Disability beyond borders: New approaches to understanding children's special health care needs and maternal mental health

The impact of children's special health care needs on maternal mental health has been the subject of considerable research, but to examine this relationship, many have focused on specific childhood diagnoses. Extending public health understandings beyond the borders of diagnostic categories requires an alternative view. Using the National Survey of Children's Health, 2003, this study assessed the broader implications of mothers' caregiving for children with special needs.

Screening questions from the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services, piloted for the first time in this national sample, formed the basis of special needs criteria. The relationships among special needs and mothers' mental health and anxiousness about their child's outcomes were assessed within the framework of the stress process using multiple regression and simple slopes analyses.

Results of this study not only indicate that children's special needs – beyond diagnoses – are significantly associated with mothers' mental health but also suggest that a broader view of maternal stressors contributes to our understanding of at-risk families with disabled children. In this sample, mothers' perceived coping, a child's regular source of care, and neighborhood support either mediated or buffered the effects of maternal caregiver stress. The significant effects of structural environments and contexts of social stress on maternal well-being underscore the importance of viewing a disability within the context of environmental limitations rather than that of individual capabilities. This important shift in perspective can form the basis for stronger and more effective family public health interventions.