Activity limitation in children with cerebral palsy and parenting stress, depression, and self-esteem: A structural equation model.

Abstract

The challenges associated with the activity limitation and participation constraints of children with cerebral palsy may increase their parents' stress. The present study aims to identify the factors associated with parenting stress in mothers of children with cerebral palsy (CP) and to test the multidimensional assumptions of the condition, focusing on the relationship between stress, self-esteem, and depression among parents and the activity limitation of their children. We used structural equation modeling to examine the relationships between activity limitation (gross and fine motor, and communication function) in children with CP and their mothers' depression, self-esteem, and parenting stress. The participants were 217 children with CP (123 boys; 94 girls). The mean age of the children involved in the study was 6.61 (SD = 2.76). The types of CP were spastic (71.0%), dyskinetic / athetotic (7.8%), ataxic (4.6%), and mixed (5.5%). We further used structural equation modeling to investigate the mediating influence of depression and self-esteem on parent-child relationships, and the direct effects on parenting stress. The proposed model showed excellent fit indices. Activity limitation had an indirect effect and depression had a direct effect on self-esteem. Activity limitation and depression had effects on parenting stress both directly and indirectly, whereas self-esteem had only a direct effect on parenting stress. The results highlight the importance of identifying parental depression and self-esteem as predictive variables for parenting stress among parents of children with CP, as well as children's activity limitation.