Relationship between parenting stress and behavioral and emotional problems in preschool children: A mediation effect analysis

Abstract

BACKGROUND

Emotional reactions, such as anxiety, irritability, and aggressive behavior, have attracted clinical attention as behavioral and emotional problems in preschool-age children.

AIM

To investigate the current status of family rearing, parental stress, and behavioral and emotional problems of preschool children and to analyze the mediating effect of the current status of family rearing on parental stress and behavioral/emotional problems.

METHODS

We use convenience sampling to select 258 preschool children in the physical examination center of our hospital from October 2021 to September 2023. The children and their parents were evaluated using a questionnaire survey. Pearson's correlation was used to analyze the correlation between child behavioral and emotional problems and parental stress and family rearing, and the structural equation model was constructed to test the mediating effect.

RESULTS

The score for behavioral/emotional problems of 258 preschool children was (27.54 ± 3.63), the score for parental stress was (87.64 ± 11.34), and the score for parental family rearing was (31.54 ± 5.24). There was a positive correlation between the behavioral and emotional problems of the children and the “hostile/mandatory” parenting style; meanwhile, showed a negative correlation with the “support/ participation” parenting style (all P < 0.05). The intermediary effect value between the family upbringing of parents in parental stress and children's behavior problems was 29.89%.

CONCLUSION

Parental family upbringing has a mediating effect between parental stress and behavioral and emotional problems of children. Despite paying attention to the behavioral and emotional problems of preschool-age children, clinical medical staff should provide correct and reasonable parenting advice to their parents to promote the mental health of preschool-age children.

Key Words: Preschool children; Parenting stress; Children's behavioral and emotional problems; Family rearing; Mediating effect

Core Tip: With the acceleration of the pace of modern society, parents are facing increasing psychological pressure and life burden, which may affect children's physical and mental health through different mechanisms. Preschool is a critical period for children's psychological and behavioral development, and parents' emotions and behaviors will directly affect children's emotional regulation, social ability and behavioral performance. This study suggests a mediating role between parental stress and behavioral and emotional problems in preschool children. This further provides a theoretical basis for the design of education, psychological intervention and family support strategies.

INTRODUCTION

In recent years, emotional reactions, such as anxiety, irritability, and aggressive behavior, have attracted clinical attention as behavioral and emotional problems in preschool-age children. A previous cross-sectional study by Li et al[1] showed that 70% of preschool children and preschool children aged 3-5 had mental health problems, and the detection rates of emotional symptoms and behavioral problems were 39% and 27%, respectively. Preschool children are in an early stage of growth and development and their emotional and behavioral problems are easily affected by the childcare environment[2]. According to family system theory[3,4], the key role of children's behavioral and emotional training is the family, and the family nurturing environment plays a crucial role, among which parental stress and family rearing style are closely related to children's behavioral and emotional problems. Parenting stress refers to a series of stressful experiences[5] caused by children's behavioral problems, parent-child interaction disorders, and parental characteristics in the process of practicing their roles and emotional interactions between parents and child. Studies have found[6] that parental stress is generally high in the process of parenting, especially among parents of preschool children, which can easily induce family dysfunction, greatly reduce the care effect of child care, and then cause tension and alienation from the parent-child relationship. The deterioration of the parent-child relationship is more likely to cause children's implicit behavioral and emotional problems. In the process of children's growth and learning, parents play a guiding, exemplary, and subtle role. Family parenting reflects parents' educational concepts and habitual parenting behavior[7]. Some studies have found[8] that supportive/participation family rearing patterns can reduce children's aggressive behaviors, and coercive/hostile family rearing patterns are the cause of children's adverse emotional reactions. To date, there is no study on the effect of parental stress and family rearing on the behavioral and emotional problems of preschool children. Therefore, this study aimed to understand the behavioral and emotional problems of preschool children and the status of parental stress and family parenting and to construct a theoretical model based on the idea that family parenting can play a mediating effect between parental stress and behavioral and emotional problems of preschool children. A total of 258 preschool children who visited our hospital were tested to verify the model. To provide suggestions for maintaining and promoting the mental health of preschool children and for parents to properly and reasonably raise preschool children.

MATERIALS AND METHODS

Subjects

Using the convenient sampling method, 258 preschool children who visited the physical examination center of our hospital from October 2021 to September 2023 were selected as research objects.

Inclusion criteria were as follows: (1) Aged 5-6 years; (2) The parents of the children were permanent residents of the city or non-local household registered but lived in the city for more than 1 year; and (3) Children's guardians voluntarily participated in this study with informed consent.

Exclusion criteria were as follows: (1) Difficult to understand the questionnaire; (2) children with no long-term companions from their parents; (3) Children who have been diagnosed with serious diseases; and (4) Lack of general clinical data.

Research methods

General information questionnaire: Self-designed content structure. General information were collected, including sex, age, single child, premature birth, birth weight, main caregiver, father's age, father's education level, mother's age, mother's education level, family monthly income per capita, outdoor activity time per day, number of interest classes per week, and sleep time per day.

Strength and difficulty questionnaire: The scale was developed by Famodu et al[9]; the scale had 25 items in three dimensions, including prosocial behaviors (5 items), externalizing behaviors (10 items), and internalizing behaviors (10 items). Each item was assigned a score of 0-2, and the total score was from 0 to 50. The higher the score, the more serious the child's behavioral and emotional problems. The validity and reliability of the scale were 0.796 and 0.834, respectively.

Parental bonding instrument: Chinese version by Liu et al[10]. The parental bonding instrument (PBI) had 23 items in two dimensions, including support/participation (11 items) and hostility/coercion (12 items). Each item was assigned a score of 0-3, and the total score ranged from 0 to 69. The higher the average score for each dimension, the more inclined the parents were to this parenting style. The validity and reliability of the scale were 0.904 and 0.841, respectively.

Parenting stress index-short form: Parenting stress index-short form (PSI-SF) was translated into Chinese by Yeh et al[11]. PSI-SF has 36 items in three dimensions, including parenting distress (12 items), parent-child interaction disorder (12 items), and difficult child (12 items). Each item was assigned a score of 1-5, and the total score ranged from 36 to 180, with higher scores indicating higher levels of parental stress. The validity and reliability of the scale were 0.719 and 0.807, respectively.

Survey methods

This study was a cross-sectional study. Before the start of the study, we refer to literature in related fields to understand the sample size of similar studies and determine the appropriate sample size in combination with our research purposes and conditions. Furthermore, statistical software generates data conforming to a specific distribution to determine the study sample size. School-age children who visited our hospital for a physical examination and their parents were asked to complete questionnaire forms. All questionnaire investigators were uniformly trained. Investigators should first adopt unified instructions as follows: Explain the purpose and meaning of the study; according to informed consent, school-age children and parents were separate, and the children were asked to fill out the form by themselves or with the help of the investigators; if the children do not understand the questions in the questionnaire, the investigator can help explain the question without interfering with their response. Completed after recycling questionnaire in the spot review, found that the problem timely leak fill a vacancy. This research used double-entry check calibration data and included a total of 260 questionnaires and 258 valid questionnaires, with an effective rate of 99.23%.

Statistical analysis

Statistical analysis was performed with SPSS 25.0 software. Measurement data were presented as mean ± SD and the count data were presented as n (%). Pearson's correlation analysis was used to analyze the correlation. Amos21.0 software was used to construct structural equation modeling (SEM), and the test level was set at α = 0.05.

RESULTS

General information about preschoolers

A total of 258 preschoolers were included in this paper; details are shown in Table 1.

Table 1 General information of preschool children, n (%).

General Information	Classification	Number and composition ratio
Gender	Male	133 (51.55)
	Female	125 (48.45)
Age (years)	5	132 (51.16)
	6	126 (48.84)
Only child	Is	65 (25.19)
	No	193 (74.81)
Premature birth	Is	37 (14.34)
	No	221 (85.66)
Birth weight (g)	≥ 2500	218 (84.50)
	< 2500	40 (15.50)
Primary caregiver	Parents	139 (53.88)
	Grandparents	74 (28.68)
	Other	45 (17.44)
Father age (years old)	≤ 30	167 (64.73)
	30-40	69 (26.74)
	> 40	22 (8.53)
Father's level of education	High school and the following	62 (24.03)
	Specialized subject	108 (41.86)
	Bachelor's degree or above	88 (34.11)
Mother's age (years)	≤ 30	180 (69.77)
	30-40	62 (24.03)
	> 40	16 (6.20)
Cultural degree of mother	High school and the following	56 (21.71)
	Specialty	123 (47.67)
	Bachelor's degree or above	79 (30.62)
Family per capita income (yuan)	6000 or less	55 (21.32)
	6000-8000	116 (44.96)
	> 8000	87 (33.72)
Outdoor activities of time every day (hour)	≤ 1	61 (23.64)
	1-3	154 (59.69)
	> 3	43 (16.67)
Number of interest classes attended per week (times)	0	43 (16.67)
	1-3	166 (64.34)
	> 3	49 (18.99)
Sleep time (hour/day)	> 8	176 (68.22)
	≤ 8	82 (31.78)

Scores of parental stress, family upbringing, and behavior problems of preschool children

The scores of parental stress, family upbringing, and behavioral and emotional problems of the preschool children were (87.64 ± 11.34), (31.54 ± 5.24), and (27.54 ± 3.63), respectively (Table 2).

Table 2 Parental stress, family upbringing and preschool children's behavior problems scores (points).

Project	Total score range, points	Score (mean ± SD)	Divide entries (mean ± SD)
PSI-SF, total score	36 to 180	87.64 ± 11.34	2.43 ± 0.32
Parenting and sorrow	12-60	33.37 ± 4.75	2.78 ± 0.40
Dysfunctional parent-child interaction	12-60	27.54 ± 3.88	2.30 ± 0.32
Difficult children	12-60	26.73 ± 3.62	2.23 ± 0.30
PBI company total score	0-69	31.54 ± 5.24	1.37 ± 0.23
Support/involvement	0-33	14.12 ± 2.38	1.28 ± 0.22
Hostility/mandatory	0 to 36	17.42 ± 3.36	1.45 ± 0.28
SDQ total score	0-50	27.54 ± 3.63	1.10 ± 0.15
Prosocial behavior	0-10	4.22 ± 0.17	0.84 ± 0.03
Externalizing behavior	0-20	10.56 ± 1.14	1.06 ± 0.11
Internalizing behavior	0-20	12.76 ± 1.58	1.28 ± 0.16

PSI-SF: Parenting stress index-short form; SDQ: Strength and difficulty questionnaire; PBI: Parental bonding instrument.

Correlation between parental stress, family upbringing, and behavior and emotional problems of preschool children

Parental stress scores (total scores of the three dimensions of PSI-SF) and children's behavior problems, the three dimensions of the strength and difficulty questionnaire (SDQ) score, are positively correlated (r = 0.171-0.906, P < 0.05). There was a negative correlation between the dimension of PBI, "support/participation," and the total score of parental stress (r = 0.126-0.897, P < 0.05). There was a significant positive correlation between the total score of parental stress and the PBI scores, “hostility/coercion” dimension (r = 0.561-0.587, P < 0.01). The total score of children's behavior problems (the total scores of the three dimensions of SDQ) and family upbringing (“support/participation”) showed a negative correlation (r = 0.204-0.842, P < 0.05), meanwhile showed a positive correlation with “hostile/force” dimension (r = 0.226-0.617, P < 0.05; Table 3).

Table 3 Parental pressure, family upbringing and preschool children's behavior correlation analysis of emotional problems.

Variable	PSI-SF, total score	Parenting and sorrow	Parent-child interaction disorder	Difficult children	SDQ total score	Prosocial behavior	Externalizing behaviors	Internalizing behavior	PBI total score	Supporting/participation
Parenting and sorrow	0.563b	1
Dysfunctional parent-child interactions	0.774b	0.524b	1
Difficult children	0.602b	0.541b	0.527b	1
SDQ total score	0.906b	0.637b	0.528b	0.742b	1
Prosocial behavior	0.754b	0.171a	0.207a	0.203a	0.545b	1
Externalizing behaviors	0.554b	0.587b	0.214a	0.525b	0.674b	0.555b	1
Internalizing behavior	0.635b	0.468b	0.562b	0.457b	0.454b	0.602b	0.571b	1
PBI company total score	0.897b	0.524b	0.567b	0.788b	0.842a	0.707b	0.813b	0.604b	1
Support/involvement	0.826b	0.197a	0.557b	0.126a	0.527b	0.204a	0.211a	0.367b	0.574b	1
Hostility/mandatory	0.578b	0.561b	0.587b	0.573b	0.617b	0.531b	0.226a	0.362b	0.603b	0.564b

^aP < 0.05.

^bP < 0.01.

PSI-SF: Parenting stress index-short form; SDQ: Strength and difficulty questionnaire; PBI: Parental bonding instrument.

Mediating effect model of parental stress, family upbringing, and behavioral and emotional problems of preschool children

We draw the path diagram of the role between parental stress, family upbringing, and preschool children's behavior problems, and between parents' family upbringing in parental stress and the intermediary role in children's behavior problems, then build a hypothetical SEM. Model parameters were evaluated using the maximum likelihood method and the model was modified (e1 and e5 correction paths were added). The results of the model adjustment showed that all the adjustment indicators met the standards, which confirmed that the model was ideal (Figure 1 and Table 4).

Figure 1 A mediation effect model.

Table 4 Adaptation degree index of structural equation modeling.

Evaluation metrics	χ2 degree of freedom ratio	Value-added fitness index	The adaptation index	Compare adaptation index	Good eligibility adaptation index	Relative adaptation index	Adjusted adaptation degree index	The square root of the approximation error
Evaluation standard	< 3.000	> 0.900	> 0.900	> 0.900	> 0.900	> 0.900	> 0.900	< 0.080
Simulation results	1.527	0.938	0.964	0.927	0.918	0.906	0.914	0.032

Effect relationship

The effect of deviation correction, the Bootstrap method, was used to test the mediation model, and resampling and 95%CI were calculated according to the results; the mediation effect of 95%CI (0.142-0.584) does not contain 0, and intermediary effect model was established. Among them, the mediating effect value of parental family upbringing accounted for the total effect [0.26/(0.26 + 0.61)] × 100% = 29.89%, indicating that the parental family upbringing had a partial mediating effect between parental stress and children's behavioral and emotional problems (Table 5).

Table 5 The path coefficient.

Affect the path	SE	Standardized effect value	Proportion of mediating effects	P value	95%CI
Parental pressure to parents' family upbringing	0.27	0.56	-	< 0.002	0.32-1.51
Parental stress - children's behavior problems	0.36	0.61	-	< 0.013	0.85-2.27
Parents' family education to children's emotional problems	0.21	0.47	-	< 0.001	0.24-1.47
Parental stress → parental family rearing → children's behavioral and emotional problems	0.11	0.26	29.89%	< 0.026	0.14-0.50

DISCUSSION

Analysis of behavioral and emotional problems of preschool children, parental parenting stress, and family rearing status

The living environment, biological inheritance, lifestyle, and other factors, especially emotional and behavioral problems in children, date back to early childhood[12]. Emotional and behavioral problems refer to depression caused by unknown reasons, unhappiness, or interpersonal barriers, and the response to fear and various physical discomfort, which is shown as mood and behavior that are not appropriate. In this study, the score of preschool children's behavior for emotional problems was 27.54 ± 3.63 points (medium level), which divides externalizing behaviors within dimensions above the pro-social behavior dimension, in contrast to the study by Gaudet et al[13]. The results are consistent in that the emotional problems exhibited by preschool-age children in certain behaviors need the attention of educators. There are many factors that can affect children's mental health. The family home, the place where children live, learn, and play, is one of the most important places that can affect children's behavior and mental health[14]. Because preschool children's weak awareness and ability are limited, many behaviors and awareness come from their parents. Parents are nurturers, and children will learn and imitate the habits and manners of their parents, which have a subtle influence on their children. The busy work in modern society has consumed the time of many families' parent-child activities, so parents must establish awareness of companionship, strengthen quality time with their children, and create a warm, harmonious, and loving family environment, which is helpful in promoting the development of physical and mental health of children.

The parental stress score of parents of preschool children was 87.64 ± 11.34, which was in the middle level and lower than that of parents of children with chronic migraine in Smirni and Carotenuto[15]. Children's growth is a long process and most parents (at least one of them) have to give up work temporarily, care for the family full-time, earn a living, and juggle between their family and work, which makes it difficult for parents to adapt to the sudden change in a short period of time. Most parents love their children and are willing to pay for the child, providing the best education, including learning, cultivating interest, and developing social skills; this will increase the cost of raising children, putting more economic pressure on them[16]. Additionally, preschool children are in a crucial period of physical and cognitive development. They explore and understand the world, establish their own independence and individuality, the exploration, and tend to cause some problems, curious, or challenging behavior, thus increasing parental stress.

In this study, the score of family rearing of the parents of preschool children was (31.54 ± 5.24) (middle level), and the average score of “hostility/coercion” was higher than that of "support/participation", which was similar to the results of the study by Wang et al[17]. The reason is likely to be affected by certain cultural and education ideas, which believed that education in the form of hostility or force could force their children to follow the rules and succeed. Subsequently, parents are faced with social and individual anxiety, which will intensify; they will be more concerned about the future of their children and hope that through the method of control and force can ensure their children reach the so-called expectations. In this study, most parents' education levels are high school and junior college, which indicates to some extent that most parents of children cannot participate in the growth process of children more rationally and may have unreasonable educational ideas, thus affecting their educational behaviors. In this state of education, children's behaviors and emotions may deviate. Moreover, in families with poor economic status or, in general, parents' complaints and worries about living conditions can be imperceptibly transmitted to children, which can make children have bad psychology such as inferiority and escape, thus directly affecting their behavior. In addition, some parents may lack effective communication and problem-solving skills that prevent them from interacting with their children in an open, supportive, and understanding manner.

Correlation analysis between preschool children's behavior and emotional problems and parental stress and family upbringing

There was a positive correlation between parental stress and the behavioral and emotional problems of preschool children, indicating that the greater parental stress, the more serious behavioral and emotional problems in preschool children. These results are consistent with the results of the study by Fields et al[4]. High parental stress can directly affect parenting to their child's upbringing, lack of family functioning, negative upbringing, low quality and low frequency of parent-child interaction, such as family problems, reducing the chance of a child's contact with the outside world[18]. Therefore, in a family with higher parental stress, children are more prone to emotional adjustment, poor language expression ability, lack of social cognition, and problems, such as lack of skills. Support/participation in family upbringing and preschool children's behavioral and emotional problems showed a negative correlation; meanwhile, hostile/forced family upbringing and preschool children's behavioral and emotional problems had a positive correlation. The preschool period is an important stage of neural development in children. In this period, parents with too much hostility or forced upbringing do not favor parent-child communication, easily induce parent-child conflict, cause the body to adjust system disorders, and increase children's inner pressure, which affects the development of children's psychological behavior[19].

Parents' family mediation effect analysis

The SEM results showed that parental stress can directly affect the behavioral and emotional problems of preschool children and can also indirectly affect the behavioral and emotional problems of preschool children through the mediating effect of family parenting. Some studies have shown that when people are exposed to high stress, negative emotions will spread to other events[20]. Due to parenting and sorrow, the disorder of parent-child interaction and difficult child characteristics of parental stress, such as parents transferring bad feelings to their parenting behavior, lead to negative parent-child interaction, lower participation and lack of enthusiasm, less patience with their children, lack of positive emotional support and response, and then choose the hostility or force, and controlling behavior[1,21]. In such a family environment, children lack independent rights to their own needs and ideas, do not dare to express themselves, and will also gradually avoid or become afraid of interaction with others. At the same time, children will also exert a subtle influence from their parents, not consciously, on this kind of behavior pattern in kindergarten, affecting their social abilities and creating emotional problem behavior.

CONCLUSION

Parental stress can indirectly affect children's behavioral and emotional problems by affecting family-rearing patterns. Clinical medical staff should pay attention to the behavioral and emotional problems of preschool children and, at the same time, provide correct and reasonable parenting advice to their parents to promote the mental health of preschool children. However, the convenience sampling method adopted in this study may cause selection bias in the sample size and cannot represent the larger population. Diversified samples can be selected for subsequent studies to enhance the universality of the research results.