Maternal burn-out: an exploratory study

A systematic review of parental burnout and related factors among parents

BACKGROUND

Parenting is both a complex and stressful endeavor, so parents sometimes experience parenting burnout. The main objective of this study was to provide an overview of factors related to general parental burnout (PB) among parents with at least one child based on the Ecological Systems Theory (EST).

METHODS

PubMed, Web of Science, EBSCO, CNKI and WanFang were systematically searched for studies published from 2010 to July 2023 for peer-reviewed articles using keywords extracted from Medical Subject Headings such as "parenting", "parental", "burnout", "psychological burnout", "burn-out syndrome". Studies were included if they described associations between factors and PB among parents of children aged 0-18 years old in the general population, and published in an English or Chinese language peer-reviewed journal. The Quality Assessment Tool for Studies with Diverse Designs (QATSDD) was employed to assess the risk of bias of included studies.

RESULTS

Of 2037 articles, 26 articles met the inclusion criteria. Based on the Ecological Systems Theory (EST), we found that microsystem-individual factors such as gender, educational level, income, parental personality, internalization of maternal parental motivation, unmitigated communion, self-compassion and concern for others, alexithymia, anxiety and depressive symptoms, parental perfectionism, resilience, low self-esteem and high need for control, mother's attachment style were identified as being associated with parenting burnout. Mesosystem-interpersonal factors involve parent-child relationship and marital satisfaction. The exosystem-organizational or community factors include the number of children in the household, neighborhood and the number of hours spent with children, child's illness, child's behavior problems and social support. The macrosystem-society/policy or culture factors are mainly personal values and cultural values.

CONCLUSIONS

This systematic review found several factors that have been investigated in relation to PB. However, the majority of the factors were reported by one or two studies often implementing a cross-sectional design. Nevertheless, we still recommend that health policymakers and administrators relieve parenting burnout among parents with children by adjusting these modifiable factors.

Swiss cohort on Traumatic Childbirth and Health (SwiTCH): protocol for a prospective, population-based cohort study on parents' mental health from pregnancy to one year postpartum

INTRODUCTION

Approximately 4%-5% of mothers develop childbirth-related post-traumatic stress disorder (CB-PTSD) and approximately 12.3% of mothers develop some CB-PTSD symptoms (CB-PTSS). To date, there is a dearth of studies on fathers and other coparents. Parental CB-PTSD and CB-PTSS may have a negative impact not only on the parents but also on the infant. Understanding risk and protective factors of CB-PTSD for both parents and its consequences on the family is key to detecting or anticipating it, to developing interventions aimed at reducing its detrimental effects and to supporting parents.

METHODS AND ANALYSIS

This study protocol describes an observational, population-based study, consisting of a longitudinal prospective cohort with online surveys at four time points. The population of interest consist of women, in the third trimester of pregnancy or at 6-12 weeks postpartum, and their partner/coparent, who will give birth or gave birth in the French-speaking part of Switzerland. The target sample size is 300-500 women and a proportional number of partners. The primary outcome of this study is the prevalence of CB-PTSD and CB-PTSS. The secondary outcomes focus on: (1) the impact of CB-PTSD and CB-PTSS on the marital and coparental relationships, the bonding with the infant, parental burnout and healthcare seeking behaviours, (2) the role of the childbirth experience in the development of CB-PTSD and CB-PTSS and (3) the social and economic determinants of CB-PTSD and CB-PTSS.

ETHICS AND DISSEMINATION

Ethical approval was granted by the human research ethics committee of the Canton de Vaud (study number 2022-00284). All study participants signed an informed consent form. Dissemination of results will occur via national and international conferences, in peer-reviewed journals, public conferences and social media.

TRIAL REGISTRATION NUMBER

NCT05865704.

Parental Burnout During the Second Year of the COVID-19 Pandemic: Exploring the Role of Parenting Stressors and Coparenting Support

The COVID-19 pandemic brought about many changes in family routines and introduced new stressors for parents. While stressors can lead to parental burnout, coparenting support may mitigate the effects of parental stress on parental burnout. The current study explored the effects of parental stress, COVID-19 stress, and coparenting support on parental burnout during the second year of the pandemic. Participants consisted of one hundred fifty-five parents in the USA (M = 39.6, SD = 7.38; female = 94.8%). Results suggested parental stress was positively associated with parental burnout while coparenting support was negatively associated with parental burnout. These findings highlight the importance of addressing parental stress and support to minimize the risk of parental burnout.

Exploring the relationship between postnatal depressive symptoms and parental burnout from the perspective of the population and individual level

BACKGROUND

Parental burnout has become increasingly common, which can lead to a range of adverse outcomes. Postnatal mothers are vulnerable and mothers with high postpartum depression scores may be more prone to parental burnout. This study aims to investigate the association between postnatal depressive symptoms and parental burnout at both the population and individual levels.

METHODS

This study comprised a cross-sectional study design and participants were recruited using convenience sampling. A total of 560 postnatal mothers answered a questionnaire on their general information, postnatal depressive symptoms and parental burnout. Multiple linear regression and binary logistic regression analysis were used to examine the association between postnatal depressive symptoms and parental burnout. Furthermore, latent class analysis was used to identify subtypes of parental burnout. Finally, binary logistic regression was used to examine the differences in postnatal depressive symptoms between latent classes comprising parental burnout.

RESULTS

The prevalence of burnout was approximately 10%. At the population level, postnatal depressive symptoms were positively associated with parental burnout (all P < 0.05). At the individual level, two latent classes were identified (i.e., "low parental burnout class" and "high parental burnout class"). Moreover, mothers with postnatal depressive symptoms were more likely to be associated with high parental burnout (PB) class than the low parental burnout class (OR = 1.12, 95% CI:1.03 to 1.23).

CONCLUSION

This study found a positive relationship between postnatal depressive symptoms and parental burnout. It provided evidence for developing depression-targeted programs for parental burnout, which could bring great benefits for both mothers and infants.

Parental Burnout and Child Maltreatment During the COVID-19 Pandemic

The novel coronavirus (COVID-19) has spread across the United States, resulting in significant changes in almost all aspects daily life. These changes place parents at increased risk for parental burnout. Parental burnout is a chronic condition resulting from high levels of parenting-related stress due to a mismatch between the demands of parenting and the resources available for parents to meet those demands. Research on parental burnout has suggested that parents who experience burnout are more likely to engage in child abuse and neglect, placing children at risk for detrimental short- and long-term outcomes. The purpose of this paper is to review the concept of parental burnout, discuss parental burnout in the context of the current COVID-19 pandemic, and focus specifically on the effects of child maltreatment. Implications for practitioners will be discussed.

Psychometric Properties of Parental Burnout Assessment and Prevalence of Parental Burnout: A Person-Centered Approach

Background/Objetive

The objective of this research is threefold. First, to study the structure of the Parental Burnout Assessment (PBA); second, to learn whether parents combine the dimensions of PBA in profiles; and third, to analyze the prevalence levels of parental burnout.

Method

To address these objectives, the responses of 438 mothers and fathers were analyzed with confirmatory factor analysis and latent profile analysis.

Results

Strong evidence of validity (structural) and reliability (internal consistency) of the PBA was found. Four parental burnout profiles were identified. Moreover, from a variable-centered perspective and a person-centered perspective, very high levels of parental burnout were found.

Conclusions

Data indicate that the PBA is a reliable and valid instrument and suggest that practitioners may use the particular scores of the dimensions or the overall score. Likewise, the level of the four dimensions in the four parental burnout profiles (PBP) is similar within and different between profiles. Finally, the prevalence level of parental burnout is very high (over 26%) compared to data from previous studies (3.2%).

Parental burnout: a scoping review

OBJECTIVE

to map available evidence on parental burnout theme.

METHOD

scoping review as according to the Joanna Briggs Institute. Search in January 2021, in six databases of publications in English, Portuguese or Spanish, without time limits. Data extracted and descriptively analyzed by three independent researchers.

RESULTS

374 articles were identified and 20 were included in the final sample, all published in English, from 2017 onwards. Parental burnout is a complex, multifactorial problem, distinct from burnout cases, depressive symptoms and other mental health alterations. It affects 0.2 to 20% of parents, has validated and suitable instruments for measurement; if not treated, can have consequences on marital life, work relationships, child neglect and violence.

CONCLUSIONS

this is a recent theme that needs to be explored, due to the possible impact on children's and families' health and on parents' work processes. Protocol registered in the Open Science Framework (https://osf.io/jd7vk).

Emotion regulation during the COVID-19 pandemic: risk and resilience factors for parental burnout (IIPB)

The COVID-19 pandemic has impacted families' lives around the world. The measures used to contain transmission have led to increased stress and put parents at increased risk for parental burnout (PB). The aim of the current study was to examine the association between COVID-related parental stress and PB, and to test whether emotion regulation (ER) moderated this association. We hypothesised that rumination, which is a generally maladaptive ER strategy, would act as a risk factor. In comparison, we hypothesised that reappraisal, which is a generally adaptive ER strategy, would act as a resilience factor. We assessed 8225 parents from 22 countries using an on-line survey, and focused on general stress and parenting stress. These stressors were associated with greater PB. Importantly, parental ER moderated these associations; rumination strengthened the link between stress-related variables and PB, whereas reappraisal weakened it. This study emphasises the negative effect COVID-19 has on parents and highlights key ER risk and resilience factors.

Latent Profiles of Parental Burnout During COVID-19: The Role of Child-Related Perceptions

The present study examined latent profiles of parental burnout dimensions (e.g., exhaustion in parental role, contrast with previous parental self, feelings of being fed up, and emotional distancing, measured with a shortened version of the parental burnout assessment scale) among Finnish parents of sixth and eighth grade children. In addition, the role of children’s strengths and difficulties (e.g., prosocial skills, hyperactivity, somatic problems, conduct problems, and peer problems) and parents’ growth mindset in predicting membership in the latent parental burnout profiles was examined. The participants were 1,314 parents (80% mothers) from the Helsinki Metropolitan area who filled in a questionnaire concerning their parenting burnout and child-related perceptions during the fall 2020. The results were analyzed using latent profile analysis (LPA) and three-step procedure. Three latent profiles of parental burnout were identified as: low parental burnout (85.7% of the parents), high parental burnout (8%), and emotionally distanced (6.3%) profiles. Parents who reported their children having some challenges (e.g., hyperactivity, somatic problems, conduct problems, and peer problems) more often belonged to the high burnout or emotionally distanced profiles rather than to the low parental burnout profile. Parents whose children had high prosocial skills and who employed growth mindset more often belonged to the low parental burnout rather than to the distanced profile.

Family violence during COVID-19 and its impact on mental health of children: A systematic review

Purpose: The COVID-19 pandemic posed unanticipated challenges that could impact how the family system operates across the world. Restrictions imposed to control the rapid spread of the virus substantially increased violence in families. The current study aims to review violence in the family and its impact on the mental health of children during the pandemic.Method: A systematic search was conducted using keywords in the electronic databases PubMed, PsycINFO, and Web of Science, and a manual search was conducted on Google Scholar for articles from January 2020 to January 2021. Of the 50 records identified, seven studies that met eligibility criteria were selected for final analysis.Results: Results revealed that family violence during the pandemic has escalated the mental health problems of children, including aggressive and self-harming behaviours. Lockdown restrictions, social detachment, financial instability, fear of infection, and unemployment led to increased parental stress. Parents with a higher level of stress were more likely to maltreat their children.Conclusions: Exposure to short and long-term family violence can adversely impact the mental health of children and can negatively affect a child's present and future life. Recommendations for researchers, mental health practitioners, public health authorities, and other service providers are also outlined.

Health and suffering are associated with social support: a cross-sectional study of women and mothers with exhaustion and pain

BACKGROUND

Despite women are generally overrepresented in behavioral, mental, and musculoskeletal disorders, motherhood as a central part of women's life is poorly understood in relation to exhaustion and long-lasting pain. Mothers' health impairments imply suffering both for herself and her family. A profound understanding of health is needed taking mothers' subjective health experience, their suffering and life situation into account to give women, their families and society better prerequisites to alleviate exhaustion and long-lasting pain. The aim of the study was to describe health and suffering of women and mothers undergoing rehabilitation for long-lasting pain and exhaustion and its correlation with perceived social support.

METHODS

The study had a cross-sectional design with an exploratory approach. A main sample consisted of 166 women undergoing rehabilitation for exhaustion and long-lasting pain and a reference sample included 129 women working and studying within health care professions. Both samples included women with and without children. Women's subjective health and suffering was assessed from a caring science perspective using the recently developed and validated Health and Suffering Scale. Two additional scales measuring exhaustion and social support were distributed among the two samples. Descriptive statistics and multiple linear regression models, including health and suffering and perceived social support, were analyzed.

RESULTS

Mothers undergoing rehabilitation for pain and exhaustion reported significantly poorer health and more suffering compared to healthy mothers, but similar health and suffering when compared with childless women in rehabilitation. Health and suffering were correlated with perceived social support among both healthy and exhausted mothers. In both samples, the correlation between health and suffering and social support was stronger among mothers than among women without children.

CONCLUSIONS

Women and mothers living with exhaustion and long-lasting pain show signs of unbearable suffering and perceived insufficient social support. Social support from various sources particularly helps mothers to create meaning in life and make their suffering bearable. Hence, health care must address the fact that mothers are dependent on their immediate social environment and that this dependency interacts with their health and suffering on an existential level.

Parental peritraumatic distress and feelings of parental competence in relation to COVID-19 lockdown measures: What is the impact on children's peritraumatic distress?

The objective of this study was to measure, via an online survey, the peritraumatic impact of COVID-19-related lockdown measures on parents and their sense of parental competence, as well as the link with their children's peritraumatic distress. We investigated the links between the distress felt by the parent and the distress felt by the child in the lockdown from March to May 2020. Participants were 287 parents and 161 children. The results of our study indicated that there is a significant association between the parents' and the children's peritraumatic stress. We also found a significant relationship between the sense of parental competence and the trauma suffered as a result of the lockdown. We also showed that people who usually felt more stressed have lower peritraumatic distress. In addition, the data indicated that mothers were more affected than fathers by the lockdown, whereas there was no difference between girls and boys in the sample of children. The peritraumatic feelings appeared to be more related to the difficulty of combining teleworking with the daily management of children than to the fear of the virus itself. All these results bear witness to the differences in the experience of lockdown between mothers and fathers, and the impact on their children's well-being.

Stigma associated with parental depression or cancer: Impact on spouse and offspring's cortisol levels and socioemotional functioning

Stress associated with caring for a mentally ill spouse can adversely affect the health status of caregivers and their children. Adding to the stress of caregiving is the stigma often placed against spouses and children of people with mental illness. Contrary to mental illness, many physical disorders such as cancer may be less stigmatized (expect pulmonary cancer). In this study, we measured externalized and internalized stigma, as well as psychological (depressive symptoms and stressful life events) and physiological (basal salivary cortisol levels) markers of stress in 115 spouses and 154 children of parents suffering from major depressive disorder, cancer, or no illness (control group). The results show that spouses and children from families with parental depression present significantly more externalized stigma than spouses and children from families with parental cancer or no illness, although we find no group differences on internalized stigma. The analysis did not show a significant group difference either for spouses or their children on depressive symptomatology, although spouses from the parental depression group reported greater work/family stress. Finally, we found that although for both spouses children the awakening cortisol response was greater on weekdays than on weekend days, salivary cortisol levels did not differ between groups. Bayes factor calculated on the null result for cortisol levels was greater than 100, providing strong evidence for the null hypothesis H0. Altogether, these results suggest an impact of stigma toward mental health disorder on psychological markers of stress but no impact of stigma on physiological markers of stress. We suggest that these results may be due to the characteristics of the families who participated in the present study.

Parental burnout: Moving the focus from children to parents

Parental burnout (PB)-a condition characterized by intense exhaustion related to parenting, emotional distancing from one's children, and a loss of parental fulfillment-has received increasing attention in recent years, even more since the worldwide COVID-19 crisis and the confinement of parents with their children. This crisis put the spotlight on parents' suffering, and the need to better understand parental burnout and how to best assess and treat it emerged as a priority. This brief article introduces the Thematic Issue of New Directions in Child and Adolescent Development focused on the measurement of parental burnout across various regions of the world. It briefly reviews the concept of parental burnout, its phenomenological experience, its etiology and consequences, and its measurement.

Do informal caregivers experience more burnout? A meta-analytic study

Informal caregivers often report exhaustion when providing care, which can be related to forms of burnout. Yet, there is no systematic inventory of studies comparing caregivers and non-caregivers in terms of burnout. For the present meta-analysis, studies comparing burnout in informal caregivers and non-caregivers were screened and included. Two categories of studies were found: those on family care burnout (spousal or parental burnout) and those on professional burnout (mostly in healthcare). For family care burnout studies, informal caregivers reported more emotional exhaustion, and, to a lesser extent, depersonalization and reduced personal accomplishment than non-caregivers. For studies on professional burnout, workers providing informal care also reported more emotional exhaustion than workers not providing such a care. Overall, the results indicate that providing informal care represents a risk for role burnout. In family care burnout studies, these results confirm the assumption that providing informal care adds extra weight on the individuals' shoulders. In professional burnout, these results support the role accumulation theory, pointing that an additional weight in one's role, i.e., providing informal care, has an impact on another role, work. This work emphasizes the consideration of the multifaceted impact that the caregiving role can have on the individual.

Development and preliminary validation of the Maternal Burnout Scale (MBS) in a French sample of mothers: bifactorial structure, reliability, and validity

The study and evaluation of burnout in the context of parenthood have been of growing interest over the last years. The aim of this study is to develop and validate the Maternal Burnout Scale (MBS) to contribute knowledge of the assessment of parental burnout. Items were developed based on elements from an extensive literature review that defined the significant dimensions interesting to the parental context. These items were also examined by expert clinicians. The revised version was submitted for an exploratory testing on 673 French mothers (mean age 31.69 ± 5.52 years) having at least one child living at home (0-25 years); then, it was submitted for a confirmatory analysis of 1277 (mean age 32.67 ± 5.49 years) mothers having the same parental profile (child aged 0.1-24 years). The exploratory analysis suggests a three-factor structure that accounted for 51% of the variance: negative emotional-behavioral manifestations (25%), physical and emotional exhaustion (15%), and a sense of parental achievement (13%). The confirmatory analysis retained a bifactorial structure recognizing maternal burnout as a common factor as well as the three other factors. According to the established threshold scores, 6.6% (n = 84) of the mothers could experience clinical maternal burnout. Indeed, Maternal Burnout Scale (MBS) has shown good psychometric properties with a high internal consistency both for the general score and for subscales. Furthermore, the validity of the scale was also confirmed. The MBS appears to be an applicable and reliable tool to determine the presence and severity of burnout symptoms among mothers. As a conclusion, the prevalence of maternal burnout indicates the importance of studying this syndrome in order to establish measures of prevention and actions to be taken.

Depression, anxiety, and guilt in mothers with burnout of preschool and school-aged children: Insight from a cluster analysis

INTRODUCTION

The primary objective of this study is to identify the typology of exhausted mothers based on, depressive, anxiety, and guilt symptoms. And, secondarily, evaluate whether these profiles differ on parental stress, environmental stress, and parental burnout.

METHODS

Five hundred and fifty French-speaking mothers suffering from exhaustion completed several questionnaires assessing parental stress, general perceived stress, maternal guilt, and depressive and anxious symptomology. Results from two hundred and ten mothers with burnout symptoms were explored (mean age [SD] = 33.69 [5.1] years). In order to identify possible subgroups, a hierarchical cluster analysis was performed.

RESULTS

Three profiles were highlighted from the sample (Wilks' λ = 0.156, p < .0001): the first was characterized by high feelings of guilt (29.52%; n = 62), the second showed a dominance of anxiety symptoms and high feelings of guilt (36.19%; n = 76), and the fourth presented low levels of depression, anxiety, and feelings of guilt (23.3%, n = 49).

DISCUSSION

These findings suggest different profiles of burned out mothers that vary according to severity of anxiety, depression, and guilt. That suggests that parental burnout, depression and anxiety are distinct disorders. This study also makes it possible to show the aggravating effect of guilt in the experience of burnout. Additional research is warranted as it is important to more carefully consider possible appropriate intervention strategies given the differing experiences of burned out mothers.

Informal Caregiver Burnout? Development of a Theoretical Framework to Understand the Impact of Caregiving

Informal caregiving is a rewarding but demanding role. The present theoretical framework proposes to adapt the tridimensional concept of burnout to informal caregiving as a way to address the potential consequences of caregiving. This adaptation reflects caregivers' reported difficulties, as well as empirical findings on emotional exhaustion, depersonalization, and personal accomplishment as caregiving outcomes. But to understand burnout in informal caregiving contexts, it is also necessary to find ways to model it. The Informal Caregiving Integrative Model (ICIM) is thus proposed. This model is based on the integration of elements from literature on both informal caregiving stress and professional burnout. The goal of the ICIM is to emphasize the importance of every category of determinants of informal caregiver burnout (i.e., relating to the caregiver, the caregiving setting, and the sociocultural context), with a key mediating role for the caregivers' appraisal of their situation and their relationship with the care-recipient. This article is a first integrative step in the consideration of a form of burnout specific to informal caregivers and supports the design of empirical and interventional studies based on the theoretical foundation that the ICIM proposes.