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Research in Autism Spectrum Disorders

Volumes 29–30, September–October 2016, Pages 8-18
Research in Autism Spectrum Disorders

Hope, social relations, and depressive symptoms in mothers of children with autism spectrum disorder

https://doi.org/10.1016/j.rasd.2016.05.006Get rights and content

Highlights

  • Hopeful thinking was associated with decreased loneliness and depressive symptoms and increased social support among mothers of children with autism spectrum disorder.

  • In a mediation model, hope was associated with decreased loneliness which, in turn, was associated with less depressive symptoms.

  • In a serial mediation model, hope was associated with depressive symptoms via family support and loneliness.

Abstract

Background

Raising a child with autism spectrum disorder (ASD) may negatively impact maternal mental health outcomes. Feelings of loneliness and a lack of social support may contribute to these outcomes. One factor that may help to promote better outcomes is hope. The current study examined the associations between maternal hope, loneliness, social support, and depressive symptoms.

Method

Ninety-four mothers of a child with ASD participated in this online study. Mothers were predominantly Caucasian, middle class, and educated. Children ranged in age from 2 to 13 years. Mothers completed questionnaires assessing hope, loneliness, perceived social support from friends and family, and depressive symptoms.

Results

The results of a multiple mediator model indicated that hope agency was indirectly associated with depressive symptoms via loneliness. In a follow-up serial mediation model, hope agency was associated with depressive symptoms through family support and loneliness.

Conclusions

The present study contributes to the growing body of research focusing on positive personality characteristics and mental health outcomes in mothers of children with ASD. Given that increased hopeful thinking was associated with less loneliness, the construct of hope should be given more attention in interventions that are aimed at improving maternal outcomes. Increasing hopeful thinking may be particularly important in aiding with improvement during psychotherapy for mothers with clinical levels of depressive symptoms.

Introduction

Mothers raising children with autism spectrum disorder (ASD) face numerous challenges that may negatively impact their quality of life and mental health outcomes (e.g., Davis and Carter, 2008, Kuhlthau et al., 2014). Studies have consistently demonstrated that mothers of children with ASD report elevated levels of stress and depressive symptoms compared to parents of typically developing children (e.g., Ingersoll & Hambrick, 2011; Lai, Goh, Oei, & Sung, 2015). Children’s behavior problems are salient predictors of maternal outcomes (e.g., Davis & Carver, 2008; Falk, Norris, & Quinn, 2014); however, feelings of social isolation (Dunn, Burbine, Bowers, & Tantleff-Dunn, 2001) may also contribute to maternal mental health outcomes. Following the increasing popularity of positive psychology, research has begun to focus on identifying factors that promote positive adaptation in mothers of children with ASD (e.g., Ekas, Timmons, Pruitt, Ghilain, & Alessandri, 2015; Faso, Neal-Beevers, & Carlson, 2013; Lloyd and Hastings, 2009a, Lloyd and Hastings, 2009b). The current study contributes to this growing body of research by examining the associations between hope, social support, loneliness, and depressive symptoms in mothers of children with ASD.

One of the dominant themes that has emerged from over two decades of research with mothers of children with ASD is the increased amount of stress, depression, and anxiety that mothers experience (e.g., Bitsika, Sharpley, & Bell, 2013; Falk et al., 2014; Lai et al., 2015). One factor that may contribute to these negative outcomes are feelings of social isolation that parents often report. In one qualitative study, parents discussed issues surrounding a lack of time available to spend with friends and family (Altiere & Von Kluge, 2009a). Another qualitative study found that parents reported several themes surrounding feelings of social isolation, including feeling unable to be in public due to their child’s behavior, losing friends, and being treated badly by strangers (Myers, Mackintosh, & Goin-Kochel, 2009). These feelings of social isolation may persist throughout the child’s lifespan as parents of adults with high-functioning ASD also reported feeling that family members and friends did not understand the disorder and, therefore, did not provide support (Griffith, Totsika, Nash, Jones, & Hastings, 2012). Loneliness refers to feelings and thoughts of isolation and being disconnected from others (Russell, Peplau, & Cutrona, 1980) and is a cognitive appraisal of social relationships (Holmén & Furukawa, 2002). Individuals who report loneliness may have a large social network, but they are not satisfied with the interactions they have with those around them (Rokach, 2011). In the general population, greater loneliness was associated with poor psychological well-being, including increased depressive symptoms (Cacioppo, Hawkley, & Thisted, 2010) and increased hopelessness (Chang, Muyan, & Hirsch, 2015). To date, however, there have been no quantitative studies examining associations between loneliness and depressive symptoms in mothers of children with ASD.

The negative outcomes associated with raising a child with ASD have been well documented; however, there is considerable individual variability in outcomes and some mothers adapt to the challenges in a positive manner (e.g., Hastings & Taunt, 2002). Therefore, in recent years, studies have begun to focus on factors that promote better psychological well-being among mothers of children with ASD (i.e., lower negative outcomes and/or increased positive outcomes). This emphasis aligns well with the growing field of positive psychology, which focuses on positive outcomes and factors that promote positive adaptation (Seligman & Csikszentmihalyi, 2000). Research in positive psychology focuses on three domains: (1) the pleasant life; (2) the engaged life; and (3) the meaningful life (Duckworth, Steen, & Seligman, 2005). The pleasant life domain focuses on positive emotions, including feelings of happiness, satisfaction, and contentment. The engaged life refers to strengths of character that promote positive functioning (e.g., kindness, humor, fairness, hope, gratitude). Finally, the meaningful life involves belonging to or serving positive institutions (e.g., families, friendships, larger community). The current study focused on two domains, the engaged and meaningful lives, and their associations with maternal psychological well-being.

Hope has received increasing attention as a variable that may promote psychological well-being. Hope has traditionally been considered a strength of character that is part of the engaged life (Peterson & Park, 2009). In his theory of hope, Snyder (2002) argues that human behavior is goal-directed and that goals are fundamental to hopeful thinking. Hopeful thinking consists of an individual’s perceived ability to generate ways of reaching goals (pathways) as well as their perceived ability to use these pathways to reach their goals (agency). Thus, agency is the motivational component of hope and reflects an individual’s intention to act upon the pathways generated (Rand & Cheavens, 2009; Snyder, Feldman, Taylor, Schroeder, & Adams, 2000). Individuals who engage in elevated levels of both agentic and pathways thinking are typically referred to as high-hope people (Snyder et al., 2000). Hope is generally measured and conceptualized as a dispositional characteristic and measured using trait measures (e.g., Snyder et al., 1991); however, hope can also fluctuate in response to different situations (Snyder et al., 1996). It is important to note that while optimism and hope are both in the realm of positive psychology and appear to be similar constructs, they are only modestly related (Snyder et al., 1991). Optimism reflects an individual’s general expectancies in life (Scheier & Carver, 1985) whereas hope refers to goal-directed thoughts and actions.

Since the development of the theory, hope has been consistently linked to a variety of favorable outcomes in the general population, including less depressive symptoms (Chang et al., 2013). Among parents of typically developing children, hope is associated with increased life satisfaction (Hoy, Suldo, & Mendez, 2013). Similar findings have been reported for parents of children with psychological and physical health problems. For example, Kashdan et al. (2002) examined hope in mothers of children with externalizing disorders and found that hope was associated with adaptive coping and better family functioning. In another study of parents of children receiving cancer treatment, Hullmann, Fedele, Molzon, Mayes, & Mullins (2014) reported that parents with higher levels of hope also reported more positive outcomes as a result of their child’s cancer diagnosis. There are, however, limited studies examining dispositional hope among mothers of children with ASD. Lloyd and Hastings, 2009a, Lloyd and Hastings, 2009b examined the relationship between dispositional hope and depressive symptoms in mothers of children with intellectual disabilities, including ASD. Results of that study indicated that hope agency and hope pathways were associated with decreased depressive symptoms. In a sample of mothers of children with ASD and mothers of children with Down syndrome, Ogston, Mackintosh, & Myers (2011) found that higher levels of hope were associated with less worry. However, mothers of children with ASD reported lower hope than mothers of children with Down syndrome. In another study of mothers of children with ASD, Faso et al. (2013) found that hope agency was associated with less depressive symptoms; however, in contrast to previous research (Lloyd and Hastings, 2009a, Lloyd and Hastings, 2009b), hope pathways was not a significant predictor of depressive symptoms. Although both studies examined the direct relationship between hope and depressive symptoms, there is no research examining potential mechanisms that might explain this relationship.

One factor that has emerged as particularly important for the psychological well-being of mothers of children with ASD is social support. In the current study, perceived social support refers to the extent to which a person feels they have received instrumental (e.g., tangible help) or emotional (e.g., advice) support from another person. In addition to reporting that they find support from friends and family to be important (Altiere & von Kluge, 2009b), mothers’ feelings of being supported was associated with decreased depressive symptoms (Benson, 2012). Hopeful thinking may engender increased social support through its association with interpersonal relationships. Hopeful thinking is believed to develop during early childhood via sensitive and supportive interactions with caregivers (Snyder, Cheavens, & Sympson, 1997; Shorey, Snyder, Yang, & Lewin, 2003) and is also thought to promote social relationships. For example, high-hope adults are more likely to report increased social support (Barnum, Snyder, Rapoff, Mani, & Thompson, 1998) and increased social competence (Snyder et al., 1997). In addition, high-hope individuals are more likely to be friends with other high-hope individuals (Parker et al., 2015). Unfortunately, the research in this area has not established if hopeful thinking leads to better social relationships or if improved social relationships promote hopeful thinking. However, Snyder et al. (1997) argued that high-hope individuals are more likely to form quality social relationships because they are interested in pursuing their own goals and are also interested in the goals of those around them. Therefore, it may be possible that hopeful thinking is responsible for promoting social relationships.

If hopeful thinking engenders quality social relationships, it may also serve to indirectly ameliorate the feelings of loneliness and social isolation that parents of children with ASD report (e.g., Myers et al., 2009). As previously discussed, loneliness refers to emotional distress that an individual experiences as a result of thinking that their social relationships are low quality (Peplau & Perlman, 1982). A large body of research in the general population has found that social support is typically associated with lower levels of loneliness (e.g., Cacioppo et al., 2010, Shiovitz-Ezra and Leitsch, 2010). Chen and Feeley (2014), in a study of older adults, found that increased social support was associated with decreased loneliness which, in turn, predicted better well-being. Thus, feeling that friends, family, or partners are supportive (i.e., perceived social support) is directly associated with a reduction in feelings of distress related to social relationships (i.e., loneliness).

The purpose of the current study was to extend previous research that found associations between hope and maternal outcomes (e.g., Faso et al., 2013) by examining the mechanisms responsible these associations. To accomplish these goals a mediation analysis was conducted wherein hope agency and hope pathways were specified as simultaneous predictors of depressive symptoms via social support and loneliness. First, consistent with previous research with mothers of children with ASD we expected that increased hopeful thinking would be associated with less depressive symptoms. Next, based on research conducted in the general population, we hypothesized that higher levels of hope would be associated with increased perceived social support and less loneliness. In turn, increased social support was hypothesized to be associated with less depressive symptoms, whereas loneliness was predicted to be associated with greater depressive symptoms. Finally, we tested a series of serial mediation models where hopeful thinking was predicted to be positively association with perceived social support which, in turn, predicted decreased loneliness and, subsequently, less depressive symptoms.

Section snippets

Participants

The current sample was from a larger study of parents of children with ASD (n = 136). In order to qualify for the current study, participants had to be female (n = 99) and have no missing data on any of the study variables (n = 94). Although data was collected from fathers, because of the small sample size (n = 37), dependent nature of the data (mothers and fathers were married to one another), and the complexity of the analyses we did not include fathers in this study. The final sample of 94 mothers

Results

Descriptive statistics are presented in Table 1 and correlations between study variables are shown in Table 2. Although the hope agency and pathways subscales as well as depressive symptoms and loneliness were significantly correlated, there was no evidence of multicollinearity between the variables. Hope agency was associated with decreased depressive symptoms, decreased loneliness, and increased friend and family support. Conversely, hope pathways was only associated with decreased

Discussion

The purpose of the current study was to examine the associations between hope (hope agency and hope pathways), social relationships (social support and loneliness), and depressive symptoms in mothers of children with ASD. The construct of hope has received little empirical attention in this population and this study was the first to examine potential mechanisms to explain the association between hope and depressive symptoms found in a previous study (Faso et al., 2013). We found that hopeful

Limitations and conclusion

Although this study complemented and expanded upon existing research on hopeful thinking in mothers of children with ASD, there are several limitations that warrant discussion. First, this study relied on maternal self-report of all measures, including children’s ASD diagnosis, at a single time point. Relying on a single method and a single reporter may lead to biased results. In addition, we were unable to independently confirm children’s diagnosis. Future studies should verify children’s

Acknowledgement

This research was supported by the Research and Creative Activities Fund, Texas Christian University.

References (74)

  • P.L. Ogston et al.

    Hope and worry in mothers of children with an autism spectrum disorder or Down syndrome

    Research in Autism Spectrum Disorders

    (2011)
  • K.E. Zuckerman et al.

    Latino parents’ perspectives on barriers to autism diagnosis

    Academic Pediatrics

    (2014)
  • M.J. Altiere et al.

    Searching for acceptance: challenges encountered while raising a child with autism

    Journal of Intellectual and Developmental Disability

    (2009)
  • M.J. Altiere et al.

    Family functioning and coping behaviors in parents of children with autism

    Journal of Child and Family Studies

    (2009)
  • E.T. Barker et al.

    Trajectories of emotional well-being in mothers of adolescents and adults with autism

    Developmental Psychology

    (2011)
  • D.D. Barnum et al.

    Hope and social support in psychological adjustment of children who have survived burn injuries and their matched controls

    Children’s Health Care

    (1998)
  • H. Ben-Zur

    Loneliness, optimism, and well-being among married, divorced, and widowed individuals

    The Journal of Psychology

    (2012)
  • P.R. Benson

    Network characteristics, perceived social support, and psychological adjustment in mothers of children with autism spectrum disorder

    Journal of Autism and Developmental Disorders

    (2012)
  • V. Bitsika et al.

    The buffering effect of resilience upon stress, anxiety and depression in parents of a child with an autism spectrum disorder

    Journal of Developmental and Physical Disabilities

    (2013)
  • J.T. Cacioppo et al.

    Perceived social isolation makes me sad: 5-year cross-lagged analyses of loneliness and depressive symptomatology in the chicago health, aging, and social relations study

    Psychology and Aging

    (2010)
  • P.S. Carbone et al.

    The medical home for children with autism spectrum disorders: parent and pediatrician perspectives

    Journal of Autism and Developmental Disorders

    (2010)
  • E.C. Chang et al.

    The color and texture of hope: some preliminary findings and implications for hope theory and counseling among diverse racial/ethnic groups

    Cultural Diversity and Ethnic Minority Psychology

    (2007)
  • E.C. Chang et al.

    Relations of religiosity and spirituality with depressive symptoms in primary care adults: evidence for hope agency and pathway as mediators

    The Journal of Positive Psychology

    (2013)
  • Y. Chen et al.

    Social support, social strain, loneliness, and well-being among older adults: an analysis of the health and retirement study

    Journal of Social and Personal Relationships

    (2014)
  • N.O. Davis et al.

    Parenting stress in mothers and fathers of toddlers with autism spectrum disorders: associations with child characteristics

    Journal of Autism and Developmental Disorders

    (2008)
  • C. Derguy et al.

    The need for an ecological approach to parental stress in autism spectrum disorders: the combined role of individual and environmental factors

    Journal of Autism and Developmental Disorders

    (2016)
  • A.L. Duckworth et al.

    Positive psychology in clinical practice

    Annual Review of Clinical Psychology

    (2005)
  • M.E. Dunn et al.

    Moderators of stress in parents of children with autism

    Community Mental Health Journal

    (2001)
  • N.V. Ekas et al.

    Optimism, social support, and well-being in mothers of children with autism spectrum disorder

    Journal of Autism and Developmental Disorders

    (2010)
  • N.V. Ekas et al.

    The power of positivity: predictors of relationship satisfaction for parents of children with autism spectrum disorder

    Journal of Autism and Developmental Disorders

    (2015)
  • N.H. Falk et al.

    The factors predicting stress, anxiety and depression in the parents of children with autism

    Journal of Autism and Developmental Disorders

    (2014)
  • F. Gander et al.

    Strength-based positive interventions: further evidence for their potential in enhancing well-being and alleviating depression

    Journal of Happiness Studies

    (2013)
  • D.E. Gray

    Ten years on: a longitudinal study of families of children with autism

    Journal of Intellectual and Developmental Disability

    (2002)
  • G.M. Griffith et al.

    We are all there silently coping. The hidden experiences of parents of adults with Asperger syndrome

    Journal of Intellectual and Developmental Disability

    (2012)
  • R.P. Hastings et al.

    Positive perceptions in families of children with developmental disabilities

    American Journal on Mental Retardation

    (2002)
  • A.F. Hayes et al.

    Statistical mediation analysis with a multicategorical independent variable

    British Journal of Mathematical and Statistical Psychology

    (2014)
  • A.F. Hayes

    Introduction to mediation, moderation, and conditional process analysis: a regression-based approach

    (2013)
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