The mediating role of social support in the relationship between care burden and sleep status of parents of children with cerebral palsy
Year 2024,
Volume: 5 Issue: 2, 107 - 113, 31.08.2024
Mehmet Emin Düken
,
Kadriye Şahin
,
Hülya Karataş
Abstract
Aim: This study was conducted to examine the mediating role of social support in the relationship between the care burden of parents of children with cerebral palsy (CP) and their sleep states.
Methods: This descriptive correlational study was conducted with the parents of children with CP who were hospitalized in the pediatric clinics of a university hospital and followed up in the pediatric outpatient clinics. The data were collected using the parent information form, Zarit Caregiver Burden Interview, Multidimensional Scale of Perceived Social Support, and Richards Campbell Sleep Scale.
Results: According to the results of the analysis, the care burden scores of the parents negatively predicted their sleep quality scores (β=-0.932; p<0.050). Parents' burden of care scores explained 86.8% of the sleep quality scores (R2=0.868). Parents' care burden scores negatively affect their perceived social support scores (β=-0.914; p<0.050). Parents' care burden scores explained 85.8% of their perceived social support scores (R2=0.858). Parents perceived social support scores positively affect sleep quality scores (β=0.130; p<0.050). As a result of the analysis conducted with the bootstrap technique, it was determined that the social support perceived by parents played a mediating role in the relationship between care burden and sleep quality (β=-0.127; 95% CI [-0.223; -0.023]).
Conclusion: The high care burden experienced by parents of children with CP affects their sleep quality and perceived social support. As the social support perceived by parents from the environment increases, their care burden decreases and their sleep quality increases.
References
- Ahanotu, C. J., Ibikunle, P. O., & Hammed, A. İ. (2018). Burden of caregiving, social support and quality of life of informal caregivers of patients with cerebral palsy. Turkish Journal of Kinesiology, 4(2), 58–64. https://doi.org/10.31459/turkjkin.418491
- Al‐Gamal, E., & Long, T. (2013). Psychological distress and perceived support among Jordanian parents living with a child with cerebral palsy: a cross‐sectional study. Scandinavian Journal of Caring Sciences, 27(3), 624–631. https://doi.org/10.1111/j.1471-6712.2012.01071.x
- Albayrak, I., Biber, A., Çalışkan, A., & Levendoglu, F. (2019). Assessment of pain, care burden, depression level, sleep quality, fatigue and quality of life in the mothers of children with cerebral palsy. Journal of Child Health Care, 23(3), 483–494. https://doi.org/10.1177/1367493519864751
- Atay, C., Uzun, N., & Tarakcı, E. (2018). Serebral palsi’li çocuğa bakım verenlerin uyku süreleri, bakım verme yükleri ve fiziksel aktivite düzeylerinin sağlıklı çocuğa sahip ebeveynler ile karşılaştırılması. Journal of Exercise Therapy & Rehabilitation, 10, 10.
- Bentum, L. S., Ohene, L. A., Agyare, V. A., Laari, L., & Ampomah, M. O. (2023). Fathers’ experiences of caring for children living with cerebral palsy: a qualitative study in a low resourced socioeconomic context, ghana. Journal of Pediatric Nursing, 73, 100–106. https://doi.org/10.1016/j.pedn.2023.07.019
- Chaput, J.-P., Gray, C. E., Poitras, V. J., Carson, V., Gruber, R., Olds, T., Weiss, S. K., Connor Gorber, S., Kho, M. E., Sampson, M., Belanger, K., Eryuzlu, S., Callender, L., & Tremblay, M. S. (2016). Systematic review of the relationships between sleep duration and health indicators in school-aged children and youth. Applied Physiology, Nutrition, and Metabolism, 41(6 (Suppl. 3)), S266–S282. https://doi.org/10.1139/apnm-2015-0627
- Dlamini, M. D., Chang, Y.-J., & Nguyen, T. T. B. (2023). Caregivers’ experiences of having a child with cerebral palsy. a meta-synthesis. Journal of Pediatric Nursing, 73, 157–168. https://doi.org/10.1016/j.pedn.2023.08.026
- Eker, D., Arkar, H., & Yaldız, H. (2001). Çok Boyutlu Algılanan Sosyal Destek Ölçeği’nin gözden geçirilmiş formunun faktör yapısı, geçerlik ve güvenirliği. Türk Psikiyatri Dergisi, 12(1), 17–25.
- Farajzadeh, A., Amini, M., Maroufizadeh, S., & Wijesinghe, C. J. (2018). Caregiver Difficulties Scale (CDS): Translation and psychometric evaluation among Iranian mothers of cerebral palsy children. Occupational Therapy in Health Care, 32(1), 28–43. https://doi.org/10.1080/07380577.2017.1422607
- Garip, Y., Ozel, S., Tuncer, O. B., Kilinc, G., Seckin, F., & Arasil, T. (2016). Fatigue in the mothers of children with cerebral palsy. Disability and Rehabilitation, 39(8), 757–762. https://doi.org/10.3109/09638288.2016.1161837
- Hulst, R. Y., Gorter, J. W., Voorman, J. M., Kolk, E., Vossen, S. Van Der, Visser-Meily, J. M., Ketelaar, M., Pillen, S., & Verschuren, O. (2024). Sleep problems in children with cerebral palsy and their parents. Developmental Medicine & Child Neurology, 66(1). https://doi.org/10.1111/dmcn.15810
- İnci, F. H., & Erdem, M. (2008). Bakım Verme Yükü Ölçeğinin Türkçe ‘ye uyarlanması geçerlilik ve güvenilirliği. Atatürk Üniversitesi Hemşirelik Yüksekokulu Dergisi, 11(4), 85–95.
- Lang, C. P., Boucaut, A., Guppy, M., & Johnston, L. M. (2021). Children with cerebral palsy: A cross‐sectional study of their sleep and their caregiver’s sleep quality, psychological health and well‐being. Child: Care, Health and Development, 47(6), 859–868. https://doi.org/10.1111/cch.12897
- Lima, M. B. S., Cardoso, V. dos S., & Silva, S. S. da C. (2016). Parental stress and social support of caregivers of children with cerebral palsy. Paidéia (Ribeirão Preto), 26(64), 207–214. https://doi.org/10.1590/1982-43272664201608
- Liu, F., Shen, Q., Huang, M., & Zhou, H. (2023). Factors associated with caregiver burden among family caregivers of children with cerebral palsy: a systematic review. BMJ Open, 13(4), e065215. https://doi.org/10.1136/bmjopen-2022-065215
- Micsinszki, S. K., Ballantyne, M., Cleverley, K., Green, P., & Stremler, R. (2018). Sleep outcomes for parents of children with neurodevelopmental disabilities: A systematic review. Journal of Family Nursing, 24(2), 217–249. https://doi.org/10.1177/1074840718773381
- Nimbalkar, S., Raithatha, S., Shah, R., & Panchal, D. A. (2014). A qualitative study of psychosocial problems among parents of children with cerebral palsy attending two tertiary care hospitals in Western India. ISRN Family Medicine, 20, 769619 https://doi.org/10.1155/2014/769619
- Novak, I., Morgan, C., Adde, L., Blackman, J., Boyd, R. N., Brunstrom-Hernandez, J., Cioni, G., Damiano, D., Darrah, J., Eliasson, A. C., De Vries, L. S., Einspieler, C., Fahey, M., Fehlings, D., Ferriero, D. M., Fetters, L., Fiori, S., Forssberg, H., Gordon, A. M., … Badawi, N. (2017). Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA Pediatrics, 171(9), 897–907. https://doi.org/10.1001/JAMAPEDIATRICS.2017.1689
- Özlü, Z. K., & Özer, N. (2015). Richard-Campbell sleep questionnaire validity and reliability study. Journal of Turkish Sleep Medicine, 2(2), 29–32. https://doi.org/10.4274/jtsm.02.008
- Parkes, J., Mccullough, N., Madden, A., Mccahey, E., Parkes Bnurs, J., Phd, B., Fellow, R., Rn, B., Research Assistant, B., & Ar, M. P. (2009). The health of children with cerebral palsy and stress in their parents. Journal of Advanced Nursing, 65(11), 2311–2323. https://doi.org/10.1111/j.1365-2648.2009.05089.x
- Pfeifer, L. I., Silva, D. B. R., Lopes, P. B., Matsukura, T. S., Santos, J. L. F., & Pinto, M. P. P. (2014). Social support provided to caregivers of children with cerebral palsy. Child: Care, Health and Development, 40(3), 363–369. https://doi.org/10.1111/cch.12077
- Polita, N. B., & Tacla, M. T. G. M. (2014). Network and social support to families of children with cerebral palsy. Escola Anna Nery - Revista de Enfermagem, 18(1). https://doi.org/10.5935/1414-8145.20140011
- Pretorius, C., & Steadman, J. (2018). Barriers and facilitators to caring for a child with cerebral palsy in rural communities of the western cape, south africa. Child Care in Practice, 24(4), 413–430. https://doi.org/10.1080/13575279.2017.1347146
- Richards, K. C., O’Sullivan, P. S., & Phillips, R. L. (2000). Measurement of sleep in critically ill patients. Journal of Nursing Measurement, 8(2), 131–144. https://doi.org/10.1891/1061-3749.8.2.131
- Singogo, C., Mweshi, M., & Rhoda, A. (2015). Challenges experienced by mothers caring for children with cerebral palsy in Zambia. The South African Journal of Physiotherapy, 71(1). https://doi.org/10.4102/SAJP.V71I1.274
- Skok, A., Harvey, D., & Reddihough, D. (2006). Perceived stress, perceived social support, and wellbeing among mothers of school‐aged children with cerebral palsy. Journal of Intellectual & Developmental Disability, 31(1), 53–57. https://doi.org/10.1080/13668250600561929
- Terzi, R., & Tan, G. (2016). Musculoskeletal system pain and related factors in mothers of children with cerebral palsy. Agri, 28(1), 18–24. https://doi.org/10.5505/agri.2015.74436
- Tosun, Z. K., & Temel, M. (2017). Burden of caregiving for stroke patients and the role of social support among family members: an assessment through home visits. International Journal of Caring Sciences, 10(3), 1696–1704.
- Tseng, M.-H., Chen, K.-L., Shieh, J.-Y., Lu, L., Huang, C.-Y., & Simeonsson, R. J. (2016). Child characteristics, caregiver characteristics, and environmental factors affecting the quality of life of caregivers of children with cerebral palsy. Disability and Rehabilitation, 38(24), 2374–2382. https://doi.org/10.3109/09638288.2015.1129451
- Vadivelan, K., Sekar, P., Sruthi, S. S., & Gopichandran, V. (2020). Burden of caregivers of children with cerebral palsy: An intersectional analysis of gender, poverty, stigma, and public policy. BMC Public Health, 20(1), 1–8.
- Wang, Y., Huang, Z., & Kong, F. (2020). Parenting stress and life satisfaction in mothers of children with cerebral palsy: the mediating effect of social support. Journal of Health Psychology, 25(3), 416–425. https://doi.org/10.1177/1359105317739100
- Wayte, S., McCaughey, E., Holley, S., Annaz, D., & Hill, C. M. (2012). Sleep problems in children with cerebral palsy and their relationship with maternal sleep and depression. Acta Paediatrica, 101(6), 618–623. https://doi.org/10.1111/j.1651-2227.2012.02603.x
- Yıldırım, M., Düken, M. E., Dağ, Y. S., & Yayan, E. H. (2022). Examining care burden, social support, and loneliness in parents of children with cerebral palsy. International Journal of Caring Sciences, 15(3), 1655–1664.
- Zarit, S. H., Reever, K. E., & Bach-Peterson, J. (1980). Relatives of the impaired elderly: correlates of feelings of burden. The Gerontologist, 20(6), 649–655. https://doi.org/10.1093/geront/20.6.649
- Zhao, M., Fu, W., & Ai, J. (2021). The mediating role of social support in the relationship between parenting stress and resilience among chinese parents of children with disability. Journal of Autism and Developmental Disorders, 51(10), 3412–3422. https://doi.org/10.1007/s10803-020-04806-8
- Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52(1), 30–41. https://doi.org/10.1207/s15327752jpa5201_2
Serebral palsili çocukların ebeveynlerinin bakım yükü ile uyku durumları arasındaki ilişkide sosyal desteğin aracı rolü
Year 2024,
Volume: 5 Issue: 2, 107 - 113, 31.08.2024
Mehmet Emin Düken
,
Kadriye Şahin
,
Hülya Karataş
Abstract
Amaç: Bu araştırmada Serebral Palsi (SP) çocukların ebeveynlerinin bakım yükü ile uyku durumları arasındaki ilişkide sosyal desteğin aracı rolünü incelemek amacıyla yapılmıştır.
Yöntem: Tanımlayıcı ilişkisel tipte bir araştırma olarak yapılan araştırma bir üniversite hastanesinin çocuk sağlığı kliniklerinde yatan ve çocuk polikliniklerinde takip edilen SP çocukların ebeveynleriyle yürütülmüştür. Verilerin toplanmasında Ebeveyn Bilgi Formu, Zarit Bakım Yükü Ölçeği, Çok Boyutlu Sosyal Destek Ölçeği ve Richards Campbell Uyku Ölçeği kullanarak toplanılmıştır.
Bulgular: Analiz sonuçlarına göre, ebeveynlerin bakım yükü puanları uyku kalitesi puanlarını negatif yönde etkilemektedir (β=-0.932; p<0.050). Ebeveynlerin bakım yükü puanları uyku kalitesi puanlarının %86.8'ini açıklamaktadır (R2=0.868). Ebeveynlerin bakım yükü puanları algılanan sosyal destek puanlarını olumsuz etkilemektedir (β=-0.914; p<0.050). Ebeveynlerin bakım yükü puanları, algıladıkları sosyal destek puanlarının %85.8'ini açıklamaktadır (R2=0.858). Ebeveynlerin algıladıkları sosyal destek puanları uyku kalitesi puanlarını pozitif yönde etkilemektedir (β=0.130; p<0.050). Bootstrap tekniği ile yapılan analiz sonucunda ebeveynlerin algıladıkları sosyal desteğin bakım yükü ile uyku kalitesi arasındaki ilişkide aracı rol oynadığı tespit edilmiştir (β=-0.127; %95 CI [-0.223; -0.023]).
Sonuçlar: SP'li çocukların ebeveynlerinin yaşadığı yüksek bakım yükü uyku kalitelerini ve algıladıkları sosyal destek durumları etkilemektedir. Ebeveynlerin çevreden algıladıkları sosyal destekleri artıkça bakım yükleri azalmakta ve uyku kaliteleri artmaktadır.
Ethical Statement
Bu araştırma yazarlar arasında çıkar çatışması yoktur. Herhangi bir kurum ve şirketten destek alınmamıştır.
References
- Ahanotu, C. J., Ibikunle, P. O., & Hammed, A. İ. (2018). Burden of caregiving, social support and quality of life of informal caregivers of patients with cerebral palsy. Turkish Journal of Kinesiology, 4(2), 58–64. https://doi.org/10.31459/turkjkin.418491
- Al‐Gamal, E., & Long, T. (2013). Psychological distress and perceived support among Jordanian parents living with a child with cerebral palsy: a cross‐sectional study. Scandinavian Journal of Caring Sciences, 27(3), 624–631. https://doi.org/10.1111/j.1471-6712.2012.01071.x
- Albayrak, I., Biber, A., Çalışkan, A., & Levendoglu, F. (2019). Assessment of pain, care burden, depression level, sleep quality, fatigue and quality of life in the mothers of children with cerebral palsy. Journal of Child Health Care, 23(3), 483–494. https://doi.org/10.1177/1367493519864751
- Atay, C., Uzun, N., & Tarakcı, E. (2018). Serebral palsi’li çocuğa bakım verenlerin uyku süreleri, bakım verme yükleri ve fiziksel aktivite düzeylerinin sağlıklı çocuğa sahip ebeveynler ile karşılaştırılması. Journal of Exercise Therapy & Rehabilitation, 10, 10.
- Bentum, L. S., Ohene, L. A., Agyare, V. A., Laari, L., & Ampomah, M. O. (2023). Fathers’ experiences of caring for children living with cerebral palsy: a qualitative study in a low resourced socioeconomic context, ghana. Journal of Pediatric Nursing, 73, 100–106. https://doi.org/10.1016/j.pedn.2023.07.019
- Chaput, J.-P., Gray, C. E., Poitras, V. J., Carson, V., Gruber, R., Olds, T., Weiss, S. K., Connor Gorber, S., Kho, M. E., Sampson, M., Belanger, K., Eryuzlu, S., Callender, L., & Tremblay, M. S. (2016). Systematic review of the relationships between sleep duration and health indicators in school-aged children and youth. Applied Physiology, Nutrition, and Metabolism, 41(6 (Suppl. 3)), S266–S282. https://doi.org/10.1139/apnm-2015-0627
- Dlamini, M. D., Chang, Y.-J., & Nguyen, T. T. B. (2023). Caregivers’ experiences of having a child with cerebral palsy. a meta-synthesis. Journal of Pediatric Nursing, 73, 157–168. https://doi.org/10.1016/j.pedn.2023.08.026
- Eker, D., Arkar, H., & Yaldız, H. (2001). Çok Boyutlu Algılanan Sosyal Destek Ölçeği’nin gözden geçirilmiş formunun faktör yapısı, geçerlik ve güvenirliği. Türk Psikiyatri Dergisi, 12(1), 17–25.
- Farajzadeh, A., Amini, M., Maroufizadeh, S., & Wijesinghe, C. J. (2018). Caregiver Difficulties Scale (CDS): Translation and psychometric evaluation among Iranian mothers of cerebral palsy children. Occupational Therapy in Health Care, 32(1), 28–43. https://doi.org/10.1080/07380577.2017.1422607
- Garip, Y., Ozel, S., Tuncer, O. B., Kilinc, G., Seckin, F., & Arasil, T. (2016). Fatigue in the mothers of children with cerebral palsy. Disability and Rehabilitation, 39(8), 757–762. https://doi.org/10.3109/09638288.2016.1161837
- Hulst, R. Y., Gorter, J. W., Voorman, J. M., Kolk, E., Vossen, S. Van Der, Visser-Meily, J. M., Ketelaar, M., Pillen, S., & Verschuren, O. (2024). Sleep problems in children with cerebral palsy and their parents. Developmental Medicine & Child Neurology, 66(1). https://doi.org/10.1111/dmcn.15810
- İnci, F. H., & Erdem, M. (2008). Bakım Verme Yükü Ölçeğinin Türkçe ‘ye uyarlanması geçerlilik ve güvenilirliği. Atatürk Üniversitesi Hemşirelik Yüksekokulu Dergisi, 11(4), 85–95.
- Lang, C. P., Boucaut, A., Guppy, M., & Johnston, L. M. (2021). Children with cerebral palsy: A cross‐sectional study of their sleep and their caregiver’s sleep quality, psychological health and well‐being. Child: Care, Health and Development, 47(6), 859–868. https://doi.org/10.1111/cch.12897
- Lima, M. B. S., Cardoso, V. dos S., & Silva, S. S. da C. (2016). Parental stress and social support of caregivers of children with cerebral palsy. Paidéia (Ribeirão Preto), 26(64), 207–214. https://doi.org/10.1590/1982-43272664201608
- Liu, F., Shen, Q., Huang, M., & Zhou, H. (2023). Factors associated with caregiver burden among family caregivers of children with cerebral palsy: a systematic review. BMJ Open, 13(4), e065215. https://doi.org/10.1136/bmjopen-2022-065215
- Micsinszki, S. K., Ballantyne, M., Cleverley, K., Green, P., & Stremler, R. (2018). Sleep outcomes for parents of children with neurodevelopmental disabilities: A systematic review. Journal of Family Nursing, 24(2), 217–249. https://doi.org/10.1177/1074840718773381
- Nimbalkar, S., Raithatha, S., Shah, R., & Panchal, D. A. (2014). A qualitative study of psychosocial problems among parents of children with cerebral palsy attending two tertiary care hospitals in Western India. ISRN Family Medicine, 20, 769619 https://doi.org/10.1155/2014/769619
- Novak, I., Morgan, C., Adde, L., Blackman, J., Boyd, R. N., Brunstrom-Hernandez, J., Cioni, G., Damiano, D., Darrah, J., Eliasson, A. C., De Vries, L. S., Einspieler, C., Fahey, M., Fehlings, D., Ferriero, D. M., Fetters, L., Fiori, S., Forssberg, H., Gordon, A. M., … Badawi, N. (2017). Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA Pediatrics, 171(9), 897–907. https://doi.org/10.1001/JAMAPEDIATRICS.2017.1689
- Özlü, Z. K., & Özer, N. (2015). Richard-Campbell sleep questionnaire validity and reliability study. Journal of Turkish Sleep Medicine, 2(2), 29–32. https://doi.org/10.4274/jtsm.02.008
- Parkes, J., Mccullough, N., Madden, A., Mccahey, E., Parkes Bnurs, J., Phd, B., Fellow, R., Rn, B., Research Assistant, B., & Ar, M. P. (2009). The health of children with cerebral palsy and stress in their parents. Journal of Advanced Nursing, 65(11), 2311–2323. https://doi.org/10.1111/j.1365-2648.2009.05089.x
- Pfeifer, L. I., Silva, D. B. R., Lopes, P. B., Matsukura, T. S., Santos, J. L. F., & Pinto, M. P. P. (2014). Social support provided to caregivers of children with cerebral palsy. Child: Care, Health and Development, 40(3), 363–369. https://doi.org/10.1111/cch.12077
- Polita, N. B., & Tacla, M. T. G. M. (2014). Network and social support to families of children with cerebral palsy. Escola Anna Nery - Revista de Enfermagem, 18(1). https://doi.org/10.5935/1414-8145.20140011
- Pretorius, C., & Steadman, J. (2018). Barriers and facilitators to caring for a child with cerebral palsy in rural communities of the western cape, south africa. Child Care in Practice, 24(4), 413–430. https://doi.org/10.1080/13575279.2017.1347146
- Richards, K. C., O’Sullivan, P. S., & Phillips, R. L. (2000). Measurement of sleep in critically ill patients. Journal of Nursing Measurement, 8(2), 131–144. https://doi.org/10.1891/1061-3749.8.2.131
- Singogo, C., Mweshi, M., & Rhoda, A. (2015). Challenges experienced by mothers caring for children with cerebral palsy in Zambia. The South African Journal of Physiotherapy, 71(1). https://doi.org/10.4102/SAJP.V71I1.274
- Skok, A., Harvey, D., & Reddihough, D. (2006). Perceived stress, perceived social support, and wellbeing among mothers of school‐aged children with cerebral palsy. Journal of Intellectual & Developmental Disability, 31(1), 53–57. https://doi.org/10.1080/13668250600561929
- Terzi, R., & Tan, G. (2016). Musculoskeletal system pain and related factors in mothers of children with cerebral palsy. Agri, 28(1), 18–24. https://doi.org/10.5505/agri.2015.74436
- Tosun, Z. K., & Temel, M. (2017). Burden of caregiving for stroke patients and the role of social support among family members: an assessment through home visits. International Journal of Caring Sciences, 10(3), 1696–1704.
- Tseng, M.-H., Chen, K.-L., Shieh, J.-Y., Lu, L., Huang, C.-Y., & Simeonsson, R. J. (2016). Child characteristics, caregiver characteristics, and environmental factors affecting the quality of life of caregivers of children with cerebral palsy. Disability and Rehabilitation, 38(24), 2374–2382. https://doi.org/10.3109/09638288.2015.1129451
- Vadivelan, K., Sekar, P., Sruthi, S. S., & Gopichandran, V. (2020). Burden of caregivers of children with cerebral palsy: An intersectional analysis of gender, poverty, stigma, and public policy. BMC Public Health, 20(1), 1–8.
- Wang, Y., Huang, Z., & Kong, F. (2020). Parenting stress and life satisfaction in mothers of children with cerebral palsy: the mediating effect of social support. Journal of Health Psychology, 25(3), 416–425. https://doi.org/10.1177/1359105317739100
- Wayte, S., McCaughey, E., Holley, S., Annaz, D., & Hill, C. M. (2012). Sleep problems in children with cerebral palsy and their relationship with maternal sleep and depression. Acta Paediatrica, 101(6), 618–623. https://doi.org/10.1111/j.1651-2227.2012.02603.x
- Yıldırım, M., Düken, M. E., Dağ, Y. S., & Yayan, E. H. (2022). Examining care burden, social support, and loneliness in parents of children with cerebral palsy. International Journal of Caring Sciences, 15(3), 1655–1664.
- Zarit, S. H., Reever, K. E., & Bach-Peterson, J. (1980). Relatives of the impaired elderly: correlates of feelings of burden. The Gerontologist, 20(6), 649–655. https://doi.org/10.1093/geront/20.6.649
- Zhao, M., Fu, W., & Ai, J. (2021). The mediating role of social support in the relationship between parenting stress and resilience among chinese parents of children with disability. Journal of Autism and Developmental Disorders, 51(10), 3412–3422. https://doi.org/10.1007/s10803-020-04806-8
- Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52(1), 30–41. https://doi.org/10.1207/s15327752jpa5201_2