The Longitudinal Impact of Marital Adjustment and Social Support on Stress in Primary Caregivers of Children with ASD

Background: Caregivers of children with ASD report higher levels of stress and lower levels of marital adjustment (e.g., Benson & Kersh, 2011; Freeman et al., 2011; Risdal & Singer, 2004). Increased social support, a stress buffer, may moderate these impacts and has been consistently related to decreased negative outcomes for caregivers of children with ASD and their families (e.g., Stuart & McGrew, 2009). Social support can be both general and specific to the stressor. For example, received support from ASD providers and the ASD community has been associated with decreased stress in parents of children with ASD following diagnosis (Stuart & McGrew, 2009). Another critical social resource is the relationship with one’s spouse or significant other. Both cross-sectional and longitudinal analyses have shown that marital adjustment can buffer stress of having a child with ASD (e.g., Kersh et al., 2006). Moreover, social support accumulates, that is,  caregivers receive support from various resources (e.g., general social support from families and friends, contextual social support from the ASD providers and community, marital support), and these resources may compensate for each other or interact in their impact on caregiver outcomes.   

Objectives: The current study examined the cross-sectional and longitudinal relationships among  general and contextual social support, marital adjustment, and outcomes in primary caregivers of children with ASD shortly after receiving the diagnosis. Specifically, we examined whether there is a compensatory or additive mechanism among sources of social support in their impact on caregiver outcomes. 

Methods: Primary caregivers of children diagnosed with ASD within the past six months (N = 79) were first recruited at baseline and again 12 months later (N = 65). Participants were assessed on caregiver outcomes using predictors within the double ABCX model (McCubbin & Patterson, 1983), e.g., life demands, social support, marital adjustment.  

Results: At baseline, marital adjustment correlated with caregiver burden (r =-.56, p<.001 ), family burden (r =-.48, p<.001 ), and mental health-related quality of life (r = .25, p =.04 ). Multivariately, marital adjustment (Beta = -.26, p = .02) and general social support (Beta = -.46, p<.001) predicted baseline caregiver stress, R² = .59, F (6, 58) = 13.69, p<.001; life demands (Beta = .33, p = .005) and general social support (Beta = -.33, p = .012) predicted family burden, R² = .51, F (6, 58) = 10.19, p< .001. Longitudinally, controlling for baseline caregiver outcomes, as well as parent, family, and child factors at baseline and changes in those variables, the results showed that interactions between contextual social support from the ASD community and providers and marital adjustment (Beta =-.32, p = .024) predicted caregiver stress at follow-up, R² =.74, F (20, 58)= 8.38, p< .001.  

Conclusions: An additive model was supported. When caregivers perceive low contextual social supports from the ASD community and ASD providers, the level of their marital adjustment does not impact their long term caregiver stress level; however, when they perceive high levels of contextual social support, better marital adjustment predicted decreased stress long term.