms as well as poor sleep quality. The study results also reveal that there is a bidirectional relationship between maternal stress and depressive symptoms as well as between poor sleep quality and depressive symptoms. For example, higher stress mothers experienced more depressive symptoms. Mothers of children with DDs with poor sleep quality are significantly associated with more depressive symptoms. Child behavior problems were significantly associated with both maternal stress and depressive symptoms, but cautious interpretation is warranted due to the shared variance between child behavior problems, maternal stress, and depressive symptoms. Methodological guidelines for future research involve the use of reliable and valid instruments for the measurement of child behavior problems, maternal stress, and sleep. Recommendations for future research are included.     

A Comparative Analysis of Well-Being and Coping among Mothers of Toddlers and Mothers of Adolescents with ASD

The present study examined the impact of autism symptoms and coping strategies on the well-being of mothers of children with autism spectrum disorder (ASD). The sample consisted of 153 mothers of toddlers and 201 mothers of adolescents drawn from two ongoing, longitudinal studies of families of individuals with ASD. For mothers of toddlers, lower levels of emotion-focused coping and higher levels of problem-focused coping were generally associated with better maternal well-being, regardless of the level of child symptomatology. For mothers of adolescents, coping often acted as a buffer when autism symptoms were high. Although there was evidence of maternal distress in both groups, the presence of significant buffering effects reflects adaptation in the face of stress, particularly for mothers of adolescents.     

Longitudinal Correlates of Depressive Symptoms and Positive and Negative Affects in Family Caregivers of People With Dementia

ObjectiveCaring for a relative with dementia is considered a chronically stressful role associated with negative consequences for psychological health such as higher levels of depression. However, the subjective experience of depressive symptomatology is complex as it relates to two unique domains: positive affect (PA) and negative affect (NA). The objective of this study was to analyze, through a longitudinal design, the associations of caregivers’ cognitive (avoidance coping, personal mastery, and coping self-efficacy) and behavioral (frequency of pleasant events) coping strategies with depressive symptoms, PA, and NA.MethodsA total of 111 caregivers of a spouse with dementia participated in this study. They were assessed yearly across 5 years. Mixed model regression analyses were conducted separately for depressive symptoms, PA, and NA, analyzing within and between-person associations of caregivers’ age, gender, role overload, sleep quality, and coping variables previously mentioned.ResultsThe results showed that different coping strategies were associated with different components of depressive symptomatology. While avoidant coping was associated with NA and depressive symptoms but not PA at both within- and between-person levels, frequency of pleasant events was associated only with NA and depressive symptoms at the within-person level, showing no effect at the between-person level. Personal mastery and coping self-efficacy were found to be more transversal variables, being associated with most of the mood outcomes in both within and between-person effects.ConclusionFindings support the concept of depressive mood as a complex construct and highlights the importance of analyzing different coping strategies when trying to comprehend the caregiving stress process.     

Coping and the course of mother's depressive symptoms during and after pediatric bone marrow transplantation

OBJECTIVE: To evaluate the role of maternal coping strategies in depressive symptoms experienced by mothers of children undergoing bone marrow transplantation (BMT). METHOD: A total of 207 mothers completed measures of coping and depressive symptoms at the time of the child's BMT, 3 and 6 months post-BMT. The sample was collected between 1998 and 2002. The acceptance rate was 73%. The contribution of demographic, illness and treatment parameters, and mothers' concerns about the child were also evaluated. Growth curve modeling was used to evaluate the role of coping in the course of depressive symptoms. Both main effects and interactions of coping strategies with time of assessment were evaluated. RESULTS: Acceptance and humor were associated with reductions in maternal depressive symptoms, and planning and alcohol/substance use were associated with increases in maternal depressive symptoms. Positive reframing, use of emotional support, and use of religion were associated with the course of depressive symptoms, but the magnitude of associations differed depending on the use of the coping strategies at the time of transplantation. Mothers' fears about the child also predicted depressive symptoms. CONCLUSIONS: Acceptance and humor may be targets for behavioral interventions to reduce mothers' depressive symptoms during and after pediatric BMT hospitalization.     

Differences in coping effectiveness and well-being among aging mothers and fathers of adults with mental retardation

In this longitudinal study, we examined stress and coping processes among 133 married mothers (age 59 to 83) and fathers (age 56 to 84) of adults with mental retardation (age 19 to 53). There were no differences between mothers and fathers with respect to their frequency of use of emotion-focused coping, but mothers used significantly more problem-focused coping strategies than did their husbands. For mothers, greater use of problem-focused coping strategies and lower use of emotion-focused coping buffered the impacts of caregiving stress on their psychological well-being. However, for fathers, no buffering effects of coping were detected. The implications of gender differences in coping effects were examined in the context of the impact of lifelong caregiving.     

Adolescent Humor and its Relationship to Coping,Defense Strategies,Psychological Distress,and Well-Being

Objective This study investigated the psychometric properties of the Humor Styles Questionnaire (HSQ) in measuring adolescent humor, including the relationship between humor and coping style, defense style, depressive symptoms, and adjustment in a non-clinical sample of adolescents. Method Humor, coping, defense strategies, depressive symptoms, and adjustment were investigated in 94 adolescents aged 12–15. Results The HSQ demonstrated adequate internal consistency. Inter-scale correlational patterns and scale means were similar for adolescents and adults. Convergent validity for the HSQ was supported by its relationship to: an adolescent-standardized humor defense scale; coping and defense strategies; and depressive symptoms and adjustment. Clinical utility of the HSQ was demonstrated by its unique contribution in predicting both depressive symptoms and adjustment above and beyond contributions from coping and defense composites. Discussion The HSQ appears to be a psychometrically sound and clinically useful measure to assess humor dimensions in adolescents.     

The important role of sense of coherence in relation to depressive symptoms for Taiwanese family caregivers of cancer patients at the end of life

OBJECTIVE: To determine whether the strength of personal coping capability, the sense of coherence (SOC), makes a unique contribution in explaining the extent of depressive symptoms experienced by family caregivers of terminally ill cancer patients. METHODS: A total of 253 Taiwanese family caregivers of terminally ill cancer patients participated in this survey. Caregiver depressive symptoms were assessed using the CES-D. Potential correlates of depressive symptoms were categorized as: (1) characteristics of the caregivers; (2) demographics and disease-related characteristics of the patients; (3) objective caregiving loads; (4) confidence in end-of-life caregiving; (5) subjective caregiving burden; and (6) SOC. RESULTS: Family caregivers scored high on the CES-D [mean (S.D.)=22.24 (11.36)]. Results from the R(2) change in the hierarchical multiple regression model indicated that the incremental variance explained by each block of variables for (1) the characteristics of family caregivers, (2) the characteristics of cancer patients, (3) objective caregiving loads, (4) confidence in caregiving, and (5) subjective caregiving burden was 20.5%, 6.8%, 1.5%, 3.7%, and 11.9%, respectively. In the final step of regression, SOC of caregivers increases the explained variation in depressive symptoms by 21.5%. CONCLUSIONS: This study confirms that, among the independent variables examined in this study, variations in SOC are comparatively important in explaining the variation of depressive symptoms experienced by Taiwanese family caregivers. Developments and evaluations of the effectiveness of clinical interventions aimed at augmenting caregivers' coping capability (such as SOC) to facilitate positive appraisal and finding meaning, to improve understanding of the demands and challenges of caregiving, and to mobilize resources available to manage caregiving tasks are highly recommended.     

Emotional suppression,caregiving burden,mastery, coping strategies and mental health in spousal caregivers

Objectives: The main aim was to explore the multiple mediation effects of personal resources (mastery, engagement and disengagement coping strategies) between caregiving burden and depression in spousal caregivers, based on integrated stress process models. A further aim was to examine whether emotional suppression moderates the relationship between perceived burden and depression.

Method: Cross-sectional data were collected in 2010–2011 by structured interviews from a sample of 110 spousal caregivers. Coefficients strategy with bootstrapping tested the strength and significance of the conditional indirect effects of simultaneous multiple mediators; and the conditional effect of burden on depression at different emotional suppression values.

Results: Caregiving burden was indirectly associated with depression, through mastery and disengagement coping, but not through engagement coping. Mastery was negatively associated with depression, while disengagement coping was positively associated with depression. Emotional suppression and functional disability were positively associated with depressive symptoms. A significant burden-by-emotional suppression interaction was found for predicting depressive symptoms.

Conclusion: The study supports the conditional indirect effect in which burden can affect depression by reducing the mastery and increasing the disengagement coping simultaneously. The study provides also initial support for the moderating effect of emotional suppression, which can increase the deleterious effects of burden on depression. Researchers and practitioners should be aware of these issues of family care in spousal caregivers.     

Early adolescent depressive mood: direct and indirect effects of attributional styles and coping

The present study used a cross-sectional survey design to examine how adolescent depressive mood was related to attributional styles and coping strategies with a sample of 326 youths (aged 8–14 years). With the cutting point adopted in the West, 20.9% of the current sample reported depressive symptoms. Regression analysis results show that, with the asymptomatic group, seeking social support strategy mediated the effects of positive-global and positive-stable attribution, and internalization strategy mediated the effects of negative-global attribution on depression mood. In the dysphoric adolescents, attributing positive events to global factors and seeking social support strategy predicted depressive mood in the negative direction whereas attributing negative events to global factors, problem solving strategy and internalization strategy, the positive direction. The current study confirmed that both attributional styles and coping strategies were significant predictors of depressive mood but different dimensions of attribution related to depressive symptoms in different magnitude.     

Early menarche,depressive symptoms,and coping strategies

During the time around menarche, young women must make many emotional and social adjustments to adapt to a new life stage. We compared depressive symptomatology and coping strategies between early and average maturer Mexican adolescents girls. The relationships between elapsed time since menarche and both depressive symptomatology and coping strategies were also studied. Three hundred eighty post-menarcheal students from 11 to 15 years completed the Children's Depression Scale and the Children's Situational Coping Scale. Early maturers showed more depressive symptoms than their peers, but they reported having used fewer non-productive coping strategies. Early maturers who experienced menarche one to three years previously reported more non-productive coping strategies than those who had experienced menarche four to six years ago. However, no differences were found in the results of the average maturers depending on the time elapsed since menarche. These findings are discussed in light of the psychosocial context of early maturers.     

Stress and Coping Predicts Adjustment and Glycemic Control in Adolescents with Type 1 Diabetes

Background

Adolescents with type 1 diabetes are at increased risk for deteriorating glycemic control, poor quality of life, and depressive symptoms. Stress and coping are related to these outcomes in adolescents with diabetes, yet few studies have examined these constructs longitudinally.

Purpose

This study aimed to describe stress and coping in adolescents with type 1 diabetes and to examine coping strategies as predictors of adolescent adjustment (i.e., depressive symptoms, quality of life) and glycemic control.

Methods

Adolescents with type 1 diabetes completed measures of diabetes-related stress, coping, symptoms of depression, and quality of life at baseline, 6 months, and 12 months. Data on glycemic control were collected from the adolescents’ medical charts.

Results

The adolescents’ use of primary control coping (e.g., problem solving) and secondary control engagement coping (e.g., positive thinking) strategies predicted significantly fewer problems with quality of life and fewer depressive symptoms over time. In contrast, the use of disengagement coping strategies (e.g., avoidance) predicted more problems with quality of life and depressive symptoms. Coping was not a significant predictor of glycemic control. Coping mediated the effects of diabetes-related stress on depressive symptoms and quality of life.

Conclusions

The ways in which adolescents with type 1 diabetes cope with diabetes-related stress predict quality of life and symptoms of depression but not glycemic control. Through the use of screening to identify adolescent’s diabetes-related stress and targeted interventions to improve coping strategies, there is potential to improve outcomes.

     

The stroke caregiving trajectory in relation to caregiver depressive symptoms,burden, and intervention outcomes

Background: Caregiver depression and burden have a detrimental effect on stroke survivors’ rehabilitation and are contributors to stroke survivors’ hospital readmission and institutionalization. The stroke caregiving trajectory is unique compared to other illnesses, and the effect of length of caregiving on stroke caregiver outcomes is poorly understood. Interventions can improve caregiver outcomes, but the optimal timing of these interventions is unclear.

Objectives: We sought to determine the relationship between: (1) length of caregiving and stroke caregiver depressive symptoms and burden, and (2) length of caregiving and amount of change in depressive symptoms and burden following the Resources and Education for Stroke Caregivers’ Understanding and Empowerment (RESCUE) intervention – an online and telephone problem-solving, education, and support intervention.

Methods: We analyzed retrospective data collected from 72 stroke caregivers who participated in the RESCUE intervention. Outcomes were caregiver depressive symptoms and burden. Data were analyzed using mixed-effects regression analysis.

Results: Baseline depressive symptoms and burden were both negatively related to length of caregiving (p < 0.05). We found significant improvement in caregiver depressive symptoms and burden following an intervention. The interaction between changes in outcomes and length of caregiving was not significant for either depressive symptoms (p = 0.26) or burden (p = 0.10).

Conclusions: This study contributes to the understanding of the relationship between length of caregiving and depression, burden, and intervention outcomes. Clinicians should recognize that the stroke caregiving trajectory can be nonlinear. Routine and repeated clinical assessment of caregiver well-being is needed, along with implementation of interventions when necessary, regardless of how much time has passed since the stroke.     

Coping and depressive symptoms in adolescents with a chronic medical condition: A search for intervention targets

The aim of the present study was to find relevant coping factors for the development of psychological intervention programs for adolescents with a chronic medical condition. A wide range of coping techniques were studied, including cognitive coping, behavioral coping and goal adjustment coping. A total of 176 adolescents participated. They were contacted through social networking websites or Internet forums and through schools for children with a physical disability. Several cognitive and behavioral coping strategies and goal adjustment were found to be related to symptoms of depression. The cognitive coping strategies had the strongest influence on depressive symptoms. Especially self-blame, rumination and catastrophizing seemed to be important factors. If these findings can be confirmed, they could contribute to the focus and content of intervention programs for adolescents with a chronic medical condition.     

Can differences in stress perception and coping explain sex differences in depressive symptoms in adolescents?

A four-year longitudinal study explored the different contribution of low self-esteem, different types of stressors, conflict in close relationships and avoidant coping to the explanation of depressive symptomatology in adolescents. One hundred and ninety adolescents, 101 females and 89 males, participated in four annual assessments using diverse instruments. ANOVAs repeated measurements revealed a higher stress level, more conflicts with mothers and more avoidant coping in females as compared to males at the age of 14 years. Males showed fewer depressive symptoms and higher positive self-esteem at all times. Multiple regression analysis revealed that stress and avoidant coping in early and mid-adolescence explained a significant proportion of depressive symptoms among females in late adolescence. Among males, only the level of conflicts with friends in early adolescence contributed to their level of depressive outcome in late adolescence.     

A longitudinal study of the associations among adolescent conflict resolution styles, depressive symptoms, and romantic relationship longevity

This study investigated whether adolescents' conflict resolution styles mediated between depressive symptoms and relationship longevity. Data were used from a sample of 80 couples aged 13-19 years old (Mage?=?15.48, SD?=?1.16). At Time 1 adolescents reported their depressive symptoms and conflict resolution styles. Additionally, time until break-up was assessed. Data were analyzed using actor-partner interdependence models. Results showed no support for conflict resolution styles as mediators. Girls' depressive symptoms were directly related to shorter relationships. Additionally, actor effects were found indicating that boys and girls with more depressive symptoms used negative resolution styles and were less likely to employ positive problems solving strategies. Finally, one partner effect was found: girls' depressive symptoms related to more positive problem solving in boys.     

Caregiving appraisal after traumatic brain injury: The effects of functional status, coping style, social support and family functioning

Perception of caregiving after traumatic brain injury (TBI) has been shown to be an important part of both survivor and family adjustment. The roles of coping style, family functioning, perceived social support and the TBI survivor's functional status have not been fully examined with respect to appraisal of caregiving. This study examined these factors with respect to both positive and negative appraisals of caregiving in four main areas: perceived burden, caregiving relationship satisfaction, beliefs about caregiving, and mastery with caregiving. Sixty primary caregivers of individuals who sustained a TBI within the last 6 months to 15 years were administered the Caregiver Appraisal Scale, as well as the Coping Inventory for Stressful Situations, a 21-item version of the Family Assessment Device, and the Social Provision Scale. These findings were examined in relation to the TBI survivor's scores on the Disability Rating Scale and the Functional Independence Measure at the same time points post-injury. Results revealed that the majority of caregivers in those with moderate to severe brain injuries experienced dissatisfaction with many aspects of caregiving, especially with respect to feelings of burden and mastery. Additionally, emotionally-focused coping, behavioral control issues with respect to family functioning, and perceived social support appear to be most highly related to perceptions of burden, whereas perceived social support alone was the strongest factor in one's perception of caregiving mastery and satisfaction with the caregiving relationship. Interestingly, caregiving ideology was most closely related to avoidance-oriented coping. These results have direct implications for the development of interventions for caregivers of persons with TBI, especially with respect for the need to assess coping style and the development of social support networks.     

Caregiving,residence, race,and depressive symptoms

The objective of this study is to evaluate the psychological responses to caregiving between black and white dementia caregivers measured by self-reports of depressive symptoms evaluating the impact of sub-components of the Center for Epidemiologic Studies Depression Scale (CES-D) and residential arrangements of the caregiving dyad. The method included 87 intergenerational family caregivers enrolled in the Duke Caregiver Study (50 white and 37 black). Total CES-D and the four sub-components were modeled as dependent measures in separate linear regressions. Three models were examined. The first model tested race, living arrangements, and their interaction. The second model adjusted for age, gender, education, income, health status, cultural justification for caregiving, crime concerns, systolic blood pressure, diastolic blood pressure, and glycosylated hemoglobin. A third model added adjustment for caregiver burden. The results showed that there was a significant race by residence interaction for CES-D, somatic symptoms and depressive affect such that when the dyads are living apart–with the care recipient in their own home or in an institutional setting–whites reported more depressive symptoms than blacks. When the dyads lived together, this was reversed, and blacks reported higher depressive symptoms than whites. To conclude, all the parameters such as race, living arrangements, and the components of depression need to be taken into account to understand the impact of caregiving on the emotional health of caregivers.     

The sense of coherence, burden, and depressive symptoms in informal caregivers during the first month after stroke

BACKGROUND: Individuals with a strong sense of coherence (SOC), which considers one's ability to respond to stressors by the appropriate use of adaptive coping resources, can avoid breakdown when confronted with stress. This study examined the associations between SOC, perceived burden (caregiver's perception of the effect of caregiving-related stress) and depressive symptoms of informal caregivers (family members and involved friends) of stroke survivors one-month after the stroke. METHODS: One-hundred and four ethnically diverse veterans who were hospitalized after experiencing an acute stroke and their informal caregivers were enrolled in the study prior to discharge. One-month after being discharged from one of five Veterans Affairs Medical Centers in Florida and Puerto Rico, comprehensive data was collected and analyzed. RESULTS: Multiple regression analyses showed that greater SOC was associated with both lower burden (p < 0.0001) and fewer depressive symptoms (p < 0.0001). Higher caregiver burden, in turn, was significantly associated with more depressive symptoms (p = 0.003). However, when depressive symptoms was regressed on both SOC and burden jointly, the previously significant association between burden and depressive symptoms was no longer significant (p = 0.80) and SOC was still strongly associated with fewer depressive symptoms (p < 0.0001). CONCLUSIONS: Determining factors that may lessen burden and depressive symptoms for caregivers of stroke survivors during the transition period after discharge to their residence are imperative for developing successful interventions. SOC appears to be an important response in alleviating the levels of perceived burden and especially in depressive symptoms.