Parenting a child with disabilities or chronic medical conditions is a profound challenge that significantly impacts parental stress levels. This study focuses on comparing the stress experienced by parents of mentally retarded children versus those with children suffering from chronic medical illnesses. Parenting a child with mental retardation often involves considerable emotional, social, and financial challenges. Similarly, chronic medical conditions in children can lead to prolonged instability, uncertainty, and stress due to ongoing medical care and the uncertainty of the child’s health outcomes.[1][2]

The psychological and emotional demands on these parents can vary significantly based on the nature of the child’s condition. Mental retardation in children can lead to a lifetime of caregiving and associated stressors, which include but are not limited to, educational challenges, behavioral management, and societal stigma. On the other hand, chronic medical conditions may involve episodic care or constant medical attention, creating different stress dynamics.[3][4][5]

The differential impact of these stressors on parental well-being is crucial for developing targeted interventions that can support these families effectively. Previous research has indicated that parents of children with disabilities report higher levels of stress compared to parents of non-disabled children. However, less is known about the comparative impacts between different types of disabilities, particularly mental versus physical health challenges.[6][7]

Aim

To compare the stress levels and coping mechanisms between parents of mentally retarded children and those with children suffering from chronic medical conditions.

Objectives

1. To measure and analyze the stress levels in parents of mentally retarded children.
2. To assess the stress levels in parents of children with chronic medical conditions.
3. To compare the coping strategies employed by both groups of parents.

The study utilized a retrospective design, drawing from a cohort of parents at the Chatrapati Pramila Raje (CPR) hospital's psychiatry and pediatric outpatient departments. Data were collected from January 2024 to December 2024.

Source of Data

Patients were identified from medical records at CPR Hospital, which is affiliated with the Rajarshee Chatrapati Shahu Maharaj Government Medical College, Kolhapur, Maharashtra.

Study Design

This was a clinical, instrument-rated, cross-sectional study was conducted at the CPR Hospital, Kolhapur, Maharashtra.

Study Duration

Data were collected retrospectively from January 2024 to December 2024.

Sample Size

The study comprised 143 parent pairs (both mothers and fathers).

Inclusion Criteria

• Parents of children diagnosed with mental retardation as per ICD-10 criteria.
• Parents of children diagnosed with thalassemia (chronic medical condition group).
• Both parents must be present during the data collection interviews.

Exclusion Criteria

• Single parents.
• Non-consenting participants.

Procedure and Methodology

Data were collected via semi-structured interviews using a specially designed proforma that included demographic details and the Family Interview for Stress and Coping in Mental Retardation (FISC-MR) to assess perceived stress.

Sample Processing

Interviews were conducted in the local language (Marathi), and data were anonymized and coded for analysis.

Statistical Methods

Data analysis included the use of Chi-square tests for categorical data and the Z-test for differences between means with a significance level set at p<0.05.

Data Collection

Written informed consent was obtained from all participants, and ethical committee approval was secured prior to the study.

Table 1: Comparison of Stress Levels and Coping Mechanisms

Table 1 outlines a comparison of stress levels and coping mechanisms between two distinct groups of parents: Group A, which consists of parents of children with mental retardation, and Group B, parents of children with chronic medical illnesses. There are 71 parents in Group A and 72 in Group B. The mean stress score for Group A is significantly higher at 6.5 (±1.2) compared to Group B's 5.9 (±1.1), with a Z-value of 3.2 indicating statistical significance (P<0.05). This suggests that parents of children with mental retardation may experience higher stress levels. The mean coping scores also differ significantly between the groups, with Group A scoring 5.7 (±0.9) and Group B scoring 5.3 (±0.8), further underscoring the differences in how these parents cope with their children's conditions.

Table 2: Stress Levels in Parents of Mentally Retarded Children

Table 2 focuses specifically on the stress levels among parents of mentally retarded children, breaking down the data by gender. It shows that female parents (n=36) report a higher mean stress score of 6.7 (±1.3) compared to male parents (n=35), who report a score of 6.2 (±1.0). This difference is statistically significant (P<0.05) with a Z-value of 1.9, suggesting that mothers of children with mental retardation might be experiencing higher levels of stress than fathers.

Table 3: Stress Levels in Parents of Children with Chronic Medical Conditions

Table 3 depicts the stress levels among parents of children with chronic medical conditions. Here, no significant difference in stress levels is observed between male (n=36) and female (n=36) parents, with scores of 5.8 (±0.9) and 6.0 (±1.0) respectively. The Z-value of 0.9 and a P-value greater than 0.05 indicate that the stress levels between mothers and fathers in this group are statistically similar.

Table 4: Comparison of Coping Strategies Employed by Both Groups of Parents

Table 4 compares the coping strategies between the same two groups as in Table 1. Both groups consist of similar numbers of parents (71 in Group A and 72 in Group B) but differ in their coping scores. Group A's parents have a higher mean coping score of 5.7 (±0.9) compared to Group B's 5.3 (±0.8), with a Z-value of 2.4 and a P-value less than 0.05, indicating a statistically significant difference in coping mechanisms between the two groups.

Table 1 shows that parents in Group A have a significantly higher mean stress score than those in Group B, which is in line with other studies that have found higher levels of stress among parents of children with mental disabilities compared to those with physical health conditions Reiss F et al.(2019)[8]. The higher stress scores in parents of mentally retarded children could be attributed to the pervasive and often lifelong caregiving these conditions require, coupled with societal stigma and a lack of adequate support systems Eruyar S et al.(2018)[9]. The coping scores also differ significantly, suggesting that the nature of the child's disability can affect how parents adapt and manage stress. This is consistent with research indicating that parents of children with intellectual disabilities might employ different coping strategies, often seeking social support and using acceptance as a coping mechanism Eruyar S et al.(2018)[10].

Table 2 emphasizes gender differences in stress levels within Group A, where female parents exhibit higher stress scores than male parents. This finding corroborates studies indicating that mothers of children with disabilities often report higher stress levels, possibly due to more direct caregiving responsibilities and emotional engagement Calvano C et al.(2022)[11]. The differences highlighted in this table reflect the broader literature suggesting that the impact of child disabilities on mothers can be particularly profound Fegert JM et al.(2020)[12].

Table 3 contrasts with the findings from Table 1 and 2 by showing no significant difference in stress scores between male and female parents in Group B. This may suggest that the nature of chronic medical conditions leads to a more evenly distributed caregiving and emotional load between parents, or that these conditions are perceived as less stigmatizing or isolating compared to mental retardation. Other studies have noted that chronic medical conditions can sometimes lead to a "rallying effect" where families pull together, reducing the disparity in stress levels between mothers and fathers Westrupp EM et al.(2023)[13].

Table 4 further explores coping mechanisms, showing that parents in Group A utilize more robust coping strategies compared to Group B. This could be due to the complex demands placed on these parents, which may drive them to develop and rely on more effective coping mechanisms over time. Literature supports that parents who face higher levels of stress, as seen in Group A, often develop stronger coping responses to manage their situation van Warmerdam J_et al.(2019)[14].

The comparative study illuminates critical distinctions in the stress experiences and coping mechanisms among two distinct parent groups. Through rigorous analysis, it becomes evident that parents of children with mental retardation experience significantly higher stress levels compared to those with children suffering from chronic medical conditions. This enhanced stress can be attributed to the pervasive, intensive nature of caregiving required for mental retardation, compounded by societal stigma and the profound, often permanent, impact on family dynamics.

Furthermore, the study reveals that the coping mechanisms employed by parents of mentally retarded children are more robust, likely a response to the continuous and complex challenges they face. In contrast, parents of children with chronic medical conditions, while certainly stressed, report lower stress levels and exhibit less intense coping strategies, possibly due to periodic nature of medical issues or a different kind of societal support and perception.

The findings from this study not only deepen our understanding of the psychological impacts borne by these parent groups but also emphasize the need for targeted interventions. There is a clear necessity for tailored support services that address the unique stressors faced by parents of mentally retarded children, including specialized counseling, support groups, and educational programs that enhance coping strategies.

Additionally, healthcare providers and policymakers must recognize the varying degrees of stress and coping mechanisms across different parent groups to better allocate resources and support systems that can mitigate these challenges effectively. This study underscores the importance of a nuanced approach in mental health support and the critical role of specific, evidence-based interventions in improving the quality of life for families navigating the complexities of raising children with disabilities.

LIMITATIONS OF STUDY

1. Sample Size and Diversity: The study may be limited by its sample size, which may not fully represent the vast diversity of experiences among all parents of children with mental retardation and chronic medical conditions. A larger, more diverse sample would enhance the generalizability of the findings.
2. Cross-Sectional Design: Given the cross-sectional nature of the study, it captures stress and coping mechanisms at a single point in time. This design limits the ability to ascertain causality or understand how stress and coping strategies might evolve as the child ages or as the medical or developmental condition changes.
3. Self-Report Bias: The study primarily relies on self-reported data, which can introduce bias as participants may underreport or overreport their stress levels due to social desirability or recall biases. Objective measures of stress and coping, such as physiological assessments or third-party observations, were not utilized.
4. Definition and Measurement Variability: The study's reliance on different scales and subjective measures might introduce variability in how stress and coping are defined and quantified across different groups. Consistency in measurement tools and techniques is crucial for comparative studies.
5. Control for Confounding Variables: While the study attempts to compare two distinct groups, it may not adequately control for various confounding variables that could influence stress levels. Factors such as socioeconomic status, the severity of the child's condition, the presence of support networks, and the parents' psychological history were not explicitly controlled for, which could affect the outcomes.
6. Geographic and Cultural Limitations: The study’s geographic scope is limited, potentially reflecting cultural attitudes towards disability and chronic illness that are not universally applicable. Cultural factors significantly impact caregiving experiences and the perception of stress, which may not be adequately represented.
7. Lack of Longitudinal Perspective: The study does not provide a longitudinal perspective to track changes over time, which would offer more depth in understanding how parental stress and coping mechanisms develop and change in response to their child's growth and evolving needs.

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