Abstract

Parents of autistic children commonly report experiencing higher levels of stress, anxiety and depression compared to parents of typically developing children and parents of children with other various developmental conditions. Considering the worldwide increase in the prevalence of autism, understanding the experiences of these parents and how they cope with their child’s condition has become increasingly important. Studies exploring parental experiences caring for their autistic child have yielded inconsistent results in relation to the impact certain factors have on their mental health. Part of this inconsistency might be explained by the tendency of previous studies to measure the effect of a single factor on parental mental health as well as investigating parental stress, anxiety and depression as a single outcome variable which could compromise the potential for research to clearly isolate and understand the specific factors that contribute to each mental health construct independently. Considering that it is more likely that there are multiple contributing factors which affect parental mental health, an analysis of the interplay between key factors linked to parental mental health issues will be better able to effectively assess the experiences of parents caring for an autistic child. Moreover, despite it being well established that caring for an autistic child can have a significant impact on parents despite their cultural background, the intricacy of this impact is not yet well understood across varying cultures since the bulk of research on the mental health of parents of autistic children is typically conducted in Western countries. To date, little research has investigated factors associated with the mental health of parents of autistic children in the Middle East. As such the overarching aim of this thesis was to explore how parental stress, anxiety and depression are impacted by different factors in a participant sample from Saudi Arabia through five quantitative studies.
The first aim of this thesis was to explore the factors negatively affecting mental health in parents of autistic children in Saudi Arabia (Chapter 2 and 3). In chapter 2, the impact of child specific factors (i.e., challenging child behavior and autism symptom severity) on parental stress, anxiety and depression were explored. Results indicated that parents who rated their children as presenting with more severe autism symptomology also reported higher levels of stress, anxiety and depression. In order to gain a better understanding of the high levels of reported mental health issues in this group of parents, chapter 3 incorporated the factor of affiliate stigma to the previous factors investigated. Results from chapter 3 indicated that affiliate stigma was the only significant predictor of parental stress, anxiety and depression in this participant sample.
Although it is common for parents with autistic children to report experiencing mental health issues, not all parents report such high levels of stress, anxiety and depression. As such, the second aim of this thesis was to explore how parents of autistic children from Saudi Arabia adaptively cope with their child’s condition. In chapter 4, the buffering effect of parent-specific factors (i.e., resilience and religious coping) on parental mental health was explored. Results indicated that resilience was the only significant factor predicting lower levels of stress, anxiety and depression in this participant sample. In chapter 5, the impact of perceived social support on parental mental health was also investigated in order to explore the extent of which it could protect against stress, anxiety and depression. Results indicated that perceived social support had a positive impact on parental mental health, specifically when the source of social support was from a spouse/life partner.
In Chapter 6 a more holistic approach was incorporated in order to explore the interplay between the previously investigated factors and their impact on parental mental health. The double ABC-X model was employed in this chapter for this purpose. Results from chapter 6 indicated that affiliate stigma was the only significant predictor of parental stress, anxiety and depression and that resilience and social support mediated the relationship between affiliate stigma and depression. However, only resilience was found to be a significant mediator in the relationship between stigma and anxiety.
Although there are various factors associated with the mental health of parents of autistic children in Saudi Arabia, affiliate stigma seems to play a major role. Resilience has been shown to be a key protective factors against mental health issues in this participant sample. The results from this thesis have important implications for clinical practice and future research. It is evident that there is an urgent need for Saudi Arabia to tackle the issue of mental health stigma effectively, and for healthcare and intervention providers to help parents develop their resilience skills and encourage them to seek social support to ensure the overall wellbeing of both parent and child.