Depression, Self-Efficacy, and Family Functioning Reported By Mothers of Children with Autism Spectrum Disorder

Background: Clinically significant depressive symptoms are reported in 30-50% of mothers of children with autism spectrum disorder (ASD), compared to 10% of mothers of typically-developing (TD) children. Improving our understanding of the prevalence and relationship of depressive symptoms to family functioning and child outcomes is needed to support professional practices as well as national and state policy decisions. Understanding the burden of depression requires rigorous study involving validated instruments, large heterogeneous samples, and comparison groups. In other populations, maternal depression is associated with lower family functioning and lower maternal self-efficacy. Evidence exists that maternal self-efficacy mediates the relationship between maternal depression and child behavior. The nuances of the relationships among these variables, however, have not been studied in ASD. Understanding these relationships will help researchers design tailored interventions to improve outcomes in families with a child on the autism spectrum.

Objectives: (1) Compare mean depression score and prevalence of depressive symptoms in mothers of children with ASD to mothers of Down syndrome (DS) children and TD children. (2) Describe the mediating role of maternal self-efficacy in the relationship between depressive symptoms and child behavior, controlling for family functioning.

Methods: Convenience sample of mothers 18 and older living with a biological child under 18, diagnosed with ASD, DS, or TD, completed an online survey with SCQ, ABC, PHQ-9, Family Assessment Device General Functioning Scale, Maternal Self-Efficacy Scale, Demographics.

Results: 245 mothers : 101 ASD, 101 DS, and 43 TD (power=0.8). Mean PHQ-9 score was higher in ASD group compared to DS and TD groups (6.6 vs 4.0 vs 2.0, respectively, p<0.001).

Significantly more mothers in ASD group screened positive for depression than the DS and TD groups (23.8% vs. 11.9% vs. 0% respectively, p<0.001).

A higher proportion of mothers of children with ASD met cutoff for poor family functioning compared to DS and TD groups (42.6% vs. 19.8% vs. 18.6%, respectively, p<0.001). Better family functioning is significantly associated with fewer maternal depressive symptoms (r=0.408, p<0.0001), better maternal self-efficacy (r = -0.410, p<.0001), and fewer child problem behaviors of irritability (r=0.255, p<0.0001), social withdrawal (r=0.310, p<0.0001), stereotypy (r=0.236, p=0.0002), hyperactivity (r=0.217, p=0.0006), and inappropriate speech (r=0.350, p<0.0001).

Controlling for family functioning, maternal self-efficacy statistically significantly mediated the relationship between maternal depressive symptoms and child behavior. The Sobel test revealed the percent of total effect mediated as follows: irritability (43%, t=5.72, p<0.0001), social withdrawal (29%, t= 4.61, p<0.0001), stereotypy (30%, t= 4.12, p<0.0001), hyperactivity (41%, t= 5.13, p< 0.0001), and inappropriate speech (43%, t= 5.72, p< 0.0001).

Conclusions: Significantly higher proportion of mothers of children with ASD screen positive for depression, compared to mothers of children with DS and TD. Associations among depressive symptoms, maternal self-efficacy, and family functioning were found. Parenting self-efficacy partially mediates the relationship between maternal depressive symptoms and child problem behaviors, controlling for family functioning. Interventions that (a) increase parenting self-efficacy and (b) improve how the family unit functions to support the needs of all family members may be helpful in addressing depression in mothers of children with ASD.