Mental health and coping strategies among caregivers of children with cerebral palsy.Mental health and coping strategies among caregivers of children with cerebral palsy.Mental health and coping strategies among caregivers of children with cerebral palsy.Mental health and coping strategies among caregivers of children with cerebral palsy.Mental health and coping strategies among caregivers of children with cerebral palsy.Mental health and coping strategies among caregivers of children with cerebral palsy.Mental health and coping strategies among caregivers of children with cerebral palsy.Mental health and coping strategies among caregivers of children with cerebral palsy.Mental health and coping strategies among caregivers of children with cerebral palsy.Mental health and coping strategies among caregivers of children with cerebral palsy.Mental health and coping strategies among caregivers of children with cerebral palsy.Mental health and coping strategies among caregivers of children with cerebral palsy.Mental health and coping strategies among caregivers of children with cerebral palsy.
VIETNAM NATIONAL UNIVERSITY, HANOI UNIVERSITY OF EDUCATION NGUYEN THI MAI HIEN MENTAL HEALTH AND COPING STRATEGIES AMONG CAREGIVERS OF CHILDREN WITH CEREBRAL PALSY DOCTORAL DISSERTATION IN CLINICALPSYCHOLOGY HANOI - 2023 VIETNAM NATIONAL UNIVERSITY, HANOI UNIVERSITY OF EDUCATION NGUYEN THI MAI HIEN MENTAL HEALTH AND COPING STRATEGIES AMONG CAREGIVERS OF CHILDREN WITH CEREBRAL PALSY DOCTORAL DISSERTATION IN PSYCHOLOGY Major: Children and Adolescent Clinical Psychology Code: 91310401.01 Supervised by: Prof Bahr Weiss Assoc Prof Tran Van Cong HANOI - 2023 DECLARATION I, the undersigned, hereby declare that this thesis “Mental health andcoping strategiesamongcaregiversofchildrenwithcerebralpalsy”isentirelymyworkwithoutplagiarism All information sources used in this dissertation have been acknowledged and its authors have been referenced This research was only submitted to the University of Education, Vietnam National University, Hanoi under the framework of the Children and Adolescent Clinical Psychology Doctoral Training Program Name: Nguyen Thi Mai Hien ACKNOWLEDGEMENTS I would like to manifest my deep gratitude to all who have contributed to the development of this dissertation Wholehearted thanks are given to my mentorsandadvisors,ProfessorBahrWeiss,andAssociateProfessorTranVan Cong for their fruitful guidance in shaping the conceptual framework, developing research tools, data analysis, thesis writing, andupholding Atsomepointintime,Ilostmotivation,felt andwantedtogiveup,myPh.D.programmate,HoThu down, Ha,gave handsto mewithgreat empathy.Sheauthenticallysharedherexperiencesindoingresearch.Thus,Istepbystepregainthee nergyandinterestinmovingtheresearchforward Therearenotenough wordstoexpressmyappreciationforhersupport Itwouldnotbepossibleformetocompletethisworkwithouttheprecious collaborationoftheCerebralPalsyFamilyAssociationofVietnam.Mysincere thanksgotothechairperson,Ms.DinhThiLanAnh,herstaff,Ms.NguyenThu Hong, and more than 300 of its members who have joined hands with the research tool development, and data collectionprocess IalsowanttoconveythankstotheVietnamPsychotherapyAssociationwhereIhave beenworkingformorethan3years,itsmembers, volunteers,andpeopleat theUniversityofEducation,VietnamNationalUniversityforenablingandassistingmeonmypat hwaytocompletetheresearch My family without whom I would never have had thecouragea n d goodwilltogothroughmanychallengesandcomplete thislongpro cess.MyhusbandH o a n g Q u o c D u n g , m y s o n H o a n g Q u o c P h o n g a n d m y d a u g h t e r HoangThiMaiNuonghaveshowntheirpatience,theirlove,andtheirbeingo nmysidetoacceptanyversionofmyself.Iamluckytohavetheminmylife Although I could not name all persons to whom I owe a debt of gratitude for their support, I hope that they understand my true respect for them LIST OF ABBREVIATIONS CDS : Caregiver Difficulties Scale COPE : Coping Orientation to Problems Experienced CP : Cerebral Palsy CPFAV : Cerebral Palsy Family Association Vietnam CWD : Children with Disabilities GSOG : General Statistics Office MFCSG : Gross Motor Function Classification System AD-7 : Generalized Anxiety Disorder-7 MoH : Ministry of Health PHQ- : Patient Health Questionnaires- 9PWD : People with Disabilities QoL : Quality of Life CRPD : United Nations’ Convention on the Rights of Persons with Disability UNICEF :UnitedNations International Children's EmergencyFund WHO : World Health Organization TABLES OF CONTENTS DECLARATION i ACKNOWLEDGEMENTS ii LISTOFABBREVIATIONS iii TABLESOFCONTENTS .iv LIST OFTABLES vi LIST OFFIGURES .viii INTRODUCTION 1 Rationales Objectives ofthestudy 3 Researchquestions 4 Researchdesign Scope oftheresearch Contribution ofthethesis CHAPTER 1THEORETICALBASIS 1.1 Literature review on mental health andcopingstrategies .7 1.1.1 Overview of the research onmentalhealth 1.1.2 Overview of the research oncoping strategies .18 1.1.3 Factors associated with mental health and coping strategies among caregivers of children with CP 22 1.2 Theoreticalframework 35 1.2.1 Keyconcepts 35 1.2.2 The underlyingtheoreticalmodels 51 CHAPTER2METHODOLOGY 62 2.1 Researchdesign 62 2.2 Researchprocedures 63 2.3 Researchsamples 68 2.3.1 Researchsites 68 2.3.2 Samples .69 2.4 Researchmeasures 75 2.4.1 Measurement of mental health among caregivers of childrenwith CP 76 2.4.2 MeasurementofcopingstrategiesusedbycaregiversofchildrenwithCP 78 2.4.3 Measurement of associated factors tomentalhealth 82 2.5 Statisticalanalyses 85 2.6 Ethicalconsiderations .87 CHAPTER3 RESULTS .89 3.1 Thementalhealth statusof thestudied caregiversofchildrenwithCP .89 3.1.1 Prevalence of depression, anxiety, and qualityof life 89 3.1.2 Differences in depression, anxiety, and quality of life among caregivers by demographiccharacteristics .93 3.2 Coping strategies among caregivers of childrenwithCP 100 3.2.1 The coping strategies used by caregivers of childrenwithCP .100 3.2.2 The aspects associated with coping strategies usedby caregivers 103 3.3 The factors associated with the mental health status ofthe caregivers 112 3.3.1 Correlation among depression, anxiety, and qualityoflife 112 3.3.2 Factors associated with depressionofcaregivers 113 3.3.3 Factors associated with anxietyofcaregivers 126 3.3.4 Key factors associated with the quality of life (QoL)ofcaregivers .139 CHAPTER4 DISCUSSION .152 3.4.1 Mental health status among caregivers of childrenwith CP 152 3.4.2 Coping strategies used by caregivers of childrenwith CP 159 3.4.3 Factors associated with identified mental health ofthecaregivers .167 CONCLUSION 179 LIST OF RESEARCH PAPERS RELATED TOTHEDISSERTATION 184 REFERENCES 185 APPENDICES 209 LIST OF TABLES Table 1.1: Summary of factors associated with mental health among caregivers of childrenwith disabilities 26 Table 2.1: List of provinces having caregivers joiningthe study 68 Table 2.2: Age, ethnicity, religion, and marital status amongprimarycaregivers 69 Table 2.3: Education and occupation ofprimarycaregivers 71 Table 2.4.Caregivingresponsibilities 72 Table 2.5 Socio-economic conditions of thecaregivers’families 73 Table 2.6: Characteristics of the childwithCP 74 Table 3.1 Percentage of caregivers with depression and the levelofseverity 89 Table 3.2 Percentage of caregivers with anxiety and the levelofseverity 90 Table 3.3: Caregivers with both depressionandanxiety 92 Table 3.4: Caregiver's quality of lifebyitems 92 Table 3.5 Mean scores of depressions, anxiety and QoLby localities 93 Table 3.6 Mean scores of depression, anxiety and QoL byfamilyconditions 95 Table 3.7 Mean scores of depression, anxiety andQoLby .96 CPchildren’ features 96 Table 3.8 Mean scores of depression, anxiety and QoL bysocialsupports 97 Table 3.9 Rate of caregivers reporting reasons for theiremotional problems 99 Table 3.10 Correlation among factorsof coping .102 Table 3.11: Correlation between copingstrategiesand 106 Table 3.12: Correlation between coping strategies and functional impairments, independent living ofCPchildren 108 Table 3.13: Correlation between coping strategies andfamilyincomes 109 Table 3.14: Correlation between coping strategies andcare responsibilities 109 Table 3.15: Correlation between coping strategies and burdenofcare 110 Table 3.16 Correlation among PHQ-9, GAD-7and QoL .112 Table 3.17: Effects of different coping strategieson depression 113 Table 3.18: Effects of social support oncaregivers’depression 114 Table 3.19: Effects of the family’s support and incomeson depression 116 Table 3.20: Effects of care responsibilitieson depression 117 Table 3.21 Effects of caregiving burdenon depression 118 Table 3.22 Effects of CP child related factorson depression 120 Table 3.23: Effects of interaction between coping strategies and risk factors on depression 121 Table 3.24: Interaction between social support and risk factorsondepression 124 Table 3.25: Effects of different coping strategiesonanxiety 126 Table 3.26: Effects of social support oncaregivers’anxiety 127 Table 3.27: Main effects of the family’s support and incomeson anxiety .130 Table 3.28: Effects of care responsibilitieson anxiety 130 Table 3.29 Effects of caregiving burdenonanxiety .132 Table 3.30 Effects of CP child related factorson anxiety .133 Table 3.31: Effects of interaction between coping strategies and risk factors on anxiety 135 Table 3.32: Interaction between social support and risk factorsonanxiety 136 Table 3.33: Effects of different coping strategieson QoL .139 Table 3.34: Effects of social support oncaregivers’QoL .140 Table 3.35: Main effects of the family’s support and incomeson QoL 142 Table 3.36: Effects of care responsibilitieson QoL 143 Table 3.37 Effects of caregiving burdenon QoL 144 Table 3.38 Effects of CP child related factorson QoL 145 Table 3.39:Effectsofinteraction between coping strategiesandriskfactorsonQoL1 Table 3.40: Interaction between some social support andrisk factors 149 LIST OF FIGURES Figure 1.1:BiopsychosocialModel 53 Figure 1.2: Theoretical model of stress, appraisal, andcopingof 58 LarazuzandFolkman 58 Figure 1.3: Conceptual framework of mental health and associated factors among caregivers of childrenwithCP 61 Figure 3.1 Percentage of caregivers bydepressionsymptoms 90 Figure 3.2 Percentage of caregivers byanxietysymptoms .91 Figure 3.3 The four-factor coping strategiesofcaregivers 101 Figure 3.4 Frequency of coping strategies usedbycaregivers .101 Figure 3.5 Differences in coping strategiesbyregion 103 Figure 3.6 Differences in coping strategies byrural/urbanareas 104 Figure 3.7 Differences in coping by CP child’s motor function impairments 107 Figure 3.8 Differences in coping strategies byCPprognosis .108 Figure 3.9 Proposed diagram of mental health care appliedbyCPFAV 183