Comparative Analysis of Parental Mental Health and Quality of Life Based on Birth Order of Children with Autism

Abstract

Autism Spectrum Disorder (ASD) imposes a substantial and prolonged psychological burden on parents, which may vary with the child’s position in the family. This study aimed to determine the association between the birth order of children with ASD and the mental health and quality of life (QoL) of their parents. This cross-sectional study was conducted over three months at child therapy centers in Karachi, Pakistan. A total of 101 parents of children with ASD were recruited through purposive non-probability sampling. Data were collected using a structured questionnaire comprising demographic variables, the Depression Anxiety Stress Scale-21 (DASS-21) and the WHO QoL-BREF (WHOQOL-BREF). The association between birth order and parental outcomes was examined using the chi-square test, with p≤0.05 considered statistically significant. Of the 101 participants, 59.4% were females and 47.5% were aged 30–39 years. First-born children with ASD constituted the largest group (37.6%). Birth order was significantly associated with parental depression, anxiety, stress and QoL (p<0.001 for each). Parents of first-born children reported the highest rates of extremely severe depression (57.9%) and anxiety (76.3%), 73.7% reported severe or extremely severe stress, and 78.9% reported poor QoL. In contrast, 90.9% of parents of fourth-born or later children reported good QoL. The birth order of children with ASD is significantly associated with parental mental health and QoL, with parents of first-born children being the most vulnerable. Routine mental health screening and targeted, family-centered support for parents of first-born children with ASD are recommended.