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Proceedings S.Z.M.C. Vol: 34(4): pp. 35-39, 2020.              PSZMC-768-34-4-2020 
 
Perceived Stress of Pakistani Parents Having Normal  
Children Aged Under Ten Visiting a Tertiary Care  
Hospital in Lahore, Pakistan 
1Saadia Shahzad, 2Rosheen Zahid, 3Bushra Rehman, 4Tahseen Haider Kazmi 
1Department of Community Medicine, Shalamar Medical and Dental College, Lahore 
2Department of Surgery, Shalamar Medical and Dental College, Lahore 
3Department of ENT, Shalamar Medical and Dental College, Lahore 
4Department of Community Medicine, Shalamar Medical and Dental College, Lahore 

 
ABSTRACT 

Introduction: Having children changes the dynamics of family functioning and parenting role can become a 
source of stress for parents, even if their child is following a normal growth pattern without any unusual 
problem. A maximal number of studies in our setup have been conducted to assess stress levels in parents 
who have differently abled (special needs) children. This study, in contrast, will assess the perceived stress 
level in parents who have normal children following a normal growth pattern. Aims & Objectives: 1) To 
determine perceived stress levels in parents having normal children ≤10 years of age. 2) To identify the 
association of perceived stress levels in parents with socio-demographic factors. Place and duration of 
study: Shalamar Hospital, Dec 18, 2019-Mar 19, 2020. Material & Methods: A cross-sectional study was 
conducted in one tertiary level hospital in Lahore. The study subjects were parents with normal children ≤10 
years of age. Purposive sampling technique was applied to recruit the subjects. Study variables were: a) socio-
demographic b) variables of perceived stress among parents. Data was collected upon the Perceived Stress 
Scale (PSS), and a structured socio-demographic Performa. Data was analyzed using SPSS 20, with perceived 
stress as the outcome. Descriptive statistics were calculated, while the Independent Samples T-test was used 
to test differences between PSS scores and characteristics of the family. Multivariable Logistic Regression 
model was applied for studying associations of perceived stress with socio-demographic characteristics. 
Results: From a total of 390 respondents, the mean parental perceived stress score was 41.59±8.27. Among 
these, 32.6% were categorized in low stress, 50.8% moderate, and 16.6% in high stress category. A 
significant association was found between perceived stress and the working status of the mother (p-
value=0.011), and with the father’s monthly income (p-value=0.000). The Independent sample t-test showed 
significant differences between PSS total score and structural types of the family (p-value=0.001). 
Conclusion: The development of a child with parents’ positive mental health is important, and parental stress 
compromises the healthy growth of children. The current results warrant further study at a community level 
with a representative sample to have a more in-depth analysis of the application of some intervention at an 
early stage. This will assist in minimizing parental stress and improve parenting quality. 
 
Keywords: Perceived Parental Stress, ≤10-year-old, typical children 
 
 

INTRODUCTION 

Typical/ normal by the dictionary means; being of 
the same sort or kind that is conventionally expected 
as usual. Typical growth of a child or typical child 
thus implies that he/she is showing all important 
traits of a type, class, or group. Similarly, the 
normal growth of a child or a normal child implies 
that he/she lacks deviation from the usual/ expected 
conventional norms.1 Parenting stress according to 

literature refers to the intensity and relative 
magnitude of stresses that exist in the parent-child 
relationship.2 Literature search has revealed the fact 
that having children naturally changes the dynamics 
of family function. Thus parental role could be a 
source of stress for many parents.3 Many studies 
have revealed that the demands and responsibilities 
that are associated with raising and caring for 
children are stressful for both parents.4 Studies also 
reveal that both mothers and fathers have reported 
perceiving stress differently.5,6  

 



36

Perceived Stress of Pakistani Parents Having Normal Children Aged Under Ten Visiting a Tertiary Care Hospital 

Literature shows that techniques of coping and 
social support could help people to face stress. 
However, it was found that gender affected how 
people evaluate, perceive, and respond to 
stressors.7,8 Literature shows that mothers as 
compared to fathers perceive more parenting stress 
and depression. Although over the period the rate of 
father’s involvement in parenting has increased; 
mothers still have the major part of parenting thus 
feel more stressed out. Especially mothers with five-
year-old children get distressed upon their child’s 
school adjustment shortly .2 
Most reviewed research articles that investigated 
parental stress when parents have children with 
some congenital disorder e.g. Autism, 
developmental delays, cerebral palsy, etc.9,10,11 
However, very few studies have examined the stress 
level in parents having normal children. Parental 
stress prevalence in parents having children with 
Autism was found to be 47.4% in fathers, and 
52.6% in mothers.12 Another study conducted in 
Jordan to assess parental stress level among parents 
with normal children have found a significant 
difference in stress levels between fathers and 
mothers; with mothers having significantly higher 
scores. The mean stress score for mothers was 17.94 
±6.41, compared with 15.13 ±7.12 for fathers.13 In a 
study various factors were reported to be predictors 
of parental stress like disability in a child, gender of 
a parent, socioeconomic status, number of children, 
years married, age of parents and age of the child, 
and parent’s social support network.14 
Researchers believe that parental stress is assumed 
to be at a higher side in developing countries like 
Pakistan as compared to developed countries. This 
phenomenon is probably due to various influencing 
factors that play a key role in this situation like 
social set up, cultural values, societal norms, family 
system, socioeconomic status, lack of resources, low 
literacy rate, lack of awareness regarding good 
parenting techniques, and overt use of social media 
by the children. A literature search could not find 
any such study conducted in Pakistan to date. There 
is very limited information in our setup about the 
magnitude of parental stress among parents having 
healthy children <10 years of age. Likewise, 
awareness regarding coping techniques for parental 
stress in a positive manner is also grossly lacking 
among parents in our setup. Social issues must be 
looked into in detail to have a better quality of life.  
Moreover, this study is very significant as to the 
maximum knowledge of the researcher this study is 
the first of its kind conducted in our Pakistani 
society; as most of the studies had been done to 
assess stress among parents with physically 

challenged children. The fact that stress among 
parents who are raising normal children must be 
taken into account as it affects their mental health as 
well as their parenting quality. 
Objectives of the study are 1) to determine 
perceived stress levels in parents having typical 
children ≤10 years of age 2) to identify the 
association of perceived stress levels in parents with 
socio-demographic factors. 
 

MATERIAL AND METHODS 

It was a cross-sectional study conducted in the 
Pediatric Out-Patient Department of the Shalamar 
Hospital, Lahore; in three months (Dec 18, 2019-
Mar 19, 2020).  
The sample size of 390 was calculated using Open 
Epi software with an assumed prevalence of 50%, 
&a margin of error of 5%. Our study subjects were 
parents visiting the outpatient department; 
&purposive sampling technique was applied to 
select the study participants. 
The inclusion criteria were: 1) willingness of the 
respondent parents 2) parents having normal 
children ≤10 years of age. The exclusion criteria: 1) 
parents having a child with any congenital 
abnormality. Study variables were: a) Socio-
demographic variables of parents b) Variables of 
parental stress. 
Data was collected upon the questionnaire after 
taking informed consent from the respondent. 
To measure parental stress, the Perceived Stress 
Scale (PSS) from the State of New Hampshire 
Employee Assistance Program was used; which is 
available in free access at info@mindgarden.com. 
Cut-offs for the PSS were 0-13 considered as a low-
stress category, 14-26 as moderate stress, and 27-40 
considered as a high-stress category. The total score 
for perceived stress was taken as an outcome.  
All ethical considerations were duly considered and 
observed during the study; and participants were 
assured of the confidentiality of the data. 
Institutional Review Board certification was 
acquired from the Ethical Board of the Shalamar 
Institute of Health Sciences, Lahore, before the start 
of the study. 
 
Statistical analysis: 
Descriptive stats, mean± SD, frequency trends, & 
percentages for categorical factors were calculated. 
Multivariable Logistic Regression was applied to 
determine the association of perceived stress with 
sociodemographic factors, comparing moderate to 
high stress against the low-stress category. 
Independent Samples T-test was used to test 



37

Perceived Stress of Pakistani Parents Having Normal Children Aged Under Ten Visiting a Tertiary Care Hospital 

differences between PSS scores and characteristics 
of the family; & p-value of<0.05 was considered 
significant.  
 

RESULTS 

Data of 390 parents were entered and analyzed via 
SPSS 20.  There were 59 (15.1%) fathers and 331 
(84.9%) mothers in the research. The mean age was 
28.99 ± 4.55. The mean stress score for respondents 
was 18.03 ±8.8.  
Table-1 shows the socio-demographic profile of the 
recruited subjects. The majority of the respondents 
were educated, with about 40% having an education 
of intermediate and above. Most respondents 
reported having less than 4 children in their 
household. More than 70% of subjects had their 
family income less than PKR 50,000. 
 
S. No Variable n (%) 

1.  Father Education  
Class 1-10 
Intermediate and above 

 
240(61.5%) 
150(38.4%) 

2.  Mother Education 
Class 1-10 
Intermediate and above 

 
233(59.8%) 
157(40.2%) 

3.  Number of children 
1-3 
>3  

 
343(88%) 
47(12%) 

4.  Type of family structure 
Nuclear  
Joint 

 
102(26.2%) 
288(73.8%) 

5.  House status  
Rented  
Own  

 
86(22.1%) 

304(77.9%) 
6.  Monthly income of the 

father 
Up to PKR 50000 
> PKR 50000 

 
285(73.07%) 
97(24.87%) 

Table-1: Socio-demographic profile of the respondents 
(n=390) 

 

 
Fig-1: Categorization of Perceived Stress among both 

parents (n=390) 

Fig-1 shows the categorization of stress scores 
among responding parents. The figure shows that 
49% of respondents had moderate stress levels, 
followed by 33% in the low category. High-stress 
scores were obtained from among 18% of the 
subjects.  
Table-2 shows the logistic regression analysis of 
stress with family characteristics. The working 
status of the mother and the family’s monthly 
income was significantly associated with perceived 
stress in the final adjusted model; the working status 
of mothers increases stress by 4 times [OR 4.12 
(95% CI: 1.39-12.25)].  
 

Variables 
Univariate 

analysis 
OR(95% CI) 

P-value 
Multivariate 

analysis 
OR(95%CI) 

P-value

Total 
number of 
children 

1.250 
(1.019-1.533) 0.033

* 1.218 
(0.978-1.516) 0.078 

House type 
Own: 
Rented: 

 
1 
1.730 
(1.003-2.984) 

 
0.049* 

1.380 
(0.777-2.451) 0.272 

Status of 
mother 
House wife: 
Working: 

 
 
1 
4.018 
(1.537-10.500) 

0.005* 4.120 (1.386-12.248) 0.011
* 

Frequent 
job changes 
by father 
No: 
Yes: 

 
 
 
1 
3.072 
(1.039-9.079) 

0.042* 1.578(0.501-4.974) 0.436
 

Monthly 
income  

0.626 
(0.505-0.777) 0.000

* 0.653 
(0.524-0.815) <.001

* 

Age of 
mother 

0.977 
(0.933-1.023) 0.326 -  

Age of 
father 

0.991 
(0.954-1.030) 0.651 -  

Gender 
Male: 
Female: 

 
 1 
1.456 
(0.824-2.570) 

0.196 -  

Familytype 
Joint: 
Nuclear: 

 
1 
0.736 
(0.449-1.205) 

0.223 - 

 

Table-2: Regression Analysis of variables related to 
Perceived Stress among parents (n=390) 

 
Table-3 shows the analysis of the differences of PSS 
scores with family structure type and gender. This 
shows that scores for joint family structures were 
found to significantly high compared to nuclear 
families (p-value 0.001). 
 

33%

49%

18%

Low Stress

Moderete Stress

High Stress



38

Perceived Stress of Pakistani Parents Having Normal Children Aged Under Ten Visiting a Tertiary Care Hospital 

Variable PSS mean score ±SD P-value 

Type of family 
Nuclear: 
Joint: 

40.287 
43.187 

7.75 
8.63 

0.001* 

Gender  
Male: 
Female: 

42.58 
41.21 

8.28 
8.25 

0.151 

P-value<.05 significant 
Table-3: Differences across PSS Total score with Type 

of Family and Gender 
 

DISCUSSION 

In the past, research defines parental stress as a 
mismatch between perceptions of environmental 
demands and personal resources.6 Furthermore, 
previous studies have found that mothers and fathers 
report perceiving stress differently.5 
Our study found a higher frequency trend of 
perceived stress total score among both parents, the 
maximum range is around 40, and its mean score 
being 18.03±8.8. Categorical breakdown of the 
perceived stress total score revealed 33% in low-
stress category, 49% in moderate, and 18% as high 
category stress level. This finding is strongly 
supported by another study that reported mothers 
had higher stress as compared to fathers.13 Literature 
search revealed that very few numbers studies had 
been done to study perceived stress among parents 
having normal children and the majority of studies 
were conducted to study stress levels among parents 
having children with special needs. The frequency 
of engagement with children was found to be related 
to the mother’s parenting stress as compared to the 
father’s parenting stress.15 
Our study also suggests that a greater number of 
mothers and fathers (40.2% and 38.4% respectively) 
had a decent education level (intermediate and 
above); yet they perceived stress scores were high 
suggesting that their difficulty in coping with 
demands and resources. The working status of 
mothers and family income might be the main 
influencing factors of their incapability towards 
coping.  The total number of children in the family 
may be another important factor in this context for 
higher parental stress. This finding is corroborated 
in other studies as well.16 
Compromised economic status might contribute 
further to parental stress and our study findings 
show that majority of respondents had an income of 
less than PKR 50,000. This finding is strongly 
supported by another study that has linked 
accessibility to socio-economic resources and 
economic strain to an appraisal of stress.17 
Contemporary norms of fatherhood emphasize the 

dual demands of bread-winning plus daily 
involvement with children. The results of recent 
qualitative research show that it is difficult for 
working-class fathers to meet the demands of 
quality parenting. Furthermore, on account of job 
instability and workplace inflexibility, this may 
increase.15 Additionally, joint family structures can 
further aggravate the perceived stress among 
individuals. Our study indicates scores to be higher 
among joint families, however, the multivariable 
model showed this to be non-significant. 
There are limitations to this research. Foremost, the 
study being cross-sectional, we cannot suggest 
causality of the above-mentioned factors with 
perceived stress among parents. Second, the sample 
size drawn from the target population might not be 
representative as the subjects were conveniently 
selected from a single hospital in Lahore. But the 
study does add an important finding that stress is 
ubiquitous among most families and a study from 
the community level with an expanded sample size 
might provide more in-depth knowledge for stress 
scores among parents. Moreover, culturally, the role 
of grandparents might be another important factor to 
influence stress among parents that was not 
explored in this research. Literature suggests that 
grandparents are found to be a likely source of 
support for many parents, providing emotional, 
financial, and instrumental assistance.18 Future 
studies could explore that relationship in detail. 
 

CONCLUSION 

The study suggests that parents of normal children 
are afflicted with moderate to a high category of 
stress. The working status of mothers and family’s 
income are significant influencers of perceived 
stress among parents. To raise children with positive 
mental health, parents themselves must have a 
positive and stress-free mental state, and measures 
are needed to assist such families as much as 
possible. Community counseling is one of the many 
measures that can be opted for a level of the 
community, assisting to minimize stress so that 
parents may provide good quality parenting for their 
children. 
 

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The Authors: 
Dr. Saadia Shahzad 
Assistant Professor, 
Department of Community Medicine, 
Shalamar Medical and Dental College, Lahore. 
 
Dr. Rosheen Zahid 
House Officer, 
Department of Surgery, 
Shalamar Medical and Dental College, Lahore. 
 
Dr. Bushra Rehman 
House Officer, 
Department of ENT, 
Shalamar Medical and Dental College, Lahore. 
 
Prof. Tahseen Haider Kazmi 
Department of Community Medicine, 
Shalamar Medical and Dental College, Lahore. 
 
Corresponding Author: 
Dr. Saadia Shahzad 
Assistant Professor, 
Department of Community Medicine, 
Shalamar Medical and Dental College, Lahore. 
E-mail: saadiazahur@live.com