Multi-Level Factors Associated with Parental Aggravation Among Parents of School-Age Children with Common Mental Disorder

Background and Purpose: Parents of school-age children with mental disorder tend to experience high levels of stress. Multiple demands from caregiving to a school-age child with internalizing and externalizing symptoms are overwhelming and can heighten parents’ stress level. According to Lazarus and Folkman (1984), perceived stress can be either aggravated by the failure to cope with risk factors or mitigated by the help of protective factors. Identifying factors associated with parental stress can inform us of preventing parents’ negative mental health outcomes such as depression and anxiety. Efforts have been made to identify stress-related factors among parents of children with psychiatric disorder. Yet, most studies concentrated on developmental disability, not on other common diagnoses (e.g., ADHD, depression, anxiety, conduct disorder) and were not specific to parents of school-age children. In addition, relevant evidence mostly presented risk factors for parental stress (e.g., child’s symptom severity, comorbidity, parents’ depression) and used community samples. To fill this gap, this study attempts to examine both risk and protective factors for parental stress in children’s ecological systems with national samples of this population

Methods: Probability-based survey data from the 2018 National Survey of Children’s Health (NSCH) is used. Study subjects are parents of school-age children (6 to 17 years) with mental disorder (e.g., ADHD, depression, anxiety, conduct disorder) (N= 4,868). Bivariate analysis is utilized to explore the correlates between parental stress, multi-level factors (child, family, and neighborhood), and socio-demographic factors (e.g., gender, race, child’s diagnosis). In multivariate models, the impacts of various predictors on parental stress are examined using a multiple linear regression.

Results: Results suggest that the model accounts for a large proportion of variances of parental aggravation (R² =.42; F(23,4844) =155.46, p<.001). All 7 child factors, all three family factors, and two of three neighborhood factors are found to be significant for parental stress. Among child factors, child arguing too much (β=.20, p<.001), experience of mental health care (β=.14, p<.001) and child bullying others (β= .13, p<.001) are most salient risk factors for parental stress and more school reports on child problems are associated with greater parental stress. On the other hand, child flourishing (β=- -.21, p<.001), child school engagement, and child being bullied are associated with lower parental stress. For family factors, higher parental demand for emotional support are associated with greater parental stress, whereas family resilience (β=- -.12, p<.001) and parental competence are associated with lower parental stress. For neighborhood factors, while better neighborhood amenities are associated with higher parental stress, school safety is associated with lower parental stress. In socio-demographic factors, parental stress differed by race and is the highest for Asian parents among other races.

Conclusions and Implications: Findings confirmed multi-level risk and protective factors for parental stress. It implies that practice and policy efforts to promote their well-being need to be geared toward reinforcing identified protectors and considering racial differences. Reexamining the impacts of child being bullied, better neighborhood amenities, and experience of mental health care on parental stress are needed due to inconsistency with prior findings.