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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 4  |  Issue : 1  |  Page : 64-67

Depression, anxiety, and stress among parents of children with special needs during the COVID-19 pandemic in Belagavi City: An observational study


Department of Paediatric Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka, India

Date of Submission15-Mar-2021
Date of Decision05-Mar-2022
Date of Acceptance09-Apr-2022
Date of Web Publication30-Jul-2022

Correspondence Address:
Emika Ann Cotta
KAHER Institute of Physiotherapy, Belagavi, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijptr.ijptr_7_21

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  Abstract 


Context: Lockdown and social isolation during the pandemic situation caused an especially stressful situation for families with children with special educational needs and disabilities. The psychological repercussions on parents of these children remain unattended.
Aims: The primary aim was to find the prevalence of depression, anxiety, and stress among parents of children with special needs during COVID-19 pandemic using Depression, Anxiety, and Stress Scale (DASS)-21. The secondary aim was to determine the correlation between the three domains of DASS-21 scale with the parent characteristics.
Settings and Design: This was an observational study on parents of children with special needs visiting tertiary care center and special schools.
Subjects and Methods: Eighty-seven parents of children with special needs participated Either parent of each child with special needs answered the questionnaire DASS-21. The total score of each participant was calculated for each component under each domain of the questionnaire.
Statistical Analysis Used: Frequency distribution for occurrence of depression, anxiety and stress was analyzed. The linear associations were studied using correlation coefficient.
Results: Out of 87 parents who participated in the study, 5.6% of the subjects had depression, 15.3% had anxiety, and 12.5% had stress. There was no significant correlation noted between individual domains of DASS-21 and the parent characteristics (P < 0.05).
Conclusion: The study concludes that during the COVID-19 pandemic, the prevalence of depression, anxiety, and stress in parents of children with special needs was not significant. Further, no correlation was found between DASS-21 and the demographic characteristics of the parents.

Keywords: Anxiety, Children with special needs, COVID-19 pandemic, Depression, Mental health, Parents, Stress


How to cite this article:
Metgud D, Patil CS, Cotta EA. Depression, anxiety, and stress among parents of children with special needs during the COVID-19 pandemic in Belagavi City: An observational study. Indian J Phys Ther Res 2022;4:64-7

How to cite this URL:
Metgud D, Patil CS, Cotta EA. Depression, anxiety, and stress among parents of children with special needs during the COVID-19 pandemic in Belagavi City: An observational study. Indian J Phys Ther Res [serial online] 2022 [cited 2022 Aug 19];4:64-7. Available from: https://www.ijptr.org/text.asp?2022/4/1/64/353009




  Introduction Top


On January 30, 2020, following the diagnosis of the first group of people infected by COVID-19 in China, the World Health Organization declared a Public Health Emergency of International Concern.[1] That same day, India reported its first case of the novel coronavirus (SARS-CoV-2). The weeks that followed saw an increase in the number of the COVID-19 cases. On March 21, 2020, Government of India ordered a nationwide lockdown for 21 days – this time period was later extended.

The onset of varying pandemics and epidemics has been seen to have colossal psychological repercussions – mental health professionals say that the psychological impact that these outbreaks pose is more devastating than their physiological aspects.[2],[3] Prolonged periods of home quarantine have bleak and potentially extended effects on the mental health of people. These can include anger, posttraumatic stress disorder, and confusion.[4] As a consequence of the COVID-19 pandemic, the mental health of individuals has considerably deteriorated.[5] Despite the favorable outcome that quarantine has had in declining the number of newly infected cases, the limitation in mobility and social isolation associated with it are cardinal concerns for the mental health of individuals.[1] Literature regarding earlier events that might have some facets similar to the COVID-19 situation reported high amounts of psychological distress such as depression, stress, irritability, and posttraumatic stress symptoms associated with social isolation with long-term impacts continuing for years following the event.[1]

Families of children with special educational needs and disabilities generally have more pressure than families with neurotypical children. Lockdown and social isolation cause an especially stressful situation for families with children with special educational needs and disabilities.[6] In addition to this, most countries prohibited the functioning of nonessential services, which included therapy for children – resulting in children going months without adequate therapy.[7] Levels of stress in these parents are therefore likely to increase during an event such as the COVID-19 pandemic.

Studies, at large, conducted during earlier pandemics and from the inception of the COVID-19 outbreak studied the psychological repercussions on the general populace leaving the study of the impact of these events on parents and particularly parents of children with special needs unexplored.[1] This study therefore aimed to determine depression, anxiety, and stress in these parents.


  Subjects and Methods Top


This present observational study was conducted at a tertiary hospital and special schools attached to the institute. The study subjects were selected using a convenience sampling, and included parents of children with special needs, aged between 2 and 18 years. The approval for the study was obtained from the institutional ethical committee.

Eighty-seven parents of children with special needs were approached and explained about the details of the study. The parents were then screened for eligibility into the study based on the inclusion and exclusion criteria. If found eligible, the parents were asked to fill in the informed consent and recruited in the study. Demographic details such age, gender, and employment status were obtained from the parents.

The assessment of psychological repercussions was done using Depression, Anxiety, and Stress Scale with 21 items (DASS-21) questionnaire to evaluate the psychological status of the parents. The parents were informed to ask for any queries or difficulties related to the questionnaire. The parents were also informed that the questionnaire would require only around 10–15 min to answer. The DASS-21 questionnaire was administered in the original English language and their native language, depending upon the parents' preference. If the parents faced any difficulty in understanding any statements or had any doubts in relation to the study, these were cleared by the research assistant while answering the questionnaire. The DASS-21 questionnaire includes basic statements related to depression, anxiety, and stress. It consists of three components, namely depression, anxiety, and stress. Each component has seven items which can be graded on a scale of 0–3 as 0 (never); 1 (sometimes); 2 (often); and 3 (almost always). The participants mark the items on the basis of the degree to which they agreed with the statement or they felt the statement was applicable to him/her. The questionnaires were then collected, with the total score of each participant was calculated for a maximum scoring of 21 for each domain. The results of the questionnaire were then computed into the excel sheet.


  Results Top


Demographic data

The present study recruited 87 parents as participants, of which 25 (28.7%) were male and 62 (71.3%) were female. The age of the parents ranged between 23 and 51 years, with a mean age of 32.24 years. The educational status of the parents consisted of 34 (39.1%) high school graduates, 22 (25.3%) higher secondary school graduates, 28 (32.2%) undergraduates, and 3 (3.4%) postgraduates. 38 (43.7%) were employed and 49 (56.3%) were unemployed with no changes in employment status pre- and post-COVID-19. 33 (37.9%) parents had a single child, 39 (44.8%) had two children, and 15 (17.2%) had three children with all parents having only one child with special needs. The children with special needs included 57 (65.5%) males and 30 (34.5%) females with ages ranging from 2 to 17 years, with a mean age of 5.89 years.

The results of the study demonstrated that 5.6% (n = 5) of the parents had depression, 15.3% (n = 13) had anxiety, and 12.5% (n = 11) had stress. It was found that more females had depression (6.4%) and stress (12.9%) as compared to males, (4.0% & 12.0% respectively).

Correlation of depression, anxiety, and stress-related scores with the parent characteristics showed no correlation between depression and different variables, i.e., gender, age, employment status pre-COVID, employment status post-COVID, and number of children [Table 1],[Table 2],[Table 3].
Table 1: Correlation between depression score and parent characteristics

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Table 2: Correlation between anxiety score and parent characteristics

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Table 3: Correlation between stress score and parent characteristics

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The correlation coefficient (R-value) for anxiety and stress was found to be 0.663 (P = 0.001). Similarly, the correlation coefficient R-value for depression and stress components was 0.567, with R-value for depression and anxiety being 0.506 (P = 0.001). The correlation scores were statistically significant in all three domains at 5% level with linear association.


  Discussion Top


The current study aimed to find the prevalence of depression, anxiety, and stress among parents of children with special needs, during the COVID-19 pandemic in Belagavi city, using the DASS-21 questionnaire. It also aimed to find whether age of the parents and child, sex of the parents and child, total number of children, and employment status played a role in the mental health of parents.

A study carried out by Al-Farsi et al. in Oman, among parents of children with autism spectrum disorder, found that 45.9% of the parents had stress, 46% had anxiety, and 48.6% had depression.[8] These results resonate with other studies which show higher levels of depression, anxiety, and stress among parents of children with special needs.[6],[8],[9] A similar study carried out during the COVID-19 pandemic by Wu et al. on the mental health status of parents in China found that 6.1% of the subjects had anxiety while 4.0% had depression.[10] As the mental health of parents of children with special needs was not studied amid the COVID-19 pandemic, our study tried to explore this aspect. The results of this study demonstrated that 5.6% of the population had depression, 15.3% had anxiety, and 12.5% had stress. The reason for the lower percentage of depression, anxiety, and stress observed could be because this study was carried out in the month of December 2020 at a time when the parents' depression, anxiety, and stress may have been alleviated as the lockdown restrictions were lifted and parents were able to have steady source of income.

This study traversed the affiliation between different parental characteristics and parent mental health. In a study carried out in the UK, it was found that depression, anxiety, and stress were more in mothers compared to fathers of children with epilepsy, with 55% of mothers and 33% of fathers having depression; 47% of mothers and 26% of fathers having anxiety; and 55% of mothers and 31% of fathers having stress.[9] Our study, which was carried out during the COVID-19 pandemic situation, also found a higher percentage of depression and stress among mothers compared to fathers, although it was statistically not significant (depression: P = 0.978, stress: P = 0.021). However, anxiety was more among fathers (16.0%) compared to mothers (14.5%) which was not statistically significant (P = 0.285). These findings are in accordance with a study done in Nigeria on the general population, where they found no significant difference in stress and self-esteem between genders during the COVID 19 pandemic.[11] Although the gender difference was not significant, the mean percentage of depression and stress was higher in mothers compared to fathers which is in accordance with a study done in India, on the general population, during the COVID-19 pandemic.[12] The current findings could be because both sexes were subjected to similar COVID-19 protocols and so were equally exposed to the same situation. This could also be attributed to gender bias, as the sample included a smaller number of men.

It was found that the total number of children, level of education, as well as the employment status, did not play a role in the mental health of the parents. This could be attributed to no change in employment status pre- and post-COVID-19. These findings are inconsistent with the findings of a study done by Abdul et al. on the general population, which found that educational qualification, as well as employment status, played a significant role in the mental health of individuals.[11]

The drawbacks of our study were as follows: a high percentage of participants were females, which could have led to gender bias. Some of the participants were hesitant while answering questions, which could have led to bias in the scores. Future studies can be undertaken with counseling for the parents and comparing results pre- and post-counseling to identify any changes in mental health and observe the impact of counseling on mental health of parents.


  Conclusion Top


The study concludes that the occurrence of depression, anxiety, and stress was lower among parents of children with special needs during COVID-19. Further, no correlation was found between psychological domains assessed and the demographic characteristics of the parents. It was also found that there was positive and significant association between depression, anxiety and stress variables.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Spinelli M, Lionetti F, Pastore M, Fasolo M. Parents' stress and children's psychological problems in families facing the COVID-19 outbreak in Italy. Front Psychol 2020;11:1713.  Back to cited text no. 1
    
2.
Cheng C, Tang CS. The psychology behind the masks: Psychological responses to the severe acute respiratory syndrome outbreak in different regions. Asian J Soc Psychol 2004;7:3-7.  Back to cited text no. 2
    
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Thurackal BJ, Chith EN, Mascarenhas P. The outbreak of novel coronavirus in India: psychological impact. SSRN Journal 2020:1-18. 10.2139/ssrn.3562062.  Back to cited text no. 3
    
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Guessoum SB, Lachal J, Radjack R, Carretier E, Minassian S, Benoit L, et al. Adolescent psychiatric disorders during the COVID-19 pandemic and lockdown. Psychiatry Res 2020;291:113264.  Back to cited text no. 4
    
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Banks J, Xu X. The Mental Health Effects of the First Two Months of Lockdown and Social Distancing during the COVID-19 pandemic in the UK. IFS Working Papers; 2020.  Back to cited text no. 5
    
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Asbury K, Fox L, Deniz E, Code A, Toseeb U. How is COVID-19 affecting the mental health of children with special educational needs and disabilities and their families? J Autism Dev Disord 2021;51:1772-80.  Back to cited text no. 6
    
7.
Pearl PL. Child neurology, COVID-19, and crisis in society. Dev Med Child Neurol 2020;62:1113.  Back to cited text no. 7
    
8.
Al-Farsi OA, Al-Farsi YM, Al-Sharbati MM, Al-Adawi S. Stress, anxiety, and depression among parents of children with autism spectrum disorder in Oman: A case-control study. Neuropsychiatr Dis Treat 2016;12:1943-51.  Back to cited text no. 8
    
9.
Reilly C, Atkinson P, Memon A, Jones C, Dabydeen L, Das KB, et al. Symptoms of depression, anxiety, and stress in parents of young children with epilepsy: A case controlled population-based study. Epilepsy Behav 2018;80:177-83.  Back to cited text no. 9
    
10.
Wu M, Xu W, Yao Y, Zhang L, Guo L, Fan J, et al. Mental health status of students' parents during COVID-19 pandemic and its influence factors. Gen Psychiatr 2020;33:e100250.  Back to cited text no. 10
    
11.
Lawal AM, Alhassan EO, Mogaji HO, Odoh IM, Essien EA. Differential effect of gender, marital status, religion, ethnicity, education and employment status on mental health during COVID-19 lockdown in Nigeria. Psychol Health Med 2022;27:1-12.  Back to cited text no. 11
    
12.
Rehman U, Shahnawaz MG, Khan NH, Kharshiing KD, Khursheed M, Gupta K, et al. Depression, anxiety and stress among Indians in times of COVID-19 Lockdown. Community Ment Health J 2021;57:42-8.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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Abstract
Introduction
Subjects and Methods
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Discussion
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