Parenting stress also known as "parental burnout" relates to stressors that are a function of being in and executing the parenting role. It is a construct that relates to both psychological phenomena and to the human body's physiological state as a parent or caretaker of a child [2] . Such effects can be exacerbated when the child has complex care needs such as physical, developmental, emotional or behavioural needs [3] [4] [5] [6] .
Unlike many stressful situations and events, parenting stressors tend to be long-term, repetitive, and can create chronic stress that manifests both in psychological and physiological ways. Extensive cross-cultural research has found that parenting stress is associated with parenting and child behaviors, various parenting-related cognitions, and the parent's and child's physiological states. Abidin [7] has presented a non-exhaustive model and a measure that attempts to define the major components of parenting stress, and the impact of these stressors on parenting behavior and their child's development. [8] [9] The model concentrates on proximal variables related to the execution of the parenting role: the perceived behavioral characteristics of the child, the parent's self-cognitions, and their perceptions of the familial and friend support available to them. These proximal factors in turn connect with other aspects of the child's and the parent's interpersonal milieu. There are several operational definitions and ways of measuring aspects of parenting stress. [10] Many of these have shown good reliability and criterion validity across a range of different samples, establishing evidence of generalizability. The Parenting Stress Index (PSI), [11] the most widely used measure of parenting stress, has shown associations with a wide range of parenting behaviors and child outcomes and has been used in hundreds of published studies. [12] Since the fourth edition of the PSI has been translated in over 30 languages, [13] cross-cultural replications of the PSI factor structure have been published using normative samples from several countries. Copies of these measures and their test manuals may be obtained from the respective publisher. The goal is to provide a brief overview of the construct of parenting stress for a broader audience, given that the topic is likely to be of interest and importance across a wide range of medical and research contexts. Parenting is a human universal across time and culture, and the construct connects with psychological development, socialization of children, education, health (including when either person in the parent-child dyad experiences other illness or injury), and a wealth of other issues. The overview concludes with links to resources for learning more, or for incorporating measures into other programs of research.
The construct of parenting stress builds on the seminal works of both Selye [14] and Lazarus. [15] Selye demonstrated that a physiological response occurred in the body by phenomenological events like physical environmental stimuli. Although not always maladaptive, the stress in parenting is more likely to be maladaptive, especially when the stress is severe or chronic. Further, he demonstrated that, regardless of the sources of stress, the greater the number of stressors, the larger the body's physiological response. That finding suggested that parenting stress would need to be understood and measured by considering multiple variables. Lazarus articulated the connection of perceptions to emotions and subsequently to both the physiological response and the likely behavioral responses of individuals. Parenting stress thus conceived is not simply a reaction to observable events but the interpretations and other cognitions of the parent relative to the events. The Lazarus model suggests four stages of the stress reaction:
Thus, the works of Selye and Lazarus provide conceptual frameworks for understanding the links between emotion perception, stress, and coping. Multiple evidence-based measures of parenting stress have been developed. [10]
Kirby Deater-Deckard, in the volume Parenting Stress, presented the first comprehensive articulation of the research on parenting stress concerning the characteristics of parents, the parent-child relationship, and parents' coping behaviors. [16] Since Deater-Deckard's work, there has been a rapid expansion of research documenting the linkage between parenting stress and a wide variety of important issues related to family functioning and child development and behavior. The summary below provides a brief sampling to illustrate the breadth of impact parenting stress has on members of the core family system. It is an illustrative review extracting some examples from a recent more comprehensive review (with its own formal literature review search and extraction process) to concisely introduce a range of topics.
Observed Parenting Behavior
Parenting stress has been demonstrated to be predictive of abusive mother's behavior towards their children during free play and task situations, parents’ verbal harshness, demanding and controlling behaviors, and parents' level of warmth and engagement with their child. [17] [18] [19] [20] [21] [22] Parental stress or burnout can manifest as an "emotional distancing from their children" due to overwhelming exhaustion among other causes [23] .
Child Development and Outcomes
Parents’ level of stress has been found to be predictive of the development of problem behaviors in children, children's aggressiveness, callous-unemotional traits in children, and children's coping competence. [17] [24] [25] [26] [27] Barroso et al. conducted a major review and meta-analysis of the parenting stress literature, which revealed that parenting stress is a major factor with parents coping with their children's behavior. [28] [29]
Child Academic Functioning
Children whose parents exhibit high levels of parenting stress display difficulties in executive functioning, lower levels of academic competence, and other behavioral problems in school. [30] [31] [29] [28]
Physical Health and Physiological Issues
Parenting stress has been associated with elevated cortisol and oxytocin levels both in parents and their children. [30] [32] [29] These are well-established chemical markers of an individual's mental and physical health. Mothers who exhibit high levels of parenting stress also display a failure to care for their own health needs while also overusing pediatric healthcare services for their children. [28] [33] Parenting stress has also been associated with parental brain functioning, epigenetic DNA methylation, and parent-child behavioral synchrony, and brain synchrony. [34] [35] [36]
Compliance with Medical and Psychological Treatment
Parents with elevated stress levels have significantly higher non-compliance rates for their treatment and the medically necessary care of their children. They also are early terminators of psychological treatments for their children. [37] [38] [39]
The Parenting Partner Relationship
The quality of the parents' relationship is a central variable in terms of child outcomes. The level of parenting stress experienced by parenting partners is associated with the child's physical and mental health. [40] [41] [42]
Stress, whether physiological, biological or psychological, is an organism's response to a stressor such as an environmental condition. When stressed by stimuli that alter an organism's environment, multiple systems respond across the body. In humans and most mammals, the autonomic nervous system and hypothalamic-pituitary-adrenal (HPA) axis are the two major systems that respond to stress. Two well-known hormones that humans produce during stressful situations are adrenaline and cortisol.
The hypothalamic–pituitary–adrenal axis is a complex set of direct influences and feedback interactions among three components: the hypothalamus, the pituitary gland, and the adrenal glands. These organs and their interactions constitute the HPS axis.
Stress management consists of a wide spectrum of techniques and psychotherapies aimed at controlling a person's level of stress, especially chronic stress, usually for the purpose of improving everyday functioning. Stress produces numerous physical and mental symptoms which vary according to each individual's situational factors. These can include a decline in physical health, such as headaches, chest pain, fatigue, and sleep problems, as well as depression. The process of stress management is named as one of the keys to a happy and successful life in modern society. Life often delivers numerous demands that can be difficult to handle, but stress management provides a number of ways to manage anxiety and maintain overall well-being.
Psychoneuroimmunology (PNI), also referred to as psychoendoneuroimmunology (PENI) or psychoneuroendocrinoimmunology (PNEI), is the study of the interaction between psychological processes and the nervous and immune systems of the human body. It is a subfield of psychosomatic medicine. PNI takes an interdisciplinary approach, incorporating psychology, neuroscience, immunology, physiology, genetics, pharmacology, molecular biology, psychiatry, behavioral medicine, infectious diseases, endocrinology, and rheumatology.
Social support is the perception and actuality that one is cared for, has assistance available from other people, and most popularly, that one is part of a supportive social network. These supportive resources can be emotional, informational, or companionship ; tangible or intangible. Social support can be measured as the perception that one has assistance available, the actual received assistance, or the degree to which a person is integrated in a social network. Support can come from many sources, such as family, friends, pets, neighbors, coworkers, organizations, etc.
Child psychopathology refers to the scientific study of mental disorders in children and adolescents. Oppositional defiant disorder, attention-deficit hyperactivity disorder, and autism spectrum disorder are examples of psychopathology that are typically first diagnosed during childhood. Mental health providers who work with children and adolescents are informed by research in developmental psychology, clinical child psychology, and family systems. Lists of child and adult mental disorders can be found in the International Statistical Classification of Diseases and Related Health Problems, 10th Edition (ICD-10), published by the World Health Organization (WHO) and in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association (APA). In addition, the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood is used in assessing mental health and developmental disorders in children up to age five.
Psychological resilience is the ability to cope mentally and emotionally with a crisis, or to return to pre-crisis status quickly.
Emotional dysregulation is characterized by an inability flexibly to respond to and manage emotional states, resulting in intense and prolonged emotional reactions that deviate from social norms, given the nature of the environmental stimuli encountered. Such reactions not only deviate from accepted social norms but also surpass what is informally deemed appropriate or proportional to the encountered stimuli.
The term eustress means "beneficial stress"—either psychological, physical, or biochemical/radiological (hormesis).
Compassion fatigue is an evolving concept in the field of traumatology. The term has been used interchangeably with secondary traumatic stress (STS), which is sometimes simply described as the negative cost of caring. Secondary traumatic stress is the term commonly employed in academic literature, although recent assessments have identified certain distinctions between compassion fatigue and secondary traumatic stress (STS).
Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.
Richard R. Abidin is a noted psychologist who has devoted much of his career to studying the relationships between parents and children. He served as founder and director of School/Clinical Child Psychology Ph.D. Program from 1967 to 1979, served as director of the Institute of Clinical Psychology between 1979 and 1988 and served as director of the Curry Programs in Clinical and School Psychology between the years 1988–1995 at the University of Virginia. Abidin retired in 2003; he is now emeritus professor, lecturer and consultant to Curry Programs in Clinical and School Psychology at the same university.
Caregiver syndrome or caregiver stress is a condition that strongly manifests exhaustion, anger, rage, or guilt resulting from unrelieved caring for a chronically ill patient. This condition is not listed in the United States' Diagnostic and Statistical Manual of Mental Disorders, although the term is often used by many healthcare professionals in that country. The equivalent used in many other countries, the ICD-11, does include the condition.
The ICD-11 of the World Health Organization (WHO) describes occupational burnout as an occupational phenomenon resulting from chronic workplace stress that hasn't been successfully managed, with symptoms characterized by "feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy." It is classified as a mismatch between the challenges of work and a person's mental and physical resources, but is not recognized by the WHO as a medical condition.
Vicarious trauma (VT) is a term invented by Irene Lisa McCann and Laurie Anne Pearlman that is used to describe how work with traumatized clients affects trauma therapists. The phenomenon had been known as secondary traumatic stress, a term coined by Charles Figley. In vicarious trauma, the therapist experiences a profound worldview change and is permanently altered by empathetic bonding with a client. This change is thought to have three requirements: empathic engagement and exposure to graphic, traumatizing material; exposure to human cruelty; and the reenactment of trauma in therapy. This can produce changes in a therapist's spirituality, worldview, and self-identity.
In psychology, stress is a feeling of emotional strain and pressure. Stress is a type of psychological pain. Small amounts of stress may be beneficial, as it can improve athletic performance, motivation and reaction to the environment. Excessive amounts of stress, however, can increase the risk of strokes, heart attacks, ulcers, and mental illnesses such as depression and also aggravation of a pre-existing condition.
Pediatric psychology is a multidisciplinary field of both scientific research and clinical practice which attempts to address the psychological aspects of illness, injury, and the promotion of health behaviors in children, adolescents, and families in a pediatric health setting. Psychological issues are addressed in a developmental framework and emphasize the dynamic relationships which exist between children, their families, and the health delivery system as a whole.
Maternal fetal stress transfer is a physiological phenomenon in which psychosocial stress experienced by a mother during her pregnancy can be transferred to the fetus. Psychosocial stress describes the brain's physiological response to perceived social threat. Because of a link in blood supply between a mother and fetus, it has been found that stress can leave lasting effects on a developing fetus, even before a child is born. According to recent studies, these effects are mainly the result of two particular stress biomarkers circulating in the maternal blood supply: cortisol and catecholamines.
The shift-and-persist model has emerged in order to account for unintuitive, positive health outcomes in some individuals of low socioeconomic status. A large body of research has previously linked low socioeconomic status to poor physical and mental health outcomes, including early mortality. Low socioeconomic status is hypothesized to get "under the skin" by producing chronic activation of the sympathetic nervous system and hypothalamic–pituitary–adrenal axis, which increases allostatic load, leading to the pathogenesis of chronic disease. However, some individuals of low socioeconomic status do not appear to experience the expected, negative health effects associated with growing up in poverty. To account for this, the shift-and-persist model proposes that, as children, some individuals of low socioeconomic status learn adaptive strategies for regulating their emotions ("shifting") and focusing on their goals ("persisting") in the face of chronic adversity. According to this model, the use of shift-and-persist strategies diminishes the typical negative effects of adversity on health by leading to more adaptive biological, cognitive, and behavioral responses to daily stressors.
The COVID-19 pandemic has impacted the mental health of people across the globe. The pandemic has caused widespread anxiety, depression, and post-traumatic stress disorder symptoms. According to the UN health agency WHO, in the first year of the COVID-19 pandemic, prevalence of common mental health conditions, such as depression and anxiety, went up by more than 25 percent. The pandemic has damaged social relationships, trust in institutions and in other people, has caused changes in work and income, and has imposed a substantial burden of anxiety and worry on the population. Women and young people face the greatest risk of depression and anxiety. According to The Centers for Disease Control and Prevention study of Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic, "63 percent of young people reported experiencing substantial symptoms of anxiety and depression".
This article was adapted from the following source under a CC BY 4.0 license (2022) (reviewer reports): Richard Abidin; Logan Smith; Hannah Kim; Eric Youngstrom (21 June 2022). "Parenting stress" (PDF). WikiJournal of Medicine. 9 (1): 3. doi: 10.15347/WJM/2022.003 . ISSN 2002-4436. Wikidata Q99676829.
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