The Effects of Stress, Social Support, Experience of Shame, and Loss of Face on Mental Health of Chinese Immigrant Mothers of Children with Developmental Disabilities in Canada

Effects of Stress, Social Support, Experience of Shame, Loss of Face and Mental Health on Chinese Immigrant Mothers of Children with Developmental Disabilities in Canada




Chinese Immigrant Mothers, Developmental disabilities, Stress, Social support, Shame, Depression


Social factors such as stress and social support impact mental health and might be associated with cultural factors such as feelings of shame and loss of face. Methods: This quantitative study examined sixty-five Chinese immigrant mothers of children with developmental disabilities (DDs) from the Great Toronto Area in Canada. Data was gathered through the following scales: Parental Stress Index-short Form, Oslo Social Support scale, Experience of Shame Scale, Loss of Face Questionnaire, Social Interaction Anxiety Scale and Social Phobia Scale, Center for Epidemiologic Studies Short Depression Scale, and General Self-efficacy Scale. Findings: Correlational analyses confirmed that shame was positively correlated significantly with loss of face (r=.43**), social anxiety (r=.62**), social phobia (r=.38**), and depression (r=.66**). Social support was negatively correlated significantly with depression (r=-.28**), self-efficacy was negatively correlated with social phobia (r=-.21**). Loss of face was positively correlated significantly with anxiety (r=.36**) and depression (r=.43**). Regression analyses indicated that shame (Z= 4.44***) and loss of face (Z= 2.36*) were the strongest mediators of effects of anxiety on mothers’ depression. Discussion: Implications are discussed with regard to providing efficient services for the families with their specific cultural backgrounds and optimizing their mental health and well-being. Conclusions: These empirical findings confirmed that Chinese immigrant mothers of children with DDs experienced more depression, when they had more feelings of shame, loss of face, and anxieties. This study highlighted the impact of social and cultural factors on the mental health of Chinese immigrant mothers of children with DDs.


Abidin, R. R. (1995). Manual for the Parenting Stress Index. Odessa, FL: Psychological Assessment Resources.

Ahmed, A., Stewart, E. D., Teng, L., Wahoush, O., & Gagnon, J. A. (2008). Experiences of immigrant new mothers with symptoms of depression. Archives of women's mental health, 11(4), 295-303. DOI:

Allik, H., Larson, J.O., & Smedje, H. (2006). Health-related quality of life in parents of school- age children with Asperger syndrome or high-functioning autism. Health and Quality of Life Outcomes, 4, 1–8. DOI:

Andrews, B., Qian, M., & Valentine, J. (2002). Predicting depressive symptoms with a new measure of shame: The experience of shame scale. British Journal of Clinical Psychology, 41, 29–42. DOI:

Ardelt, M., & Eccles, J. S. (2001). Effects of mothers’ parental efficacy beliefs and promotive

parenting strategies on inner-city youth. Journal of Family Issues, 22, 944-972.

Armstrong, M. I., Birnie-Lefcovitch, S., & Ungar, M. T. (2005). Pathways between social support, family well-being, quality of parenting, and child resilience: What we know. Journal of Child and Family Studies, 14, 269-281. DOI:

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191-215. DOI:

Bandura, A. (1997). Self-efficacy: The exercise of control. New York: Freeman.

Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic and statistical considerations. Journal of Personality and Social Psychology, 51, 1173-1182. DOI:

Bedford, O. & Hwang, K. (2003). Guilt and shame in Chinese Culture: a cross-cultural framework from the perspective of morality and identity. Journal for Theory of Social Behaviour, 33(2), 127-144. DOI:

Bhugra, D. (2004). Migration, distress, and cultural identity. British Medical Bulletin, 69, 129- DOI:

Bitsika, V. & Sharpley, C. F. (2004). Stress, anxiety and depression among parents of children with autism spectrum disorder. Australian Journal of Guidance and Counselling, 14(2), 151-161. DOI:

Bromley, J., Harem J. D., & Davison, K. (2004). Mothers supporting children with autistic spectrum disorders. Social Support, Mental Health Status and Satisfaction with Services, 8(4), 409-423. DOI:

Canary, H. E. (2008). Creating supportive connections: A decade of research on support for families of children with disabilities. Health Communication, 23(5), 413-426. DOI:

Citizenship and Immigration Canada (2017). Population profile: Syrian refugees. Ottawa, ON: Citizenship and Immigration Canada; 2015. Available from:

Cunningham, M. R., & Barbee, A. P. (2000). Social support. In C. Hendrick & S. S. Hendrick (Eds.), Close relationships: A sourcebook (pp. 272–285). Thousand Oaks, CA: Sage. DOI:

DeLambo, D., Chung, W., & Huang, W. (2011). Stress and age: A comparison of Asian American and non-Asian American parents of children with developmental disabilities. Journal of Developmental and Physical Disabilities, 23(2), 129-141. DOI:

Dinh, K., & Nguyen, H. (2006). The effects of acculturative variables on Asian American parent child relationships. Journal of Social and Personal Relationships, 23, 407-426. DOI:

Dowling, M., & Dolan, L. (2001). Families with children with disabilities: Inequalities and social model. Disability and Society, 16(1), 21-35. DOI:

Dowrick, C., Casey, P., Dalgard, O., Hosman, C., Lehtinen, V., Vazquez- Barquero, J. L., & Wilkinson, G. (1998). The outcome of depression international network (ODIN). Background, methods and field trials. British Journal Psychiatry, 172, 359-363. DOI:

Dunn, M. E., Burbine, T., Bowers, C. A., & Tantleff-Dunn, S. (2001). Moderators of stress in

parents of children with autism. Community Mental Health Journal, 37, 39-52.

Dunst, C. J., Trivette, C. M., & Hamby, D. W. (2007). Meta-analysis of family-centered help giving practices research. Mental Retardation and Developmental Disabilities Research Reviews, 13, 370-378. DOI:

Durking, M. (2002). The epidemiology of developmental disabilities in low-income countries. Mental Retard Developmental Disabilities, 8(3), 206-211. DOI:

Emerson, E. (2003). Mothers of children and adolescents with intellectual disability: Social and economic situation, mental health status, and self-assessed social andpsychological impact of the child’s difficulties. Journal of Intellectual Disability DOI:

Research, 47, 385-399.

Fields, M. A. (2006). Parenting children on the autistic spectrum: A survey of parents' perceived self-efficacy (Doctoral dissertation). Available from ProQuest Dissertations & Theses Global. (304968971).

theses/parenting-children-on-autistic spectrum-survey/docview/304968971/se-2

Folkman, S. (2013). Stress: Appraisal and Coping. In: Gellman M.D., Turner J.R. (eds). Encyclopedia of Behavioral Medicine. Springer, New York, NY. DOI:

Fuligni, A. J., & Pedersen, S. (2002). Family obligation and the transition to young adulthood. Developmental Psychology, 38(5), 856-868. DOI:

Ghosh, S., & Magana, S. (2009). Chapter 6 a rich mosaic. Emerging research on Asian families of persons with intellectual and developmental disabilities. International Review of Research in Mental Retardation, 37(Families), 179-212. DOI:

Grote, N. K., Bledsoe, S. E., Swartz, H. A., & Frank, E. (2004). Feasibility of providing culturally relevant, brief interpersonal psychotherapy for antenatal depression in an obstetrics clinic: A pilot study. Research on Social Work Practice, 14, 397–407. DOI:

Hastings, R. P. (2003). Child behaviour problems and partner mental health as correlates of stress in mothers and fathers of children with autism. Journal of Intellectual Disability Research, 47(4-5), 231-237. DOI:

Hechanova, R., & Waelde, L. (2017). The influence of culture on disaster mental health and psychosocial support interventions in Southeast Asia. Mental Health Religion Cult, 20, 31–44. DOI:

Heerman, W. J., Taylor, J. L., Wallston, K. A., Barkin, S. L. (2017). Parenting self-efficacy, parent depression, and healthy childhood behaviors in a low-income minority population: A cross-sectional analysis. Journal of Maternal Child Health, 21(5), 1156-1165. DOI:

Hernandez-Plaza, S., Alonso-Morillejo, E. & Pozo-Munoz, C. (2006). Social support interventions in migrant populations. British Journal of Social Work, 36(7), 1151-1169. DOI:

Ho, D. Y., Fu, W., & Ng, M. S. (2004). Guilt, Shame, and Embarrassment: Revelations of face and self. Culture and Psychology, 10(1), 64-84. DOI:

Holroyd, E.E. (2003). Chinese cultural influences on parental caregiving obligations toward children with disabilities. Qualitative Health Research, 13(1), 4 -19. DOI:

Hon, C., Sun, P., Suto, M., J., & Forwell, S. (2011). Moving from China to Canada: Occupational transitions of immigrant mothers of children with special needs. Journal of Occupational Science, 18(3), 223-236. DOI:

Huang, Y. P., Kellett, U. M. & St. John, W. (2010). Crebral palsy: experiences of mothers after learning their child’s diagnosis. Journal of Advanced Nursing, 66(6), 1213-1221. DOI:

Jennings. J., Khanlou, N., & Su, C. (2014). Public health policy and social support for immigrant mothers raising disabled children in Canada. Disability and Society, 29(10), 1645-1657. DOI:

Johnson, C.S., Bacsu, J., McIntosh, T., Jeffery, B., & Novik, N. (2017). Addressing social isolation among immigrant and refugee seniors: Environmental scan of programs and services in Canada. Regina, SK: Saskatchewan Population Health and Evaluation Research Unit, University of Regina and University of Saskatchewan. Scan_18June 2017final.pdf

Khanlou, N., Haque N., Mustafa1, N., Vazquez, L. M., Mantini, A., & Weiss, J. (2017). Access Barriers to Services by Immigrant Mothers of Children with Autism in Canada. International Journal of Mental Health Addiction, 15(2), 239-259. DOI:

Khanlou, N., Haque, N., Sheehan, S., & Jones, G. (2016). It is an issue of not knowing where to go: service providers’ perspectives on challenges in accessing social support and services by immigrant mothers of children with disabilities. Journal of Immigrant and Minority Health. 17, 1840-1847. DOI:

Khanlou, N., Mustafa, N., Vazquez, L. M., Haque, N., & Yoshida, K. (2015). Stressors and barriers to services for immigrant fathers raising children with developmental disabilities. International Journal of Mental Health & Addiction, 13, 659- 674. DOI:

Kilbride, K. M. (2000). A Review of the Literature on the Human, Social and Cultural Capital of Immigrant Children and Their Families with Implications for Teacher Education. CERIS Working Paper Series No. 13. Toronto: Joint Centre of Excellence for Research on Immigration and Settlement.

Kraemer H. C., & Blasey, C. M. (2004). Centring in regression analyses: a strategy to prevent errors in statistical inference. International Journal Methods Psychiatric Research, 13(3),141-51. DOI:

Kramer, E., Kwong, K., Lee, E., & Chung, H. (2002). Cultural factors influencing the mental health of Asian Americans. Western Journal of Meditation, 176(4), 227 – 231.

Lai, A. (2006). Eye on religion: Cultural signs and caring for Chinese patients. Southern Medical Journal, 99(6), 688-689. DOI:

Lai, Y. & Hynie, M. (2010). Community engagement and well-being of immigrants: The role of knowledge. Canadian Issues, 93 - 97.

Lai, Y., & Ishiyama, F. I. (2004). Involvement of immigrant Chinese Canadian mothers of children with disabilities. Exceptional Children, 71(1), 97-108. DOI:

Lamb, M. E. (2010). The role of the father in child development (5th ed.). Hoboken, NJ: John Wiley & Sons.

Leinonen, J. A. (2002). Social support and the quality of parenting under economic pressure and workload in Finland: The role of family structure and parental gender. Family Psychology, 17(3), 409-418. DOI:

Li, B., Qian, M., & Zhong, J. (2005). A shame mediated model of social anxiety in college students (in Chinese). Chinese Mental Health Journal, 19, 304–306.

Liamputtong, P. (2001). Motherhood and the Challenge of Immigrant Mothers: a personal reflection. Families in Society, 82(2), 195-201. DOI:

Liddy, C., Moroz, I., Ewan A., Boulay E., Cook S., Crowe, L., et al. (2020). How long are Canadians waiting to access specialty care? Retrospective study from a primary care perspective. Canadian Family Physician, 66(6), 434-444.

Lim, J., & Zebrack, B. (2004). Caring for family members with chronic physical illness: A critical review of caregiver literature. Health and Quality of Life Outcomes, 2, 50-59. DOI:

Liu, G. Z. (2001). Chinese culture and disability: information for U.S. service providers. Retrieved September 15, 2010, from

Luszczynska, A., Scholz, U., & Schwarzer, R. (2005). The general self-efficacy scale: Multicultural validation studies. The Journal of Psychology Interdisciplinary and Applied, 139(5), 439-457. DOI:

Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455-470. DOI:

McCabe, H. (2007) Parent advocacy in the face of adversity: autism and families in the People's Republic of China. Focus on Autism and Other Developmental Disabilities. 22(1), 39-50. DOI:

Meirsschaut, M., Roeyers, H., & Warreyn, P. (2010). Parenting in families with a child with autism spectrum disorder and a typically developing child: Mothers' experiences and cognitions. Research in Autism Spectrum Disorders, 4, 661-669. DOI:

Murphy, N. A., Christian, B., Caplin, D. A., & Young, P. C. (2006). The health of caregivers for children with disabilities: Caregiver perspectives. Child Care Health and Development, 33(2), 180–187. DOI:

Nangia, P. (2013). Discrimination Experienced by Landed Immigrants in Canada. Nangia_No_2013_7.pdf

Naseef, R. A. (2001). Special children. Challenged parents. The struggles and rewards of raising a child with a disability. Baltimore: Paul H. Brookes.

Ones, K., Yilmaz, E., Cetinkava, B., & Caglar, N. (2005). Assessment of the Quality of Life of Mothers of Children with Cerebral Palsy (Primary Caregivers). Neurorehabilitation & Neural Repair, 19(3), 232-237. DOI:

Padden, C., & James, E. J. (2017). Stress among parents of children with and without autism spectrum disorder: A comparison involving physiological indicators and parent self-reports. Journal of Developmental and Physical Disabilities, 29(4), 567-586. DOI:

Papp, A. (2017). Work: Culture conflicts in the workplace.


Qian, M., Andrews, B., Zhu, R., & Wang, A. (2000). The development of Shame Scale of Chinese college students. Chinese Mental Health Journal, 14, 217-221.

Quian, M. N. (2012). Child Functioning, Parent Coping Strategies and Parent Mental Health Outcomes in Families with Children with Developmental Disabilities.

Radloff, L. S. (1977) The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401. DOI:

Ramzan, N., & Minhas, K. (2014). Anxiety and depression in mothers of disabled and non-disabled children. Annals of King Edward Medical University, 20(4), 313-320.

Rezendes, L.D. & Scarpa, A. (2011). Associations between Parental Anxiety/Depression and Behavior Problems Related to Autism Spectrum Disorders: The Roles of Parenting Stress and Parenting Self-Efficacy. Autism Research and Treatment. Journal of Maternal Child Health, 21(5), 1156-1165. DOI:

Riggio, N. R., & Avalos, B. I. (2017). Parenting challenges and resilience of Latino immigrant parents. Electronic Theses, Projects, and Dissertations, 469. Retrieved from http://schol arwor

Rutgers, A., van IJzendoorn, M., Bakermans-Kranenburg, M., Swinkels, S., van Daalen, E., Dietz, C., & van Engeland, H. (2007). Autism, attachment and parenting: A comparison of children with autism spectrum disorder, mental retardation, language disorder, and non-clinical children. Journal of Abnormal Child Psychology, 35, 859- 870. DOI:

Schwarzer, R., & Jerusalem, M. (1995). Generalized Self-Efficacy scale. In J. Weinman, S. Wright, & M. Johnston, Measures in health psychology: A user’s portfolio. Causal and control beliefs (pp. 35-37). Windsor, UK: NFER-NELSON. DOI:

Shumow, L., & Lomax, R. (2002). Parental efficacy: Predictor of parenting behavior and 103 adolescent outcomes. Parenting: Science & Practice, 2, 127-151. DOI:

Simich, L., Beiser, M., Stewart, M., & Mwakarimba, E. (2005). Providing Social Support for Immigrants and Refugees in Canada: Challenges and Directions. Journal of immigrant Health, 7, 259-268. DOI:

Simich, L., Mawani, F., Wu, F., & Noor, A. (2004). Meanings of social support, coping, and help-seeking strategies among immigrants and refugees in Toronto. Toronto: University of Toronto.

Small, R. P. (2010). A Comparison of parental self-efficacy, parenting satisfaction, and other factors between single mothers with and without children with developmental disabilities. Wayne State University Dissertations.

Smart, K. L. (2016). Parenting Self-Efficacy in Parents of Children with Autism Spectrum Disorders.

Smith, A., & Grzywacz, J. (2014). Health and Well-being in Midlife Parents of Children with Special Health Needs. Family System Health, 32(3), 303–312. DOI:

Statistics Canada (2016). 150 Years of immigration in Canada. Ottawa, ON: Statistics Canada.

Su, C., & Hynie, M. (2011). Effects of Life Stress, Social Support and Cultural Norms on Parenting Styles among Mainland Chinese, European-Canadian and Chinese-Canadian Immigrant Mothers. Journal of Cross-cultural Psychology, 42(6), 945-963. DOI:

Su, C., Khanlou, N., & Mustafa, N. (2018). Chinese immigrant mothers of children with developmental disabilities: Stressors and social support. International Journal of Mental Health Addiction. DOI:

Sue, S., & Morishima, J. K. (1982). The Mental Health of Asian Americans. San Francisco, CA: Jossey-Bass.

Surkan, P. J., Peterson, K. E., Hughes, M, D., & Gottlieb, B. R. (2006). The role of social networks and support in postpartum women’s depression: a multiethnic urban sample. Journal of Maternal Child Health, 10, 375– 383. DOI:

Tang, T. N., Oatley, K., & Toner, B. B. (2007). Impact of life events and difficulties on the mental health of Chinese immigrant women. Journal of Immigration and Minority Health, 9(4), 281–290. DOI:

Tews, L., & Merali, N. (2008). Helping Chinese parents understand and support children with learning disabilities. Professional Psychology, 39(2) 137-144. DOI:

Wang, W. C. (2016). Social support and parental stress among parents of young children with autism spectrum disorder: An international comparison of United States and China.

Warren, J. S., Brown, C. R., Layne, C. M., & Nelson, P. L. (2011). Parenting self-efficacy as a predictor of child psychotherapy outcomes in usual care: A multi-dimensional approach. Psychotherapy Research, 21(1), 112-123. DOI:

Wayland, V. S. (2007). The Housing Needs of Immigrants and Refugees in Canada.

Weiss, M. J. (2002). Hardiness and social support as predictors of stress in mothers of typical children, children with autism and children with mental retardation. Autism, 6(1), 115–130. DOI:

Wright, L. (2014). New Canadians struggle with financial hurdles: report. Finding jobs, learning language and daily expenses big worries for immigrants.

Yin, H., Wardenaar, K., Xu, G., Tian, H., & Schoevers, A. R. (2020). Mental health stigma and mental health knowledge in Chinese population: a cross sectional study. BMC Psychiatry, 20, 323-332. DOI:

Zane, N. (2000). Loss of Face Scale. In Psychosocial measures for Asian Americans: Tools for practice and research. Retrieved from

Zhong, J., Li, B., & Qian, M. (2003). Shame, personality and mental health: an original structural

model research (in Chinese). Chinese of Mental Health Journal, 17, 31–35.




How to Cite

Su, C., & Khanlou, N. (2023). The Effects of Stress, Social Support, Experience of Shame, and Loss of Face on Mental Health of Chinese Immigrant Mothers of Children with Developmental Disabilities in Canada: Effects of Stress, Social Support, Experience of Shame, Loss of Face and Mental Health on Chinese Immigrant Mothers of Children with Developmental Disabilities in Canada . INYI Journal, 12(1).