Effects of stress and self-efficacy on quality of life of mothers with autistic children: Covariance-Based Structural Equation Modeling (CB-SEM) approach


autism spectrum disorder
parenting stress
quality of life

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Bee Wah, Y., Mohd Nasir, N. N., Hadrawi, M. F., Kamaruddin, A. A., Jannoo, Z., & Afthanorhan, A. (2024). Effects of stress and self-efficacy on quality of life of mothers with autistic children: Covariance-Based Structural Equation Modeling (CB-SEM) approach. Belitung Nursing Journal, 10(2), 201–208. https://doi.org/10.33546/bnj.3096
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Accepted for publication: 2024-02-21
Peer reviewed: Yes

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Background: Mothers who have children with autism encounter significant difficulties in caring for their autistic youngsters, leading to higher stress levels and a reduced overall quality of life. External or internal factors can cause and respond to stress, affecting an individual’s physical, psychological, and emotional health. Thus, it is crucial to examine the quality of life of mothers with autistic children.

Objectives: This study aimed to investigate the relationships between stress, self-efficacy, and quality of life (QoL) in mothers of children with autism.

Methods: A cross-sectional study design was used. Self-administered questionnaires were distributed from October to November 2019 to mothers with autistic children using cluster sampling techniques to capture their demographics and perceptions of stress, self-efficacy, and QoL. The data analysis was performed using covariance-based structural equation modeling (CB-SEM).

Results: Of the 290 questionnaires distributed, 238 (response rate of 82%) sets were returned, but only 181 questionnaires were usable for further analysis. The findings demonstrated a notable impact of stress and self-efficacy on quality of life and an adverse effect of stress on self-efficacy. Self-efficacy serves as an intermediary in the relationship between stress and quality of life.

Conclusion: In general, mothers of autistic children typically face moderate stress levels, but they have low levels of self-efficacy and quality of life. Mothers of children with autism need assistance and support from healthcare professionals, such as doctors, nurses, and psychiatrists, so that they can bear the challenges of raising children with special needs and enjoy a higher standard of living with less emotional and physical strain.


Supporting Agencies

The authors thank UNITAR International University for the funding of the publication of this paper


Copyright (c) 2024 Yap Bee Wah, Noor Nadia Mohd Nasir, Mohd Fikri Hadrawi, Ainur Amira Kamaruddin, Zeinab Jannoo, Asyraf Afthanorhan

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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Declaration of Conflicting Interest

The authors declare no conflict of interest.


The authors would like to thank Mrs. Rusmawati Bt Abdullah and all NASOM officers for their assistance and support of this study. We hope that the findings will be beneficial to NASOM and related agencies. The authors would like to express their gratitude to all participants in this study and the hospital for their help in completing this research.

Authors’ Contributions

Conceptualization and design (YBW), Investigation and data collection (NNMN), Methodology ZJ, AA), Data analysis and interpretation (MFH), and Manuscript writing (AAK, YBW). All authors were accountable for and approved this study according to ICMJE authorship criteria.

Data Availability

The datasets generated during and analyzed during the current study are not publicly available due to respondents’ confidentiality but are available from the corresponding author upon reasonable request.

Declaration of Use of AI in Scientific Writing

The authors have declared that no generative AI and AI-assisted technologies are used in writing.


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