Measuring Mental Health of Caregivers of Special Children: A Case of Gilgit-Baltistan (GB),Pakistan

Abstract

The objective of this study was to assess the mental health of caregivers of special children in Gilgit-Baltistan (GB), Pakistan. The sample of 100 caregivers (50 special and 50 normal) was recruited. Mental Health Inventory was used to assess parents’ mental health, and demographic information was collected using demographic sheet. The results of the study showed that caregivers of special children reported a lower level of mental health (t = 2.25, p = .02), psychological well-being (t = 2.89, p = .00), general positive affect (t = 2.52, p = .01), emotional ties (t = 2.54, p = .01), and life satisfaction (t = 2.54, p = .01) and higher level of depression (t = 1.96, p = .05) and loss of emotional/behavioral control (t = 2.28, p = .02) as compared with caregivers of normal children. However, insignificant differences were found in psychological distress (t = 1.64, p = .10) and anxiety (t = .59, p = .55) between both groups. Caregivers’ gender was found as a significant risk factor for their mental health. Likewise, in other areas, caregivers of special children in GB were also vulnerable to mental health problems, particularly females, so that it is essential to address their mental health problems. The results of the study revealed significant and valuable recommendations for mental health professionals.

Keywords

caregivers special children mental health female mental issues

Introduction

Being a parent of a child with special care needs may emasculate the long-term health of parents as indicated by research findings. Parents of a child with special care needs had poor mental health and greater depressive symptoms as compared with parents of typically developing children (Smith & Grzywacz, 2014). Another study reported 44.4% of parents of children with disabilities reported psychological distress and 8.9% had serious mental illness (Yamaoka et al., 2015). In Pakistan, there is a significant delay in detection of intellectual disabilities, especially in rural settings. This missed opportunity for rehabilitation during early developmental years results in significant distress for caregivers (Mirza et al., 2009).

In South Asia, particularly Pakistan and India, the burden of care of children with autism spectrum disorder was entirely on mothers, which lead to a higher level of stress (Minhas et al., 2015). Findings of the study conducted in Pakistani context reported that mothers of special children were facing multiple problems in different domains of life. Mothers’ lower education, low income, and nuclear family system were reported as risk factors (Iqbal et al., 2014). Another study reported that mothers of children with disabilities reported a higher level of depression (76%) and anxiety (78%) as compared with mothers of nondisabled children. Interestingly, when a child’s age increases, mothers understand the demands of raising their disabled child and cope with these demands effectively, which results in lesser anxiety (Ramzan & Minhas, 2014). Contrary to earlier studies, which focused on negative aspects of caring for children with mental retardation, another study within the national context reported positive contributions to family life due to caring for children with mental retardation. Positive effects on family life as reported by mothers were learning through experiences to cope with special problems in life, feelings of happiness and fulfillment, awareness about future issues, and family closeness and strength (Lakhani et al., 2013).

Research work in other countries had found that parents as caregivers of children with intellectual disability reported mental health problems, and very few studies in Pakistani context addressed the issue and one of them revealed contradictory findings (Lakhani et al., 2013) but actual condition has not been studied in Gilgit-Baltistan (GB). Therefore, this study aimed to examine the association between children’s intellectual disability and mental health of their caregivers in GB.

Method

A total of 100 caregivers of children (50 special and 50 normal) were recruited based on a purposive sampling technique.

Caregivers of special children were approached in their homes through special education complex of Gilgit, while the control group was approached through the convenient sampling technique. Parents’ of special children younger than 4 years and older than 17 years were not included in the study because in Pakistan, there is a delay in the detection of children with special needs (Mirza et al., 2009) and parents adopt the situation with the passage of time (Ramzan & Minhas, 2014). Parents of children with other disabilities including autism spectrum disorder were also excluded due to the fact that this study was conducted to assess the mental health of parents with intellectually disable children only. Mental Health Inventory (Veit & Ware, 1983) was administered to assess participants’ mental health. The inventory has six subscales: anxiety, depression, loss of emotional/behavioral control, general positive affect, emotional ties, and life satisfaction. The first three subscales create psychological distress, while the last three subscales build psychological well-being. Aggregate scores on both, psychological distress and psychological well-being, constitute overall mental health. Keeping in view the sociocultural context of GB, female researchers collected data from female participants and male researchers collected data from male participants. Research participants were briefly interviewed to rule out any possible history of psychiatric illnesses and only those parents were included in the study who were free from any kind of psychiatric history. Data were collected only from consented parents, and they were assured about the confidentiality of their identifying information and the use of data only for research purpose.

Collected data were analyzed through descriptive (M, SD, and frequencies) and inferential (independent sample t test) statistical techniques by using statistical package for social sciences (SPSS. v.21). The level of significance p ≤ .05 was considered significant, and effect sizes of associations were also calculated (Cohen, 1992).

Results

Descriptive statistical techniques (M, frequency, and SD) were used to describe sample characteristics and summarize data. Mental health of both groups was compared using independent sample t test, and Cohen’s d (Cohen, 1992) was applied to assess effect size.

Table 1 shows the demographics of caregivers, where 25 (50%) of the caregivers were females, and all of them were biological parents.

Table 1.

Caregivers’ Characteristics (N = 100).

Demographics	Caregivers’ special children	Caregivers’ normal children
Males	25 (50%)	25 (50%)
Females	25 (50%)	25 (50%)
Age (years)
18–35	17 (34%)	30 (60%)
36–55	23 (46%)	18 (36%)
56 and older	10 (20%)	2 (4%)
Marital status
Married	43 (86%)	50 (100%)
Divorced/widowed	7 (14%)	0.0 (0.0%)

Table 2 shows that the caregivers of special children had a lower level of mental health (t = 2.25, p = .02), psychological well-being (t = 2.89, p = .00), general positive affect (t = 2.52, p = .01), emotional ties (t = 2.54, p = .01), and life satisfaction (t = 2.54, p = .01) and higher level of depression (t = 1.96, p = .05) and loss of emotional/behavioral control (t = 2.28, p = .02) as compared with caregivers of normal children. However, insignificant differences were found in psychological distress (t = 1.64, p = .10) and anxiety (t = .59, p = .55) between both groups.

Table 2.

Mental Health of Caregivers of Special and Normal Children (N = 100).

	Caregivers of special children (n = 50)		Caregivers of normal children (n = 50)
Variable	M	SD	M	SD	t	p	d
Mental health index	153.32	29.25	166.84	30.74	2.25	.02	0.45
Psychological well-being	53.56	11.58	60.38	11.99	2.89	.00	0.57
Psychological distress	66.44	20.17	59.54	20.65	1.64	.10	0.32
Anxiety	24.24	8.20	23.26	8.22	.59	.55	0.11
Depression	10.96	3.89	9.44	3.86	1.96	.05	0.39
Loss of emotional/ behavioral control	24.64	7.98	20.9	8.41	2.28	.02	0.45
General positive affect	37.96	8.96	42.54	9.17	2.52	.01	0.50
Emotional ties	8	2.29	9	2.32	2.54	.01	0.43
Life satisfaction	8	2.29	9	2.32	2.54	.01	0.43

The effect size for mental health (d = 0.45), emotional ties (d = 0.43), life satisfaction (d = 0.43), depression (d = 0.39), and loss of emotional/behavioral control (d = 0.45) was small, while it was medium for psychological well-being (d = 0.57) and general positive affects (d = 0.50).

Table 3 shows that female caregivers of special children reported lower levels of mental health (t = 4.05, p = .00), psychological well-being (t = 2.57, p = .01), and general positive affect (t = 2.33, p = .02) and higher levels of psychological distress (t = 4.36, p = .00), anxiety (t = 3.19, p = .00), depression (t = 2.97, p = .00), and loss of emotional/behavioral controls (t = 4.76, p = .00) as compared with male caregivers. However, insignificant differences were found in emotional ties (t = 1.17, p = .54) and life satisfaction (t = 1.17, p = .54) between both groups.

Table 3.

Mental Health of Male and Female Caregivers of Special Children (N = 50).

	Male caregivers (n = 25)		Female caregivers (n = 25)
Variable	M	SD	M	SD	t	p	d
Mental health index	167.96	25.42	138.68	25.59	4.05	.00	1.14
Psychological well-being	57.56	12.13	49.56	9.65	2.57	.01	0.72
Psychological distress	55.6	16.07	76.88	18.35	4.36	.00	1.23
Anxiety	20.84	7.77	27.64	7.27	3.19	.00	0.90
Depression	9.44	3.09	12.48	4.06	2.97	.00	0.84
Loss of emotional/behavioral control	20.16	6.18	29.12	7.07	4.76	.00	1.34
General positive affect	40.8	9.47	35.12	7.62	2.33	.02	0.66
Emotional ties	8.40	2.12	7.60	2.44	1.17	.54	0.35
Life satisfaction	8.40	2.12	7.60	2.44	1.17	.54	0.35

The effect size was large for mental health index (d = 1.14), psychological distress (d = 1.23), anxiety (d = .90), and loss of emotional/behavioral control (d = 1.34), while it was medium for psychological well-being (d = .72), general positive affect (d = .66), and depression (d = .84).

Discussion

The present study findings showed that caregivers of special children reported lower levels of mental health, psychological well-being, general positive affect, emotional ties, and life satisfaction and a higher level of depression and loss of emotional/behavioral control when compared with caregivers of normal children. Researchers reported consistent findings from Pakistan, that is, parents of children with intellectual disability reported a higher level of stress (Nadeem et al., 2016), anxiety, and depression as compared with parents of normal healthy children. Drastically high ratio of parents of children with intellectual disabilities has psychiatric diagnosis of both anxiety and depression (Azeem et al., 2013). Researchers from international context also found similar results, that is, mothers of children with intellectual disabilities (Norlin & Broberg, 2013) and children with special health care needs (Dillon-Wallace et al., 2014) had lower well-being and poorer mental health as compared with other parents. Like mothers, fathers of children with intellectual disability are also at increased risk of experiencing mental health difficulties and parental stress, in turn; it affects paternal mental health–related quality of life (Giallo et al., 2015). Both parents of children with intellectual disability (Grant et al., 2013) and children with special health care needs (Smith & Grzywacz, 2014) reported poorer self-rated mental health, higher level of anxiety and depression, and restrictions in instrumental activities of daily living.

In the present study, female caregivers of special children were more vulnerable to mental health problems as indicated by their lower levels of mental health, psychological well-being, and general positive affect and higher levels of psychological distress, anxiety, depression, and loss of emotional/behavioral control as compared with male caregivers. These results endorsed earlier findings reported by researchers where mothers of special children had lower well-being and poorer mental health (Dillon-Wallace et al., 2014; Norlin & Broberg, 2013). In Pakistan, burden of care of special children is entirely on mothers so that they were facing multiple problems in different areas of their lives which in turn resulted in a higher level of distress (Iqbal et al., 2014; Minhas et al., 2015).

While recognizing the fact that caregivers of special children have mental health problems, researchers attempt to identify the underlying risk factors to address them. Some evidences reported stress (Batool & Khurshid, 2015; Cramm & Nieboer, 2011; Crnic et al., 2017), family processes, behavioral problems of special child (Boehm et al., 2015; Crnic et al., 2017), and financial difficulty (McConnell et al., 2014) as risk factors of caregivers’ poor mental health. Regarding protective factors, researchers reported perceived ability and confidence in their competence as a parent of special children (Batool & Khurshid, 2015) level of support needs (Boehm et al., 2015), and perceived social support (McConnell et al., 2014) as protective factors. However, such parents usually perceive a higher level of burden, which influences their emotional state including depression, anxiety, stress, positive and negative affect, eudemonic and hedonic happiness, and life satisfaction (Fianco et al., 2015). Poor mental health in these parents associated with a series of negative health and social and family outcomes, so it is necessary to pay attention to the mental health needs of these parents (Gallagher & Hannigan, 2014). Therefore, researchers recommend skill training programs and mindfulness interventions for parents to reduce parental stress (Crnic et al., 2017) that resultantly minimize mental health problems of caregivers of special children.

Conclusion

Caregivers of special children reported a lower level of mental health including psychological well-being, general positive affect, emotional ties, and life satisfaction and higher level of depression and loss of emotional/behavioral control as compared with caregivers of normal children. Female caregivers of special children reported lower levels of mental health including psychological well-being and general positive affect and higher levels of psychological distress, anxiety, depression, and loss of emotional/behavioral controls as compared with male caregivers. These findings revealed that likewise, in other areas, caregivers of special children in GB were also vulnerable to mental health problems, particularly females. Therefore, we recommend proactive services such as awareness seminars, conferences, and training sessions to protect parents of special children from mental health problems and reactive services such as counseling and psychotherapy to already mentally disturbed parents of special children with particular focus on female caregivers. In addition to its applied value, the current study has theoretical contribution, that is, provides evidence to enrich scientific literature regarding mental health of caregivers of special children.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Sadiq Hussain

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