Maternal and Child Health Journal

, Volume 18, Issue 8, pp 1993–2002 | Cite as

Anxiety and Depression in Mothers and Fathers of a Chronically Ill Child

  • H. A. van OersEmail author
  • L. Haverman
  • P. F. Limperg
  • E. M. van Dijk-Lokkart
  • H. Maurice-Stam
  • M. A. Grootenhuis


We aimed to determine the levels of anxiety and depression in mothers and fathers of a chronically ill child (0–18 years) and to study which parental and child variables are associated with anxiety and depression. In a cross-sectional design, anxiety and depression were assessed with the Hospital Anxiety and Depression Scale. Scores were compared to a Dutch reference group by analysis of variance and logistic regression analysis. Linear regression analyses were performed to examine which variables were associated with anxiety and depression. Mothers of a chronically ill child (n = 566) scored significantly higher than the reference group (p < .001) on anxiety (Mean 5.9 vs 4.8) and depression (Mean 4.5 vs 3.1). Fathers (n = 123) had higher depression scores (Mean 4.5 vs 3.6; p < .05), but fathers’ anxiety scores were comparable to the reference group. The percentages of mothers in the clinical range of anxiety (31.8 vs 20.7 %, OR 2.03, 95 % CI 1.46–2.83) and depression (23.0 vs 12.0 %, OR 2.76, 95 % CI 1.84–4.13) were higher (p < .001) than in the reference group. No differences were found for fathers in the clinical range for anxiety and depression. Practical problems in daily life (a: β = .33, d: β = .25) and parenting stress (a: β = .30, d: β = .32) showed the strongest association with anxiety and depression for parents as a group. Illness-related characteristics of the child were not related. Parents of a chronically ill child, especially mothers, reported high levels of anxiety and depression. Awareness about parental anxiety and depression in pediatrics is important as well as targeted interventions.


Anxiety Chronically ill children Depression Parents Pediatrics 



We would like to thank all the parents and patient associations who participated in this study. In addition, we wish to thank Biomedia/Artsen voor kinderen for the web design. Furthermore, we would like to thank Carline Tacke, Hennie Knoester, Lûte Kaales and Sophia Barrow for their support during the data collection. Finally, we would like to thank Ad Vingerhoets for providing the HADS reference group.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Mokkink, L. B., van der Lee, J. H., Grootenhuis, M. A., Offringa, M., & Heymans, H. S. (2008). Defining chronic diseases and health conditions in childhood (0–18 years of age): National consensus in the Netherlands. European Journal of Pediatrics, 167(12), 1441–1447.PubMedCrossRefGoogle Scholar
  2. 2.
    Perrin, J. M., Bloom, S. R., & Gortmaker, S. L. (2007). The increase of childhood chronic conditions in the United States. JAMA, 297(24), 2755–2759.PubMedCrossRefGoogle Scholar
  3. 3.
    Cousino, M. K., & Hazen, R. A. (2013). Parenting stress among caregivers of children with chronic illness: A systematic review. Journal of Pediatric Psychology, 38(8), 809–828.PubMedCrossRefGoogle Scholar
  4. 4.
    Wallander, J. L., & Varni, J. W. (1998). Effects of pediatric chronic physical disorders on child and family adjustment. Journal of Child Psychology and Psychiatry, 39(1), 29–46.PubMedCrossRefGoogle Scholar
  5. 5.
    Grootenhuis, M. A., & Bronner, M. B. (2009). Paediatric illness! Family matters. Acta Paediatrica, 98(6), 940–941.PubMedCrossRefGoogle Scholar
  6. 6.
    Hatzmann, J., Heymans, H. S., Carbonell, A., van Praag, B. M., & Grootenhuis, M. A. (2008). Hidden consequences of success in pediatrics: Parental health-related quality of life—results from the Care Project. Pediatrics, 122(5), e1030–e1038.PubMedCrossRefGoogle Scholar
  7. 7.
    Kazak, A. E., Kassam-Adams, N., Schneider, S., Zelikovsky, N., Alderfer, M. A., & Rourke, M. (2006). An integrative model of pediatric medical traumatic stress. Journal of Pediatric Psychology, 31(4), 343–355.PubMedCrossRefGoogle Scholar
  8. 8.
    Haverman, L., van Oers, H. A., Limperg, P. F., Houtzager, B. A., Huisman, J., Darlington, A. S., et al. (2013). Development and validation of the Distress Thermometer for Parents of a chronically ill child. Journal of Pediatrics, 163(4), 1140–1146.PubMedCrossRefGoogle Scholar
  9. 9.
    Lovejoy, M. C., Graczyk, P. A., O’Hare, E., & Neuman, G. (2000). Maternal depression and parenting behavior: A meta-analytic review. Clinical Psychology Review, 20(5), 561–592.PubMedCrossRefGoogle Scholar
  10. 10.
    Dix, T., Gershoff, E. T., Meunier, L. N., & Miller, P. C. (2004). The affective structure of supportive parenting: Depressive symptoms, immediate emotions, and child-oriented motivation. Developmental Psychology, 40(6), 1212–1227.PubMedCrossRefGoogle Scholar
  11. 11.
    Bartlett, S. J., Krishnan, J. A., Riekert, K. A., Butz, A. M., Malveaux, F. J., & Rand, C. S. (2004). Maternal depressive symptoms and adherence to therapy in inner-city children with asthma. Pediatrics, 113(2), 229–237.PubMedCrossRefGoogle Scholar
  12. 12.
    Feldman, J. M., Steinberg, D., Kutner, H., Eisenberg, N., Hottinger, K., Sidora-Arcoleo, K., et al. (2013). Perception of pulmonary function and asthma control: The differential role of child versus caregiver anxiety and depression. Journal of Pediatric Psychology, 38(10), 1091–1100.Google Scholar
  13. 13.
    Barakat, L. P., Patterson, C. A., Weinberger, B. S., Simon, K., Gonzalez, E. R., & Dampier, C. (2007). A prospective study of the role of coping and family functioning in health outcomes for adolescents with sickle cell disease. Journal of Pediatric Hematology/Oncology, 29(11), 752–760.PubMedCrossRefGoogle Scholar
  14. 14.
    Raina, P., O’Donnell, M., Rosenbaum, P., Brehaut, J., Walter, S. D., Russell, D., et al. (2005). The health and well-being of caregivers of children with cerebral palsy. Pediatrics, 115(6), 626–636.CrossRefGoogle Scholar
  15. 15.
    King, G., King, S., Rosenbaum, P., & Goffin, R. (1999). Family-centered caregiving and well-being of parents of children with disabilities: Linking process with outcome. Journal of Pediatric Psychology, 24(1), 41–53.CrossRefGoogle Scholar
  16. 16.
    Hatzmann, J., Maurice-Stam, H., Heymans, H. S., & Grootenhuis, M. A. (2009). A predictive model of Health Related Quality of life of parents of chronically ill children: The importance of care-dependency of their child and their support system. Health Qual Life Outcomes, 7, 72.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Bronner, M. B., Peek, N., Knoester, H., Bos, A. P., Last, B. F., & Grootenhuis, M. A. (2010). Course and predictors of posttraumatic stress disorder in parents after pediatric intensive care treatment of their child. Journal of Pediatric Psychology, 35(9), 966–974.PubMedCrossRefGoogle Scholar
  18. 18.
    Manuel, J. C. (2001). Risk and resistance factors in the adaptation in mothers of children with juvenile rheumatoid arthritis. Journal of Pediatric Psychology, 26(4), 237–246.PubMedCrossRefGoogle Scholar
  19. 19.
    Vermaes, I. P., Janssens, J. M., Mullaart, R. A., Vinck, A., & Gerris, J. R. (2008). Parents’ personality and parenting stress in families of children with spina bifida. Child: Care, Health and Development, 34(5), 665–674.Google Scholar
  20. 20.
    Yilmaz, O., Sogut, A., Gulle, S., Can, D., Ertan, P., & Yuksel, H. (2008). Sleep quality and depression-anxiety in mothers of children with two chronic respiratory diseases: Asthma and cystic fibrosis. Journal of Cystic Fibrosis, 7(6), 495–500.PubMedCrossRefGoogle Scholar
  21. 21.
    Besier, T., Born, A., Henrich, G., Hinz, A., Quittner, A. L., & Goldbeck, L. (2011). Anxiety, depression, and life satisfaction in parents caring for children with cystic fibrosis. Pediatric Pulmonology, 46(7), 672–682.PubMedCrossRefGoogle Scholar
  22. 22.
    Gallagher, S., Phillips, A. C., Oliver, C., & Carroll, D. (2008). Predictors of psychological morbidity in parents of children with intellectual disabilities. Journal of Pediatric Psychology, 33(10), 1129–1136.PubMedCrossRefGoogle Scholar
  23. 23.
    Kashdan, T. B., Jacob, R. G., Pelham, W. E., Lang, A. R., Hoza, B., Blumenthal, J. D., et al. (2004). Depression and anxiety in parents of children with ADHD and varying levels of oppositional defiant behaviors: Modeling relationships with family functioning. Journal of Clinical Child and Adolescent Psychology, 33(1), 169–181.PubMedCrossRefGoogle Scholar
  24. 24.
    Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scand, 67(6), 361–370.CrossRefGoogle Scholar
  25. 25.
    Spinhoven, P., Ormel, J., Sloekers, P. P., Kempen, G. I., Speckens, A. E., & Van Hemert, A. M. (1997). A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychological Medicine, 27(2), 363–370.PubMedCrossRefGoogle Scholar
  26. 26.
    Vingerhoets, A. J. J. M. (2012). Normdata HADS.Google Scholar
  27. 27.
    Abidin, R. R. (1990). Parenting stress index/short form. Lutz: Psychological Assessment Resources Inc.Google Scholar
  28. 28.
    Brock A. J. J. L. d., Vermulst A. A., Gerris J. R. M., Abidin R. R. (1992). NOSI: Nijmeegse ouderlijke stress index. Lisse: Swets & Zeitlinger.Google Scholar
  29. 29.
    Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hilldale: Lawrence Erlbaum Associates.Google Scholar
  30. 30.
    Helgeson, V. S., Becker, D., Escobar, O., & Siminerio, L. (2012). Families with children with diabetes: Implications of parent stress for parent and child health. Journal of Pediatric Psychology, 37(4), 467–478.PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    Kong, L. P., Cui, Y., Qiu, Y. F., Han, S. P., Yu, Z. B., & Guo, X. R. (2013). Anxiety and depression in parents of sick neonates: A hospital-based study. Journal of Clinical Nursing, 22(7–8), 1163–1172.PubMedCrossRefGoogle Scholar
  32. 32.
    Bayat, M., Erdem, E., & Gul, K. E. (2008). Depression, anxiety, hopelessness, and social support levels of the parents of children with cancer. Journal of Pediatric Oncology Nursing, 25(5), 247–253.PubMedCrossRefGoogle Scholar
  33. 33.
    Chiu, M. C., Ng, C. F., Lee, L. P., Lai, W. M., & Lau, S. C. (2007). Automated peritoneal dialysis in children and adolescents—benefits: A survey of patients and parents on health-related quality of life. Peritoneal Dialysis International, 27(Suppl 2), 138–142.Google Scholar
  34. 34.
    Norberg, A. L., Lindblad, F., & Boman, K. K. (2006). Support-seeking, perceived support, and anxiety in mothers and fathers after children’s cancer treatment. Psychooncology, 15(4), 335–343.PubMedCrossRefGoogle Scholar
  35. 35.
    Eccleston, C., Palermo, T. M., Fisher, E. & Law, E. (2012). Psychological interventions for parents of children and adolescents with chronic illness. Cochrane Database of Systematic Reviews, 8, CD009660.Google Scholar
  36. 36.
    Dissanayaka, N. N., O’Sullivan, J. D., Silburn, P. A., & Mellick, G. D. (2011). Assessment methods and factors associated with depression in Parkinson’s disease. Journal of the Neurological Sciences, 310(1–2), 208–210.PubMedCrossRefGoogle Scholar
  37. 37.
    Field, T., Diego, M., & Hernandez-Reif, M. (2010). Prenatal depression effects and interventions: A review. Infant Behavior and Development, 33(4), 409–418.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Britton, J. R. (2008). Maternal anxiety: Course and antecedents during the early postpartum period. Depression and Anxiety, 25(9), 793–800.PubMedCrossRefGoogle Scholar
  39. 39.
    Cosco, T. D., Doyle, F., Ward, M., & McGee, H. (2012). Latent structure of the Hospital Anxiety and Depression Scale: A 10-year systematic review. Journal of Psychosomatic Research, 72(3), 180–184.PubMedCrossRefGoogle Scholar
  40. 40.
    Doyle, F., Cosco, T., & Conroy, R. (2012). Why the HADS is still important: Reply to Coyne & van Sonderen. Journal of Psychosomatic Research, 73(1), 74–78.PubMedCrossRefGoogle Scholar
  41. 41.
    Coyne, J. C., & van Sonderen, E. (2012). No further research needed: Abandoning the Hospital and Anxiety Depression Scale (HADS). Journal of Psychosomatic Research, 72(3), 173–174.PubMedCrossRefGoogle Scholar
  42. 42.
    Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale. An updated literature review. Journal of Psychosomatic Research, 52(2), 69–77.PubMedCrossRefGoogle Scholar
  43. 43.
    Kazak, A. E., Cant, M. C., Jensen, M. M., McSherry, M., Rourke, M. T., Hwang, W. T., et al. (2003). Identifying psychosocial risk indicative of subsequent resource use in families of newly diagnosed pediatric oncology patients. Journal of Clinical Oncology, 21(17), 3220–3225.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • H. A. van Oers
    • 1
    Email author
  • L. Haverman
    • 1
  • P. F. Limperg
    • 1
  • E. M. van Dijk-Lokkart
    • 2
  • H. Maurice-Stam
    • 1
  • M. A. Grootenhuis
    • 1
  1. 1.Pediatric Psychosocial DepartmentEmma Children’s Hospital, Academic Medical CenterAmsterdamThe Netherlands
  2. 2.Department of Medical PsychologyVU University Medical CentreAmsterdamThe Netherlands

Personalised recommendations