RESEARCH ARTICLE

Coping Strategies as Mediators and Moderators

between Stress and Quality of Life among Parents of
Children with Autistic Disorder
Latefa A. Dardas*† & Muayyad M. Ahmad
The University of Jordan, Amman, Jordan

Abstract
The purpose of this cross-sectional study was to examine coping strategies as mediators and moderators between
stress and quality of life (QoL) among parents of children with autistic disorder. The convenience sample of the
study consisted of 184 parents of children with autistic disorder. Advanced statistical methods for analyses of
mediator and moderator effects of coping strategies were used. The results revealed that ‘accepting responsibility’
was the only mediator strategy in the relationship between stress and QoL. The results also revealed that only
‘seeking social support’ and ‘escape avoidance’ were moderator strategies in the relationship between stress and
QoL. This study is perhaps the first to investigate the mediating and moderating effects of coping on QoL of parents
of children with autistic disorder. Recommendations for practice and future research are presented. Copyright ©
2013 John Wiley & Sons, Ltd.

Received 4 February 2013; Revised 15 June 2013; Accepted 19 June 2013

Keywords
mediators; moderators; coping; quality of life; autistic disorder

*Correspondence
Latefa A. Dardas, The University of Jordan, Amman 11942, Jordan.
†
Email: l.dardas@ju.edu.jo

Published online 19 July 2013 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/smi.2513

Introduction disorder show complex behaviours, which can create

Coping with stressful situations that exceed one's abilities
is one of the greatest challenges of life. According to
Lazarus and Folkman's Transactional Model of Stress
and Coping (1984), coping is defined as the cognitive
and behavioural efforts that are constantly changing to
master, reduce or tolerate a specific stressor appraised as
exceeding one's available resources and abilities. A striking
point in the model is that coping strategies are considered
the intermediate process between stressors and health
outcome. Indeed, Folkman, Lazarus, Dunkel-Schetter,
DeLongis, and Gruen (1986) found that the process of
coping can change the relationship between life stressors
and health. Coping is considered to be of critical impor-
tance in determining whether a stressful event results in
adaptive or maladaptive outcomes.
To a parent, having a new child is considered a
stressful situation. However, when the child is born
with disability, parents bear greater stressors and
demands that can disrupt the whole family's life,
requiring a wide range of coping strategies (Gray,
2006). Autistic disorder is considered one of the perva-
sive developmental disorders. Children with autistic
chaos in the parents' life. Particularly, those children
are characterized by significant qualitative impairment
in social interaction and communication, and
restricted patterns of repetitive and stereotyped behav-
iour, interests and activities (the American Psychiatric
Association (APA), 2000). Compared with parents of
typical children and parents of children with other
developmental disabilities, parents of children with
autistic disorders have been found to experience
significantly higher levels of parenting stress and psy-
chological distress (Ericzon, Frazee, & Stahmer, 2005;
Weiss, 2002). Further, poor quality of life (QoL) levels
have been documented for those parents (Mungo,
Ruta, Arrigo, & Mazzona, 2007; Yamada et al., 2012).
Therefore, parents of children with autistic disorder
are expected to be in vital need to develop ongoing
effective coping responses to deal with their children's
lifelong disability and to maintain their QoL. Indeed,
the types of coping strategies used by parents of
children with disability were found to have more
decisive effect on their level of stress than the stressors
itself (Beresford, 1994).

Stress Health 31: 5–12 (2015) © 2013 John Wiley & Sons, Ltd. 5
Coping Strategies as Mediators and Moderators
Despite the practical importance of studying coping,
there has been a dearth of information available on this
concept and its influences on parenting stress and QoL
among parents of children with autistic disorder.
Parenting stress is considered an aversive psychological
reaction to the demands of being a parent that stems
from a complex combination related to the child, the
parent and the child–parent interactions (Abidin,
1995). The concept of QoL is defined as ‘individuals'
perception of their position in life in the context of
the culture and value systems in which they live and
in relation to their goals, expectations, standards and
concerns’ (WHO, 1996, p. 5). Although there is a
growing awareness of the need to integrate the concept
of QoL in the support services provided for children
with chronic disabilities and their parents, the factors
contributing to the QoL of those parents (e.g. their
style of coping with life stressors) have received
relatively little attention.
Among the few studies that have investigated the
interactions between the concepts of stress, coping
strategies and QoL among parents of children with
autistic disorder (e.g. Dabrowska & Pisula, 2010; Gray,
2006; Smith, Seltzer, Tager-Flusberg, Greenberg, &
Carter, 2008), links between the types of coping strate-
gies used by the parents and their levels of stress and
QoL were revealed. It was inferred from these studies
that parents who are able to develop effective coping
strategies are likely to experience satisfactory levels of
QoL and wellbeing and functional levels of parenting
stress. In particular, active problem-focused strategies
were associated with positive outcomes. Meanwhile,
the reliance on passive, avoidant coping strategies was
associated with negative outcomes.
While drawing attention to the studies that investi-
gated the concepts of stress, coping and QoL among
parents of children with autistic disorder, two main
methodological limitations can be argued. First, authors
made their interpretation of the results in terms of the
two general categories of coping strategies (emotion
focused and problem focused). It has been argued by
Folkman and Moskowitz (2004) that relying on this
classification for the synthesis of findings may run the
risk of distorting important differences within catego-
ries. In addition, classifying coping strategies into two
distinct sets has the expectation that problem and
emotion-focused strategies are independent of one an-
other. However, different types of coping seem to overlap
and facilitate each other. For example, emotion-focused
strategies relieve emotional distress and, consequently,
may encourage the person to engage in problem-focused
coping. Conversely, effective problem-focused coping
can lead to relieving the stressor-associated distressing
feelings. Fortunately, Folkman and Lazarus (1988)
adapted their work on coping classification and
derived new eight classifications, including positive
reappraisal, confrontive coping, planful problem sol-
ving, seeking social support, distancing, self-control,
6 Stress Health 31: 5–12 (2015) © 2013 John Wiley & Sons, Ltd.
L. A. Dardas and M. M. Ahmad
escape avoidance and accepting responsibility. Those
categories provide a clear description for the thoughts
and actions an individual uses to cope with a specific
stressful encounter.
A second limitation for the previous studies that
investigated the concepts of stress, coping and QoL
among parents of children with autistic disorder is that
it presented these concepts through bivariate relation-
ships. However, relationships among variables are
often considered more complex than simple bivariate
relationship such as between an independent variable
and an outcome variable. Rather, these relationships
may be modified by a third variable such as mediator
and moderator (Baron & Kenny, 1986; Bennett, 2000).
Mediators provide information about how or why
two variables are strongly related, whereas moderators
answer why a weak or strong association between two
variables occurs (Lindley & Walker; 1993; Moore,
Biegel, & Mcmahon, 2011). The importance of investi-
gating mediation and moderation effects has been
recognized in literature (Connor-Smith, & Compas,
2002; Littleton, Horsley, John, & Nelson, 2007). If re-
searchers fail to consider the possibility of a mediator
or moderator effect in the data, inappropriate explana-
tion for the outcome may be reached. Unfortunately,
few studies have tested coping strategies as mediators
or moderators between life stress and health outcome.
Further, no studies have been conducted on coping as
a moderator and mediator in the relationship between
stress and QoL among parents of children with autistic
disorder. The purpose of this study was to examine
coping strategies as mediators and moderators between
stress and QoL among parents of children with autistic
disorder.
Methods
Sample
To determine the sample size based on power analysis,
Cohen's technique (1988) for power analysis was used.
The estimated sample size needed for this study was
114 participants, based on α level of 0.05, power of
0.80, relatively small effect size (0.10) and three predic-
tors in regression analysis. The convenience sample of
the study was composed of 184 parents of children with
autistic disorder. Parents were included in the study if
(1) they had a child under the age of 12 years with a
clinical diagnosis of autistic disorder and (2) they were
able to read and write in Arabic. Parents were
contacted individually through the special education
centres where their children have been diagnosed with
autistic disorder by licensed professionals. Participants
were provided with simple incentives. The diagnosis
was made on the basis of the Diagnostic and Statistical
Manual of Mental Disorders DSM-IV-TR (fourth
edition, text revision) provided by the American Psy-
chiatric Association (APA, 2000).
L. A. Dardas and M. M. Ahmad
Measures
The Parenting Stress Index—Short Form
(Abidin, 1995)
The Parenting Stress Index—Short Form (PSI-SF) is
a 36-item self-reported questionnaire designed to
measure stress associated with parenting among
parents of children younger than 12 years (Abidin,
1995). The PSI-SF scale is one of the most commonly
used measures across many different samples inclu-
ding parents with a range of income and education
levels and parents of children with a broad range of
ability levels (Dardas & Ahmad, 2013). The items of
the scale range from 1 (strongly disagree) to 5 (strongly
agree). Higher scores indicate greater levels of paren-
ting stress (Abidin). The total stress score has been
used for this study. The internal consistency reliability
coefficient for the total stress was 0.91 (Abidin, 1995).
In this sample, Cronbach's α for the total stress scale
was 0.91.
The Revised Ways of Coping Checklist (Folkman
& Lazarus, 1988)
The revised ways of coping is a 66-item question-
naire that contains eight different cognitive and behav-
ioural strategies used to cope with stressful encounters,
including confrontive coping (six items; describes
active effort to alter a situation, sometimes associated
with some degree of aggression, hostility and risk
taking), distancing (six items; refers to cognitive efforts
made to detach oneself from a stressful situation and
minimize its significance), self-controlling (seven
items; describes an individual's active effort to regulate
their feelings and actions), seeking social support (six
items; refers to efforts to seek informational, tangible
and emotional support), accepting responsibility (four
items; refers to the acknowledgment of one's contribu-
tion to the problem and trying to fix things out),
escape avoidance (eight items; includes wishful think-
ing and behavioural efforts to avoid facing the pro-
blem), planful problem solving (six items; covers
deliberate focus on altering the situation using careful
analyses to solve the problem and generate possible
solutions) and positive reappraisal (seven items;
describes efforts that focus on personal growth and
some religious aspects to create a positive meaning
for a situation). Participants were required to respond
to a specific stressor, raising a child with autistic disor-
der and subsequently respond to each statement in the
scale by expressing the extent to which they used the
strategy in coping with that stressful situation on a
four-point scale from 0 (not used) to 3 (used a great
deal). The internal consistency reliability coefficients
ranged from 0.68 to 0.79 for the eight subscales
(Folkman & Lazarus, 1988). In this sample, Cronbach's
alphas for the eight subscales ranged from moderate
to high.
Stress Health 31: 5–12 (2015) © 2013 John Wiley & Sons, Ltd.
Coping Strategies as Mediators and Moderators
The World Health Organization Quality of Life
Assessment–Bref self-administered instrument
(WHO, 1996)
The World Health Organization Quality of Life
Assessment–Bref (WHOQOL-BREF) contains a total
of 26 questions that were developed in an attempt to
provide a QoL measure that would be applicable
cross-culturally (WHO, 1996). It produces a profile
with four physical, psychological, social and environ-
mental domain scores and two individually scored
items about an individual's overall perception of QoL
and health. Items of the scale range from 1 to 5 with
higher scores denoting higher QoL. The total QoL score
has been used for this study. The WHOQOL-BREF is a
cross-culturally valid and reliable assessment of QOL.
In this sample, Cronbach's α for the total QoL scale
was 0.93.
Ethical considerations
The Academic Research Committee at the Deanship of
the Academic Research at the University of Jordan
granted the ethical approval for conducting this study.
The purpose, methods, risks and benefits of the study
were explained to the participants before they decided
to participate. The participants were assured that their
participation would be completely voluntary and that
they would have the right to quit their participations
at any stage if they did not feel comfortable in continu-
ing the process. The researchers assigned identification
number to the participants to assure the confidentiality
of the data obtained.
Results
A total of 184 parents participated in the study. Of
them, 62% (n = 114) were mothers. The mean age for
the sample was 37 years [standard deviation (SD) = 7.6]
ranging from 21 to 69 years. The majority of the par-
ents (96.7%, n = 178) were married. In relation to the
parents' level of education, 46.2% (n = 85) of them
had secondary school or less (ranging from 9th grade
to 12th grade), 23.9% (n = 44) had diploma and
29.9% (n = 55) had baccalaureate degree or higher.
Overall, 56% (n = 103) of the parents were not work-
ing. All the parents had only one child diagnosed with
autistic disorder.
All children in this study were diagnosed with
autistic disorder using the DSM-IV criteria (APA,
2000). The criteria of the DSM-IV are considered a
standardized diagnostic procedure for autistic disorder
in the country. About 84% (n = 155) of children were
male. The mean age for children was 6.3 years (SD = 3)
ranging from 2 to 12 years. The mean age of symptoms
was 2 years (SD = 1). The mean age of diagnosis was
3 years (SD = 1).
Regarding the level of parental stress, the analysis
showed that the mean of the total stress score was 118
(SD = 23), which indicates a clinically significant high
7
Coping Strategies as Mediators and Moderators L. A. Dardas and M. M. Ahmad

levels of stress. The most frequently used coping strategy Table II. Association of the possible mediators with the QoL
among the parents was ‘positive reappraisal’ (mean =
74.30, SD = 12.97), whereas ‘distancing’ was the least Independent variables QoL
used coping strategy (mean = 55.19, SD = 13.56). The 2
R R t β Significance
mean scores for the other six coping strategies ranged
from 55 to 68. The mean of the total QoL score was 80 Escape avoidance 0.366 0.134 5.314 0.366 0.001
(SD = 16). Accepting responsibility 0.236 0.056 3.271 0.236 0.001

Tests of mediated models

Several steps were performed to examine the mediating
only mediator variable in this study, which fulfilled all
effect of coping strategies on the relationship between
the required criteria, was accepting responsibility
stress and QoL using the Statistical Package for Social
(Figure 1).
Sciences (IBM Corp., 2012). Eight sets of regressions
were tested, with each set exploring mediation of the
Tests of moderated models
relationship between stress and QoL by one of the eight
coping strategies. Following standard procedures, each Moderated models of regression analyses were used to
mediated model was tested in three steps (Baron & test the hypothesis that the relationship between stress
Kenny, 1986; Warner, 2008). and QoL occurs primarily under certain conditions,
In the first step, associations of the independent with coping serving either as an amplifier or as a buffer
variable (stress) with the possible mediator (the eight (Warner, 2008). Following a standard procedure, mea-
coping strategies) were examined. Stress was able to sures of coping and stress were centred in tests of cop-
predict significantly two types of coping strategies: ing moderation to maximize interpretability and
escape avoidance (t = 6.40; P < 0.001) and accepting minimize potential problems with multicollinearity
responsibility (t = 4.55; P < 0.001). Thus, the other six (Aiken & West, 1991).
types of coping were dropped from next steps of exam- Moderation was examined by constructing eight hi-
inations (Table I). erarchical regression equations that included stress,
In the second step, the dependent variable (QoL) eight coping strategies and a multiplicative term
was regressed on the possible mediators (escape avoid- representing the interaction between each of the coping
ance and accepting responsibility) of coping strategies. strategies and stress. As with tests of the mediated
The two sets of regression demonstrated that escape models, a separate set of regression analyses was used
avoidance and accepting responsibility had significant for each of the eight coping strategies with all regres-
negative relationships with QoL (Table II). sions controlling for stress as stress is entered first in
In the third step, the association of stress and QoL the analysis on the basis of the Lazarus and Folkman
reduced significantly when ‘accepting responsibility’ model. In these models, a significant interaction term
was added to the hierarchical equation. The coping with a negative beta would suggest that a coping strat-
strategy ‘escape avoidance’ in the second step of regres- egy is buffering the relationship between stress and
sion remained significant predictor; thus, it was not QoL. A significant interaction term with a positive beta
considered as a mediator (Table III). Therefore, the would indicate that a coping strategy is amplifying the
relationship (Aiken & West, 1991; Baron & Kenny,
1986; Warner, 2008).
Table I. Association of the independent variable with possible The model with ‘seeking social support’ coping
mediators strategy accounted for 39% of the variance in QoL,
with the interaction between coping and stress indicat-
Dependent variables Stress (independent variable) ing that seeking social support served as amplifier. Sim-
ilarly, the model with escape avoidance coping strategy
R t Significance
accounted for 41% of the variance, with escape avoid-
Positive reappraisal 0.007 0.092 0.927 ance serving as amplifier (Figure 2). All other coping
Confrontive coping 0.135 1.838 0.068 strategies did not show moderating effects between
Planful problem 0.138 1.874 0.063 stress and QoL (Table IV).
solving
Seeking social 0.013 0.181 0.856 Discussion
support Investigating the mediation and moderation effects of
Distancing 0.070 0.948 0.344
the variables is of great importance in providing expla-
Self-control 0.092 1.245 0.215
nations for the outcomes. The examination of media-
Escape avoidance 0.429 6.401 0.001
2 tors and moderators in descriptive studies can clarify
(R = 0.184) (β = 0.429)
why or how a direct association occurs between an
Accepting 0.320 4.551 0.001
responsibility
2
(R = 0.102) (β = 0.320)
independent variable and an outcome variable. To the
best of our knowledge, no previous studies have yet

8 Stress Health 31: 5–12 (2015) © 2013 John Wiley & Sons, Ltd.
L. A. Dardas and M. M. Ahmad Coping Strategies as Mediators and Moderators

Table III. Hierarchical regression testing for coping strategies as mediators

Steps Independent variables QoL

2
R R t β Significance

1 Stress 0.608 0.370 10.332 0.608 0.001

2 Stress 0.619 0.383 8.551 0.552 0.001
Escape avoidance 2.007 0.139 0.046
1 Stress 0.608 0.370 10.332 0.608 0.001
2 Stress 0.610 0.372 9.541 0.593 0.001
Accepting responsibility 0.739 0.046 0.461

examined coping as a moderator and mediator in the
relationship between stress and QoL among parents
of children with autistic disorder. In this study, medi-
ated and moderated models were examined to explore
the role of coping in the relationship between stress
and QoL.
The results of this study showed that accepting
responsibility was the only mediator strategy in the
relationship between stress and QoL among parents
of children with autistic disorder. The other seven types
of coping did not show a mediating effect. This indi-
cates that only accepting responsibility was able to
explain the relationship between stress and QoL among
the parents. According to Folkman and Lazarus (1988),
accepting responsibility entails the acknowledgment of
one's contribution to the problem and trying to correct
the situation. In this study, it can be inferred that
accepting responsibilities for the problems that parents
face due to having a child with autistic disorder can
explain the higher levels of QoL they reported.
Accepting responsibility does not entail that parents
should believe that the problems they have are their
fault, rather what this means is that parents need to
accept that they have the problem and they are the only
ones who can fully determine the outcome. By taking
responsibility for their life problems, parents will find

Figure 1 Accepting responsibility as mediator between stress and QoL. Note: The coefficient 0.05 represents the strength of linear
association between QoL and stress when accepting responsibility is controlled by including it as another predictor of QoL; the coefficient
0.59 represents the linear association between QoL and stress when accepting responsibility is not statistically controlled

Figure 2 Coping strategies as moderators in the association between stress and QoL

Stress Health 31: 5–12 (2015) © 2013 John Wiley & Sons, Ltd. 9
Coping Strategies as Mediators and Moderators L. A. Dardas and M. M. Ahmad

Table IV. Moderated model regression analyses for the eight On the other hand, the results of this study showed that
coping strategies (QoL is dependent variable) only seeking social support and escape avoidance were
2
moderator strategies in the relationship between stress
Steps R β T and QoL among parents of children with autistic disorder.
1 Stress 0.384 0.607 10.409*** All other coping strategies did not show moderating effect
Positive reappraisal 0.120 2.059* between stress and QoL. Given the difficulty of detecting
2 Stress 0.386 0.612 10.391*** moderator effects in non-experimental studies, interac-
Positive reappraisal 0.118 2.017* tions between stress and seeking social support explained
Stress × Positive reappraisal 0.039 0.662 1.7%, as well as stress and escape avoidance explained
1 Stress 0.370 0.609 10.227*** 2.3% of the variance, which can be meaningful (Yip,
Confrontive coping 0.008 0.130 Rowlinson, & Siu, 2008). This indicates that when parents
2 Stress 0.377 0.988 3.603*** of children with autistic disorder use more seeking social
Confrontive coping 0.483 1.373 support or escape avoidance coping strategies to alter
Stress × Confrontive coping 0.664 1.416 stressful encounters, these strategies are able to im-
1 Stress 0.398 0.584 10.042*** prove significantly the QoL of the parents. In contrast
Planful problem solving 0.171 2.938** to Kashdana, Barriosb, Forsyth, and Stegerc (2006)
2 Stress 0.402 0.851 3.327*** and Hastings et al. (2005) who reported that avoidance
Planful problem solving 0.126 0.444 strategy has been linked to increases in intrusive
Stress × Planful problem 0.376 1.071 thoughts, anxiety and depression, our study found
solving
escape avoidance as a buffer for stress. It is important
1 Stress 0.374 0.609 10.351***
to note that although avoidance strategy may be help-
Seeking social support 0.065 1.099
ful in the short term (Heckman et al., 2004), it is found
2 Stress 0.391 1.265 4.207***
to adversely affect the mental health of individuals
Seeking social support 0.736 2.019*
Stress × Seeking social support 1.050 2.225*
when used on the long run when dealing with chronic
1 Stress 0.382 0.616 10.506***
stressors such as raising a child with a lifelong disa-
Distancing 0.109 1.861 bility (Holahan, Moos, & Bonin, 2004). Since people
2 Stress 0.382 0.500 2.210* who do not deal with their stressors directly are more
Distancing 0.263 0.885 likely to suffer health problems, researchers believe
Stress × Distancing 0.202 0.529 that avoidance coping strategy is not as efficient as
1 Stress 0.371 0.612 10.339*** confrontive strategies (Folkman & Moskowitz, 2004;
Self-control 0.042 0.707 Lazarus & Folkman, 1984).
2 Stress 0.374 0.914 2.658** Regarding seeking social support, the result was
Self-control 0.247 0.750 consistent with the logical interpretation and previous
Stress × Self-control 0.440 0.891 findings in reducing stress. McCubbin and Patterson's
1 Stress 0.383 0.552 8.551*** (1983) viewed seeking social support to be the most
Escape avoidance 0.130 2.007* important for parents experiencing stress. Gray (2006)
2 Stress 0.406 1.033 5.263*** supported this finding and reported that seeking social
Escape avoidance 0.863 2.970** support is one of the popular effective strategies that
Stress × Escape avoidance 1.045 2.587** parents of children with autistic disorder use when
1 Stress 0.372 0.593 9.541*** dealing with their stressors. Moreover, McConkey,
Accepting responsibility 0.046 0.739
Truesdale-Kennedy, Chang, Jarrah, and Shukri (2008)
2 Stress 0.373 0.732 3.579***
reported that families in different cultures utilize differ-
Accepting responsibility 0.241 0.858
ent coping strategies when caring for a child with chronic
Stress × Accepting responsibility 0.277 0.712
disability. The sample of this study was in part from the
*P ≤ 0.05, **P ≤ 0.01, ***P ≤ 0.001. Arab world. Arabs are united in a shared culture that is
considered substantially different from their western
counterparts (Retso, 2002). According to Fakhr El-Islam
(2008), many educational, economic and cultural factors
a greater sense of control and will quickly progress in affect mental health perceptions and practices in the
recovery rather than dwelling on the past or blaming Arab world. Social support is considered a valued Arabic
the problem on an outside factor. The results indicate tradition that plays a prophylactic role in the develop-
that accepting responsibilities need to be encouraged ment of mental health problems. The extended family
through equipping parents with the needed skills and system in the traditional Arab cultures was found to
support services that could help them adapt with their significantly help individuals deal with their life stressors
responsibilities and develop positive outcomes for their (Fakhr El-Islam, 2008; Kandel, Morad, Vardi, Press, &
acceptance. The results also further support inves- Merrick, 2004). This explanation may also be supported
tigation of the role that coping strategies play in the by the fact that the vast majority of the parents (96.7%)
relationship between stress and QoL. were married.

10 Stress Health 31: 5–12 (2015) © 2013 John Wiley & Sons, Ltd.
L. A. Dardas and M. M. Ahmad
Confrontive coping, planful problem solving, self-
controlling and positive reappraisal coping strategies
did not show any mediation or moderation effect in
the relationship between parental stress and QoL. It is
worth noting that the mentioned strategies were among
the most commonly used strategies by the parents.
However, it had no effect on the relationship between
their perceived parental stress and QoL. These findings
warrant further investigations for the actual application
of coping and the meaning that coping has for the par-
ents. For example, confrontive coping includes fighting
for what is wanted, expressing anger to the cause of the
problem and letting feelings out somehow (Folkman &
Lazarus, 1988). Failure to employ confrontive coping in
an adaptive style can lead to adverse effects and higher
levels of parental stress.
On the other hand, distancing coping was the least
reported parental coping strategy in this study and
showed no effect on the relationship between parental
stress and QoL. Although distancing coping, which
was defined by Folkman and Lazarus (1988) as under-
taking cognitive efforts to detach oneself from a stress-
ful situation and minimize its significance, was found
to be correlated with negative outcomes (Smith et al.,
2008), it has been argued by some researchers that
distancing is considered a significant moderator in the
relationship between stressors and mental health
(Dunn, Burbine, Bowers, & Tantleff-Dunn, 2001;
Sivberg, 2002). In other words, for parents of children
with chronic disabilities (e.g. autistic disorder), being
unable to detach themselves from their children-related
problems may lead to exaggerate their distress and as a
result negatively affect their mental health. Therefore, it
may be beneficial to encourage parents with chronic
stressors to distance themselves appropriately from
their stress-provoking situations. In this study, having
distancing the least reported coping strategy with no
effects on the relationship between parental stress and
QoL may indicate that parents are enmeshed in their
relationship with their children with autistic disorder
and, as such, are at high risk for developing negative
outcomes for their parenting experience.
Another area in this study deserving special conside-
ration is related to gender differences in regard to coping
reactions to life stressors. Discussion on gender-related
issues is unsettled. Research on gender and coping has
traditionally assumed that men and women perceive
stressors similarly. In addition, the traditional perception
was that men are more likely to suppress their feelings,
whereas women are more likely to vent their feelings
and use social support as a means of dealing with their
distress. However, this assumption was refuted by Lazarus
(1996) who reported that men and women do not
experience the same problems when exposed to the same
stressful life events. Lazarus also maintained that differen-
ces in the coping strategies used by men and women are
related to the different roles they assume in their societies
and cultures, and not to their gender per se. Therefore, in
Stress Health 31: 5–12 (2015) © 2013 John Wiley & Sons, Ltd.
Coping Strategies as Mediators and Moderators
this study, we considered mothers and fathers together
rather than separately as we were unable to identify the
different roles and responsibilities that the fathers and
mothers actually assumed.
Referring to the Lazarus and Folkman model (1984),
the relative use of coping strategies varies significantly
among individuals. The stress coping process is
influenced by antecedent person characteristics and en-
vironmental variables (Folkman & Lazarus, 1988). In
addition, Gray (2006) argued that coping among
parents of children with autistic disorder appears to
be a complex process incorporating a variety of strate-
gies that change over time. Thus, although correlations
between stress and most coping strategies were low in
this study, it is possible that personality characteristics
influenced this relationship. It is also possible that
events that would be perceived as stressors for some
individuals were irrelevant events for others.
Implications, limitations and
recommendations
One should consider variations in coping strategies
among individuals across cultures. In particular, health
professionals and researchers should be alerted about
making false generalizations that are not based on
specific research findings in a specific culture. The
results of this study also indicate that professionals
who work with parents of children with autistic disor-
der need to be aware of the coping strategies that the
parents use to deal with the demands of parenting
and the associations between coping, and parental
stress and mental health. The focus need to be on
increasing their use of healthy coping, perhaps by
enhancing positive perceptions and acceptance of
raising a child with autistic disorder. In addition, health
professionals need to provide parents of children with
autistic disorder with adequate formal support. This
would be especially beneficial in developing countries
where formal support is almost nonexistent.
There are some methodological issues that should be
considered when interpreting the results of this study.
The psychometric properties of the PSI-SF were
previously examined in parents of children with typical
development. Thus, findings related to this measure
should be carried with caution when it is used across
populations with pervasive chronic disabilities. Further,
considering the limitations associated with the use of
meditational analyses in cross-sectional samples, we
recommend replicating this study in a variety of
distressed samples using longitudinal designs. The sample
of this study was convenience; nevertheless, the heteroge-
neity and the size of the sample are assumed to be
strength for the purpose of the analyses. However, it is
recommended for future studies in this field to follow
the probability sampling. It is also noteworthy to consider
the sensitivity of the measures when carrying out cross-
cultural research.
11
Coping Strategies as Mediators and Moderators
Acknowledgment
The authors acknowledge the partial funding for this
study provided by The University of Jordan.
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