Perceived Stress And Post-Traumatic Stress Disorder In Chinese Shidu Parents:The Mediating Role Of Anxiety Symptoms And The Moderating Role Of Self-Efficacy

Objective: In China,parents who have lost their only child and cannot have another child or have not adopted another child are called Shidu parents.Shidu parents not only face financial and life stress,but also have various psychological problems as a result of the traumatic event of "Shidu".The purpose of this study was to investigate the current status of post-traumatic stress disorder(PTSD)in Chinese Shidu parents,to explore the relationship between PTSD and perceived stress in Shidu parents,and to analyze the mediating role of anxiety symptoms and the moderating role of self-efficacy.Methods: Fifteen communities were randomly selected in five urban areas of Shenyang City,Liaoning Province,and one of the Shidu parents who met the inclusion criteria was randomly selected from all the Shidu families in each community as the respondents.506 Shidu parents were finally included.This study is a cross-sectional survey study,and Shidu parents were evaluated using the Shidu Parent Demographic Information and Deceased Child-Related Information Scale,the Posttraumatic Stress Disorder Screening Scale(PCL-5),the Perceived Stress Scale(PSS-10),the SelfAssessment Scale for Anxiety(SAS),and the General Self-Efficacy Scale(GSES).Independent samples t-test and one-way ANOVA were used to compare differences in PTSD among Shidu parents with different demographic characteristics.Pearson correlation analysis was used to explore the correlations among the four variables.PROCESS for SPSS(Model 4)was used to investigate the relationship between perceived stress and PTSD and the mediating role of anxiety symptoms.PROCESS for SPSS(Model 59)was used to investigate the moderating role of self-efficacy in the direct and indirect relationship between perceived stress and PTSD.Results:1.A total of 506 Shidu parents were surveyed in this study,of whom 204(40.32%)were Shidu fathers and 302(59.68%)were Shidu mothers.126 of the 506 Shidu parents had PTSD,with a prevalence of 24.90%.Shidu parents with chronic diseases had higher PTSD scores than Shidu parents without chronic diseases(P<0.001).There was a difference in PTSD scores between different household annual income groups of Shidu parents(P<0.001).Shidu parents with religious beliefs had higher PTSD scores than Shidu parents without religious beliefs(P<0.05).Shidu parents with suicidal ideation had higher PTSD scores than Shidu parents without suicidal ideation(P<0.001).Shidu parents who had experienced avoidance interactions had higher PTSD scores than Shidu parents who had not experienced avoidance interactions(P<0.001).Shidu parents whose deceased child was female had higher PTSD scores than Shidu parents whose deceased child was male(P<0.05).2.After controlling for demographic and sociological variables,there was a positive relationship between perceived stress and PTSD among Shidu parents(B=0.530,P<0.01).3.The Bootstrap method of testing the mediating effect of anxiety symptoms showed a significant partial mediating effect of Shidu parents’ anxiety symptoms between perceived stress and PTSD(95% CI [0.159,0.275])with an indirect mediating effect value of 0.214.4.Self-efficacy significantly moderated the pathway between anxiety symptoms and PTSD(model 2: B=-0.011,P<0.05).In contrast,the moderating effect of selfefficacy on the pathway between perceived stress and anxiety symptoms and the pathway between perceived stress and PTSD were not statistically significant(P>0.05).Conclusion: The prevalence of PTSD among Shidu parents in this study was 24.90%.The symptoms of PTSD were more severe in Shidu parents with chronic illness,low annual family income,religious beliefs,suicidal ideation,and avoidance of interaction.This study found that perceived stress not only directly influenced PTSD symptoms but also indirectly through anxiety symptoms.Finally,this study also found that Shidu parents with high self-efficacy were better able to cope with anxiety symptoms from traumatic events and thus better able to suppress PTSD symptoms.Therefore,in future studies of PTSD interventions for Shidu parents,reducing perceived stress and anxiety symptoms in Shidu parents and increasing Shidu parents’ self-efficacy will help alleviate PTSD symptoms in Shidu parents.