Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Jul 19, 2021; 11(7): 388-402
Published online Jul 19, 2021. doi: 10.5498/wjp.v11.i7.388
Mental health of parents of children with autism spectrum disorder during COVID-19 pandemic: A systematic review
Büşra Yılmaz, Merve Azak, Nevin Şahin
Büşra Yılmaz, Nevin Şahin, Department of Women's Health and Gynecologic Nursing, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul 34381, Turkey
Merve Azak, Department of Pediatric Nursing, Florence Nightingale Faculty of Nursing, Istanbul University- Cerrahpasa, Istanbul 34381, Turkey
Author contributions: Yılmaz B, Azak M, and Şahin N contributed to the study design, data collection, and manuscript writing; Yılmaz B and Azak M conducted the data analyses; Şahin N supervised study and made critical revisions for important intellectual content; All authors read and approved the final manuscript.
Conflict-of-interest statement: All authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Merve Azak, MSc, RN, BSN, Research Assistant, Department of Pediatric Nursing, Florence Nightingale Faculty of Nursing, Istanbul University- Cerrahpasa, Abide-i Hurriyet St. Sisli, Istanbul 34381, Turkey.
Received: February 7, 2021
Peer-review started: February 7, 2021
First decision: March 16, 2021
Revised: March 26, 2021
Accepted: June 3, 2021
Article in press: June 3, 2021
Published online: July 19, 2021
Research background

Although staying at home prevents the spread of coronavirus disease 2019 (COVID-19), this poses a number of challenges, especially for children with special needs such as autism spectrum disorders (ASD) and their parents. The parents of children with ASD participate in special education practices that involve physical activity in order to cope with the behavioral, cognitive and mental problems of their children. However, during COVID-19 pandemic, this process was disrupted, and the mental health of the parents was affected.

Research motivation

Although there were many studies on the effects of the COVID-19 pandemic in the literature search, it was observed that there was very limited information on mental health effects on the parents of children with ASD, and there was no systematic review on this topic.

Research objectives

In this systematic review, it is aimed to determine the mental health status of the parents of children with ASD in the COVID-19 pandemic.

Research methods

Articles in English, which could be accessed in full text without any limitation of publication year and country, were included in the study. The systematic review was conducted according to the PICOS strategy (Participants: The parents of children with ASD; Interventions: Effects of COVID-19 pandemic on mental health; Comparators: The parents of children without ASD; Main outcomes: Anxiety, stress, difficulty in coping, loneliness, inadequacy of support systems, social isolation, change in routines and financial difficulties; Additional outcomes: Exercise at home, practicing yoga and meditation, reading newspapers, receiving support from a therapist, cooking meals, talking to their loved ones on online platforms during the pandemic. These results have been reported in studies and included and presented in this systematic review. Study design: Quantitative/qualitative studies). The search results were reached by browsing the Web of Science, PubMed (including MEDLINE), Cochrane, Scopus, Science direct and Google Scholar databases using the keywords COVID-19 AND (“autism” OR “autistic” OR “autism spectrum disorder”) AND parent AND (“mental health” OR “anxiety” OR “stress”). The list of the references of the included studies was reviewed to access additional studies.

Research results

The systematic review was conducted according to the PICOS strategy, and a total of 12 studies were included in a quantitative and qualitative design. The studies have revealed that parents are negatively affected by the COVID-19 pandemic. It was reported that the parents of children with ASD had increased anxiety and stress during the pandemic, children became aggressive as their routines changed, and the parents had difficulty coping with this process. During the pandemic, the parents met with their friends via online platforms, practiced yoga and meditation, the spouses provided rest breaks to each other and received support from therapists.

Research conclusions

The COVID-19 pandemic negatively affected the mental health of children with ASD and their parents. It may be recommended to plan more interventions that will positively affect the mental health of parents and support them.

Research perspectives

Given the uncertainty of how long the COVID-19 pandemic will last, it is important to conduct a large number of descriptive and interventional studies on the mental health of parents with children who have ASD. In this systematic review, it was revealed that the number of studies on this topic is quite limited. It is thought that this systematic review will form the basis for future studies.