Parenting Stress Index (PSI) Article Summary 2/24/19
Almogbel YS, Goyal R, Sansgiry SS. Association between parenting stress and functional impairment among children diagnosed with neurodevelopmental disorders. Community Ment Health J. 2017;53:405–414
- Purpose
- There is an abundance of research on parenting stress in parents of children with Neurodevelopmental Disorder (NDD). The majority of this research has been conducted on families of children with intellectual disability, autism spectrum disorder, ADHD, and language and learning disorders, and most studies conclude that parents stress is significantly higher in parents of children with NDD compared to control groups. This increase in stress may be attributed to an imbalance between parents’ perception of their demands versus their capabilities. There is, however, a lack of research on the level of stress in parents in association with the level of functional impairment in the child. The current study aimed to investigate this matter.
- Study population
- Parents of children diagnosed with NDD aged between 3-18 and attending schools that provided special education were chosen for the sample. The sample demographics were reflective of the population in the area (Houston, TX). A total of 565 questionnaires were sent out, and 150 were collected (~26% response rate).
- Methods & Outcome Measures
- Questionnaires were distributed through each school to parents, and they were given a 3-month period of time to complete the survey and return it to the school. The survey consisted of three parts: parent/family demographic information, the Parenting Stress Index-Short Form(PSI-SF; measure of parent stress in which a score of ≥ 85 on a scale of 36-180 indicates stressed parents), and the Columbia Impairment Scale(CIS; measure of functional impairment in domains of interpersonal relations, psychopathology, job/schoolwork, and leisure time). All data collected were categorized dichotomously for statistical analysis.
- Intervention
- This was a cross-sectional, non-experimental, exploratory study according to authors, so there were no interventions conducted.
- Results
- The mean score for the CIS was 17.4, and 61% of children scored ≥ 16, which classified them as functionally impaired. The mean score for the PSI-SF was 108, and 70.6% of parents scored ≥ 85, which classified them as stressed. Nearly 40% of parents reported they had a condition of their own that may impact their childcare abilities (and 73% of those individuals reported depression). In functionally impaired children, there was a positive relationship between the PSI-SF and CIS (with all other variables constant); a one-point increase in the CIS resulted in a 59% increase in stress (0.59 points on the PSI-SF. Parent education was negatively correlated with the PSI-SF. Researchers also found a strong positive correlation between parents’ own identified diseases and the PSI-SF. Interestingly, in children who were not classified as functionally impaired on the CIS, there was no significant correlation between the CIS and PSI-SF.
- Major Strengths/Limitations
- Strengths: The authors used two well-researched outcome measures, which helped with the validity of their findings. At ~26%, this study had a relatively good response rate from its participants. Lastly, the authors were concise with their data presentation and extracted meaningful conclusions from this information.
- Limitations: As stated by the authors, there were several limitations to this study. They used convenience sampling (certain schools in a certain area), so data may not reflect the general population. Researchers were unable to determine causation due to the cross-sectional and non-experimental study design. Also, since the questionnaire was not administered in person, it left some questions up to interpretation by the parents, which may have led to confusion and inaccurate responses and resulted in many non-responders. Lastly, the inherent bias of the questions asked in these questionnaires can cause exaggerated responses by the parents.
- Overall Conclusion
- The authors concluded that, among parents whose children classified as functionally impaired on the CIS, level of impairment was a good predictor of parenting stress (increased impairment leads to increased stressed). Thus, healthcare practitioners should be able to identify parents at high risk for stress based on functional impairment level and recommend stress-relieving strategies for those parents (as an early intervention strategy), and since the demands for caring for a child with NDD are multifaceted (physical, economical, emotional, etc.), parents should have access to a variety of resources. These researchers also alluded to the fact that managing parents’ health is extremely important, as mental and physical well-being are closely related.
3 responses to “Parenting Stress Index (PSI) Article Summary 2/24/19”
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This outcome measure is very interesting to assess the stress on the caregivers to the children with needs. Often studies focus on those who have been diagnosed with a disability, and does not look at the possible burden of the caregiver. I did notice that this study only collected data in one city. It would be interesting to see if data would should similar results across multiple locations, demographics, diagnoses, etc. Also, if the questionnaire was given in person, I wonder if the response rates would be higher, or if data would show different outcomes due to parents being hesitant with an in-person interview.
Great article review!
Dani
Dani,
Thanks for your response. I agree that it would be interesting to see the study conducted across different locations (perhaps across the entire country) and with different populations (in this study nearly half of the parents had children who were diagnosed with Autism Spectrum Disorder). Maybe the demographics and lifestyles in Houston lead to certain stress levels different than another location in the US. I believe the researchers would have gotten different results from their data if they conducted the questionnaire in person, as they would have gotten a significantly higher response rate, which may have included parents with greater or less stress that what they found (maybe lack of time was a reason for not responding).
Kind regards,
Ryan
I knew that this would make for an interesting read and I was not disappointed. It’s no secret that being a parent is stressful and having a child with a NDD can be even more stressful. With that being said, it was surprising to see that there is an actual outcome measure to score that. I would be interested to see what kinds of questions were asked on the outcome measure. Also, just out of curiosity, it would be interesting to see the outcome scores of the control group (NDD) compared to the outcome scores of parents who are parenting their first child. Theoretically there is a learning curve to parenting and so it would be nice to see if novelty alone produces a bulk of that stress.
Kindly,
-Chioma