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Challenges to Rearing a Child with DSD: Mothers Are at Greatest Risk
Cortney Wolfe-Christensen, PhD1, Elizabeth Molzon, MS2, David A. Fedele, PhD3, Larry L. Mullins, PhD2, Yegappan Lakshmanan, MD1, Amy B. Wisniewski, PhD4.
1Children's Hospital of Michigan, Detroit, MI, USA, 2Oklahoma State University, Stillwater, OK, USA, 3Brown University, Providence, RI, USA, 4University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.

BACKGROUND:
Caregivers of children with a Disorder of Sex Development (DSD) are an understudied and often overlooked population. We previously reported that male and female caregivers respond differently to decisions around genitoplasty, and that caregivers of undermasculinized males were at greatest risk for depressive symptoms. The current study sought to examine differences in parenting variables and mental health outcomes in male and female caregivers of children with a DSD.
METHODS:
Caregivers of children with a DSD were recruited through six multidisciplinary clinics that specialize in treatment of these children. Additionally, some caregivers were recruited through national support groups for families of children with DSDs. The caregivers completed the Parental Protection Scale (PPS), which assesses level of parental overprotection (OP), Parenting Stress Index - Short Form (PSI), which assesses level of parental stress (PS), Child Vulnerability Scale (CVS), which measures level of perceived vulnerability of their child, the caregivers levels of depressive and anxious symptoms were assessed using the Beck Depression Inventory - 2nd Edition (BDI-2) and Beck Anxiety Inventory (BAI), respectively.
RESULTS:
One hundred and thirty-five caregivers (95 Females, 40 Males) of 92 children with a DSD (sex of rearing: 66 female, 26 male) participated in the study. They ranged in age from 19 - 68 years old (M = 35.73 + 8.71) and the majority reported being married (95/135, 71.9%) and self-identified as Caucasian (106/135, 78.5%). A MANCOVA, comparing male vs. female caregivers, while controlling for child age, caregiver education level, and annual household income, was conducted with total scores from the measures as the dependent variables. The overall model was significant (F(7,115)=2.39, p=.025). Post-hoc comparisons revealed that, compared to male caregivers, female caregivers had significantly higher levels of parenting stress related to personal distress (p=.033), overprotective behavior (p=.030), perceptions of child vulnerability (p=.037), and depressive symptoms (p=.002). No differences emerged with regard to overall parenting stress or level of anxious symptoms.
CONCLUSIONS:
Female caregivers of children with a DSD are at increased risk for maladaptive parenting strategies and poorer mental health outcomes, as compared to male caregivers. Previous research suggests that these parenting variables can indirectly affect child functioning. As such, family-based interventions are critical for this population.


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