Objective This study examined predictors of excess psychological morbidity in parents of children with
intellectual disabilities. Methods Thirty-two parents of children with intellectual disabilities and 29 parents
of typically developing children completed the Hospital Depression and Anxiety Scale, and measures of social
support, child problem behaviors, sleep quality, and perceived caregiver burden. Results Parents of children
with intellectual disabilities registered high depression and anxiety scores, and the majority met the criteria for
possible clinical depression and/or anxiety. The strongest predictor of psychological morbidity was caregiver
burden. Analyses of its component dimensions indicated that feelings of guilt held the greatest consequence for
Key words anxiety; caregiving; depression; parents of children with intellectual disability.
Parents of children with intellectual disabilities frequently Social support has long been regarded to mitigate
report symptoms of depression and anxiety (Dunn, distress (Bailey, Wolfe, & Wolfe, 1994; Dunn et al., 2001)
Burbine, Bowers, & Tantleff-Dunn, 2001; Hastings et al., and considerable research has been directed at its role in
2005; Yirmiya & Shaked, 2005). Two key factors: the parents caring for a child with intellectual disabilities. It
adequacy of social support and the extent of the childs has generally been found to minimize the impact of
problem behaviors have been argued to account for much of caregiving on parental distress in such parents; those with
the distress observed. Social support has generally been greater social support show better psychological adjust-
found to be inversely related to depression and anxiety in ment (Gray & Holden, 1992; Dunn et al., 2001). The
such parents (Gray & Holden, 1992; Weiss, 2002; White & childs behavioral problems appear to be a major source of
Hastings, 2004), whereas the childs problem behaviors are psychological distress in parents of children with intellec-
positively associated with these symptoms (Baker et al., tual disabilities (Baker et al., 2003; Blacher & McIntyre,
2003; Blacher & McIntyre, 2006). More recently, within the 2006; Floyd & Gallagher, 1997; Maes, Broekman, Dosen,
wider caregiving context, sleep quality and caregiver burden & Nauts, 2003). Higher scores on the Aberrant Behaviour
have been identified as significant predictors of psycholog- Checklist (Aman, Richmond, Stewart, Bell & Kissel, 1987)
ical morbidity (Brummett et al., 2006; Magana, Ramirez subscales (e.g. lethargy, stereotypical behavior, and
Garcia, Hernandez, & Cortez, 2007; Meltzer & Mindell, hyperactivity) were associated with greater distress
2006; Phipps, Dunavant, Lensing, & Rai, 2005; Thompson, (Stores, Stores, Fellows, & Buckley, 1998). Further, the
Fan, Unutzer, & Katon, in press). These are factors ame- more challenging the behaviors that a child exhibits, the
nable to psychological intervention (Carter, 2006; Ostwald, greater the recourse to mental health services by parents
Hepburn, Caron, Burns, & Mantell, 1999). However, sleep (Floyd & Gallagher, 1997).
quality and caregiving burden have rarely been examined as Sleep quality is an important aspect of well-being and
possible predictors of depression and anxiety in parents is strongly related to overall quality of life (Zammit,
caring for children with intellectual disabilities. Weiner, Damato, Sillup, & McMillan, 1999), secretion
All correspondence concerning this article should be addressed to Stephen Gallagher, School of Sport and Exercise
Sciences, University of Birmingham, Birmingham, B15 2TT, England. E-mail: sxg598@bham.ac.uk
Journal of Pediatric Psychology 33(10) pp. 11291136, 2008
doi:10.1093/jpepsy/jsn040
Advance Access publication April 22, 2008
Journal of Pediatric Psychology vol. 33 no. 10 The Author 2008. Published by Oxford University Press on behalf of the Society of Pediatric Psychology.
All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org
1130 Gallagher, Phillips, Oliver, and Carroll
(Bramley, Easton, Morley, & Snaith, 1988; Herrmann, encompasses several dimensions of sleep from subjective
1997), and performs well as a psychiatric screening device sleep quality, sleep latency, to daytime dysfunction.
(Herrmann, 1997). The scale has been used in research Scores on items range from 0 (no difficulty) to 3 (severe
with parents of children with intellectual disabilities difficulty). By summing component scores, a total sleep
(Hastings & Brown, 2002; Hastings et al., 2005). For the quality score is obtained that ranges from 0 (good sleep
present sample, Cronbachs a was .86 for both the quality) to 21 (poor sleep quality). This index has been
depression and the anxiety subscales. shown to distinguish between good sleepers, poor
sleepers, and sleeping disorder patients over an
Social Support 18-month period (Buysse et al., 1989). Global and
Social support was assessed using the 12-item Support component scores of the scale were also found to correlate
Functions Scale (Dunst, Trivette, & Deal, 1988). Parents with a sleep diary, actigraphy, and depression scores
rate sources of support available to them (e.g., someone to (Grandner, Kripke, Yoon, & Youngstedt, 2006). Further,
help take care of my child and (e.g., someone to talk to sensitivity and specificity rates to the clinical diagnosis of
about things that worry me) support on a 5-point Likert insomnia were 93% and 100%, respectively, for a PSQI
scale ranging from 1, never, to 5, quite often. The reliability Global Score of >8, and 83% and 100% for a diagnosis of
and validity of the scale were established in a study of 121 insomnia based exclusively on PSQI-derived sleep variable
Examples of items loading on these factors are Do you Table I. Demographics, Anxiety, and Depression Levels for Caregivers
of Children with Intellectual Disabilities (Caregivers) vs. Caregivers of
feel that your child currently affects your relationship with Normally Developing Children (Controls)
other family and friends in a negative way? Do you feel
Caregivers Controls Test of
strained when you are around your child? Do you feel (N 32) (N 29) difference
you could do a better job in caring for your child?,
Sex (Female) 24 (75%) 20 (69%) w2 (1) 0.06, p .81
respectively. This study examined both the overall scale Marital status (Partnered) 28 (88%) 20 (70%) w2 (1) 2.11, p .15
score and scores on the three individual dimensions, in Ethnicity (Caucasian) 29 (91%) 26 (90%) w2 (1) 0.00, p 1.00
order to elucidate possible future intervention strategies. Occupational status 15 (47%) 16 (55%) w2 (1) 0.15, p .70
(Professional)
Statistical Analyses Currently employed 23 (72%) 28 (96%) w2 (1) 7.19, p .007
outside the home
Initial analyses of group differences were by chi-squared Mean age (SD) years 42.8 (5.78) 39.9 (4.36) F (1,59) 4.76, p .03
and univariate ANOVA and ANCOVA, with 2 reported as Mean age of main care 11.5 (3.35) 8.8 (4.23) F (1,58) 7.52, p .008
a measure of effect size. These analyses were employed to recipient (SD) years
test the first hypothesis. Subsequent analysis within the Mean depression 8.6 (3.92) 3.2 (2.31) F (1,59) 41.64, p <.001
score (SD)
parents of children with intellectual disabilities was by
Mean anxiety score (SD) 11.0 (4.40) 5.0 (2.44) F (1,59) 43.12, p <.001
regression. Linear regression was applied with continuous
you dont have enough money to care for your child, in social and personal consequences; psychological burden;
addition to the rest of your expenses? were significantly and guilt (Ankri et al., 2005). It was the latter of these that
associated with both depression b .41, p .03 and proved to be the strongest predictor of psychological
anxiety scores, b .36, p .03. In addition, parents morbidity in parents caring for an intellectually disabled
response to the item Do you feel you could do a better job child. There is indirect evidence in favor of this contention.
in caring for your child? significantly predicted anxiety, A number of studies have observed that the parents of
b .39, p .02. children with intellectual disabilities who reported feelings
of guilt also indicated that they lacked confidence in their
parenting abilities and decision-making which, in turn, was
Discussion associated with increased distress, including anxiety
(Benderix, Nordstrom, & Sivberg, 2006; Lenhard,
The present study confirmed that parents caring for a child
Breitenbach, Ebert, Schindelhauer-Deutscher, & Henn,
with an intellectual disability report substantial symptoms
2005).
of depression and anxiety (Dunn et al., 2001; Yirmiya &
The current study has a number of limitations. First,
Shaked, 2005). Almost two-thirds of the parents of
the analyses are cross-sectional. Accordingly, the high
intellectually disabled children in the current study met
levels of psychological morbidity observed in parents
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