Interpretability and clinical utility of the strength and stressors in parenting questionnaire

This study aimed to enhance the interpretability and clinical utility of the strength and stressors in parenting (SSF) questionnaire, a parent-reported questionnaire designed to assess strength, stress and associated risks of mental ill-health in parents of children with developmental disabilities. Responses to the SSF and a demographic questionnaire were collected from 576 parents of children with (n = 203) and without (n = 373) developmental disabilities. To enhance the interpretability of the SSF, a subset of 129 parents were invited to complete an additional questionnaire consisting of three free-text questions regarding recent help-seeking behavior, experiences of mental ill-health and experiences of parenthood. Parents' responses to the free-text questions were then categorized as indicative of higher or lower degrees of stress and compared to their SSF score distribution to derive empirical cut-offs for strength, stress and risk of mental ill-health as measured by the SSF. The credibility of these cut-offs was evaluated by comparing the cut-offs with SSF scores collected from the other 447 parents. Finally, SSF scores from parents of children without developmental disabilities (n = 373) were used to generate percentile values for the SSF to enable a standardized interpretation of SSF scores. To increase the utility of the SSF, we examined a recurring pattern of missing answers to items 23 and 33-38, noted in previous studies of the SSF and repeated in the present study. These items were excluded from further analysis since our examination revealed that they were not missing at random but rather constituted real differences in parental experiences, such as receiving a healthcare allowance, or caring for more than one child. The proposed empirical cut-offs performed well in discriminating between the two groups and yielded a specificity of 77-89% and a sensitivity of 68-76% for the strength, stress and risk of mental ill-health subscales of the SSF. This study also presents a conversion chart associating each SSF score with a corresponding percentile value. We propose modifications to the SSF, whereby items 23 and 33-38 are excluded, which will enable a more reliable assessment of parental experiences. This will, together with the empirical cut-offs and percentile values, enhance the interpretability and clinical utility of the SSF.