Copingstrategiesasmediatorsandmoderatorswithissueandvolume [613909]

RESEARCH ARTICLE
Coping Strategies as Mediators and Moderators
between Stress and Quality of Life among Parents of
Children with Autistic Disorder
Latefa A. Dardas *†& Muayyad M. Ahmad
The University of Jordan, Amman, Jordan
Abstract
The purpose of this cross-sectional study was to examine coping strategies as mediators and moderators between
stress and quality of life (QoL) among parents of children with autistic disorder. The convenience sample of thestudy consisted of 184 parents of children with autistic disorder. Advanced statistical methods for analyses ofmediator and moderator effects of coping strategies were used. The results revealed that ‘accepting responsibility ’
was the only mediator strategy in the relationship between stress and QoL. The results also revealed that only‘seeking social support ’and‘escape avoidance ’were moderator strategies in the relationship between stress and
QoL. This study is perhaps the first to investigate the mediating and moderating effects of coping on QoL of parents
of children with autistic disorder. Recommendations for practice and future research are presented. Copyright ©2013 John Wiley & Sons, Ltd.
Received 4 February 2013; Revised 15 June 2013; Accepted 19 June 2013
Keywords
mediators; moderators; coping; quality of life; autistic disorder
*Correspondence
Latefa A. Dardas, The University of Jordan, Amman 11942, Jordan.
†Email: [anonimizat]
Published online 19 July 2013 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/smi.2513
Introduction
Coping with stressful situations that exceed one's abilities
is one of the greatest challenges of life. According toLazarus and Folkman's Transactional Model of Stressand Coping (1984), coping is de fined as the cognitive
and behavioural efforts that are constantly changing tomaster, reduce or tolerate a speci fic stressor appraised as
exceeding one's available resources and abilities. A strikingpoint in the model is that coping strategies are consideredthe intermediate process between stressors and healthoutcome. Indeed, Folkman, Lazarus, Dunkel-Schetter,DeLongis, and Gruen (1986) fo und that the process of
coping can change the relationship between life stressorsand health. Coping is considered to be of critical impor-tance in determining whether a stressful event results inadaptive or maladaptive outcomes.
To a parent, having a new child is considered a
stressful situation. However, when the child is bornwith disability, parents bear greater stressors anddemands that can disrupt the whole family's life,requiring a wide range of coping strategies (Gray,2006). Autistic disorder is considered one of the perva-sive developmental disorders. Children with autisticdisorder show complex behaviours, which can create
chaos in the parents' life. Particularly, those children
are characterized by signi ficant qualitative impairment
in social interaction and communication, and
restricted patterns of repetitive and stereotyped behav-
iour, interests and activities (the American Psychiatric
Association (APA), 2000). Compared with parents of
typical children and pare nts of children with other
developmental disabilities, parents of children with
autistic disorders have been found to experience
significantly higher levels of parenting stress and psy-
chological distress (Ericz on, Frazee, & Stahmer, 2005;
Weiss, 2002). Further, poor quality of life (QoL) levels
have been documented for those parents (Mungo,
Ruta, Arrigo, & Mazzona, 2007; Yamada et al., 2012).
Therefore, parents of children with autistic disorder
are expected to be in vital need to develop ongoing
effective coping responses to deal with their children's
lifelong disability and to maintain their QoL. Indeed,
the types of coping strategies used by parents of
children with disability were found to have moredecisive effect on their level of stress than the stressors
itself (Beresford, 1994).
5 Stress Health 31:5–12 (2015) © 2013 John Wiley & Sons, Ltd.

Despite the practical importance of studying coping,
there has been a dearth of information available on thisconcept and its in fluences on parenting stress and QoL
among parents of children with autistic disorder.Parenting stress is considered an aversive psychologicalreaction to the demands of being a parent that stemsfrom a complex combination related to the child, theparent and the child –parent interactions (Abidin,
1995). The concept of QoL is de fined as ‘individuals'
perception of their position in life in the context ofthe culture and value systems in which they live andin relation to their goals, expectations, standards andconcerns ’(WHO, 1996, p. 5). Although there is a
growing awareness of the need to integrate the conceptof QoL in the support services provided for childrenwith chronic disabilities and their parents, the factorscontributing to the QoL of those parents (e.g. theirstyle of coping with life stressors) have receivedrelatively little attention.
Among the few studies that have investigated the
interactions between the concepts of stress, coping
strategies and QoL among parents of children withautistic disorder (e.g. Dabrowska & Pisula, 2010; Gray,2006; Smith, Seltzer, Tager-Flusberg, Greenberg, &Carter, 2008), links between the types of coping strate-gies used by the parents and their levels of stress andQoL were revealed. It was inferred from these studiesthat parents who are able to develop effective copingstrategies are likely to experience satisfactory levels ofQoL and wellbeing and functional levels of parentingstress. In particular, active problem-focused strategieswere associated with positive outcomes. Meanwhile,the reliance on passive, avoidant coping strategies wasassociated with negative outcomes.
While drawing attention to the studies that investi-
gated the concepts of stress, coping and QoL amongparents of children with autistic disorder, two mainmethodological limitations can be argued. First, authorsmade their interpretation of the results in terms of thetwo general categories of coping strategies (emotionfocused and problem focused). It has been argued byFolkman and Moskowitz (2004) that relying on thisclassi fication for the synthesis of findings may run the
risk of distorting important differences within catego-ries. In addition, classifying coping strategies into twodistinct sets has the expectation that problem andemotion-focused strategies are independent of one an-other. However, different types of coping seem to overlapand facilitate each other. For example, emotion-focusedstrategies relieve emotional distress and, consequently,may encourage the person to engage in problem-focusedcoping. Conversely, effective problem-focused copingcan lead to relieving the stressor-associated distressing
feelings. Fortunately, Folkman and Lazarus (1988)
adapted their work on coping classi fication and
derived new eight classi fications, including positive
reappraisal, confrontive coping, planful problem sol-ving, seeking social support, d istancing, self-control,escape avoidance and accept ing responsibility. Those
categories provide a clear description for the thoughtsand actions an individual uses to cope with a speci fic
stressful encounter.
A second limitation for the previous studies that
investigated the concepts of stress, coping and QoLamong parents of children with autistic disorder is thatit presented these concepts through bivariate relation-ships. However, relationships among variables areoften considered more complex than simple bivariaterelationship such as between an independent variableand an outcome variable. Rather, these relationshipsmay be modi fied by a third variable such as mediator
and moderator (Baron & Kenny, 1986; Bennett, 2000).
Mediators provide information about how or why
two variables are strongly related, whereas moderatorsanswer why a weak or strong association between twovariables occurs (Lindley & Walker; 1993; Moore,Biegel, & Mcmahon, 2011). The importance of investi-gating mediation and moderation effects has been
recognized in literature (Connor-Smith, & Compas,
2002; Littleton, Horsley, John, & Nelson, 2007). If re-searchers fail to consider the possibility of a mediatoror moderator effect in the data, inappropriate explana-tion for the outcome may be reached. Unfortunately,few studies have tested coping strategies as mediatorsor moderators between life stress and health outcome.Further, no studies have been conducted on coping asa moderator and mediator in the relationship betweenstress and QoL among parents of children with autisticdisorder. The purpose of this study was to examinecoping strategies as mediators and moderators betweenstress and QoL among parents of children with autisticdisorder.
Methods
Sample
To determine the sample size based on power analysis,
Cohen's technique (1988) for power analysis was used.The estimated sample size needed for this study was114 participants, based on αlevel of 0.05, power of
0.80, relatively small effect size (0.10) and three predic-tors in regression analysis. The convenience sample ofthe study was composed of 184 parents of children withautistic disorder. Parents were included in the study if(1) they had a child under the age of 12 years with aclinical diagnosis of autistic disorder and (2) they wereable to read and write in Arabic. Parents werecontacted individually through the special education
centres where their children have been diagnosed with
autistic disorder by licensed professionals. Participantswere provided with simple incentives. The diagnosiswas made on the basis of the Diagnostic and StatisticalManual of Mental Disorders DSM-IV-TR (fourthedition, text revision) provided by the American Psy-chiatric Association (APA, 2000).Coping Strategies as Mediators and Moderators L. A. Dardas and M. M. Ahmad
6 Stress Health 31:5–12 (2015) © 2013 John Wiley & Sons, Ltd.

Measures
The Parenting Stress Index —Short Form
(Abidin, 1995)
The Parenting Stress Index —Short Form (PSI-SF) is
a 36-item self-reported questionnaire designed tomeasure stress associated with parenting amongparents of children younger than 12 years (Abidin,
1995). The PSI-SF scale is one of the most commonly
used measures across many different samples inclu-ding parents with a range of income and educationlevels and parents of children with a broad range ofability levels (Dardas & Ahmad, 2013). The items ofthe scale range from 1 (strongly disagree) to 5 (stronglyagree). Higher scores indic ate greater levels of paren-
ting stress (Abidin). The total stress score has beenused for this study. The internal consistency reliabilitycoefficient for the total stress was 0.91 (Abidin, 1995).
In this sample, Cronbach's αfor the total stress scale
was 0.91.
The Revised Ways of Coping Checklist (Folkman
& Lazarus, 1988)
The revised ways of coping is a 66-item question-
naire that contains eight different cognitive and behav-ioural strategies used to cope with stressful encounters,including confrontive coping (six items; describesactive effort to alter a situation, sometimes associatedwith some degree of aggression, hostility and risktaking), distancing (six items; refers to cognitive effortsmade to detach oneself from a stressful situation andminimize its signi ficance), self-controlling (seven
items; describes an individual's active effort to regulatetheir feelings and actions), seeking social support (sixitems; refers to efforts to seek informational, tangibleand emotional support), acce pting responsibility (four
items; refers to the acknowledgment of one's contribu-tion to the problem and trying to fix things out),
escape avoidance (eight ite ms; includes wishful think-
ing and behavioural efforts to avoid facing the pro-blem), planful problem solving (six items; coversdeliberate focus on altering the situation using carefulanalyses to solve the problem and generate possiblesolutions) and positive reappraisal (seven items;describes efforts that focus on personal growth andsome religious aspects to create a positive meaningfor a situation). Participants were required to respondto a speci fic stressor, raising a child with autistic disor-
der and subsequently respond to each statement in thescale by expressing the extent to which they used the
strategy in coping with that stressful situation on a
four-point scale from 0 (not used) to 3 (used a greatdeal). The internal consistency reliability coef ficients
ranged from 0.68 to 0.79 for the eight subscales(Folkman & Lazarus, 1988). In this sample, Cronbach'salphas for the eight subscales ranged from moderateto high.The World Health Organization Quality of Life
Assessment –Bref self-administered instrument
(WHO, 1996)
The World Health Organization Quality of Life
Assessment –Bref (WHOQOL-BREF) contains a total
of 26 questions that were developed in an attempt toprovide a QoL measure that would be applicablecross-culturally (WHO, 1996). It produces a pro file
with four physical, psychological, social and environ-mental domain scores and two individually scoreditems about an individual's overall perception of QoLand health. Items of the scale range from 1 to 5 withhigher scores denoting higher QoL. The total QoL scorehas been used for this study. The WHOQOL-BREF is across-culturally valid and reliable assessment of QOL.In this sample, Cronbach's αfor the total QoL scale
was 0.93.
Ethical considerations
The Academic Research Committee at the Deanship of
the Academic Research at the University of Jordangranted the ethical approval for conducting this study.The purpose, methods, risks and bene fits of the study
were explained to the participants before they decidedto participate. The participants were assured that theirparticipation would be completely voluntary and thatthey would have the right to quit their participationsat any stage if they did not feel comfortable in continu-ing the process. The researchers assigned identi fication
number to the participants to assure the con fidentiality
of the data obtained.
Results
A total of 184 parents participated in the study. Ofthem, 62% ( n= 114) were mothers. The mean age for
the sample was 37 years [standard deviation (SD) = 7.6]ranging from 21 to 69 years. The majority of the par-ents (96.7%, n= 178) were married. In relation to the
parents' level of education, 46.2% ( n= 85) of them
had secondary school or less (ranging from 9th gradeto 12th grade), 23.9% ( n= 44) had diploma and
29.9% ( n= 55) had baccalaureate degree or higher.
Overall, 56% ( n= 103) of the parents were not work-
ing. All the parents had only one child diagnosed withautistic disorder.
All children in this study were diagnosed with
autistic disorder using the DSM-IV criteria (APA,2000). The criteria of the DSM-IV are considered astandardized diagnostic procedure for autistic disorderin the country. About 84% ( n= 155) of children were
male. The mean age for children was 6.3 years (SD = 3)
ranging from 2 to 12 years. The mean age of symptoms
was 2 years (SD = 1). The mean age of diagnosis was3 years (SD = 1).
Regarding the level of parental stress, the analysis
showed that the mean of the total stress score was 118(SD = 23), which indicates a clinically signi ficant highL. A. Dardas and M. M. Ahmad Coping Strategies as Mediators and Moderators
7 Stress Health 31:5–12 (2015) © 2013 John Wiley & Sons, Ltd.

levels of stress. The most frequently used coping strategy
among the parents was ‘positive reappraisal ’(mean =
74.30, SD = 12.97), whereas ‘distancing ’was the least
used coping strategy (mean = 55.19, SD = 13.56). Themean scores for the other six coping strategies rangedfrom 55 to 68. The mean of the total QoL score was 80(SD = 16).
Tests of mediated models
Several steps were performed to examine the mediating
effect of coping strategies on the relationship betweenstress and QoL using the Statistical Package for SocialSciences (IBM Corp., 2012). Eight sets of regressionswere tested, with each set exploring mediation of therelationship between stress and QoL by one of the eightcoping strategies. Following standard procedures, eachmediated model was tested in three steps (Baron &Kenny, 1986; Warner, 2008).
In the first step, associations of the independent
variable (stress) with the possible mediator (the eightcoping strategies) were examined. Stress was able topredict signi ficantly two types of coping strategies:
escape avoidance ( t= 6.40; P<0.001) and accepting
responsibility ( t= 4.55; P<0.001). Thus, the other six
types of coping were dropped from next steps of exam-inations (Table I).
In the second step, the dependent variable (QoL)
was regressed on the possible mediators (escape avoid-ance and accepting responsibility) of coping strategies.The two sets of regression demonstrated that escapeavoidance and accepting responsibility had signi ficant
negative relationships with QoL (Table II).
In the third step, the association of stress and QoL
reduced signi ficantly when ‘accepting responsibility ’
was added to the hierarchical equation. The copingstrategy ‘escape avoidance ’in the second step of regres-
sion remained signi ficant predictor; thus, it was not
considered as a mediator (Table III). Therefore, theonly mediator variable in this study, which ful filled all
the required criteria, was accepting responsibility(Figure 1).
Tests of moderated models
Moderated models of regression analyses were used to
test the hypothesis that the relationship between stress
and QoL occurs primarily under certain conditions,
with coping serving either as an ampli fier or as a buffer
(Warner, 2008). Following a standard procedure, mea-sures of coping and stress were centred in tests of cop-ing moderation to maximize interpretability andminimize potential problems with multicollinearity(Aiken & West, 1991).
Moderation was examined by constructing eight hi-
erarchical regression equations that included stress,eight coping strategies and a multiplicative termrepresenting the interaction between each of the copingstrategies and stress. As with tests of the mediatedmodels, a separate set of regression analyses was usedfor each of the eight coping strategies with all regres-sions controlling for stress as stress is entered first in
the analysis on the basis of the Lazarus and Folkmanmodel. In these models, a signi ficant interaction term
with a negative beta would suggest that a coping strat-egy is buffering the relationship between stress andQoL. A signi ficant interaction term with a positive beta
would indicate that a coping strategy is amplifying therelationship (Aiken & West, 1991; Baron & Kenny,1986; Warner, 2008).
The model with ‘seeking social support ’coping
strategy accounted for 39% of the variance in QoL,with the interaction between coping and stress indicat-ing that seeking social support served as ampli fier. Sim-
ilarly, the model with escape avoidance coping strategyaccounted for 41% of the variance, with escape avoid-ance serving as ampli fier (Figure 2). All other coping
strategies did not show moderating effects betweenstress and QoL (Table IV).
Discussion
Investigating the mediation and moderation effects ofthe variables is of great importance in providing expla-nations for the outcomes. The examination of media-tors and moderators in descriptive studies can clarifywhy or how a direct association occurs between anindependent variable and an outcome variable. To thebest of our knowledge, no previous studies have yetTable I. Association of the independent variable with possible
mediators
Dependent variables Stress (independent variable)
Rt Significance
Positive reappraisal 0.007 /C00.092 0.927
Confrontive coping 0.135 1.838 0.068Planful problemsolving0.138 /C01.874 0.063
Seeking social
support0.013 0.181 0.856
Distancing 0.070 0.948 0.344
Self-control 0.092 1.245 0.215Escape avoidance 0.429
(R
2= 0.184)6.401
(β= 0.429)0.001
Accepting
responsibility0.320
(R2= 0.102)4.551
(β= 0.320)0.001Table II. Association of the possible mediators with the QoL
Independent variables QoL
RR2t βSignificance
Escape avoidance 0.366 0.134 /C05.314/C00.366 0.001
Accepting responsibility 0.236 0.056 /C03.271/C00.236 0.001Coping Strategies as Mediators and Moderators L. A. Dardas and M. M. Ahmad
8 Stress Health 31:5–12 (2015) © 2013 John Wiley & Sons, Ltd.

examined coping as a moderator and mediator in the
relationship between stress and QoL among parentsof children with autistic disorder. In this study, medi-ated and moderated models were examined to explorethe role of coping in the relationship between stressand QoL.
The results of this study showed that accepting
responsibility was the only mediator strategy in therelationship between stress and QoL among parentsof children with autistic disorder. The other seven typesof coping did not show a mediating effect. This indi-
cates that only accepting responsibility was able to
explain the relationship between stress and QoL amongthe parents. According to Folkman and Lazarus (1988),
accepting responsibility entails the acknowledgment ofone's contribution to the problem and trying to correctthe situation. In this study, it can be inferred thataccepting responsibilities for the problems that parentsface due to having a child with autistic disorder canexplain the higher levels of QoL they reported.Accepting responsibility does not entail that parentsshould believe that the problems they have are theirfault, rather what this means is that parents need toaccept that they have the problem and they are the only
ones who can fully determine the outcome. By taking
responsibility for their life problems, parents will findTable III. Hierarchical regression testing for coping strategies as mediators
Steps Independent variables QoL
RR2t β Significance
1 Stress 0.608 0.370 /C010.332 /C00.608 0.001
2 Stress 0.619 0.383 /C08.551 /C00.552 0.001
Escape avoidance /C02.007 /C00.139 0.046
1 Stress 0.608 0.370 /C010.332 /C00.608 0.001
2 Stress 0.610 0.372 /C09.541 /C00.593 0.001
Accepting responsibility /C00.739 /C00.046 0.461
Figure 1 Accepting responsibility as mediator between stress and QoL. Note : The coef ficient/C00.05 represents the strength of linear
association between QoL and stress when accepting responsibility is controlled by including it as another predictor of QoL; the coef ficient
/C00.59 represents the linear association between QoL and stress when accepting responsibility is not statistically controlled
Figure 2 Coping strategies as moderators in the association between stress and QoLL. A. Dardas and M. M. Ahmad Coping Strategies as Mediators and Moderators
9 Stress Health 31:5–12 (2015) © 2013 John Wiley & Sons, Ltd.

a greater sense of control and will quickly progress in
recovery rather than dwelling on the past or blamingthe problem on an outside factor. The results indicatethat accepting responsibilities need to be encouragedthrough equipping parents with the needed skills andsupport services that could help them adapt with theirresponsibilities and develop positive outcomes for theiracceptance. The results also further support inves-tigation of the role that coping strategies play in therelationship between stress and QoL.On the other hand, the result so ft h i ss t u d ys h o w e dt h a t
only seeking social support and escape avoidance weremoderator strategies in the relationship between stressand QoL among parents of children with autistic disorder.All other coping strategies did not show moderating effectbetween stress and QoL. Given the dif ficulty of detecting
moderator effects in non-experimental studies, interac-tions between stress and seeking social support explained1.7%, as well as stress and escape avoidance explained2.3% of the variance, which can be meaningful (Yip,R o w l i n s o n ,&S i u ,2 0 0 8 ) .T h i si n d i c a t e st h a tw h e np a r e n t sof children with autistic disorder use more seeking socialsupport or escape avoidance coping strategies to alterstressful encounters, these s t r a t e g i e sa r ea b l et oi m –
prove signi ficantly the QoL of the parents. In contrast
to Kashdana, Barriosb, Forsyth, and Stegerc (2006)and Hastings et al. (2005) who reported that avoidancestrategy has been linked to increases in intrusivethoughts, anxiety and depression, our study foundescape avoidance as a buffer for stress. It is important
to note that although avoidance strategy may be help-
ful in the short term (Heckman et al., 2004), it is foundto adversely affect the mental health of individualswhen used on the long run when dealing with chronicstressors such as raising a ch ild with a lifelong disa-
bility (Holahan, Moos, & Bonin, 2004). Since peoplewho do not deal with their stressors directly are morelikely to suffer health problems, researchers believethat avoidance coping strategy is not as ef ficient as
confrontive strategies (Folkman & Moskowitz, 2004;Lazarus & Folkman, 1984).
Regarding seeking social support, the result was
consistent with the logical interpretation and previousfindings in reducing stress. McCubbin and Patterson's
(1983) viewed seeking social support to be the mostimportant for parents experiencing stress. Gray (2006)supported this finding and reported that seeking social
support is one of the popular effective strategies thatparents of children with autistic disorder use whendealing with their stressors. Moreover, McConkey,Truesdale-Kennedy, Chang, Jarrah, and Shukri (2008)reported that families in different cultures utilize differ-ent coping strategies when caring for a child with chronicdisability. The sample of this study was in part from theArab world. Arabs are united in a shared culture that isconsidered substantially different from their westerncounterparts (Retso, 2002). According to Fakhr El-Islam(2008), many educational, economic and cultural factorsaffect mental health perceptions and practices in theArab world. Social support is considered a valued Arabictradition that plays a prophylactic role in the develop-ment of mental health problems. The extended familysystem in the traditional Arab cultures was found to
significantly help individuals deal with their life stressors
(Fakhr El-Islam, 2008; Kandel, Morad, Vardi, Press, &Merrick, 2004). This explanation may also be supportedby the fact that the vast majority of the parents (96.7%)were married.Table IV. Moderated model regression analyses for the eight
coping strategies (QoL is dependent variable)
Steps R2β T
1 Stress 0.384 /C00.607 /C010.409***
Positive reappraisal 0.120 2.059*
2 Stress 0.386 /C00.612 /C010.391***
Positive reappraisal 0.118 2.017*
Stress × Positive reappraisal 0.039 0.662
1 Stress 0.370 /C00.609 /C010.227***
Confrontive coping 0.008 0.130
2 Stress 0.377 /C00.988 /C03.603***
Confrontive coping /C00.483 /C01.373
Stress × Confrontive coping 0.664 1.416
1 Stress 0.398 /C00.584 /C010.042***
Planful problem solving /C00.171 2.938**
2 Stress 0.402 /C00.851 /C03.327***
Planful problem solving /C00.126 /C00.444
Stress × Planful problem
solving0.376 1.071
1 Stress 0.374 /C00.609 /C010.351***
Seeking social support 0.065 1.099
2 Stress 0.391 /C01.265 /C04.207***
Seeking social support /C00.736 /C02.019*
Stress × Seeking social support 1.050 2.225*
1 Stress 0.382 /C00.616 /C010.506***
Distancing 0.109 1.861
2 Stress 0.382 /C00.500 /C02.210*
Distancing 0.263 0.885Stress × Distancing /C00.202 /C00.529
1 Stress 0.371 /C00.612 /C010.339***
Self-control 0.042 0.707
2 Stress 0.374 /C00.914 /C02.658**
Self-control /C00.247 /C0
0.750
Stress × Self-control 0.440 0.891
1 Stress 0.383 /C00.552 /C08.551***
Escape avoidance /C00.130 /C02.007*
2 Stress 0.406 /C01.033 /C05.263***
Escape avoidance /C00.863 /C02.970**
Stress × Escape avoidance 1.045 2.587**
1 Stress 0.372 /C00.593 /C09.541***
Accepting responsibility /C00.046 /C00.739
2 Stress 0.373 /C00.732 /C03.579***
Accepting responsibility /C00.241 /C00.858
Stress × Accepting responsibility 0.277 0.712
*P≤0.05, ** P≤0.01, *** P≤0.001.Coping Strategies as Mediators and Moderators L. A. Dardas and M. M. Ahmad
10 Stress Health 31:5–12 (2015) © 2013 John Wiley & Sons, Ltd.

Confrontive coping, planful problem solving, self-
controlling and positive reappraisal coping strategiesdid not show any mediation or moderation effect inthe relationship between parental stress and QoL. It isworth noting that the mentioned strategies were amongthe most commonly used strategies by the parents.However, it had no effect on the relationship betweentheir perceived parental stress and QoL. These findings
warrant further investigations for the actual applicationof coping and the meaning that coping has for the par-ents. For example, confrontive coping includes fighting
for what is wanted, expressing anger to the cause of theproblem and letting feelings out somehow (Folkman &Lazarus, 1988). Failure to employ confrontive coping inan adaptive style can lead to adverse effects and higherlevels of parental stress.
On the other hand, distancing coping was the least
reported parental coping strategy in this study andshowed no effect on the relationship between parentalstress and QoL. Although distancing coping, which
was de fined by Folkman and Lazarus (1988) as under-
taking cognitive efforts to detach oneself from a stress-ful situation and minimize its signi ficance, was found
to be correlated with negative outcomes (Smith et al.,2008), it has been argued by some researchers thatdistancing is considered a signi ficant moderator in the
relationship between stressors and mental health(Dunn, Burbine, Bowers, & Tantleff-Dunn, 2001;Sivberg, 2002). In other words, for parents of childrenwith chronic disabilities (e.g. autistic disorder), beingunable to detach themselves from their children-relatedproblems may lead to exaggerate their distress and as aresult negatively affect their mental health. Therefore, itmay be bene ficial to encourage parents with chronic
stressors to distance themselves appropriately fromtheir stress-provoking situations. In this study, havingdistancing the least reported coping strategy with noeffects on the relationship between parental stress andQoL may indicate that parents are enmeshed in theirrelationship with their children with autistic disorderand, as such, are at high risk for developing negativeoutcomes for their parenting experience.
Another area in this study deserving special conside-
ration is related to gender differences in regard to copingreactions to life stressors. Discussion on gender-relatedissues is unsettled. Research on gender and coping hastraditionally assumed that men and women perceivestressors similarly. In addition, the traditional perceptionwas that men are more likely to suppress their feelings,whereas women are more likely to vent their feelingsand use social support as a means of dealing with theirdistress. However, this assumption was refuted by Lazarus(1996) who reported that men and women do not
experience the same problems when exposed to the same
stressful life events. Lazarus also maintained that differen-ces in the coping strategies used by men and women arerelated to the different roles they assume in their societiesand cultures, and not to their gender per se. Therefore, inthis study, we considered mothers and fathers together
rather than separately as we were unable to identify thedifferent roles and responsibilities that the fathers andmothers actually assumed.
Referring to the Lazarus and Folkman model (1984),
the relative use of coping strategies varies signi ficantly
among individuals. The stress coping process isinfluenced by antecedent person characteristics and en-
vironmental variables (Folkman & Lazarus, 1988). Inaddition, Gray (2006) argued that coping amongparents of children with autistic disorder appears tobe a complex process incorporating a variety of strate-gies that change over time. Thus, although correlationsbetween stress and most coping strategies were low inthis study, it is possible that personality characteristicsinfluenced this relationship. It is also possible that
events that would be perceived as stressors for someindividuals were irrelevant events for others.
Implications, limitations and
recommendations
One should consider variations in coping strategies
among individuals across cultures. In particular, healthprofessionals and researchers should be alerted aboutmaking false generalizations that are not based onspecific research findings in a speci fic culture. The
results of this study also indicate that professionalswho work with parents of children with autistic disor-der need to be aware of the coping strategies that theparents use to deal with the demands of parentingand the associations between coping, and parentalstress and mental health. The focus need to be onincreasing their use of healthy coping, perhaps byenhancing positive perceptions and acceptance ofraising a child with autistic disorder. In addition, healthprofessionals need to provide parents of children withautistic disorder with adequate formal support. Thiswould be especially bene ficial in developing countries
where formal support is almost nonexistent.
There are some methodological issues that should be
considered when interpreting the results of this study.The psychometric properties of the PSI-SF werepreviously examined in parents of children with typicaldevelopment. Thus, findings related to this measure
should be carried with caution when it is used acrosspopulations with pervasive chronic disabilities. Further,considering the limitations associated with the use ofmeditational analyses in cross-sectional samples, werecommend replicating this study in a variety ofdistressed samples using longitudinal designs. The sampleof this study was convenience; nevertheless, the heteroge-n e i t ya n dt h es i z eo ft h es a m p l ea r ea s s u m e dt ob e
strength for the purpose of the analyses. However, it is
recommended for future studies in this field to follow
the probability sampling. It is also noteworthy to considerthe sensitivity of the measures when carrying out cross-cultural research.
L. A. Dardas and M. M. Ahmad Coping Strategies as Mediators and Moderators
11 Stress Health 31:5–12 (2015) © 2013 John Wiley & Sons, Ltd.

Acknowledgment
The authors acknowledge the partial funding for this
study provided by The University of Jordan.
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