Parenting stress and external stressors as ... - Wiley Online Library

Scandinavian Journal of Psychology, 2013, 54, 213–221

DOI: 10.1111/sjop.12045

Development and Aging Parenting stress and external stressors as predictors of maternal ratings of child adjustment 1 € MONICA OSTBERG and BERIT HAGEKULL2 1 2

Department of Women’s and Children’s Health, Uppsala University Hospital, Uppsala, Sweden Department of Psychology, Uppsala University, Uppsala, Sweden

€ Ostberg, M. & Hagekull, B. (2013). Parenting stress and external stressors as predictors of maternal ratings of child adjustment. Scandinavian Journal of Psychology 54, 213–221. This study sought to disentangle the effects of different kinds of stress on maternal ratings of child externalizing and internalizing problems, social inhibition, and social competence, with a primary focus on parenting stress. The relations were explored in a sample consisting of mothers of 436 children (Mage = 7 years) in Sweden. Half the sample had had early clinical contacts during infancy due to child regulation problems, and the rest were mothers without known such early contacts. Demographic factors, family stressors, and parenting stress were examined in stress – adjustment models. Family stressors were clinical contact during infancy, current child and parent health problems, recent negative life events, and insufficient social support. Parenting stress as a mediator of the effect of other stressors on rated child adjustment was tested as was social support as a moderator of the effect of parenting stress on adjustment. The results showed that a higher parenting stress level was associated with maternal ratings of more externalizing and internalizing behaviors, more social inhibition, and lower social competence. Other family stressors and background variables were also found to be of importance, mainly for externalizing and internalizing problems and to some extent for social competence. Social inhibition had a unique relation to parenting stress only. Parenting stress mediated effects of other stressors in twelve models, whereas social support had no moderating effect on the link between parenting stress and child adjustment. Thus, parenting stress seems to be an important overarching construct. Clinical implications are proposed. Key words: Parenting stress, family stressors, externalizing problems, internalizing problems, social inhibition and social competence. € Monica Ostberg, Department of Women’s and Children’s Health, Specialist Child Health Clinic, Uppsala University Hospital, Box 609, 751 25 Uppsala, Sweden. Tel: +46 18 50 80 20; e-mail: [email protected]

INTRODUCTION Psychological stress has been conceptualized as negative experiences emanating from continuous interactions and adjustments between a person and his environment (Lazarus & Folkman, 1984), and parenting stress has been described as a perceived discrepancy between situational demands and personal resources connected to parenthood (Deater-Deckard, 1998). Parenting stress can affect several areas of life, and such stress can influence the parent-child relationship as well as child behavior (e.g., Crnic & Low, 2002; Deater-Deckard, 1998). In addition to the subjective parenting stress, there are other potentially stressing aspects such as demographic factors, health problems, and other negative life events that can affect family life and the parenting situation. The influence from such stressors has rarely been systematically compared to the impact of parenting stress. The present study sought to disentangle the effects on maternal ratings of child adjustment of demographic and family stressors (external factors) and of stress specifically connected to parenthood (parenting stress).

Parenting stress In parenting research the Parenting Stress Index (PSI; Abidin, 1990) has been commonly used. The PSI focuses on general parenting distress pertaining to two domains. The child domain is designed to reveal stress arising from experiences of a particular child and the specific demands the child makes on the parent.

The parent domain concerns negative feelings and stress related to the parent’s self rather than to the child (Huth-Bocks & Hughes, 2008). In the present study the focus will be on the parent domain and parenting stress reactions, for instance, feelings of incompetence, role restriction, and problems in the spouse relationship which are seen as emanating from parenthood as such. We consider parenting stress as being an internal subjective psychological variable in contrast to the external stressor variables described below.

External stressors Demographic variables such as a low level of education, single parenthood, minority ethnic background, economic hardship, child gender and age, maternal parity and age have been pointed out as potential stressors connected to problematic child behaviors (Goldberg, Janus, Washington, Simmons, MacLusky & Fowler, 1997; Huaqing Qi & Kaiser, 2003; Morgan, Robinson € & Aldridge, 2002; Ostberg & Hagekull, 2000). Commonly used family stressors include negative life events, daily hassles, parent and child health problems, and inadequate social support (Barry, Dunlap, Cotton, Lochman & Wells, 2005; Crnic, Gaze & Hoffman, 2005; Deater-Deckard, Smith, Ivy & Petril, 2005; Shaw, Winslow, Owens & Hood, 1998). Early maternal experiences of difficult infant regulation problems leading to clinical treatment may function as a sensitizing stressor across time (cf. Essex, Klein, Cho & Kalin, 2002; Koch, Ludvigsson & € Sepa, 2010; Ostberg, Hagekull & Hagelin, 2007). Social support

© 2013 The Authors. Scandinavian Journal of Psychology © 2013 The Scandinavian Psychological Associations. Published by John Wiley & Sons Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA. ISSN 0036-5564.

214 M. Östberg and B. Hagekull has a special position because inadequate support can be seen as a stressor in the parent-child relationship, but satisfying support can be considered to counteract the impact of other stressors. Besides direct effects, moderating effects of social support have often been expected but not always found (e.g., Armstrong, Birnie-Lefcovitch & Ungar, 2005; Cohen & Wills, 1985; Quittner, Glueckauf & Jackson, 1990). All of the above mentioned stressors can certainly cause stress and have negative effects on family functioning as pointed out by Crnic and Low (2002). However, in line with their statement “Stress has been considered to be role specific and parenting stress would therefore be qualitatively distinct from stress in other domains” (Crnic & Low, 2002, p. 262), we see a need for disentangling the impact of external sources of maternal stress from that of parenting stress. Also from a clinical perspective it is important to distinguish between different kinds of stress in order to tailor more efficient interventions (cf. Huth-Bocks & Hughes, 2008).

Child social adjustment and parents’ stress Social adjustment includes both positive and negative aspects of a person’s behavior in social situations. Multivariate studies (first reviewed by Achenbach & Edelbrock, 1978) have consistently identified two broad dimensions of children’s problematic social behavior, externalizing (behaviors indicative of conduct problems, hyperactivity, inattention, and intense negative emotional behaviors) and internalizing behaviors (indicators of loneliness, sadness, anxiety, worries, and psychosomatic complaints). Social inhibition, or shyness, is a behavioral construct pertaining to the temperament area and not primarily linked to problems (Kagan, 1989). However, in prospective studies shyness has been found to predict anxiety (Biederman, Rosenbaum, Bolduc-Murphy et al., 1993; Bohlin & Hagekull, 2009; Degnan & Fox, 2007), and social inhibition behaviors resemble some of the indicators of internalizing problems and may therefore cause parental concerns (Mesman & Koot, 2000). Social competence has been defined as the adaptive functioning in a social environment (Cavell, 1990; Rydell, Hagekull & Bohlin, 1997) and is shown in positive behaviors in different social situations, such as prosocial behaviors (e.g., helping peers) and taking social initiatives. Parents of children with disruptive, externalizing behaviors, Attention Deficit Hyperactivity Disorder, and temperamental difficultness have reported higher parenting stress levels (e.g., Anastopoulos, Guevremont, Shelton & DuPaul, 1992; Jackson & € Huang, 2000; Johnston & Mash, 2001; Ostberg & Hagekull, 2000; Williford, Calkins & Keane, 2007). These child problems have also been connected to other external stressors such as daily hassles, socioeconomic disadvantages and health problems (Barry et al., 2005; Morgan et al., 2002; Shaw et al., 1998). Concerning internalizing problems the picture is less clear. Some studies have supported a connection between parenting stress and such child problems (e.g., Anhalt, Telzrow & Brown, 2007; Goldberg et al., 1997; Mesman & Koot, 2000; Rodriguez, 2011). Others have shown that parenting stress has an association to externalizing but not to internalizing behavior problems (Creasey & Jarvis, 1994), or that the relations between different types of stressors and ratings of externalizing behaviors are

Scand J Psychol 54 (2013)

stronger than those regarding internalizing behaviors (Shaw et al., 1998). Studies of connections between parents’ stress and child social inhibition have been difficult to find, but recently Essex, Klein, Slattery, Goldsmith and Kalin (2010) concluded from a longitudinal study that infants who were exposed to maternal stress (both external stressors and parenting stress) were at greater risk for developing chronic high inhibition. Research on parents’ stress and child social competence is not as common as studies on problematic behaviors. However, a high level of parenting stress has been found to relate negatively to children’s high prosocial orientation (Humbke, 2004) and to teacher-rated child social competence (Gutermuth Anthony, Anthony, Glanville, Naiman, Waanders & Shaffer, 2005). Children’s positive social behavior and their behavior problems have been shown to account for unique parts of variance in parenting stress experiences (Beck, Hastings, Daley & Stevenson, 2004). To sum up, most research attention has been directed toward stress in relation to children’s externalizing problems, yielding consistent findings. Concerning internalizing problems, social inhibition behaviors, and social competence, the picture is less clear.

Conceptual and measurement issues In their extensive review on stress and parenting Crnic and Low (2002) point out that the quest for understanding the role of stress in child adverse outcomes involves searching for a causative link; they also state that such a link has received general support. Several theoretical models depicting direct, indirect, and transactional influences between parents’ stress and child, parent, and family system factors have been proposed (e.g., Abidin, 1992; Dishion, French & Patterson, 1995; Jackson & Huang, 2000; Mash & Johnston, 1990; Putnic, Bornstein, Hendricks, Painter & Suwalsky, 2008). A model of relations between parenting stress and stress conceptualized as arising from external factors was tested in a sample of mothers € with infants (Ostberg & Hagekull, 2000). Negative life events, domestic workload, caretaking hassles, social support, parity, maternal age, and child temperamental difficultness were found to be independently linked to parenting stress. The results suggest that parenting stress may be an overarching experience and a potential mediator of effects of other kinds of stress, that is, if such stress accounts for an established relation between an external stressor (predictor) and an adjustment variable (outcome). If so, the mediator explains how external factors take on internal psychological significance (Baron & Kenny, 1986). Mothers are often seen as the best informants of their children’s behavior, both in research and other settings (cf. Renk, Roddenberry, Oliveros & Sieger, 2007). Achenbach and Edelbrock (1978) reported that parents give more complete descriptions of their children, and parents’ reports show higher rater agreement than those of teachers and trained clinicians. Mothers are also the best informants of their own internal states. A one rater situation – mother informing on both her own stress and her child’s behavior – necessitates a clear differentiation between measures in order to achieve discriminate

© 2013 The Authors. Scandinavian Journal of Psychology © 2013 The Scandinavian Psychological Associations.

Stress and child social adjustment 215


validity (Crnic & Low, 2002). In the present study the measures of external (actual states or events) and internal (cognitive appraisal of a situation) stress reflect attempts at separating the stress constructs. The exclusion of the child domain from the parenting stress ratings aims at differentiating measures of parenting stress and child adjustment, and we see the ratings of child behaviors as reflecting maternal perceptions of child adjustment.

The present study The primary aim of this study is to disentangle the impacts of parenting stress and external stressors on maternal ratings of their children’s social adjustment in middle childhood regarding four aspects, externalizing and internalizing problems, social inhibition, and social competence. Aligned according to the external/objective – internal/subjective dimension direct and unique contributions of single and grouped stress variables are explored. Mediator effects of parenting stress explaining links between external stressors and adjustment ratings as well as moderator effects of social support on the relations between parenting stress and maternal adjustment ratings are tested. Positive relations are expected between the different types of stress and child problems and social inhibition, whereas stress and social competence should be negatively associated.

METHODS Participants The total sample consisted of mothers of 436 children living in Sweden. Two data sets were combined. The first set consisted of follow-up data after a mean interval of 6 years and 5 months (SD = 10 months) from mothers who had had clinical contacts with a specialist child health team at infant mean age 12.6 months (SD = 8.0 months). Out of 355 treated families, 70% accepted to participate in the follow-up. Four mothers were excluded due to missing data and 22 questionnaires had been completed by fathers and were excluded. Thus, the clinical sample

consisted of data from 222 mothers. The most frequent reasons for the early contacts were severe sleeping (55%) or feeding (33%) problems. A reference sample was recruited for the follow-up study. All children in the county are listed in a health register from which reference children, n = 355, with no specialist team contacts and next in order to a clinical child in age and gender were selected. Sixty-six percent of the families accepted to participate. One participant was excluded due to missing data and 21 because fathers had completed the questionnaire. Thus, the second set contained data from 214 mothers. Sample descriptions and comparisons between the subsamples are presented in Table 1. In view of the small demographic differences the two samples were combined. Regarding demographic profile, the sample corresponds to the Swedish population of women in parenthood age (78% of children in Sweden live with both parents, 76% have one or two parents born in Sweden, 47% of the mothers have a post-high school or university degree, 42% have attended a 2–4 years high-school program and 10% have left school after the compulsory 9 years; Statistics Sweden, 2011).

Procedure The study was approved by the Ethics Committee at the Faculty of Medicine, Uppsala University. Mothers were contacted by mail and asked to participate. A questionnaire was sent to those who had not declined participation. Three reminders were sent.

Instruments and measures Outcome variables. Externalizing problems were estimated by two instruments: the Conners (1990) parent rating scales, consisting of 10 items of which six items concern hyperactivity and inattention and four negative emotionality (e.g., rapid, intensive mood swings), and eight items from the externalizing subscale in the Children’s Behavior Questionnaire (CBQ; Rutter, Tizard & Whitmore, 1970), measuring conduct problems and negative emotional behaviors (e.g., temper tantrums, fighting, lying, disobedience, destructive behaviors). Mothers responded to the statements on 4- (Conners) or 5-point (CBQ) scales, and the measure of externalizing problems was calculated as a mean of all 18 items (standardized scores). A measure of internalizing problems was calculated as the mean of six items (loneliness, sadness, anxiety, worries, headache, and stomach ache) from the CBQ internalizing subscale. Social inhibition was measured by seven items adapted from the Swedish version of the EAS (Emotionality, Activity, Sociability) temperament scale (Buss &

Table 1. Sample descriptions and comparisons between the two subsamples Total sample (N = 436) M (SD)% Child Age (years) Gender (female) Parity (firstborn) Living with both parents Parents Mother’s age (years) Ethnicity (Swedish born) Both parents One parent None of the parents Maternal education Compulsory 9 years 2-y practical high school 3- or 4-y theoretical high school Post-high school/university Divorce after the child’s birth

Clinical subsample (n = 222) M (SD)%

Reference subsample (n = 214) M (SD)%

Difference clinical/reference p

7.4 (1.5) 48.9 46.6 81.0

7.4 (1.5) 50.9 51.6 78.4

7.4 (1.5) 46.7 41.6 83.6

0.80 0.38 0.04 0.16

37.2 (5.1)

37.5 (5.2)

36.8 (5.1)

0.16 0.01

76.4 13.5 10.1

70.7 16.7 12.6

82.2 10.3 7.5

8.5 29.7 13.6 48.2 15.9

7.3 28.6 13.6 50.5 17.2

9.8 30.8 13.6 45.8 14.6

0.28


0.45

216 M. Östberg and B. Hagekull


Table 2. Means, standard deviations, ranges and internal consistency (a) for outcome variables, family stressors and parenting stress

Outcome variables Externalizing problems (s) Internalizing problems Social inhibition Social competence Family stressors Early clinical contacts Child health problems Parent health problems Negative life events Social support Parenting stress

M

SD

Potential range

0.00 1.79 2.47 3.90

0.62 0.64 0.82 0.54

na 1–5 1–5 1–5

na 0.77 1.74 0.75 3.05 2.44

na 1.08 2.00 1.09 0.70 0.59

na 0– 9 0–16 0–8 1–5 1–5

Obtained range

0.7–2.6 1.0–4.2 1.0–5.0 1.6–5.0 na 0–6 0–10 0–5 1.3–4.9 1.1– 4.3

a

0.91 0.66 0.83 0.89 na na na na 0.83 0.91

Notes: (s) standardized variable; na not applicable

Plomin, 1984; Hagekull & Bohlin, 1998). The items tapped shyness and withdrawal behaviors towards unknown children and adults. The broad social competence construct was studied in 20 items from the Social Competence Inventory (Rydell et al., 1997). The instrument measures two moderately correlated aspects of competence, prosocial orientation (empathic, sharing, helping behaviors) and social initiative (a leader in play, takes initiative in games and with unknown children). See Table 2 for all scale means, standard deviations, ranges, and internal consistencies. External stressors. Demographic variables were coded as follows: male gender = 1 and female = 2; child living with both parents = 1 and single parenting = 2; parity, firstborn child = 1 and later born child = 2. Ethnicity was coded in 3 steps and Maternal education in 4 steps (see Table 1). Also maternal and child age were included. Concerning family stressors (Table 2) early clinical contacts was measured as a binominal variable, no referral = 1, referral = 2. A measure of current child health problems was constructed as the sum of yes responses to nine questions about the child’s health during the previous year concerning asthma, hay fever, eczema, food-allergy, gastrointestinal dysfunctions/complaints, otitis, other infections, functional disorders, and other health problems described by the parent. Parents’ health problems was the sum of yes responses to eight questions concerning both mother’s and father’s current stomach trouble, headache, sleeping problem, dizziness, backache, lack of appetite, nervous troubles, and longlasting illness/handicap. These items were selected by medical experts as representative of frequent health problems in the population of parents in the relevant age span. The negative life events scale was a sum of yes responses to eight questions about family members’ personal problems, death of parent or sibling, conflicts between the parents/other persons close to the family, unemployment, problems and conflicts at work, and economical problems during the last two years. Social support was measured in 10 items asking for quantity (number of available supporting persons) aspects of support, five concerning support with childcare and five with more general support from family and friends (derived from Crnic, Greenberg, Ragozin, Robinson & Basham, 1983). Responses were marked on five-point scales (1 = 0 persons, and 5 = 6 or more persons). Parenting stress. Parenting stress was measured by the Swedish Parent€ hood Stress Questionnaire (SPSQ; Ostberg, Hagekull & Wettergren, 1997), which is based on the PSI parent domain and has its focus on parents′ experiences arising from the parenting situation with no reference to specific child behaviors. Parents marked their degree of agreement/disagreement on 34 items. Factor analysis has revealed five interrelated stress SPSQ subareas, feelings of incompetence, role restriction, social isolation, spousal relationship strain, and the parent′s physical € health (see Ostberg et al., 1997, for item descriptions). In contrast to the

parents’ health problem scale (see above), no specific illnesses/symptoms are mentioned in the SPSQ, only parenting-related concerns about physical fitness, infections, and fatigue. A total score was calculated as the mean of scores on all items (Table 2).

Statistical Analyses Analyses were performed using the Statistical Analyses System (SASâ; SAS, Cary, NC). Internal missing data, causing variation of N, were noted for seven mothers, one omission regarding parity and six regarding child health problems and negative life events. Preliminary analyses showed that maternal age, ethnicity and parity were not significantly correlated to child adjustment ratings. Range of rs for maternal age was 0.00–0.08, for ethnicity 0.03–0.06 and for parity 0.01–0.09. These demographic variables were not included in further analyses. To study the contributions from each set of stress variables to an explanation of variance in the adjustment aspects, the four aspects were in separate equations hierarchically regressed first on the demographic variables, in a second step on family stressors, in a third step on social support, and in the last step on parenting stress. The logic of the hierarchy was based on assumptions about level of objectivity in the measures with demographic variables seen as the most objective and parenting stress as the most subjective. The family stressor variables ranked in between these two steps as they consisted of sums of occurrences of actual life events and illness. Social support was studied in terms of quantity of support, a more objective measure than the commonly used satisfaction with support. We used the same model in all four equations with the conservative method of entering the same variables into all equations instead of using only predictors that correlated significantly with a specific outcome. A second set of regression analyses examined the role of parenting stress as a mediator of the relations between external stressors (predictor) and ratings of social adjustment (outcome), and the third set tested the role of social support as a moderator in the relations between parenting stress and child adjustment ratings. The mediator and moderator analyses followed the recommendations by Baron and Kenny (1986). In a mediational model only variables with significant bivariate intercorrelations should be included. To test for mediation we first regressed the mediator on the predictor, then the outcome on the predictor and finally the outcome on both the predictor and the mediator. Mediation is established if these three equations are significant in the predicted direction and the effect of the predictor on the outcome is less in the third equation than in the second. The Sobel test was conducted to confirm the significance of the mediating effects of parenting stress (Preacher & Leonardelli, 2012). In the tests of parenting stress as a mediator and social support as a moderator the demographic variables were controlled.




Table 3. Hierarchical multiple regression analyses for the child social adjustment measures regressed on demographic variables, family stressors and parenting stress Externalizing problems b DR2 Step 1 Demographic variables Gender Child age Single parenting Mother’s education Step 2 Family stressors Early clinical contacts Child health problems Parent health problems Negative life events Step 3 Social support Step 4 Parenting stress Total explained variance%

Internalizing problems b DR2

Social inhibition b DR2

0.06**** 0.09 0.07 0.14** 0.14**

0.03* 0.00 0.13** 0.06 0.09

0.01 0.04 0.04 0.03 0.08

0.06**** 0.02 0.13** 0.15** 0.07 0.03**** 0.18**** 0.06**** 0.32**** 21.4****

0.06**** 0.09 0.14** 0.09 0.06 0.02** 0.15** 0.07**** 0.33**** 17.4****

0.01 0.02 0.04 0.06 0.10 0.01 0.09 0.05*** 0.28**** 7.9***

Social competence b DR2

0.04** 0.19**** 0.00 0.04 0.10* 0.02 0.00 0.05 0.05 0.09 0.03**** 0.19**** 0.04**** 0.26**** 13.7****

Notes: df =10, 421; *p < 0.05, **p < 0.01, ***p < 0.001, ****p < 0.0001.

RESULTS Bivariate correlations Among the demographic variables, single parenting was significantly related to parenting stress, r = 0.11, p < 0.05, and to parent health problems, r = 0.14, p < 0.01, negative life events, r = 0.24, p < 0 .0001, and social support, r = 0.12, p < 0.01. All family stressors were significantly connected to parenting stress in expected directions. The highest correlations were obtained for social support, r = 0.44, p < 0.0001, parent health problems r = 0.42, p < 0.0001, and negative life events, r = 0.34, p < 0.0001. Mothers who had children with more health problems, r = 0.19, p < 0.0001, and who had had early clinical contacts during infancy, r = 0.13, p < 0.01 also reported more parenting stress. Parenting stress was related to all adjustment aspects, showing the highest correlations with adjustment ratings of all the stressor variables: externalizing problems, r = 0.38, internalizing problems, r = 0.34, social inhibition, r = 0.19, social competence, r = 0.29; all ps < 0.0001. Multivariate prediction of child social adjustment ratings With control of the variance accounted for in previous steps the contributions of each step to the explanation of adjustment ratings are presented in Table 3. The total explanatory effects of the demographic variables in step 1 were significant for all but the social inhibition ratings. Single mothers and mothers with lower education described their children as more externalizing, and mothers with older children saw their children as more internalizing. Mothers with higher educational level regarded their children as more socially competent, and girls were rated more competent than boys. The family stressors in step 2 added significantly to the explanation of externalizing and internalizing problem ratings

but not to ratings of social inhibition and social competence. Child and parent health problems had significant links to externalizing problems. Internalizing problems were predicted by child health problems only. Early clinical contacts and negative life events had no predictive power in the multivariate analyses. In the third step social support explained significant amounts of variance in all adjustment aspects except social inhibition. Parenting stress, entered in step 4 after control for all other stressors, was the single most important predictor in all four equations, explaining unique significant variance ranging from 4% to 7%. Finally, Table 3 shows that the total explained variance by these models was significant for all adjustment ratings, highest for those of externalizing behaviors and lowest for ratings of social inhibition. Significant relations between stressors and adjustment ratings were all in the expected direction.

Mediator and moderator analyses For tests of parenting stress as a mediator of stress induced by demographic variables on ratings of adjustment, 16 models (4 adjustments combined with 4 background variables) were possible. Only one, the relation between single parenting and externalizing problems, fulfilled the requirements of having significant bivariate correlations between all three variables. The Sobel test showed a significant partial mediating effect of parenting stress. The partial effect is shown in that the original relation (r) between single parenting and externalizing problems is still significant (b) after taking the significant mediation effect into account (Table 4). Of 20 potential family stressor models (4 adjustments combined with 5 stressors) 11 models fulfilled the Baron and Kenny (1986) criteria. The Sobel tests showed significant mediation of parenting stress in all models. The mediation was partial in two


218 M. Östberg and B. Hagekull


Table 4. Mediation analyses with parenting stress as the mediator between external stressors and child adjustment ratings

Single parenting Externalizing problems Early clinical contacts Internalizing problems Child health problems Externalizing problems Internalizing problems Parent health problems Externalizing problems Internalizing problems Negative life events Externalizing problems Internalizing problems Social competence Social support Externalizing problems Internalizing problems Social competence

Original bivariate r

Resulting b

Sobel test z

0.16***

0.12**

2.3*

0.12*

0.07

2.5*

0.18*** 0.17***

0.11* 0.11*

3.6*** 3.6***

0.23**** 0.15**

0.06 0.00

6.3**** 8.0****

0.17*** 0.13** 0.10*

0.01 0.00 0.02

5.4**** 5.3**** 4.7****

0.24**** 0.19**** 0.22****

0.06 0.03 0.09

6.4**** 6.2**** 5.4****

Notes: *p < 0.05, **p < 0.01, ***p < 0.001, ****p < 0.0001.

models: effects of child health problems on externalizing and internalizing problems. In the other nine models, the mediator accounted for all or nearly all of the effects of the family stressors. Parenting stress mediated the relation between early clinical contacts and internalizing problems, and between parent health problems and both externalizing and internalizing problems. Further, the effects of negative life events and social support on externalizing and internalizing problems and on social competence were mediated by parenting stress (Table 4). In multiple regression analyses four moderator models were tested. Social support, parenting stress, and the interaction term social support x parenting stress were entered in these equations. The interaction term was not significant for any of the child adjustment aspects, t range 0.39–1.72, ps > 0.05.

DISCUSSION The present results point to an important role for the parenting stress construct as a proximal predictor of variance in mothers’ child adjustment ratings. Parenting stress also seems to function as a mediator between stress related to demographic and family stressors on the one hand and child adjustment ratings on the other. According to the multiple regressions parenting stress has a stronger impact on mothers’ ratings of all four child adjustment aspects in comparison with the external stressors. Most types of stress, whether due to demographic conditions, family stressors including inadequate social support, or parenthood as such, help to explain variance in maternal ratings of externalizing and internalizing child problems. Parenting stress is the only stress variable with a significant explanatory value for social inhibition. The positive adjustment aspect, social competence, is explained foremost by parenting stress, but also by social support, gender, and maternal education.

Relations between external stressors and parenting stress Among the demographic factors only single parenting has significant links to family stressors as well as to parenting stress. This could be seen as a reflection of the strain put on a single parent in the society of today (cf. Huaqing Qi & Kaiser, 2003; Morgan et al., 2002). The weak but significant association between early clinical contacts and parenting stress suggests that there may be remaining sequelae from problems as far back as in infancy, sensitizing the mothers in their appraisal and coping with the parenthood situation. This adds to a previous finding of a relatively high level of parenting stress several years after clinical € contacts (Ostberg et al., 2007). Further, due to sample differences also stress due to being a first time mother or belonging to a minority group may be contributing factors here. Current child health problems explain only 4% of the parenting stress variance. As the dual-earner family is the norm in Sweden, one might expect that even relatively minor child health problems could cause parenting stress. We speculate about good child health status, access to good health care for children, and paid parental leave for caring for a sick child as reasons behind the present result. Recent negative life events related moderately (12% shared variance) to parenting stress which corroborates € findings for mothers of infants (Ostberg & Hagekull, 2000) suggesting that large and disturbing events cause stress reactions independent of child age. The family stressors most clearly linked to parenting stress in this study are social support and parent health problems (19% and 18% shared variance). Social support can be regarded as social relations a person forms and actively maintains over time, and parents’ health problems may cause feelings of discomfort interfering with the daily life issues that constitute the core of parenting stress. Thus, both these can be considered to be closer to the internal/subjective end of the continuum than other stressors. € The present results are in line with previous results (Ostberg & Hagekull, 2000); social support, life events, and a few demographic factors were significant predictors of parenting stress in mothers with infants. A couple of other stressors, domestic workload, and caretaking hassles also predicted parenting stress during infancy. These stressors are comparable to parenting daily hassles which lack counterparts in the present study. Most likely such frequent and often irritating challenges could account for a substantial share of parenting stress variance also in middle childhood if included in future studies (cf. Crnic & Low, 2002).

Stress and maternal ratings of child adjustment Allowing all other stressors to account for their variance in adjustment ratings before entering parenting stress, we find that parenting stress still captures much of the variance in adjustment ratings. The relations between several external stressors and parenting stress are elucidated by the clear mediation results. According to Baron and Kenny (1986) there is strong evidence for a dominant mediator when the relation between the predictor and criterion variable is much reduced or close to zero. This is an important result in the present study indicating that the stress due to several external stressors is transformed into experiences of parenting incompetence, role restriction etc. (Table 4). Such




stress influences perceptions and rating of child behaviour. It should be noted that the links from child health problems and single parenting to ratings of behavior problems are only partially mediated. The concerns caused by these external stressors could be more closely tied to the child; if so, this type of stress might have been fully mediated if the parenting stress measure had included a child domain. Concerning social competence ratings the relations with the two significant predictors (life events and social support) are fully mediated by parenting stress. The temperament aspect of social inhibition is linked only to parenting stress; thus no mediation effect can exist. The results suggest that parenting stress is the broad construct it was meant to be (cf. Abidin, 1990), harboring stress reactions emanating from many external stressors. This is most clearly shown in the links to ratings of problematic child behaviors. Our study corroborates studies that have not found moderating € effects of social support (e.g., Cohen & Wills, 1985; Ostberg & Hagekull, 2000; Quittner et al., 1990). It has been pointed out that differences in conceptualizations and operationalizations of social support need to be clarified before clear evidence for buffering effects can be obtained (Armstrong et al., 2005; Cohen & Wills, 1985; Thoits, 1982). This should be an important task in future research with implications for both theory and clinical interventions. In line with previous research (see reviews by Huaqing Qi & Kaiser, 2003; Morgan et al., 2002) we demonstrate that a substantial part of the variation in maternal ratings of children’s externalizing behavior can be explained by the influence of several stressors. The results are similar for the less well researched area of internalizing problems, although slightly weaker relations are obtained. In spite of behavioral resemblance with internalizing behavior (Mesman & Koot, 2000; present study correlation: r = 0.40), ratings of social inhibition are not found to be related to external stressors. Being a basic temperament trait, the characteristic behaviors of uncertainty and hesitancy in first contacts with unknown persons may have been observable since infancy, making mothers used to and accepting of such behaviors, and the ratings of a shy child may be less affected by external stress factors. Genetics may also explain child shyness to many parents. Still, general parenting stress does relate to social inhibition, maybe because a child’s inhibited behaviors can be taxing in parenting situations characterized by deadlines in domestic and out-of-home work, social obligations etc. Adding to the scant literature on social competence and stress experiences, our mediation results show that effects of the external stress factors, inadequate social support, and negative life events are fully carried by parenting stress.

Strengths and limitations Associations between maternal personality and psychopathology (e.g. neuroticism, depression), and mothers’ ratings of child adjustment problems and parenting stress have been frequently reported (e.g. Anhalt et al., 2007; Barry et al., 2005; Ellenbogen € & Hodgins, 2004; Jackson & Huang, 2000; Ostberg et al., 1997; Williford et al., 2007). As we focus on impact of external stressors as compared to parenting stress, such internal maternal

characteristics were not included. If measured in future studies together with external and other subjective stress measures maternal characteristics may help to further advance our understanding of mothers’ adjustment ratings. An important limitation in the present study is the use of a single informant, the mother. However, maternal reports of child behavior are frequently used in both research and clinical practice and have been associated with child self-ratings of internalizing symptoms (Rodriguez, 2011). It is reasonable to assume that mothers’ views about their children are important because such perceptions influence the daily mother – child interactions and thus contribute to child adjustment (cf. Dishion, et al., 1995; Renk et al., 2007). Our efforts to achieve as little overlap as possible between measures to avoid confounding seem to have been fairly successful with results in the expected directions, unique contributions to variance accounts, and no suppressor effects. Another limitation concerns the cross-sectional and correlational design that makes it impossible to sort out causal directions; the word predictor is to be seen as a statistical term. However, we see the relation between parenting stress and child adjustment in terms of a transactional model with reciprocal effects. Arguments for such transactional relations have been presented (e.g., Crnic & Low, 2002; Dumas & Wekerle, 1995; Gutermuth Anthony et al., 2005; Johnston & Mash, 2001) and are supported in a longitudinal study where maladaptive child behavior and parenting stress showed mutually escalating effects (Baker, McIntyre, Blacher, Crnic, Edelbrock & Low, 2003). Note, however, that it is not likely that a transactional model suits the relations between most external stressors (e.g., single parenting, life events), and child adjustment. Finally, although our relatively large sample was not population based, its demographic profile is similar to that of Swedish women in childbearing age. We therefore regard the results to be fairly representative for mothers in the broad middleclass Swedish setting.

CONCLUSIONS AND CLINICAL IMPLICATIONS With a parenting stress perspective this study probes into questions concerning the relevance of different types of stress for maternal views of their child’s positive and negative social adjustment. The conclusion is clear in this study: general parenting stress is the most important stress phenomenon for understanding maternal ratings of middle childhood adjustment. Most likely this is due to the fact that parenting stress covers many aspects of life related to parenting. Specific illnesses and experiences of negative life events are narrower in scope and less common than the everyday worries captured by the parenting stress construct. Although demographic and family stressors can cause serious reactions we conclude that much concern caused by external stressors is reflected in the parenting stress experience. Consequently, stress measures should be carefully chosen to fit study purposes. Our results also point toward the clinical relevance of assessing external stressors and the mother’s perceived parenting stress to reach a deeper understanding of her situation, in particular the perception of her child’s positive and negative social adjustment. Renk (2011) points out that interventions focusing


220 M. Östberg and B. Hagekull on change in mothers’ perceptions of their young children and their parenting behaviors could be related to decreases in young children’s behavior problems. Using a transactional view several possibilities to design creative interventions open up. For instance, child behavior management strategies could be incorporated in clinical work with parents, during which feelings of incompetence, role restriction and other aspects of parenting stress could be targeted, and bidirectional processes might follow. Important external stressors could be addressed in these interventions as well. A reduction of stress related to parenthood should improve the situation for both mother and child. This paper was supported by grants from Uppsala County Council and Uppsala University.

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