title: Mental health and parenting characteristics of caregivers of children with spina bifida.
abstract: BACKGROUND
  Within the chronic medical illness literature, associations exist between caring for an affected child and parent mental health. The few studies examining both mothers and fathers provide mixed results. The purpose of this study is to examine associations between caregiver anxiety, depression, and parenting variables in caregivers of youth with SB as these relate to marital status, age, education, household income, work status, and child's severity of SB.
  
  
  OBJECTIVE
  The aim of this study is to examine associations between anxiety, depression, and parenting variables in caregivers of youth with spina bifida and how they relate to demographic and disease variables. Exploratory analyses examined the relationship between participation in support activities and depressive and anxious symptomatology and parenting characteristics.
  
  
  METHODS
  Eighty-four primary caregivers (49 mothers) of 51 youth with spina bifida completed measures of depressive and anxious symptomology, parenting stress, parent overprotection, and perceived child vulnerability.
  
  
  RESULTS
  There were differences between mothers and fathers on several parenting characteristics; however, these were related more to marital status and employment than to gender of the caretaker per se. In the 33 married/remarried couples for whom both spouses participated, stress for the mothers was correlated with stress for the fathers. This correlation was strongest in the 12 married couples in which the mother works. Higher perceived vulnerability scores were reported in parents of SB patients in the younger age group, especially preschoolers (0-4 years). Parents of children with shunts reported more anxiety, depression and perceived child vulnerability. Both male and female caregivers of younger children reported significantly higher protectiveness scores. Involvement in recreational activities with other families affected by SB was associated with more positive parenting characteristics for mothers.
  
  
  CONCLUSIONS
  Stress and protectiveness were found to be positively correlated (r > 0.6); depression, anxiety, and perceived vulnerability were not (0.3 < r < -0.3). Overall, mothers reported more stress and anxiety than fathers. Higher perceived vulnerability scores were reported in parents of SB patients in the younger age group, especially preschoolers (0-4 years). Parents of children with shunts reported more anxiety, depression and perceived child vulnerability. Both male and female caregivers of younger children reported significantly higher protectiveness scores compared to caregivers of older children. Involvement in recreational activities with other families affected by SB was associated with more positive parenting characteristics for mothers. There were differences between mothers and fathers on several parenting characteristics; however, these were related more to marital status and employment than to gender of the caretaker per se. Limitations to the current study qualify our results and conclusions. Associations do not prove causation. Our measure of parent protection had a lower Cronbach's alpha score for male caregivers (0.68) than female caregivers (0.83), consistent with an examination of the factor structure of the PPS that found the measure to have a poor factor structure and limited reliability in samples with a chronic medical condition.
  
  
  CONCLUSIONS
  Anxiety, depression, and parenting characteristics were differentially impacted by variables such as caregiver and child age, shunt status, and employment status/income for parents of youth with SB. Interventions to improve parenting skills and mental health of these caregivers can be designed to target specific needs of parents. Groups such as the Greater Oklahoma Disabled Sports Association (GODSA) offer real-world support to improve the lives of caregivers of SB children, and should be studied further to optimize outcomes for children.
authors: Department of Urology, Section of Pediatric Urology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA.
authors: Elizabeth
authors: E
authors: Malm-Buatsi
authors: Department of Urology, Section of Pediatric Urology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA.
authors: Christopher E
authors: CE
authors: Aston
authors: Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, OH, USA.
authors: Jamie
authors: J
authors: Ryan
authors: Department of Urology, Section of Pediatric Urology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA.
authors: Yeun
authors: Y
authors: Tao
authors: Department of Urology, Section of Pediatric Urology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA.
authors: Blake W
authors: BW
authors: Palmer
authors: Department of Urology, Section of Pediatric Urology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA.
authors: Bradley P
authors: BP
authors: Kropp
authors: Department of Urology, Section of Pediatric Urology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA.
authors: Jake
authors: J
authors: Klein
authors: Department of Urology, Section of Pediatric Urology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA.
authors: Amy B
authors: AB
authors: Wisniewski
authors: Department of Urology, Section of Pediatric Urology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA. Electronic address: Dominic-frimberger@ouhsc.edu.
authors: Dominic
authors: D
authors: Frimberger
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001007:Anxiety / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D017028:Caregivers / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology / Q000503:physiopathology; D019988:Children with Disabilities / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D016487:Parenting / Q000523:psychology*; D011788:Quality of Life; D018570:Risk Assessment; D012737:Sex Factors; D016135:Spinal Dysraphism / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D013315:Stress, Psychological / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D011795:Surveys and Questionnaires
keywords: Anxiety; Depression; Overprotection; Parenting stress; Spina bifida