Effect of resilience training on stress, hope and psychological toughness of mothers with mentally and physically disabled children

doi:10.21203/rs.3.rs-3133431/v1

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Effect of resilience training on stress, hope and psychological toughness of mothers with mentally and physically disabled children

https://doi.org/10.21203/rs.3.rs-3133431/v1

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Introduction:

The present study aimed at determining the impact of resilience training on stress, hope and psychological toughness of mothers with mentally and physically disabled children.

Materials and methods

In this interventional study, 70 parents of children with mental and physical disabilities were selected in an accessible manner and then classified into two control and intervention groups by random block allocation. In the intervention group, nine endurance training sessions were held for 60 min, one session per week at the welfare and rehabilitation center for mothers. Immediately before and one month after the intervention, the parenting stress, hope and psychological toughness questionnaire was completed by the mothers. The data were analyzed using Chi-square, Kruskal-Wallis, Fisher's exact test and t-test by SPSS software (version 23) at a significance level of 0.05.

Results

There was no significant difference in the parental stress between before and after the intervention in the both intervention and control groups (0.370), but it was significant after the intervention (0.001). Moreover, no significant difference was observed in parental hope before the intervention (0.452), while it was significant after the intervention (0.001). Parental psychological toughness was not significant before the intervention (0.179), while it was significant after the intervention (0.000).

Conclusion

Based on the results, resilience training reduced parental stress and increased hope and tenacity in mothers of the test group. Therefore, resilience training is recommended to reduce parental stress and increased hope and psychological toughness of mothers of mentally and physically disabled children.

Disability

Resilience

Stress

Hope

Tenacity

Despite the progress made in medical science, mental and physical disorders are still one of the major problems in children [1]. Mental and physical disability as two major group of disorders affect about 3% of the world's population. It has been estimated that about 2.5% of all children and students have mental disabilities [2]. Based on the report of the country's welfare organization, there are two million and eight thousand disabled people in Iran, of which 28,795 people are mentally disabled [3, 4].

Mental and physical disabilities, in addition to a person's daily life, affect the functioning of family members, and the birth of a child with mental and physical disability is considered a crisis [5]. Also, the effects of the birth of a child with a mental and physical disorder in the family can cause financial burden, and disruption in family life, especially for the mother [6]. Mothers may experience consequences such as depression, anxiety, aggression, fear, embarrassment, denial, and guilt [7]. One of the most important reasons for the vulnerability of mothers is that mothers spend more time with their children compared to other family members and fathers. On the other hand, mothers feel more responsible in raising their children and are often involved in their children's problems [8]. Moreover, a previous study reported that the negative effects of having a weak or disabled child cause tension and pressure in family members, especially the mother [9].

Mothers of children with mental and physical disorders are under stress such as taking care of the child and controlling and raising the child, which may gradually result in a feeling of burnout and fatigue [10]. Therefore, psychological toughness and resilience are effective factors in the mental functions of mothers, which can improve their ability to deal with emotional and psychological problems by improving their creation, behavior and thinking [11]. The concept of tenacity is a very useful concept representing that individuals with a disabled child can maintain their mental health [12].

Resilience also refers to positive outcomes after experiencing adversities, positive and effective performance under adverse conditions, and recovery after a serious mental or physical injury [13]. Previous studies demonstrated that resilience increases a person's ability in difficult situations and there is a significant relationship between resilience and quality of life [14,15].

In a similar study, Wu et al., reported that social support, hope and resilience significantly affect the quality of life [16]. On the other hand, the literature implied that there is a direct relationship between resilience and toughness [17]. Therefore, conducting studies investigating the relationship of resilience interventions with stress control, hope and psychological toughness can help to improve the activity and performance level of mothers of children with mental and physical disabilities. Due to the importance of the above mentioned content, the present study aimed at determining the impact of resilience training on stress, hope and psychological toughness of mothers with mentally and physically disabled children.

In this semi-experimental pre-test and post-test study, 70 mothers with mentally and physically disabled children referred to the welfare and rehabilitation centers of Hamadan city were selected as case samples.

Inclusion and exclusion criteria

Inclusion criteria included the mother's minimum age of 20 and maximum of 50 years, the ability to read and write, having a child with a definite diagnosis of physical or mental disability, at least one year has passed since the diagnosis. Exclusion criteria included not agreeing to participate in the study for any reason and not attending training classes for more than two sessions.

Sample size

The sample size was calculated based on the Kaboudi et al., study [18]. The first type error level was considered to be 0.05 and the power of the test was 90%.

$$n=\frac{{({Z}_{1-\alpha /2}^{2}+{Z}_{1-\beta })}^{2}\times [{{\sigma }_{1}}^{2}+{{\sigma }_{2}}^{2}]}{{({\mu }_{1}-{\mu }_{2})}^{2}}=\frac{{(1.96+0.842)}^{2}\times [{11.34}^{2}+{16.50}^{2}]}{{\left(10\right)}^{2}}=31$$

In each group of 31 people and considering a drop of 10%, the sample size was considered to be 35 individuals, and hence the sample size was totally estimated to be 70 individuals.

Tools

In this study, demographic questionnaire, parental stress scale short form questionnaire, hope questionnaire and Kubasa psychological toughness questionnaire were used for collecting data. Demographic questionnaire included age of mother, father and child, education of mother and father, occupation of mother and father, economic status of family, gender of child and number of children. The questionnaire of the short form of the parental stress scale was directly taken from the long form of this scale prepared by Abdin (1983) in response to the needs of clinical professionals and researchers. The scale was prepared based on the theory that the general stress that parents experience is a function of the child's behavioral characteristics, the parents' personality traits, and the psychological pressures of the family environment, which is directly related to the role of parents. The short form of the Parental Stress Scale consisted of 36 questions with the same wording as in the original long form of 101 questions. In Hosseini Qomi et al., (19) study reliability was conducted through test-retest of 531 mothers with a time interval of six months, and the overall stress reliability coefficient was 84%. The hope questionnaire was first introduced by Schneider et al., (1991) and consisted of 12 questions and its purpose is to evaluate the level of hope in people. This questionnaire is designed for people aged 15 years and above, and its scoring method is based on the 5-option Likert scale as follows: Score five: I completely agree, Score four: I agree, Score three: I have no opinion, Score two: I disagree, and Score one: I completely disagree.

In order to calculate the overall score of the questionnaire, the sum of the scores of each question are calculated together. Higher scores indicate more hope in the respondent, so that: score between 12 and 24 indicates low level of hope, score between 24 and 36 shows average level of hope for life, and scores higher than 36 represent high level of hope [20]. In Iran, the validity and reliability of this questionnaire was checked using the internal consistency method, and the Cronbach's alpha coefficient was 0.89 [21, 22]. Kubasa Psychological Toughness Questionnaire was designed by Kubasa et al., (1982) to evaluate individual's psychological toughness. The short form of this questionnaire consisted of 20 items on a 4-point Likert scale (never, rarely, sometimes and often), which is summarized and analyzed as a score between 0 and 3. The scoring method in this questionnaire is as follows: never: score zero, rarely: score 1, sometimes: score 2 and often: score 4. This scale includes 3 scales of control, commitment and struggle. To obtain the overall score of the questionnaire, the sum of the score of each question is calculated together. A higher score indicates more toughness in the respondent and a lower score indicates less toughness. Cronbach's alpha coefficient for the internal consistency of this questionnaire was 0.67 [23].

Intervention

Seventy parents of children with intellectual and physical disabilities were studied using an available selection method and then classified into two groups, including a control group and an experimental group, through random block allocation. After obtaining the necessary permissions, the researcher referred to the welfare and rehabilitation centers in Hamadan, introduced themselves as the supervisor and manager of the center. Then, the mother of children with mental disorders and physical disabilities were selected as samples. The objectives of the study were explained and the written consent form was obtained from the participants. All participating mothers in the experimental group completed the Parental Stress Scale, Hope Scale, and Psychological Resilience Scale questionnaires. Next, in the experimental group, the researcher held nine 60-min resilience training sessions, one session per week (approximately 2 months), in a classroom located at the welfare and rehabilitation center. It should be noted that the resilience training covered three parts: the concept of resilience for families and the characteristics of individuals with high resilience, internal and external factors influencing resilience, and the ways to increase family resilience(Table 1). One month after the intervention, in the experimental group, the participants were asked to complete the Parental Stress Scale, Hope Scale, and Psychological Resilience Scale questionnaires again. In the control group, the participating mothers first completed the Parental Stress Scale, Hope Scale, and Psychological Resilience Scale questionnaires. Next, in this group, without any intervention, the same questionnaires were again completed by the mothers two months later.

Table 1

Resilience skill training protocol in the present study [18]
Session number	Session content
First session	Pre-intervention - providing guidance for the participation of members and explaining how to do the work: the researcher introduces himself, introduces the members, explains the general direction of the meetings to the members
Second session	An introduction to the general framework of the discussion: 1. Define resilience 2. Introducing the characteristics of resilient people: 1. Joy 2. Wisdom and insight 3. Humor 4. Sympathy 5. Rational adequacy 6. Purposefulness in life, and 7. Stability.
Third session	Solution: Understanding the unpleasant situations in life and increasing coping and tolerance in personal life. Objective: Familiarity with internal support factors 1. The concept of optimism 2. Self-esteem 3. Source of control Solution: Recognizing talents and interests and emphasizing them, and wanting to use them.
Fourth Session	Purpose: Familiarity with external support factors 1. Social support system 2. Individual responsibility and acceptance of important roles. Solution: sense of belonging and value and willingness to participate.
Fifth meeting	Purpose: Familiarity with the methods of providing resilience. Establishing and maintaining relationships with others, a framework for parental stress and problem acceptance.
Sixth session	Purpose: to continue the ways of providing resilience. Purposefulness and hope for the future, acting.
Seventh session	Purpose: to continue the ways of providing resilience. Self-awareness, self-confidence development.
Eighth session	Purpose: to continue the ways of providing resilience, Self-care
Ninth session	Purpose: conclusion and implementation of the post-intervention.

Statistical Analysis

Descriptive statistics were used to describe the data and chi-square, Kruskal-Wallis, Fisher's exact test and t-test were used to analyze the data using SPSS software (version 23) at a significance level of 0.05.

The findings of this study regarding the qualitative demographic characteristics of the participants showed that the level of education of the mothers in the intervention group (47.3%), and the control group (45.6%) was more in elementary school. The studied children in the both groups were mostly male (51.7%) and the results of chi-square test showed that the both groups were similar in terms of all demographic variables. Regarding the quantitative data of the present study, the majority of participating mothers in the both experiment and control groups were in the age range of 29–42 years. The number of family members in the experiment and control groups was 4. In general, the Kruskal-Wallis test did not show any difference between the groups, and based on the results the both groups were similar.

Table 2

Intra-group comparison of parental stress, hope and psychological toughness before and after the intervention between the intervention and control groups
Group		Mean	SD	T	Df	P-value
parental stress	intervention	35.43	18.30	9.25	34	0.000
parental stress	control	-1.85	27.22	-0.577	34	0.254
hope	intervention	-4.43	-6.03	-6.62	34	0.000
hope	control	-3.65	-5.58	-2.09	34	0.031
psychological toughness	intervention	-19.56	13.41	-7.32	34	0.000
psychological toughness	control	3.28	18.43	0.877	34	0.155

The results of Table 2 regarding the intra-group comparison of parental stress before and after the intervention in the experimental group showed a significant difference, and resilience training was able to reduce parental stress in mothers of children with cancer (p = 0.000). However, in the control group, the intra-group comparison of parental stress before and after the intervention showed no significant difference (p = 0.254). The intra-group comparison of hope before and after the intervention in the experimental group showed a significant difference, and resilience training was able to increase hope in mothers of children with cancer (p = 0.000). Moreover, in the control group, the intra-group comparison of hope before and after the intervention showed a significant difference (p = 0.031). The intra-group comparison of psychological resilience before and after the intervention in the experimental group showed a significant difference, and resilience training was able to increase psychological resilience in mothers of children with physical and mental disabilities (p = 0.000). However, in the control group, the intra-group comparison of psychological resilience before and after the intervention showed no significant difference (p = 0.155).

Table 3

Intergroup comparison of parental stress, hope and psychological toughness before and after the intervention between the intervention and control groups
Group		Intervention		Control		T	Df	P-value
Group		Mean	SD	Mean	SD	T	Df	P-value
parental stress	Before intervention	110.13	17.54	102.89	11.56	8.18	68	0.370
parental stress	After intervention	70.43	14.12	105.98	16.45	-0.437	68	0.001
hope	Before intervention	39.56	3.76	39.77	3.55	-4.67	68	0452
hope	After intervention	45.87	2.98	43.59	3.89	-2.87	68	0.001
psychological toughness	Before intervention	51.56	12.43	53.79	9.90	-6.43	68	0.179
psychological toughness	After intervention	72.34	6.54	50.16	6.87	0.987	34	0.000

The findings of Table 3 regarding the inter-group comparison of parental stress before and after the intervention in the experimental and control groups showed no significant difference before the intervention (p = 0.370), but after the intervention, this difference was significant (p = 0.001). The inter-group comparison of hope before and after the intervention in the experimental and control groups showed no significant difference before the intervention (p = 0.452), but after the intervention, this difference was significant (p = 0.001). The inter-group comparison of psychological resilience before and after the intervention in the experimental and control groups showed no significant difference before the intervention (p = 0.179), but after the intervention, this difference was significant (p = 0.000).

Table 4

Mean Difference of Hope, Parental Stress, and psychological toughness Scores Before and After Intervention between the Experimental and Control Groups
Group	Intervention				Control
Group	Minimum	Maximum	Mean	SD	Minimum	Maximum	Mean	SD
Hope	-7	14	3.37	4.23	-12	18	2.74	5.75
Parental Stress	91-	10	-28.55	19.31	-87	51	3.26	24.77
psychological toughness	2	54	19.78	14.31	-38	32	4.20	15.50

As shown in Table 4, the average score of hope in the intervention group was 3.37. In the control group, the average was 2.58. These findings implied that hope increased by an average of 3.37units and in the control group this amount increased by 2.58and both groups experienced an improving trend in the variable of hope. The average score of parenting stress in the intervention group was − 28.55, while in the control group was 3.26. These results implied that in the intervention group receiving resilience training, parental stress was reduced by 28.55units, while in the control group without any intervention, this level increased by an average of 3.26 units, and hence parental stress in this group was increased. The mean score of psychological toughness increased by 19.78 units on average in the experimental group, while in the control group, the mean resilience score of mothers decreased by 4.20 units on average, indicating a decrease in resilience in this group.

This study aimed to examine the effects of resilience training on the stress, hope and psychological toughness levels of mothers who have children with mental and physical disabilities. The results showed that there was no significant difference between the groups in terms of parental stress scores before the intervention, but there was a significant difference after the intervention. These results are consistent with the findings of Kore and Venkatraman [24], Hosseini-Ghomi and Jahanshahi, [25], Lida et al., [26], Moghimi et al. [27], Mohammadi et al., [28], Aslani et al., [29], Motaghi et al., [30], Kaboudi et al., [18], and Hosseini-Ghomi et al., [19] studies.

Kore and Venkatraman in a related study reported that parents of children with mental disabilities with a higher level of hope showed a lower score in perceived stress compared to parents with a lower level of hope [24]. This means that the factors increasing hope in the parents of children with mental disabilities can simultaneously reduce the level of their stress. Therefore, methods of increasing hope can be used to reduce the perceived stress of parents of children with mental disabilities. Moreover, Hosseini Qomi and jahanbakhshi reported that resilience training program and formation of counseling and support groups can be used as part of intervention programs to reduce stress and improve the mental health of mothers of children with mental disabilities [25].

Lida et al., in a similar study reported that there was a statistically significant difference among the average scores of stress, anxiety, and depression before and after the intervention in the research samples. As a result, parental training is effective in improving the coping style of mothers of children with autism spectrum disorder and reducing their levels of depression and anxiety [26]. "Moghimi et al., found that resilience training through text messages can reduce the stress of mothers of children with intellectual disabilities [27]. Based on the mentioned study, it can be concluded that the mothers of children with mental health problems suffer from various disorders such as stress, which can have long-term negative effects on other aspects of their lives. Therefore, with the use of minimal education and support, it is possible to minimize this disorder in the mothers of the children with mental health problems. On the other hand, Mohammadi et al., reported that the effect of resilience training on reducing parenting stress was significant and its effect was stable after two months of training [28]. It can be concluded that systematic and planned education in the long-term can have significant and lasting effects on reducing parental stress. It is necessary to include such training program in parenting education programs for parents of children with mental and physical disabilities. In this regard, Aslani et al., found that the resilience level and improvement of the mother-child relationship in mothers who underwent this treatment program were significantly higher compared to mothers who did not receive treatment, and parental stress was reduced in the intervention group [29]. Training programs such as resilience training not only reduce parental stress, but also improve the parent-child relationship by making parents stronger, empowering mothers to solve the challenges ahead, and promoting constructive thinking. In this regard, Motaghi et al., reported that resiliency training for mothers is effective in reducing their stress, and resiliency training can result in strengthening abilities such as managing negative emotions, problem solving and constructive thinking in mothers, which improves the relationship between parents and children [30].

Kaboudi et al., study reported that mothers who were trained in resilience skills made significant progress in increasing coping style and reducing parental stress compared to mothers in the control group [18]. In this regard, Hosseini Qomi et al., concluded that resilience training had a significant impact on reducing stress and increasing resilience of mothers [19]. Therefore, it can be concluded that using resilience training is an effective method for reducing parental stress, especially mothers of autistic children. In all the above studies, it was also reported that resilience training was able to reduce the stress of parents of children with various mental and cognitive disorders, and in all the studies, the studied parents experienced less stress after receiving resilience training.

The findings of the present study indicated that the difference in the average score of hope before the intervention in the intervention and control groups was not significant, but it was significant after the intervention. These findings are consistent with the results of Khosrobeigi et al., [31], Martin et al., [32], Rafiepoor., [33], Momeni., [34], Reza Zadeh et al., [35], Akbari et al., [36] and Kanwal M, Asad [37], studies. It was anticipated that the resilience training intervention would increase the hope of mothers in the intervention group. However, in the control group, the mothers who did not receive any intervention, the level of hope among mothers increased compared to the pre-intervention state. This indicated that mothers of children with mental and physical disabilities are encouraged by medical staff and other mothers with similar experiences. Additionally, according to cultural beliefs, they are encouraged to have hope and rely on a higher power, which may be an effective factor in increasing the level of hope in the control group. However, when comparing the hope levels of mothers in the intervention and control groups, it was found that the average score of hope among mothers in the intervention group was higher than that of mothers in the control group. In this regard, Khosrobeigi et al., concluded that teaching self-compassion had a significant effect on increasing resilience and reducing hopelessness among parents of children with cancer [31]. Martin et al., also showed that changes in the level of gratitude and hope cause changes in depression, however, no change was observed in the anxiety score [32]. Rafiepoor et al., in a related study reported that hope therapy can improve the quality of life of mothers with disabled children and also showed that the hope therapy acts as an effective step in improving their mental state and parent-child relationship [33]. The results of these studies implied that the parents of children with mental disorders and physical disabilities generally face frustration and other problems in the path of their child's growth and development. Their resilience and hope can be increased with support and training. This return of hope can double their strength to continue the path, support their child and increase their hope for the future.

Moreover, Momeni et al., reported that the average score of expectancy and psychological well-being of mothers with children with special learning disabilities in the intervention group increased compared to the control group [34]. Therefore, it can be said that resilience training was effective on the life expectancy and psychological well-being of mothers with children with special learning disabilities. In this regard, Reza Zadeh et al., concluded that providing educational and therapeutic interventions based on positive psychology can be effective in promoting hope and resilience against stress in mothers with mentally disabled children [35]. Akbari et al., reported that the implementation of resilience training programs can be effective in reducing aggression and increasing happiness in students, and hence it is useful to add these programs to the university curriculum [47]. In, Kanwal and Asad study, it was found that there was a positive and significant relationship between resilience and hope [37]. In all of the above studies, it was seen that resilience training was able to give hope to mothers of children with various mental and cognitive disorders, and in all studies, the studied parents experienced a higher level of hope after receiving resilience training.

The findings of the present study showed that the difference in the average score of toughness in the intervention and control groups was not significant before the intervention, but it was significant after the intervention, which is in agreement with the findings of Dunseth [38], Sabz Menesh Jafari et al. [39], Mohammadi Hasil et al. [28], Sanei Menesh et al. [40], Salehian and Sarvari [41] and Khodabakhshi Kolai [42]. Dunst et al., concluded in his study that family resilience is an internal resource that simultaneously has stress-inhibiting and health-enhancing effects on parenting and family functioning [38]. Sabz Menesh Jafari et al., also found that family resilience training is a suitable intervention to improve psychological toughness in mothers of disabled children and should be used in rehabilitation clinics and family training centers [39]. Therefore, another advantage of resilience training is increasing the tenacity of mothers in facing situations and challenges, which doubles the importance of the role of nurses involved in caring for children with mental and physical disabilities. Basic and planned trainings, such as resilience, make mothers tougher and more resilient in dealing and solving the challenges. In this regard, Mohammadi et al., reported that using a tenacity training program can be effective in increasing tenacity and reducing the perceived stress level of parents of students with disabilities [28]. Moreover, Sanieemanesh et al., showed that group counseling based on acceptance and commitment therapy improves marital stress and psychological toughness of mothers of children with severe and multiple disabilities [40]. These findings are consistent with the results of Salehian and Sarvari and Khodabakhshi-Koolaee et al., studies [41,42].

The findings of the above studies highlighted the role of tenacity training on the reduction of the stress level of mothers and families and hence increased toughness of mothers to deal with unfortunate and challenging situations. Therefore, it can be concluded that resilience training can increase the psychological toughness of mothers of children with various mental and cognitive disorders. In all studies, the parents experienced a higher level of psychological toughness after receiving resilience training

The overall findings of this study indicated that resilience training was able to reduce the level of parental stress, while it increased the levels of hope and resilience in mothers of the intervention group. The differences in these three variables between the intervention and control groups before and after the intervention were significant. Consistent with these findings, Mohammadi et al., in a related study reported the effect of resilience training on reducing parental stress was significant and its effect remained stable after two months. Therefore, resilience training can lead to long-term reduction in the level of stress in the studied mothers, and hence decreasing stress levels could increase the levels of hope and resilience in mothers. Therefore, resilience training can be used as an effective factor in helping mothers of children with mental and physical disabilities to cope with various challenges of the disease. Additionally, Aslani et al., found that the level of resilience and improvement in mother-child relationships in mothers who received this treatment program was significantly higher compared to those who did not receive treatment, and parental stress decreased in the intervention group [29].

Moreover, the findings of Motaghi et al., study showed that resilience training for mothers is effective in reducing their stress levels, and that resilience training can strengthen their skills such as negative emotion management, problem-solving, and constructive thinking, which improves parent-child relationships. Therefore, according to the findings of the above studies, resilience training can be used not only to increase levels of hope and reduce maternal stress, but also to improve parent-child relationships and enhance constructive thinking for facing future challenges.

Kaboudi et al., study showed that mothers who were trained in resilience skills made significant progress in increasing coping style and reducing parental stress compared to mothers in the control group [18]. In Momeni et al., study, it was found that the average score of life expectancy and psychological well-being of mothers with children with special learning disabilities of the intervention group increased compared to the control group [34]. Don Seth also concluded that family is an internal resource that simultaneously, stress-relieving and health-enhancing effects on the functioning of parents and the family [38]. In this regard, Jafari et al., reported that family resilience training is a suitable intervention to improve psychological toughness in mothers of disabled children and should be used in rehabilitation clinics and family education centers [43]. Therefore, resiliency training can be used as a tool to empower parents against the difficulties and to face the challenges of their children's growth and development. Moreover, these results are consistent with the findings of Salehian and Sarvari, study. They reported that toughness with equipping a person with a shield to deal with stressful situations reduces the level of anxiety and depression, and by activating problem-based coping strategies in stressful situations, it enables a person to look at events with more optimism [41].

Resilience training was able to reduce the level of parental stress and increase the level of hope and tenacity in the mothers of the test group. For this reason, resilience training can be used as a solution to equip parents, especially mothers who have the most involvement with children in their growth and development path. The important point is that increasing resilience can lead to increased hope and increased hope can in turn increase the ability to cope with challenges and hardships in mothers and for this reason, resilience can be a simple but very effective tool for empowering parents in this path. Therefore, it is recommended to use resilience to reduce parental stress and also increase the level of hope and resilience in mothers with mentally and physically disabled children.

Ethics approval and consent to participate

The study was approved by the Ethics Committee of the Hamadan University Medical Sciences (UMSHA) under number (140105043256; IR.UMSHA.REC.1401.313). This study complies with all the provisions of the Declaration of Helsinki. All participants were informed about the study and only those providing written informed consent were enrolled in the study.

Consent for publication

All authors express their consent for the publication of this article.

Availability of data and materials

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

Competing interests

The authors declared no conflict of interest regarding this research.

Funding

This study was done with the financial support of Hamadan University of Medical Sciences.

Authors' contributions

P.SH: Conductor of the study, Z.K: Collecting data and M.SH: Supervisor

Acknowledgment

The researcher would like to express his appreciation and gratitude to the honorable vice president of research of the Hamadan University of Medical Sciences, Hamadan, Iran, all patients, nurses and all the people who cooperated in conducting this study.

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No competing interests reported.

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Effect of resilience training on stress, hope and psychological toughness of mothers with mentally and physically disabled children

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