Depression, Stress and Anxiety among Parents of

Sons with Disabilities

Margarida Pocinho 1,3, Líria Fernandes 2,3
1
Departamento de Psicologia, Universidade da Madeira, Portugal Received:
2
Governo Regional da Madeira, Portugal 29 October 2017
3
Centro de Investigação em Estudos Regionais e Locais (CIERL), Universidade da Madeira,
Portugal

Accepted:
Corresponding author: Margarida Pocinho | [email protected]
08 August 2018

Abstract
Background: The prevention of depression, stress, and anxiety is an enormous concern of the World Health Organization and it has
been a topic of research over the last decades. However, studies with families with sons or daughters with disabilities are scarce, which
stresses out the need to develop scientific research in this area. It is of paramount importance to understand the impact of having a
child with disability, so that effective strategies of action can be delineated.
Goals: This study aims to assess depression, stress and anxiety of parents with sons or daughters having intellectual deficit, multi-
deficiency or autism, considering gender, age of both parents and sons/daughters, as well as education level of the parents.
Methods: With a cross-sectional observational study, data were collected at schools and at special education institutions through self-
administered questionnaires. Two different groups of participants were included in the sample: parents of sons/daughters having
intellectual deficit, multi-deficiency or autism, and parents of sons/daughters without disability. Participants were recruited according
to a random stratified (by sons/daughters’ age and gender) random sampling. The Depression Anxiety Stress Scale (DASS-21) was
administered to both groups of parents, with the collaboration of special educations teachers and school psychologists. Data were
analysed using SPSS version 21.0. Descriptive and parametric inferential statistic (t-tests and ANOVA) were performed. Effect sizes
based on differences between means were also calculated.
Results: Overall, 871 participants were enrolled in the study: 403 parents (227 mothers and 176 fathers; 21 to 81 years old, M = 45) of
sons/daughters having a disability, and 468 parents (242 mothers and 226 fathers; 25 to 79 years old, M = 43)) of sons/daughters
without disabilities. Most of the children had intellectual disabilities (n = 206), followed by autism (n = 143) and multi-deficiency (n =
52). Parents with children/youth with disabilities showed higher levels of anxiety, depression and stress than the other parents. Levels
of anxiety, depression and stress are associated with disabled sons/daughters’ age (higher levels associated to older ages) and nega-
tively with parent’s education level (higher levels associated to lower education).
Discussion: These results highlight the need to more deeply reflect about the necessity of designing intervention programs targeting
the development of coping strategies to prevent or minimize parent’s anxiety, depression and stress. This type of intervention is of
key importance to capacitate families to cope with these adverse conditions, thus promoting the mental health and psychological
wellbeing of parents and disabled children.

Keywords: Depression, Stress, Anxiety, Children, Disability.

Introduction decades. However, studies with families having disa-

bled dependents are scarce, stressing out the need to
The prevention of depression, stress and anxiety is a develop scientific research in this area.
main concern of the World Health Organization (OMS; It is of paramount importance to understand the im-
2017) and it has been a topic of research over the last pact of the birth of a child with disabilities for the

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Advance Online Publication. August, 2018 page 94
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family, so that effective strategies of action can be de- Depression and anxiety in parents with children hav-
lineated. ing disabilities

The current systemic models and theories sustain a The birth of a child causes structural changes and rep-
definition of ‘family’ as a system, which can only be resents a stressful event in any family. The
correctly understood from the holistic point of view vulnerability of a child with a disability or at risk of
(Relvas, 1996), based on two main aspects. The first is atypical development may lead to an increase in the
that no family is the same as another and, since family levels of parental and family stress, implying an addi-
is a system, any change in one of its members affects tional effort in terms of adaptation and organization
the whole (Assunpção & Sprovieri, 1993). A second of the family system (Alves & Nex, 2015; Pereira &
premise of this systemic perspective refers to its in- Nóbrega, 2011).
trinsic complexity, considering family as part of wider
contexts, integrated into the surrounding community Studies conducted with families with children having
and, more broadly, into the society as a whole. disabilities identified three types of stressors (How-
ard, Wiliams, Port, & Lepper, 2001): acute factors,
The family is the first relational context of a child with related to periodic incidents associated with the
disability, being the major determinant of behaviour child's disability; chronic factors, including concerns
and personality formation (Buscaglia, 2006). The fam- about the future, financial limitations and acceptance
ily structure is dynamic and goes from stable phases of individual differences by society; and transition fac-
to less stable ones. These moments of transformation tors, appearing in major life moments (mainly, at
imply great stress and anxiety in the family life and are transition between stages of the life cycle). According
typically referred to as moments of crises (Martins & to the authors, these stress factors influence the type
Couto, 2014, Pereira & Kohlsdorf, 2014). Inde- of relationships that parents establish with their chil-
pendently of the stage of development of the family, dren, also depending (obviously) on the
the birth of a disabled child is most usually perceived characteristics of the child.
as a particularly problematic moment of crisis (Da Paz
& Wallander, 2017). The birth of a disabled child is as- Scientific research has put greater attention to moth-
sociated with frustration, physical and psychological ers than to fathers. Mothers of children with
stress, anxiety, and perceived inability to cope with disabilities have higher levels of stress than fathers
the situation in an appropriate way (Caruso, 2017). (Dyson, 1997; Hornby, 1995; Lamb & Billings, 1997;
Within this context, the adaptation of the family to the Sloper et al., 1991, as cited in Pereira-Silva & Dessen
specific needs of the child is extremely important since 2001). Yilmaz, Yildirim, Turan, Kilinç, and Ozer (2013)
the way the child is included in the group will ulti- evaluated psychological indicators of parents of 35
mately affect his or her development children with moderate disability. Parents’ anxiety,
(Bronfenbrenner, 1999). depression, and quality of life were assessed through
the BDI, the State-Trait Anxiety Inventory (STAY) and
The increased level of stress and anxiety on parents
the Nottingham Health Profile. The level of trait anxi-
can, in turn, increase their likelihood of having depres-
ety of mothers was higher comparing to fathers; the
sion, with a relevant negative impact on their quality
levels of state anxiety do not differ between parents;
of life (Caruso, 2017; Pereira & Kohlsdorf, 2014; Pe-
fathers presented higher values of anxiety, depression
reira & Nobrega, 2011)
and lower quality of life before a male child whereas
mothers did not differ according to the sex of the dis-
abled child. Mothers who spend more time caring for
their children were more depressed and had lower
quality of life. Also, Isa et al. (2013) shown that moth-
ers with children with disabilities had a less adequate

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Depression, Stress and Anxiety among Parents of Sons with Disabilities
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functioning compared to fathers. In another study, studies reported differences in terms of family stress
Olsson and Hwang (2001) reported that fathers pre- according to the type of diagnosis. For example, par-
sented lower rates of depression than mothers. The ents of children with autism showed higher levels of
fact that mothers with children with disabilities are stress than parents of children with Trisomy 21
more likely to describe symptoms of depression than (Holroyd & McArthur, 1976, as cited in Pereira, 1996).
fathers (Bailey, Golden, Roberts, & Ford, 2007) may The sociodemographic characteristics and financial
explain this gender difference, together with the fact status of the family play an important role on the ad-
that mothers are usually responsible for most of the justment of families to the condition of raising disable
additional care that needs to be given to the disabled children. The results of the study by Llewellyn,
child. On the other hand, according to Silva and Des- McConnell, Gething, Cant, and Kendig (2010) revealed
sen (2001), fathers show less satisfaction with family worse mental health among younger parents of chil-
life, which influences family interactions and marital dren having disabilities. The authors examined health
relationships. status and coping strategies in older Australian par-
ents when caring for a dependent adult with
Different studies have revealed marked differences intellectual disability. Overall, the results did not differ
between mothers of children with disabilities and significantly from those of the Australian general pop-
mothers of children without disabilities (Shapiro et al., ulation. Members of socioeconomic lower-class
1998; Slonims & McChonachie, 2006, cited by Pereira- families experience more severe stress, also impacting
Silva & Dessen, 2006). Pereira-Silva and Dessen (2006) the ability of parents to interact with their children
reported that mothers of children with disabilities are (Rosenberg, 1979). In a longitudinal study by Chess
more affected by the provision of care and obligations and Kron (1978, as cited in Pereira, 1996), it is sug-
with the child than mothers of children having no dis- gested that middle-class professions are associated
abilities, being this overload a factor that generates with higher levels of family stress. This is especially rel-
stress and less positive feelings, often generating feel- evant when considering that the existence of a
ings of anxiety and depression. The same authors disabled member creates additional financial needs
reported that stress depends on the different types of resulting from increased consumption and a decline in
disability and vulnerability of the child. productive capacity (Turnbull & Turnbull, 1990).

Stress is indeed one of the most commonly studied When applying the Brief Family Distress Scale to par-
variable in mothers of children with disabilities (Bryne, ents of children with autism spectrum disorders,
Cunningham, 1985, as cited in Pereira-Silva & Dessen, Weiss and Lunsky (2011) showed a positive associa-
2004; Caruso, 2017). As already stated, different stud- tion between coping strategies and quality of life of
ies revealed that these mothers experience more the caregiver, and a negative association between
stress than mothers of children with a normal devel- stressors (e.g., severity of aggressive behavior, nega-
opment (Chouhan, Singh, & Kumar, 2016; Pereira- tive life events) and caregiver’s mental health
Silva & Dessen, 2004). For example, Shin and Nhan problems.
(2009), in a comparative study regarding stress and
perceived social support of mothers of children with Cherubini, Bosa, and Bandeira (2008) analyzed the
or without disabilities, found that mothers of children prevalence of symptoms of anxiety and depression
with disabilities experience more stress and more among parents of children with X-fragile syndrome,
health disorders than the other mothers. However, children with Trisomy 21 and children with typical de-
other studies found that the parents of children with velopment. They identified a higher prevalence of
developmental disabilities did not differ significantly agoraphobia and panic disorder in mothers group with
from parents of children without disabilities in terms X-fragile syndrome; in the group of mothers with Tri-
of parental stress, social support or family functioning somy 21, depression and generalized anxiety were the
(Al-Farsi, Al-Farsi, Al-Sharbati, & Al-Adawi, 2016, Dy- most prevalent disorders; depression also appeared in
son, 1997, Hayes, & Watson, 2013). Finally, other

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the group of mothers with typical development, but Methods

with lower prevalence.
This is an observational cross-sectional study with
Olsson and Hwang (2001) evaluated depression indi- data collection through self-administered question-
cators using the Beck Depression Inventory (BDI) in naires.
216 families with children with autism and/or intellec-
tual disability. The results showed that the effort to Participants and sampling
provide care and attention to children with disabilities A sample composed by fathers and mothers with
lays parents at risk of depression. Mothers of children sons/daughters with disabilities was recruited from
with autism have attained higher BDI scores than the overall population of 3 979 users of the Regional
mothers of children with other-than autism intellec- Directorate for Special Education and Rehabilitation of
tual disabilities. Also Chouhan, Singh and Kumar the Autonomous Region of Madeira, Portugal (regis-
(2016) showed that diagnosis of autism or serious be- tered population within the previous 12 months). It
havioural disorders was highly associated with was a random stratified sample by types of disabilities,
symptoms of depression in parents. Their study also age, and gender of sons/daughters with disabilities.
revealed that it is more difficult for mothers to cope Three types of disabilities were considered: intellec-
with child’s behavioural disfunctions, associated to tual deficit, autism, and multi-deficiency. These types
the disability, than with the physical or cognitive as- of disabilities were chosen because they are the three
pects of the disability. most prevalent ones among youngsters in Portugal,
according to data from Regional Directorate for Spe-
Chou, Pu, Fu, and Kröger (2010) evaluated symptoms cial Education and Rehabilitation of the Autonomous
of depression and health status in 350 mothers (55 Region of Madeira database about registered disabled
years of age or older) having adult descendants with children (Fernandes, 2014).
intellectual disabilities. They concluded that 60% to
70% of the caregivers had symptoms of depression. A comparative random and stratified (by sons/daugh-
Self-reported physical health was the variable most ters’ gender and age) sample of parents with
strongly associated with symptoms of depression. sons/daughters without disabilities was also recruited
from public schools of the Autonomous Region of Ma-
Not all news is bad news. It has been shown to exist is deira, Portugal, at the same time.
a negative correlation between family overload in
caregiving and the age of the children (Hsieh et al., Instruments and procedures
2009) suggesting that family members gradually adapt The DASS-21 and a sociodemographic questionnaire
as their children grow up. were used for data collection. The DASS-21 is a ques-
tionnaire that measures (by self-report assessment)
The present study aims to study anxiety, depression three constructs in individuals over 17 years of age:
and stress among parents of sons or daughters with a depression, anxiety, and stress (Lovibond & Lovibond,
disability (intellectual deficit, multi-deficiency or au- 1995). It is a good research and clinical measure, es-
tism) versus parents having of sons/daughters without pecially when we need to assess the complex relations
disabilities. This comparison was done taking into ac- between emotional disorders and environmental
count parents’ gender, age, educational level and area stressors, because it allows a differentiation between
of residence, as well as according to gender and age of the three constructs (Daza, Novy, Tanley, & Averill,
the child with disabilities. 2002, as cited in Pais-Ribeiro, 2004).

DASS-21 is composed of 21 items, seven per subscale.

Respondents answer each item with a 4-point Likert-
type scale, ranging from 0 (“Did not apply to me at all”)

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Depression, Stress and Anxiety among Parents of Sons with Disabilities
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to 3 (“Applied to me very much or most of the time”). moderate size effect for d between .50 and .79; large
Items comprising the scales are summed and doubled size effect for d >= .80.
to be equivalent to the longer DASS-42 version. The
scale provides three scores, one per subscale, where Ethical issues
the minimum is "0" and the maximum is "21". High This study was submitted to and approved by the Re-
scores express more negative psychological state. gional Directorate for Education and the Regional
Directorate for Special Education.
The Portuguese version of DASS-21 was developed
and tested by Pais-Ribeiro, Honrado, and Leal (2004). All technicians who collaborated in the study (for data
They found good Cronbach’s alpha values for depres- collection) were previously informed about the goals
sion, anxiety and stress (a=.85, .74 and .81, and procedures of the study. Participant’s also signed
respectively), similar to the internal reliability of the an informed consent document, with detailed infor-
original version. The same study also showed that mation about the goals, procedures and right to refuse
DASS-21 has good convergent and discriminant valid- and quite participation at any moment. Anonymity of
ity. Our study also showed good Cronbach’s alpha participants was guaranteed.
values of .88, .87, and .88, respectively, for depres-
sion, anxiety and stress.
Results
The variables included in the sociodemographic com-
ponent of the questionnaire were: children and Overall, 871 parents (fathers and mothers) partici-
parents’ age, children and parents’ gender, and par- pated in the study: 403 parents (227 mothers and 176
ent’s education. fathers) having sons/daughters with one of the con-
sidered disabilities (intellectual deficit, multi-
Questionnaires were distributed by researchers at deficiency or autism) and 468 (242 mothers and 226
schools and special education institutions that ac- fathers) having sons/daughters without disabilities.
cepted to participate. The questionnaires were self- The autism (n = 83) and multi-deficiency (n = 32) sam-
administered individually with the collaboration of ple of parent-dyads corresponded to the existing
specialized teachers and school psychologists, techni- population (participation rate = 100%). From the total
cians with whom parents have a relationship of trust. of 797 sons/daughters with intellectual deficit, 100
Sometimes, due to the absence of one of the parents, parent-dyads were randomly selected (12,5% of the
it was agreed that the parent who was invited (at population). From this sample size (430 parents; 215
school) would take a copy of the questionnaire to be father-mother dyads), 403 parents participated (an-
answered by the missing parent, with a commitment swer rate = 93,7%), 227 mothers and 176 fathers, aged
to return it to the school's technician. However, most between 21 and 81 years old (M = 45; SD = 9). Regard-
of the questionnaires were answered at school by ing the sample size per type of disability, 206 father-
both parents. mother dyads had sons/daughters with intellectual
disabilities (51,1% of the sample), 143 dyads (35,5%)
Data analysis had a son/daughter with autism, and 52 dyads (12,9%)
Data were analysed using SPSS version 21.0. Besides had a son/daughter with multi-deficiency.
univariate descriptive statistics, we used ANOVA and Sons/daughters with disabilities were mostly males
t-Student tests, with estimation of effect sizes, for (62.3%), aged between 4 and 30 years (with 30.7%
studying bivariate associations. When finding signifi- aged 7 to 12 years).
cant differences with ANOVA, post-hoc comparison
test was performed with Bonferroni test. Statistical Regarding the sample of parents with dons/daughters
significance was defined as α =.05 for all tests. For ef- without disability, this was composed of 468 parents:
fect size, the following cut-offs were applied (Cohen, 242 mothers and 226 fathers, aged between 25 and 79
1988): small size effect when d ranging from .20 to .49; years (M = 43.04, SD = 7.89).

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The levels of anxiety, depression and stress in parents (intellectual deficit, multi-deficiency or autism) is not
with sons/daughters with disabilities are significantly associated with parents’ levels of depression
higher than those of the comparative sample: t(869) = (F(2,398) = 1.14, p = .32) stress (F(2,398= 65, p = .52) or
5.65, p < .001, d = .38) for anxiety, t(869) = 5.65, p <.001, anxiety (F(2,398) = 2.68, p = .07).
d = .39 for depression, and t(869) = 2.83, p < .001, d =
.19 for stress (Table 1). However, the type of disability

Table 1. DASS-21 results for parents with or without a child or adolescent having a disability (by relevant
sociodemographic characteristics)
Anxiety Depression Stress
M (DP) F(2,398); p M (DP) F(2,398); p M (DP) F(2,398); p
a
Son/daughter’s age
<= 6 (n=88) 2.25 (3.42) 2.58 (2.92) 3.96 (3.40)
4,23 ; .01 5.33 ; .00 2.76 ; .06
7 – 18 (n=224) 3.13 (3.63) 3.63 (4.10) 4.91 (4.09)
19 – 30 (n=118) 3.88 (4.56) 4.91 (4.09) 5.34 (4.68)
Parents’ agea
21 – 39 (n=272) 2.57 (3.09) 3.03 (3.37) 4.48 (3.46)
4.66 ; .01 3.07 ; .04 2.45 ; .08
40 - 49 (n=398) 2.92 (3.72) 3.54 (4.07) 4.57 (4.10)
>= 50 (n=204) 4.06 (4.66) 4.36 (4.59) 5.55 (4.73)
Parents’ educationa
<= 4th (n=214) 4.57 (5.05) 5.03 (4.90) 5.91 (4.77)
5th – 9th (n=224) 2.80 (3.31) 15.09 ; .00 3.04 (3.30) 14.08 ; .00 4.25 (3.71) 7.16 ; .00
10th – 12th (n=207) 1.61 (2.10) 2.28 (2.63) 3.76 (3.27)
University (n=223) 0.92 (1.42) 1.68 (1.66) 3.76 (2.68)
Parents’ gendera
Fathers (n=402) 2.85 (3.79) -1.30 ; .19b 3.05 (3.61) 2.54 ; .01b 4.40 (4.14) 1.79 ; .07b
Mothers (n=469) 3.37 (3.97) 4.08 (4.34) 5.15 (4.13)
Sons or daughters
With disability (n=215) 3.14 (3.89) 5.65 ; .00c 3.14 (3.89) 5.65 ; .00c 4.82 (4.14) 2.83 ; .00c
Without disability (n=215) 1.85 (2.83) 1.85 (2.83) 4.07 (3.61)
a
Only considering the sample of sons or daughters with disabilities
b c
t401 ; t869

When considering only the sample of parents with Only the stress scores were not different according to
sons/adolescents having a disability, significant differ- parents' age. Parents between 21 and 39 years old
ences were found for anxiety and depression have significant different scores for depression (F(2,398)
according to the age of the son/daughter. Comparing = 3.07, p <.05, d = .33) and anxiety (F(2,398) = 4.66, p
the group “0-6 years” with the group “19-30 years”, <.05, d = .37) of parents aged 50 years or older. The
there were significant differences for both depression group of parents aged 50 years or older have higher
(F(2,398) = 5.33, p < .01, d = .53) and anxiety (F(2,398) = scores of depression (M = 4.36, SD = 4.59) and anxiety
4.23, p <.05, d = .42). The group of parents with (M = 4.06, SD = 4.66) than parents aged 21 to 39, and
sons/daughters between 19 and 30 years old showed than parents between 21 and 39 (depression: M =
higher values of depression (M = 4.91, SD = 4.09) and 3.03, SD = 3.37; anxiety: M = 2.57, SD =3.09) (Table 1).
anxiety (M = 3.88, SD = 4.56), compared to parents In both cases the effect size was small.
with children less than 6 years (anxiety, M = 2.25, SD =
3.42; depression, M = 2.58, SD = 2.92) (Table 1). The Significant differences were found for all subscales of
effect size was moderate for depression and small for DASS-21 according to parents’ education level. The
anxiety. multiple comparisons between the various groups
considering the education level allow us to conclude

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Depression, Stress and Anxiety among Parents of Sons with Disabilities
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that all subscales tend to decrease as the level of edu- and stress than parents with children without disabili-
cation increases (Table 1): anxiety (F(2,398) = 15.09, p < ties. These results are in line with what has been
.01), depression (F(2,398) = 14.08, p < .01) and stress reported by Caruso (2017), Pereira and Kohlsdorf
(F(2,398) = 7.16, p < .01). Less qualified parents (up to (2014), Shapiro et al. (1998), Hayes and Watson
the 4th grade) have significantly higher anxiety, de- (2013), and Al-Farsi, Al-Farsi, Al-Sharbati, and Al-Ad-
pression and stress values than parents with higher awi (2016). However, some studies do not
levels of education, and the effect size of the differ- corroborate these results or only partially. For exam-
ences is progressively higher as the education level ple, Pereira-Silva and Dessen (2006), in a comparative
increases. Thus, among the group "up to the 4th study between fathers of children with Trisomy 21 and
grade", there were higher levels of anxiety (M = 4.57, fathers of children with typical development, did not
SD = 5.05), depression (M = 5.03, SD = 4.90) and stress find significant parental stress differences. Also, Dyson
(M = 5.91, SD = 4.77) than for parents of the other ed- (1997) found out that parents with or without children
ucation level groups. The effect sizes are small when with disabilities do not differ significantly in terms of
comparing the group of “up to the 4th grade” with the parental stress.
group "5th – 9th grade" (d = .42, d =.48 and d =.41 for
anxiety, depression, and stress, respectively). When Our study shows that the type of disability (intellectual
comparing the same less education level (up to 4th deficit, multi-deficiency or autism) is not associated
grade) with parents with secondary education (10th to with the levels of depression, stress or anxiety of par-
12th grades), the size of the effect increases to moder- ents. These results are not in line with Dale's findings
ate magnitude (d = .74, d =.58 and d =.52 for anxiety, (1996, as cited in Coutinho, 2004), concluding that the
depression, and stress, respectively). Finally, when more severe the disability, the more the distress expe-
comparing parents having less than the 5th grade with rienced by families. The same happened in the studies
parents with university studies, the difference of of Cherubini, Bosa, and Bandeira (2008) and of
scores of anxiety and depression is even greater (high Holroyd and McArthur (1976, cited by Pereira, 1996),
effect sizes: d = .92 and d =. 94, respectively). The ef- that revealed that parents of autistic children have
fect size is moderate for stress (d = .55). higher levels of stress than parents of children with
Trisomy 21. Olsson and Hwang (2001) also demon-
Comparing fathers with mothers of sons/daughters strated that mothers of children with autism are at
with disability, significant differences were found for higher risk than mothers of children with intellectual
depression (t(399) = 2.54, p <.05, d = .26). Mothers re- disabilities without autism. In the same sense, Schmidt
vealed higher scores of depression (M = 3.37, SD = and Bosa (2007) also shown that the mothers of chil-
3.97) than fathers (M = 2.85, SD = 3.79), with a small dren and youth with autism are a group at high risk for
difference effect size. the development of stress. On the other hand, the
findings of Pereira-Silva and Dessen (2006) are in line
with our results: they did not find significant differ-
ences in the functioning of families with children with
Discussion Trisomy 21, comparing them with those with normal
development in respect to parental stress.
This study aimed to assess depression, stress and anx-
iety of parents with (and without) sons or daughters The parent’s and sons/daughters’ sociodemographic
having intellectual deficit, multi-deficiency or autism, characteristics deserved special attention in our study.
considering gender, age of both parents and We found out that anxiety and depression scores of
sons/daughters, as well as education level of the par- older disabled sons/daughters’ parents are higher
ents. than the corresponding scores for parents of younger
sons/daughters with disability. On the other hand, no
In our study, parents of sons/daughters with disabili- significant differences were found regarding the level
ties presented higher values of depression, anxiety of stress. These data are consistent with the study of

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Pocinho & Fernandes
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Chou et al. (2010) with a sample of 350 mothers of dis- mentioned that mothers are heavily overloaded with
abled adults. These researchers showed that 60-70% the care of children with disabilities, triggering feel-
of older women, caregivers of adults with disabilities, ings of anxiety, depression and stress. Similarly,
are at high risk for symptoms of depression. In the Cherubini, Bosa and Bandeira (2008) concluded that
same way, Martins and Couto (2014) concluded that fathers present less psychiatric symptoms than moth-
the prevalence of depression and anxiety in older par- ers. Bailey et al. (2007), as well as Olsson and Hwang
ents with adult children with disabilities is higher than (2001), also concluded that fathers indicate lower val-
in younger parents. However, Hsich et al. (2009) found ues of depression than mothers. It is relevant to
that age of the children was negatively correlated with mention here that we obtained greater collaboration
the impact on the family. They concluded that family of parents of sons/daughters without disabilities than
members gradually adapt as their children grow up. from parents of sons/daughters with disabilities (also,
more resistance from fathers than from mothers).
We also found that stress, anxiety and depression lev-
els is associated with the age of the parents. Younger Future research should be extended to physical disa-
parents are much less susceptible to anxiety and de- bilities (sensorial and motor handicaps). It would also
pression than parents 50 years or older. These results be interesting to study the marital functioning of fam-
are according with Dave et al. (2014) who showed that ilies and their supportive networks, insofar as these
the levels of depression (prevalence of 63%) of par- may constitute moderating variables of parents' anxi-
ents of intellectual disabled children are highly ety, depression or stress. Another suggestion relates
associated with the age of these caregivers. The same to the possibility of evaluating the concerns of older
conclusions are pointed out by Martins and Couto parents of adults with intellectual disabilities with
(2014). Pereira (1996) contradicts these studies by qualitative studies using individual interviews or focus
showing that younger parents with children with disa- groups. According to Poston et al. (2004), this would
bilities present higher levels of stress because they be a relevant approach also to evaluate the spirituality
feel less prepared to cope with the situation. in lives of these families as a protective strategy.

Considering parent’s education level, it was verified Finally, recent literature (e.g. Burton, Zwahr-Castro,
that anxiety, depression and stress decrease as the Magrane, Hernandez, Farley, & Amodei, 2018; Siller,
level of education increases, which is according to Hotez, Swanson, Delavenne, & Sigman, 2018) has
Alarcão and Gaspar (2007), who reported that low ed- shown the importance of implementing parental psy-
ucational level is associated with disturbances in the chological intervention programs that should include
family and individual development. preventive coping strategies for anxiety, depression
and for stress situations. The Nurturing Program for
According to our data, the gender of the disabled Parents and Their Children with Special Needs and
son/daughter has no association with the anxiety, de- Health Challenges (SNHC) is a 12-sessions program for
pression or stress of their parents. These results parents of children with special needs that has been
contradict Lamb and Bilings (1997, as cited in Pereira- shown to be effective for promoting the empower-
Silva & Dessen, 2001), who found that parents have ment of families (Burton et al., 2018). Also, home-visit
higher anxiety, depression and/or levels of stress programs have been widely recognized as having a
when they have daughters with a disability than when high potential for parental coping development (Azzi-
they have sons with a disability. Lessing, 2011). It would be important to validate pro-
grams like these ones and to create a parental support
Considering the sex of the parents who participated in service for Portuguese families with children with dis-
our study, mothers included revealed higher scores of abilities. It is of paramount importance to develop
depression than fathers. Similar conclusion was re- families and disabled children’s autonomy, assuring
ported by Pereira-Silva and Dessen (2006), who

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Depression, Stress and Anxiety among Parents of Sons with Disabilities
____________________________________________________________________________________________________________

active participation of parents and children with disa- Buscaglia, L. (2006). Os Deficientes e Seus Pais (Fifth Edition).
Rio de Janeiro: Editora Record.
bilities in their own life projects. Educating these
Caruso, J. M. (2017). Stress, Anxiety, and Depression Experi-
parents and children for self-determination is impera- enced by Parents of Children with Special Needs and Self-Care
tive to diminish anxiety, depression and stress among Techniques. (Doctoral dissertation, Psychology in Counseling
Psychology Program). ProQuest Dissertations Publishing: Col-
these families.
lege of Saint Elizabeth, EUA.
Cohen, J. (1988). Statistical power analysis for the behavioral
sciences (Second Edition). Hillsdale, NJ: Lawrence Earlbaum
Associates.
Cherubini, Z. A., Bosa, C. A., & Bandeira, D. R. (2008). Estresse e
Acknowledgements Autoconceito em Pais e Mães de Crianças com a Síndrome do
X-Frágil. Psicologia: Reflexão e Crítica, 21(3), 409-417.
Disponível em: http://www.redalyc.org/articulo.oa?id=
We want to thank the active collaboration of the 18811682009
Agência Regional para o Desenvolvimento de Investi- Chou, Y. C., Pu, C.Y., Fu, L.Y., & Kröger, T. (2010). Depressive
gação, Tecnologia e Inovação (ARDITI). symptoms in older female careers of adults with intellectual
disabilities. Journal of Intellectual Disability Research, 54(12)
1031–1044. doi:10.1111/j.1365-2788.2010.01332.x.
Chouhan, S. C., Singh, P., & Kumar, S. (2016). Assessment of
Declaration of Conflicting Interests Daily Parenting Stress and Depressive Symptoms among Par-
ents of Children with Intellectual Disability. International
Multispecialty Journal of Health, 2(4), 22-29.
The authors declare no conflicts of interest with re- Coutinho, M. T. B. (2004). Apoio à família e formação parental.
spect to the research, authorship, and/or publication Análise Psicológica, 1, 55-64.
Da Paz, N. S. & Wallander, J. L. (2017). Interventions that target
of this article. improvements in mental health for parents of children with
autism spectrum disorders: A narrative review. Clinical psy-
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