Several studies have reported that families of children with autism spectrum disorder (ASD) experience more parenting stress than families of typically developing (TD) children or those diagnosed with other disabilities (1, 2, 3, 4). From these studies, an emerging trend suggests that mothers of children with ASD exhibit higher levels of depression, anxiety, and stress than the general population.
Several international studies support what has been reported previously. A study in Italy assessed the parental burden in families of children with ASD compared to a control group of parents with children who were diagnosed with type 1 diabetes mellitus, and parents with children diagnosed with Down syndrome. The parents of children with ASD reported higher objective and subjective burden, more frequent psychological distress, and lower social support. Moreover, mothers reported greater subjective burden than fathers did (5). A study in the Netherlands found that both parents reported more stress when parenting with their child with ASD and/or ADHD than while parenting with the unaffected sibling; they also experienced more stress than the general population (6). In the United States, a multistate-wide study reported that parents of toddlers with ASD demonstrated increased parenting-related stress compared with parents of toddlers with developmental delay and typically developed children. However, psychological distress did not differ significantly between the groups (7). Although parental stress, anxiety, and depression were reported significantly higher in parents of children with ASD than in parents of TD children, a study in the United Kingdom found that parent-reported distress, anxiety, depression, and health were not correlated with physiological measures, with the exception that parents of children with ASD had significantly lower cortisol levels 30 min after waking(8).
Studies that addressed the prevalence of depression, anxiety, and stress among mothers of children with diabetes were not conclusive and revealed mixed results. Parents of children with type-1 diabetes have a higher expression of anxiety and depressive feelings compared with parents of children without diabetes (9, 10, 11, 12). All subjects in the above studies included both parents. A study by Hauenstein several years ago (13), did not find a difference in a group of mothers regarding their overall stress. The degree of anxiety and stress was not only high in the period following diagnosis but worries continued for a longer period due to the illness chronic nature (14).
In the EMRO region, studies conducted revealed similar findings. One study in Oman revealed that caregivers of children with ASD carry a greater risk of depression and stress than caregivers of children with intellectual disabilities, along with an even greater risk when compared to the general population (3). A study in Saudi Arabia found a mean score of depression and anxiety that was significantly higher in a sample of parents of children with ASD when compared to a control consisting of parents of TD children (4). studies from Iran noted that the most common psychiatric conditions among parents of children with ASD were poor mental health “melancholic personality, persistent depression, and negativism” (16, 17). A prospective study in Kuwait found that mothers of children with ASD had higher levels of parenting-related stress and psychological distress when compared to a control, the study also reported no significant difference between fathers of children with ASD and fathers from the general population (17). In Bahrain, mothers were found to be negatively impacted by having children with ASD. The sample studied was found to have more physical and mental health issues, along with a decreased quality of life, when compared to the general population. Mothers also reported more physiological and environmental problems than mothers of intellectually disabled children and typically developed children (2, 18). We could not trace any study addressing the mothers of diabetic children's mental health locally.
The goal of this study is to identify any significant differences in depression, anxiety, and stress among mothers of children with ASD when compared to mothers of children with another chronic illness, diabetes, and mothers of typically developed (TD) children.