Parental burnout and depression among Iranian mothers: The mediating role of Maladaptive Coping modes

Depression in mothers impacts children negatively. Understanding the antecedents and the underlying mechanisms of depression is essential in helping clinicians target depressive symptoms effectively. This study investigated the relationship between parental burnout and depression in mothers and examined the mediation role of Maladaptive Coping modes.


F I G U R E 1
The conceptualized model of the study.
one's parental duties. Burned-out parents doubt their own ability to be a good parent and feel emotionally detached from their children (Mikolajczak et al., 2019). Potential factors that may help account for the association between parental burnout and depression are not discussed in the literature.
Schema Therapy, first formulated by Jeffrey Young for personality disorders, is now used for a wide range of mental health issues, including depression (Carter et al., 2013;Renner et al., 2016). In recent years, the Schema Therapy is becoming more focused on the Schema mode model (Arntz et al., 2021). Schema modes are momentary states that contain emotional, behavioral, and cognitive components and arise in response to triggering circumstances (Young et al., 2006). These modes can shift but tend to have a persistent nature. The four main categories of Schema modes are as follows: Inner Child modes, Maladaptive Parent modes, Maladaptive Coping modes, and Healthy modes (Young et al., 2006;Arntz & Jacob, 2012) (see Appendix A). Maladaptive Coping modes include Compliant Surrender, Detached Protector, Detached Self-Soother, Self-Aggrandizer, and Bully and Attack mode (Young et al, 2006).
The current study proposes that Maladaptive Coping modes can mediate the association between parental burnout and depression.
Previous research studies demonstrate that depression and Maladaptive Coping modes are positively related, and avoidant coping strategies are more pervasive in depressed patients (Basile et al., 2018). Nia et al. (2014) reported that overcompensation is the most prevalent Maladaptive Coping mode in depressed Iranian women. Simpson et al. (2018) showed that Detached Protector mode is a significant predictor of emotional exhaustion. Abeltina and Rascevska (2021) suggested Detached Protector and Self-Aggrandizer modes contribute to burnout pathology.
To our knowledge, the relationship among parental burnout, coping modes, and depression has not yet been investigated and therefore this study investigates if (1) parental burnout is positively related to depression; (2) parental burnout is positively The conceptualized model for this study is illustrated in Figure 1.

Demographic questionnaire
The participants completed information about their educational level, age, marital, and employment status and also the number of their children.

Depression
Patient Health Questionnaire (PHQ-9) (Kroenke et al. (2001) was used for evaluating depression in the sample. PHQ-9 is a self-report measure consisting of nine questions referring to symptoms experienced by the patients during the 2 weeks prior to responding to the questionnaire.
Items such as "Little interest or pleasure in doing things" and "Trouble falling asleep, staying asleep, or sleeping too much" are scored from 0 (not at all), 1 (several days), 2 (more than half of the days) to 3 (nearly every day), whereas total score ranges from 0 to 27. The internal reliability and test-retest reliability of PHQ-9 were reported to be excellent (Cronbach's alpha value .89) in a study by Kroenke et al. (2001)

Statistical analysis
The collected data (which did not allow for missing data due to online survey) was analyzed using SPSS 26 (for descriptive analysis). Structural equation modeling (SEM) was employed for statistical analysis using AMOS 24 software. Depression, parental burnout, and coping modes were assigned as the endogenous variable, the exogenous variable, and mediator variables, respectively. Mediation analysis was performed using the bootstrap method in AMOS. The acceptable level of error was (p < .05).

Demographic characteristics of the sample
A total of 224 mothers took part in this study (n = 224) who were between 25 and 51-year old with a mean age of 36.86 (SD = 5.08). A total of 209 participants (93.3%) were married, 12 participants (5.4%)

TA B L E 2 Partial correlations between study variables
Coping modes reported having a bachelor's degree, and 33.5% (n = 75) had no university degree. Overall, 31.3% (n = 70) were mothers with one child, 52.2% (n = 117) had two children, and 16.4% (n = 37) had three or more children.

Descriptive statistics
Correlations were calculated using the Pearson coefficient in SPSS (see Table 1). Skewness and kurtosis values were between −2 and +2; therefore, data distribution was normal. Multivariate normality was checked using Mardia's coefficient and the Mahalanobis distance in AMOS, and outliers were corrected according to the obtained values.

Measurement model
The measurement model was tested using AMOS. Factor loadings were checked in confirmatory factor analysis, and items 1, 7, 17, 26, and 39 of the coping mode variables were eliminated from the model because the values were less than .4. The validity and reliability of the research questionnaires are reported in  comparative fit index (CFI), goodness of fit index (GFI), root mean square error of approximation (RMSEA), and normed chi-square (chi square/df) were used to assess the fitness of the model. Table 4 shows the model has an acceptable fit. The coefficient of determination for depression was .57, which indicates parental burnout and coping modes explained 57% of the variance for depression. Table 5 shows that 10 out of 11 direct paths were significant (p < .05), and the only insignificant path was Self-Aggrandizer and depression path (p > .05). The path between the Bully and Attack mode and depression was narrowly confirmed because t value was 1.96, and significance level was .05. Results show parental burnout was correlated with depression and all five coping modes. Mediation analysis was performed using the bootstrap method.

Structural model
The results from Table 6 indicate that all coping modes except the Self-Aggrandizer mode mediate the relationship between parental burnout and depression (p < .05), and the Detached Protector mode was the strongest mediator with an indirect effect equal to .20.
An alternative model evaluating the mediating role of parental burnout in the association between coping modes and depression was additionally tested, which was not identified by AMOS. Therefore, the results of this alternative model are not reported but are present in Appendix B.

DISCUSSION
Findings of this study provide preliminary support for the role of Maladaptive Coping modes in explaining the association between parental burnout and depression in mothers of primary school-aged children.
Overall, the proposed model was a good fit for the data. This finding is consistent with Schema theory that suggests distressing life events or circumstances are dealt with by shifting to certain Schema modes, and these Schema modes are related to psychopathology (Young et al., 2006).
The results of the current study, in-line with literature (Kawamoto et al., 2018), confirm that parental burnout and depression are related (confirmation of the first hypothesis). This finding was predictable based on previous studies which explain that even though depression and burnout are different constructs, they have many similarities and share the same risk factors Schonfeld et al., 2018

Limitations and implications for further research
Some limitations need to be highlighted. This study was based on the cross-sectional design, which limits causal inference. To identify the causal relationships, further longitudinal and experimental studies are needed. Another limitation is that the study findings are based on the responses from self-administered online questionnaires that may be influenced by subjective bias and also participant profile bias.   (Kline, 2015), but we recommend a larger sample in future studies to further confirm the results. Despite these limitations, the current study provides a framework for the researchers through testing the mediating effects of coping modes in the relationship between parental burnout and depression in mothers.

CONFLICT OF INTEREST STATEMENT
The authors declare no conflict of interests.

DATA AVAILABILITY STATEMENT
The data analyzed for the results of this research is available from the corresponding author on reasonable request.