Anxiety and depression in parents of children with autism spectrum disorder during the first COVID-19 lockdown: Report from the ELENA cohort

Ela Miniarikova, Christelle Vernhet, Marianne Peries, Julie Loubersac, Marie-Christine Picot, Kerim Munir, Amaria Baghdadli, Ela Miniarikova, Christelle Vernhet, Marianne Peries, Julie Loubersac, Marie-Christine Picot, Kerim Munir, Amaria Baghdadli

Abstract

Background: The Covid-19 pandemic had a strong impact on mental health in the general population. This study conducted during the first lockdown in France considered parents of children with Autism Spectrum Disorder (ASD) prospectively followed in the ELENA Cohort.

Objectives: We aimed to (1) compare the Anxiety and Depression (AaD) levels during the lockdown between mothers and fathers, (2) compare the parent's AaD between the lockdown and the last ELENA follow-up visit, and (3) identify risk factors for parental AaD during lockdown among socio-demographic and children's clinical characteristics.

Methods: The Hospital Anxiety and Depression Scale (HADS) was used to assess AaD in 134 parent's pairs. Parents also completed the Questionnaire about their living conditions during COVID-19, their child's interventions and perceived changes about their child's behaviors and sleep. Child's ASD severity, intellectual and socio-adaptive skills and parent's socio-demographic characteristics were collected from ELENA follow-up.

Results: The parents' AaD levels were lower during the lockdown compared to the last ELENA visit that coincided in 96% with the child's ASD diagnosis. The AaD levels were more pronounced in mothers and significantly associated with the child's challenging behaviors, parents' teleworking and perceived knowledge about COVID-19. The perception of an insufficient knowledge was the only risk factor for mothers' AaD.

Conclusion: Our findings highlighted the pertinence for an assessment of the mental health of main caregivers of children with ASD, consideration of their gender characteristics, and the importance of providing relevant information during pandemic. Future studies examining the pandemic long-term effects are needed.

Trial registration number: NCT02625116.

Keywords: Anxiety; Autism spectrum disorder; COVID-19; Depression; Parents.

Conflict of interest statement

The authors have no conflicts of interest to declare.

Copyright © 2021 Elsevier Ltd. All rights reserved.

Figures

Fig. 1
Fig. 1
Flow chart of participants.
Fig. 2
Fig. 2
Paired comparison of AaD levels between mothers and fathers (n = 134 pairs) caring for children with ASD during the lockdown.
Fig. 3
Fig. 3
Paired comparison of parents' AaD levels between lockdown and the last ELENA follow-up visit. (a) Mother's HADS scores (n = 94). (b) Father's HADS scores (n = 79).

References

    1. Adam D. Special report: the simulations driving the world's response to COVID-19. Nature. 2020;580(7803):316–318.
    1. Almansour M.A., Alateeq M.A., Alzahrani M.K., Algeffari M.A., Alhomaidan H.T. Depression and anxiety among parents and caregivers of autistic spectral disorder children. Neurosciences. 2013;18(1):58–63.
    1. Baghdadli A., Miot S., Rattaz C., Akbaraly T., Geoffray M.M., Michelon C., Loubersac J., Traver S., Mortamais M., Sonié S., Pottelette J., Robel L., Speranza M., Vesperini S., Maffre T., Falissard B., Picot M.C. Investigating the natural history and prognostic factors of ASD in children: the multicEntric Longitudinal study of childrEN with ASD - the ELENA study protocol. BMJ Open. 2019;9(6)
    1. Baghdadli A., Pry R., Michelon C., Rattaz C. Impact of autism in adolescents on parental quality of life. Qual. Life Res. 2014;23(6):1859–1868.
    1. Barker E.T., Hartley S.L., Seltzer M.M., Floyd F.J., Greenberg J.S., Orsmond G.I. Trajectories of emotional well-being in mothers of adolescents and adults with autism. Dev. Psychol. 2011;47(2):551–561.
    1. Bekker M.H., van Mens-Verhulst J. Anxiety disorders: sex differences in prevalence, degree, and background, but gender-neutral treatment. Gend. Med. 2007;4(Suppl. B):S178–S193.
    1. Berard M., Rattaz C., Peries M., Loubersac J., Munir K., Baghdadli A. Impact of containment and mitigation measures on children and youth with ASD during the COVID-19 pandemic: report from the ELENA cohort. J. Psychiatr. Res. 2021;137:73–80.
    1. Bitsika V., Sharpley C. Stress, anxiety and depression among parents of children with autism spectrum disorder. Aust. J. Guid. Counsell. 2004;14(2):151–161.
    1. Blendon R.J., Benson J.M., DesRoches C.M., Raleigh E., Taylor-Clark K. The public's response to severe acute respiratory syndrome in Toronto and the United States. Clin. Infect. Dis. 2004;38(7):925–931.
    1. Brooks S.K., Webster R.K., Smith L.E., Woodland L., Wessely S., Greenberg N., Rubin G.J. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395(10227):912–920.
    1. Brunet O., Lézine I., Josse D. 1997. Brunet-Lézine révisé: échelle de développement psychomoteur de la première enfance: BLR. Editions et applications psychologiques.
    1. Centre de Ressources Autisme I.-d.-F. Centre de Ressources Autisme Ile-de-France; Paris: 2020. Synthèse de la mini-enquête lors du confinement; p. 6.
    1. Chan-Chee C., Léon C., Lasbeur L., Lecrique J.-M., Raude J., Arwidson P., du Roscoät E. La santé mentale des Français face au Covid-19 : prévalences, évolutions et déterminants de l'anxiété au cours des deux premières semaines de confinement (Enquête CoviPrev, 23-25 mars et 30 mars-1er avril 2020) Bulletin épidémiologique hebdomadaire. 2020;13:260–269.
    1. Davis N.O., Carter A.S. Parenting stress in mothers and fathers of toddlers with autism spectrum disorders: associations with child characteristics. J. Autism Dev. Disord. 2008;38(7):1278–1291.
    1. Dubey S., Biswas P., Ghosh R., Chatterjee S., Dubey M.J., Chatterjee S., Lahiri D., Lavie C.J. Psychosocial impact of COVID-19. Diabetes Metabol. Syndr. 2020;14(5):779–788.
    1. Escudero-Castillo I., Mato-Díaz F.J., Rodriguez-Alvarez A. Furloughs, teleworking and other work situations during the COVID-19 lockdown: impact on mental well-being. Int. J. Environ. Res. Publ. Health. 2021;18(6)
    1. Everts J. Announcing swine flu and the interpretation of pandemic anxiety. Antipode. 2013;45(4):809–825.
    1. Gotham K., Risi S., Pickles A., Lord C. The Autism Diagnostic Observation Schedule: revised algorithms for improved diagnostic validity. J. Autism Dev. Disord. 2007;37(4):613–627.
    1. Guller B., Yaylaci F., Eyuboglu D. Those in the shadow of the pandemic: impacts of the COVID-19 outbreak on the mental health of children with neurodevelopmental disorders and their parents. Int. J. Dev. Disabil. 2021:1–13.
    1. Haesebaert F., Haesebaert J., Zante E., Franck N. Who maintains good mental health in a locked-down country? A French nationwide online survey of 11,391 participants. Health Place. 2020;66:102440.
    1. Hamlyn-Wright S., Draghi-Lorenz R., Ellis J. Locus of control fails to mediate between stress and anxiety and depression in parents of children with a developmental disorder. Autism. 2007;11(6):489–501.
    1. Howlin P., Savage S., Moss P., Tempier A., Rutter M. Cognitive and language skills in adults with autism: a 40‐year follow‐up. JCPP (J. Child Psychol. Psychiatry) 2014;55(1):49–58.
    1. Hus V., Gotham K., Lord C. Standardizing ADOS domain scores: separating severity of social affect and restricted and repetitive behaviors. J. Autism Dev. Disord. 2014;44(10):2400–2412.
    1. Hus V., Lord C. The autism diagnostic observation schedule, module 4: revised algorithm and standardized severity scores. J. Autism Dev. Disord. 2014;44(8):1996–2012.
    1. Hyland P., Shevlin M., McBride O., Murphy J., Karatzias T., Bentall R.P., Martinez A., Vallières F. Anxiety and depression in the Republic of Ireland during the COVID-19 pandemic. Acta Psychiatr. Scand. 2020;142(3):249–256.
    1. Jones L., Totsika V., Hastings R.P., Petalas M.A. Gender differences when parenting children with autism spectrum disorders: a multilevel modeling approach. J. Autism Dev. Disord. 2013;43(9):2090–2098.
    1. Kaufman A.S., Kaufman N.L. 2013. Kaufman Assessment Battery for Children.
    1. Kuehner C. Gender differences in unipolar depression: an update of epidemiological findings and possible explanations. Acta Psychiatr. Scand. 2003;108(3):163–174.
    1. Lanyi J., Mannion A., Chen J.L., Leader G. Developmental Neurorehabilitation; 2021. Relationship between Comorbid Psychopathology in Children and Adolescents with Autism Spectrum Disorder and Parental Well-Being; pp. 1–11.
    1. Lepine J.P., Godchau M., Brun P. Anxiety and depression in inpatients. Lancet. 1985;2(8469–70):1425–1426.
    1. Lerthattasilp T., Charernboon T., Chunsuwan I., Siriumpunkul P. Depression and burden among caregivers of children with autistic spectrum disorder. J. Med. Assoc. Thai. 2015;98(Suppl. 2):S45–S52.
    1. Liu X., Kakade M., Fuller C.J., Fan B., Fang Y., Kong J., Guan Z., Wu P. Depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic. Compr. Psychiatr. 2012;53(1):15–23.
    1. Lord C., Rutter M., DiLavore P., Risi S., Gotham K., Bishop S. Autism Diagnostic Observation Schedule. second ed. Western Psychological Services; Los Angeles: 2012. (ADOS-2)
    1. Luque Salas B., Yáñez Rodríguez V., Tabernero Urbieta C., Cuadrado E. The role of coping strategies and self-efficacy as predictors of life satisfaction in a sample of parents of children with autism spectrum disorder. Psicothema. 2017;29(1):55–60.
    1. McLean C.P., Asnaani A., Litz B.T., Hofmann S.G. Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. J. Psychiatr. Res. 2011;45(8):1027–1035.
    1. McStay R.L., Trembath D., Dissanayake C. Stress and family quality of life in parents of children with autism spectrum disorder: parent gender and the double ABCX model. J. Autism Dev. Disord. 2014;44(12):3101–3118.
    1. Meltzer L.J. Factors associated with depressive symptoms in parents of children with autism spectrum disorders. Res. Autism Spectr. Disord. 2011;5(1):361–367.
    1. Mohammed A., Sheikh T.L., Gidado S., Poggensee G., Nguku P., Olayinka A., Ohuabunwo C., Waziri N., Shuaib F., Adeyemi J., Uzoma O., Ahmed A., Doherty F., Nyanti S.B., Nzuki C.K., Nasidi A., Oyemakinde A., Oguntimehin O., Abdus-Salam I.A., Obiako R.O. An evaluation of psychological distress and social support of survivors and contacts of Ebola virus disease infection and their relatives in Lagos, Nigeria: a cross sectional study-2014. BMC Publ. Health. 2015;15:824.
    1. Olsson M.B., Hwang C.P. Socioeconomic and psychological variables as risk and protective factors for parental well-being in families of children with intellectual disabilities. J. Intellect. Disabil. Res. 2008;52(12):1102–1113.
    1. Öz B., Yüksel T., Nasiroğlu S. Depression-anxiety symptoms and stigma perception in mothers of children with autism spectrum disorder. Noro Psikiyatr Ars. 2020;57(1):50–55.
    1. Reed P., Picton L., Grainger N., Osborne L.A. Impact of diagnostic practices on the self-reported health of mothers of recently diagnosed children with ASD. Int. J. Environ. Res. Publ. Health. 2016;13(9):888.
    1. Roy D., Tripathy S., Kar S.K., Sharma N., Verma S.K., Kaushal V. Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic. Asian J. Psychiatr. 2020;51:102083.
    1. Schopler E., Lansing M., Reichler R., Marcus L. Psychoeducational Profile. third ed. 2004. (PEP-3). Pro-Ed ed. USA.
    1. Sheikh M.H., Ashraf S., Imran N., Hussain S., Azeem M.W. Psychiatric morbidity, perceived stress and ways of coping among parents of children with intellectual disability in Lahore, Pakistan. Cureus. 2018;10(2)
    1. Singer G.H. Meta-analysis of comparative studies of depression in mothers of children with and without developmental disabilities. Am. J. Ment. Retard. 2006;111(3):155–169.
    1. Snaith R.P. The hospital anxiety and depression scale. Health Qual. Life Outcome. 2003;1:29.
    1. Sparrow S.S., Balla D.A., Cicchetti D.V. Doll. Pearson Assessments; 2005. Vineland-II: Survey Forms Manual; Vineland Adaptive Behavior Scales; Survey Interview Form and Parent/caregiver Rating Form; a Revision of the Vineland Social Maturity Scale by Edgar A.
    1. Stern W. 1912. The Psychological Methods of Intelligence Testing.
    1. Türkoğlu S., Uçar H.N., Çetin F.H., Güler H.A., Tezcan M.E. The relationship between chronotype, sleep, and autism symptom severity in children with ASD in COVID-19 home confinement period. Chronobiol. Int. 2020;37(8):1207–1213.
    1. Van de Velde S., Bracke P., Levecque K. Gender differences in depression in 23 European countries. Cross-national variation in the gender gap in depression. Soc. Sci. Med. 2010;71(2):305–313.
    1. Vernhet C., Dellapiazza F., Blanc N., Cousson-Gélie F., Miot S., Roeyers H., Baghdadli A. Coping strategies of parents of children with autism spectrum disorder: a systematic review. Eur. Child Adolesc. Psychiatr. 2019;28(6):747–758.
    1. Waddington H., McLay L., Woods L., Whitehouse A.J.O. Child and family characteristics associated with sleep disturbance in children with autism spectrum disorder. J. Autism Dev. Disord. 2020;50(11):4121–4132.
    1. Webster R.K., Brooks S.K., Smith L.E., Woodland L., Wessely S., Rubin G.J. How to improve adherence with quarantine: rapid review of the evidence. Publ. Health. 2020;182:163–169.
    1. Wechsler D. 2002. Wechsler Primary and Preschool Scale of Intelligence.
    1. Wechsler D. Wechsler Intelligence Scale for Children. fourth ed. (WISC-IV); 2003.
    1. Wechsler D. NCS Pearson; Incorporated: 2014. WISC-V: Administration and Scoring Manual.
    1. Wechsler D. ECPA; 2014. WPPSI-IV, échelle d'intelligence de Wechsler pour enfants.
    1. Wiggins L.D., Rubenstein E., Daniels J., DiGuiseppi C., Yeargin-Allsopp M., Schieve L.A., Tian L.H., Sabourin K., Moody E., Pinto-Martin J., Reyes N., Levy S.E. A phenotype of childhood autism is associated with preexisting maternal anxiety and depression. J. Abnorm. Child Psychol. 2019;47(4):731–740.
    1. Zhao M., Fu W. The resilience of parents who have children with autism spectrum disorder in China: a social culture perspective. Int. J. Dev. Disabil. 2020:1–12.
    1. Zigmond A.S., Snaith R.P. The hospital anxiety and depression scale. Acta Psychiatr. Scand. 1983;67(6):361–370.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する