**5. Results**

The sample consisted of 56 parents with mean age 49.6 years (SD = 7.8) (Table 1 presents sample characteristics). Two PSI subscales, namely Defensive Responding and Parental Distress scores, along with Total PSI score were significantly decreased from the financial to the COVID-19 crisis. Significant reduction in Mobilizing Family to Acquire and Accept Help and Acquiring Social Support subscales was recorded. Moreover, scores on Passive Appraisal had a significant increase. No changes in CES-D scale were recorded from the financial to the COVID-19 crisis. As far as WHO-QOL subscales were concerned, a significant increase in the mean score of the Environment subscale was found (Table 2). Using the Benjamini-Hochberg procedure, all aforementioned significant comparisons remain statistically significant.

**Table 2.** Changes in PSI, F-COPES, CES-D, and WhoQolBref subscales from the financial to the COVID-19 crisis.


After having adjusted for parental educational level, income after the pandemic, DSM-5, and the child's age, it was found that Defensive Responding score remained significantly lower during the COVID-19 crisis (*p* < 0.001), as did Parental Distress score (*p* = 0.007) and total PSI score (*p* = 0.005). Moreover, Mobilizing Family to Acquire and Accept Help and Acquiring Social Support subscales were significantly lower during the COVID-19 crisis (*p* = 0.002 for both subscale), after adjusting for parental educational level, income after the pandemic, DSM-5, and the child's age. On the contrary, Passive Appraisal and Environment subscales were significantly greater during the COVID-19 crisis after adjusting for parental educational level, income after the pandemic, DSM-5, and the child's age (*p* < 0.001 and *p* = 0.001, respectively).

Pearson's correlation coefficients among all scales are presented in Table 3. In general, greater stress was significantly associated with greater depression, worse coping, and

worse quality of life. Moreover, greater depression was significantly associated with worse coping and worse quality of life, while better coping was associated significantly with better quality of life.

When multiple linear regression was conducted it was found that Passive Appraisal (β = −3.17; SE = 1.25; *p* = 0.015) and Acquiring Social Support β = −1.16; SE = 0.52; and *p* = 0.032) were significantly associated with total PSI score.


**Table 3.** Pearson's correlation coefficients among all understudy scales during the COVID-19

 crisis.

> < 0.05; \*\* *p* < 0.01; \*\*\* *p* < 0.001.

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#### **6. Discussion**

In the present study, we compared the impact of the two different social crises, the financial and the COVID-19 crises, on the parenting stress, depressive symptomatology, quality of life, and coping strategies of mothers who have children and adolescents with ASD.

#### *6.1. Parenting Stress*

Parental Stress as measured in PSI-SF refers to the stresses that a parent is experiencing in his/her role; it does not include all life stresses, just the stress deriving from his/her parenting. In particular, Parental Distress measures the sense of parenting competence, the stress associated with restrictions in life, conflict with the other parent, social support, and depression. As expected from previous findings in a Greek sample [2], parental stress was significantly associated with greater depression, worse coping, and worse quality of life. Moreover, two dysfunctional coping mechanisms, namely increased passive appraisal and reduced social support, predicted elevated parental stress during the pandemic.

Interestingly the parenting stress during the COVID-19 crisis as reflected in the total PSI score and the Parental Distress Score was significantly lower compared to the parenting stress during the economic crisis. Moreover, during the pandemic, mothers made fewer attempts to deny or minimize problems when responding to the questionnaire.

Differences between the two types of crises regarding the impact on daily life and the strategies to accommodate to the change might explain differences in the parental distress measures.

The financial crisis in Greece has been a prolonged and sustained economic downturn. The Greek Government had to implement austerity measures that had various consequences on the daily lives of Greeks. The funding for mental health was reduced. Many parents lost their jobs or had their salaries dramatically reduced resulting in the discontinuation of their children's treatments. Moreover, parents of both typically developing children and children with autism or other developmental disorders tend to spend a lot of money on their children's after-school activities [2]. They had, therefore, to face a twofold difficult situation that could affect their sense of competence as parents: first, their children had to discontinue both their treatment and their extra activities because of their parents' inability to cover expenses, and second, they had to be away from home to find extra financial resources to cover basic family needs.

During the COVID-19 crisis and the restrictions implemented by the Government to control the pandemic, the daily lives of Greeks changed as well, but in a different direction. Approximately 68% of children and adolescents in our study stopped receiving any kind of intervention. Contrary to the economic crisis, parents were spending most of their time at home because of tele-working, because they were entitled to claim special time-off from their work to stay with their children, or because they were temporarily out of work. They lost the support of grandparents whose role in the Greek family is central. However, they had the opportunity to be with their children and strengthen their relationships. Moreover, fathers who are often reported to be less involved in the care of their child with ASD [2] had the chance to spend more time with their child and support the mother. Unfortunately, in our study, 35.8% of the parents reported a decrease in the income of the family. Nevertheless, there was a halting of the continuous race of getting involved in numerous and all sorts of costly activities, which resulted in a decrease of expenses. Moreover, the crisis was a worldwide and pan-European phenomenon, and Greece received financial rescue funds that supported many of these families. This difficult situation was, therefore, probably conceived as a temporary and universal phenomenon imposed by governmental restrictions, not related to parents' competence to fulfill their role.

During our clinical practice and in the literature, there have been many reports about difficult behaviors of children with ASD during the COVID-19 crisis [29,41]. In our study, 10.7% of the families had to increase the dose of a previously prescribed sedative for their child. Overall, though, it seems that during the first phase of the pandemic crisis the

primary caregivers of people with ASD in Greece felt more competent, less restricted, and more supported in their role as a parent compared to the economic crisis period.

#### *6.2. Depressive Symptomatology*

Parents of disabled children, and especially parents of children with autism, experience more challenges and are likely to report mental health problems compared to parents of typically developing children [2,64,65]. In particular mothers, as the primary caregivers of children with autism [2,16], report higher levels of psychological stress [15,17]. In accordance with previous findings [2], increased symptoms of depression were significantly associated with more dysfunctional coping strategies and worse quality of life in our study.

Mothers' depressive symptomatology as reflected in CES-D scoring, showed no difference between the first phase of the COVID-19 and the financial crisis period. In both cases, the CES-D score was elevated. The negative impact of the economic crisis on the depressive symptomatology and wellbeing of the general population has been previously studied [48,50,66] although not in particular in the population of parents with individuals with ASD. Financial difficulties and burdens have been repeatedly reported, though, as important stressors for those parents [3,64]. High levels of depression in parents of disabled children have been described during the COVID-19 pandemic crisis [34,36,67]. It seems that no matter the nature of the crisis, the threatening of an individual's functioning, values, and goals during this period and the imbalance between demands, family capabilities, external resources, and subjective appraisal that has been described to characterize crises in families of individuals with ASD [22], appears to have an equally strong impact on parents' levels of depression.
