Introduction

The coronavirus disease 2019 (COVID-19) outbreak has been an ongoing public health issue. Particularly, the prolonged preventive measures against COVID-19 (e.g., social distancing measures) upended the normal lives of Hong Kong general populations in the past few years (Chan et al., 2021). Previous research found that the prevalence of anxiety has elevated by 42.3%, and the stress level has increased by 28.3% among the Hong Kong populations amid COVID-19, compared with that prior to COVID-19 (Zhao et al., 2020). Similarly, the prevalence of severe levels of psychological distress among the local population during COVID-19 was high at 12.8% (Chair et al., 2023). Those indicated that COVID-19 pandemic has been highly stressful for Hong Kong populations.

Distress among parents of children with special educational needs amid COVID-19

COVID-19 has also disproportionately affected the physical and mental health of several vulnerable groups, including families with children having special educational needs (SEN) (Chan & Fung, 2022). In Hong Kong, there are more than 57,000 children with SEN, with a majority enrolling in the mainstream public sector schools (Hong Kong Annual Digest of Statistics, 2021). The major SEN types in Hong Kong include attention-deficit/ hyperactivity disorder (ADHD), autism spectrum disorders (ASD), speech and language impairment, specific learning difficulties, and other types of impairment (speech and language, hearing, visual), plus different types of disabilities (physical, intellectual) (Department of Health., 2022). Even in non-pandemic situations, it has been found that local parents of children with SEN commonly report high levels of psychological stress (Chan & Lam, 2018).

Recent research and anecdotal evidence further highlight the specific challenges faced by parents of children with SEN during pandemic situations. Families having children with SEN confined at home often did not have their specific needs catered due to social distancing measures (e.g., school closures) and online teaching at schools (Wong et al., 2021). Children with SEN (e.g., those with ADHD and ASD who usually thrive with predictability and routine) have been severely affected by school closures and the disruption of routine during the pandemic (Chan & Fung, 2022). During COVID-19, local parents of children with SEN have expressed worries about their children’s health (Chan & Fung, 2022) and academic progress (Wong et al., 2021). Those parents were also struggling to provide suitable and adequate learning environments at home settings and perceive difficulties to function as teachers and therapists to provide the academic and special needs of their children in the pandemic (Chan & Fung, 2022; Wong et al., 2021). However, empirical research on factors associated with those parents’ adjustment to the COVID-19 pandemic was still limited in the literature.

Applying the conservation of resources theory to examine factors associated with distress

The Conservation of Resources (COR) theory connects resources and distress, which postulates that stress could be resulted from circumstances involving threatened or actual loss of valued resources (Hobfoll, 1989). According to the theory, resources could be things that people value, including objects, conditions, and energies (Hobfoll, 1989). The theorist posits that people are enthusiastic about retaining, protecting, and gaining resources (Hobfoll, 1989). Notably, the potential or actual loss of resources is crucial in determining distress because the loss is more influential than the gain of resources (Hobfoll, 1989), implying that people prefer to protect their resources rather than obtain new ones. Therefore, it is common for people to preserve their limited resources and recover from the losses. However, people who have fewer resources are more vulnerable to losing resources, and such loss can subsequently cause further investment in resources, making the situation more susceptible to a loss cycle (Hobfoll, 1989). According to the COR theory, prolonged exposure to stressors could magnify the effect of actual or potential loss of resources, and cause the actual loss of resources, which could result in the depletion of emotional resources (Chwaszcz et al., 2021). The COR theory has been applicable to understand the relationship between loss of resources and psychological distress during COVID-19 (e.g., in an adult Jewish-Iraeli population) (Egozi Farkash et al., 2022). Given that the Hong Kong populations were subject to the loss of resources in different aspects (e.g., financial, family, social, control over future) due to the pandemic (Yu et al., 2023a, b), which were associated with poorer psychological well-being. Under the stressful pandemic and caregiving situations, we could expect that parents of children with SEN were also vulnerable to the loss of those resources and psychological distress (Ye et al., 2021). This study aimed to fill the knowledge gap in examining how perceptions of loss in different domains of resources might be associated with psychological distress among parents of children with SEN in Hong Kong.

Intrapersonal and interpersonal co** resources as contributors of distress

Parenting self-efficacy refers to parents’ perceived confidence and belief in fulfilling parenting responsibilities, involves adapting social, cultural, and emotional support in parenting (Chong & Kua, 2017). It has been found that parenting self-efficacy is associated with better psychological well-being among parents (Albanese et al., 2019). Similarly, a study conducted in the United States indicated that parenting self-efficacy was negatively associated with depression and anxiety symptoms among mothers of children with ASD (Rezendes & Scarpa, 2011). Under exposure to COVID-19-related stressors and disrupted support services in Hong Kong, how parenting self-efficacy would apply to parents of children with SEN still needs to be explored.

In addition to parents’ perceptions about their capabilities of parenting, resilience in the family could also contribute to parents’ well-being. Family resilience refers to the capacity of the family to maintain their function of withstanding (e.g., hel** the family endure the loss, accommodating the situations) and rebuilding in stressful events, such as COVID-19 (Walsh, 2020). A review found that family communication was crucial to family well-being during COVID-19, which allowed families to build trust and cohesion (Gayatri & Irawaty, 2022). Both in pandemic and non-pandemic contexts, it has been found that family communication is positively associated with quality of life (Chow et al., 2022) and negatively associated with depressive symptoms (Chan et al., 2021) among the general populations in Hong Kong. We therefore hypothesized that positive family communication dynamics could be protective for negative health outcomes among parents of children with SEN.

Co** strategies in association with distress

Moreover, people’s co** strategies are important determinants for adjustment outcomes during difficult situations (Freire et al., 2020). Co** can be cognitive and behavioral efforts to meet the distressing demands beyond the resources possessed by people (Freire et al., 2020). In a review, it has been found that parents of SEN tend to use more avoidance-focused co** strategies (e.g., distraction, self-blame) than parents of typical children; adoption of co** strategies (e.g., positive reframing, problem-solving) also are associated with parents’ psychological well-being and familial quality of life (Craig et al., 2020). In the local context of Hong Kong, a qualitative study identified that acceptance-based co** was commonly-used among parents of children with SEN, which reduced their emotional struggle and caregiving stressors (Wong & Wong, 2021).

On the other hand, parents of children with SEN might also be subject to stigmatization. A recent local study found that the level of self-stigmatization was associated with psychological distress among parents of children with SEN amid COVID-19 (Ye et al., 2021). Given that Chinese culture emphasizes social identity and interpersonal orientation (Chan & Lam, 2018), it would be worth examining whether self-blame contributes to psychological distress of those parents amid COVID-19. Previously, a recent study showed that acceptance co** was positively correlated with better psychological health, while self-blame co** showed an inverse relationship among the general population in Poland during COVID-19 (Chwaszcz et al., 2021). We would also like to see if the similar patterns of relationships were apparent among parents of children with SEN in Hong Kong.

Purpose of study and hypotheses

This study investigated the factors associated with psychological distress among Hong Kong parents of children with SEN amid the COVID-19 pandemic. We hypothesized that higher levels of perceived COVID-19-related resource losses and self-blame co**, plus lower levels of parenting self-efficacy, family communication, and acceptance co** would be associated with higher levels of psychological distress.

Method

Recruitment

This study was a cross-sectional design, using self-administered questionnaires for data collection. Inclusion criteria for the participants were (1) parents aged above 18 years, (2) who had a child with SEN, (3) Hong Kong residents, and (4) being able to speak and understand Chinese. The exclusion criteria were being illiterate, having a severe mental or physical illness that prevented completion of the questionnaire. Similar criteria have been used in other studies on caregivers of children with SEN in Hong Kong (Ye et al., 2021). Prospective participants were approached through social media and social workers’ networks, who could directly access the online questionnaire (operated by Qualtrics) by a web link. Before participation, prospective participants were required to read the information sheet and agree with the informed consent on the cover page. After giving the informed consent, they were asked to answer three questions about the inclusion criteria as mentioned above to screen for their eligibility. Eligible participants were then invited to complete the online questionnaire. All questions of the survey were conducted in Chinese. It took approximately 15 min to complete the questionnaire. Participants were compensated with grocery store vouchers (worth HK$70) upon completion. The protocol was approved by the Survey and Behavioral Research Ethics Committee of the authors’ affiliation (reference number: SBRE-21-0709A).

This study was conducted shortly after the pandemic between 3 February and 30 March 2023 (when most of the pandemic-control measures in Hong Kong were relaxed. Through the different sources, 278 individuals responded to the study invitation. Among those individuals, 25 were ineligible after screening, 100 did not complete a majority of the survey or provided contradictory answers, and 3 re-participated. Those participants (N-128) were excluded from the final sample, yielding a sample of 150 in the final analysis.

Measurements

Psychological Distress The 6-item Kessler Psychological Distress Scale (K6) was used to measure participants’ psychological distress (Lee et al., 2012). On a 5-point Likert scale (0 as never, 4 as all of the time), the participants rated how frequently they had the feeling listed in the statements over the past month (e.g., helpless; α = 0.89) (Lee et al., 2012). The sum of scores ranged from 0 to 24, with a cutoff score of 13 (Lee et al., 2012). The Chinese version of K6 has shown to be valid and reliable in a Hong Kong sample with excellent sensitivity and specificity (Lee et al., 2012).

Perceived Resource Loss due to COVID-19. The Conversation of Resources Scale-COVID-19 (COR-COVID-19) was used to measure participants’ perceived resource loss since COVID-19 (Yu et al., 2023b). Participants rated the extent of the resource losses since COVID-19 in the subscales Loss in Future Control (3 items, α = 0.88), Loss in Financial Resources (4 items, α = 0.90), and Loss in Fun (3 items, α = 0.67), on a 3-point Likert scale (1 as none, 3 as a loss to a great extent) (Yu et al., 2023b). Higher scores in each subscale indicated greater perceived resource loss of that subscale (Yu et al., 2023b). Regarding validity and reliability, the scale was associated with higher emotional distress among the general population in Hong Kong during COVID-19 (Yu et al., 2023b).

Parenting Self-Efficacy. The 5-item Brief Parental Self-Efficacy Scale (BPSES) was used to measure participants’ confidence in parenting among parents of SEN children (Woolgar et al., 2012). On a 5-point Likert scale (1 as strongly disagree, 5 as strongly agree), participants rated the extent of agreement on the parenting-related statements (e.g. ‘‘I can make an important difference to my child’’; α = 0.77) (Woolgar et al., 2012). Higher scores indicated higher perceived parental self-efficacy (Woolgar et al., 2012). Regarding validity and reliability, participants who indicated lower degrees of BPSES also indicated they had poorer mental health (Galpin et al., 2018).

Family Communication. The 8-item family communication and connectedness subscale of the Family Resilience Assessment Scale Short Form (FRS16) was used to measure participants’ communication with family (Chow et al., 2022). On a 4-point Likert scale (1 as strongly disagree, 4 as strongly agree), the participants indicated their agreement with the statements (e.g. ‘‘we can compromise when problems come up’’; α = 0.85) (Chow et al., 2022). Higher mean scores indicated higher levels of perceived family communication (Chow et al., 2022). Regarding validity and reliability, the FRS16 was associated with better quality of life among the population in mainland China (Chow et al., 2022).

Co** Strategies The Acceptance (2 items, α = 0.81) and Self-blame (2 items, α = 0.82) subscales of the Brief COPE Inventory (BCI) were used to measure participants’ cognitive co** strategies (Carver, 1997). On a 4-point Likert scale (1 as do not do this at all, 4 as do this a lot), participants indicated how frequently they used the strategies for co**. Higher mean scales indicated more frequent use of that strategy (Carver, 1997). Regarding the reliability, the acceptance subscale has a negative correlation with burnout among Chinese nurses during COVID-19 (Yeung et al., 2023), while self-blame showed a positive correlation with depression among Chinese caregivers of stroke survivors (Qiu & Li, 2008).

Socio-demographic and SEN-related variables. Participants’ socio-demographic information and their children’s SEN-context information (e.g., parents’ age, gender, marital status, monthly household income, education level and employment status, number of SEN children and types of SEN) were measured (Ye et al., 2021).

Analytic plan

The descriptive statistics and Pearson correlation coefficients among the variables of interest (including perceived resource loss due to COVID-19, parenting self-efficacy, family communication, acceptance, self-blame, and potential covariates) were computed. Pearson correlation analysis and hierarchical regression were conducted to investigate the associations between the independent variables and psychological distress. The reliabilities of instruments were shown by Cronbach’s alphas. In the hierarchical regression analysis, the variables were entered in different blocks. In Block 1, only the background variable(s) significantly associated with the dependent variable (p < .05) would be added as covariate(s) in the model. In Block 2, perceived resource losses (future control, financial resource, and fun) were added. Co** resources (parental self-efficacy and family communication) were added into Block 3. Lastly, co** strategies (acceptance and self-blame) were added to Block 4. The analyses were conducted with SPSS 28.0. Similar analytic strategies have been applied in other studies exploring adjustment outcomes among populations amid the COVID-19 pandemic (Yeung et al., 2023).

Sample size planning

As we expected to have a small-to-medium effect size (f2 = 0.12) in the association between the independent variables and psychological distress, based on prior studies (Chan & Fung, 2022; Ye et al., 2021), we required at least 134 participants to achieve a statistical power of 0.80 at alpha p = .05 (G*Power 3.1.9.6) in a hierarchical regression analysis. Our sample size (N = 150) could allow the detection of the aforementioned effect size with enough statistical power.

Results

Participants’ characteristics and SEN-related variables

Of the 150 valid responses, the average age of the participants was 40.44 years (SD = 6.85). The majority of the participants were women (90.7%). Most of them were married (84.0%). More than half of the participants received post-secondary college or above (58.0%). Nearly half of them were full-time employees (45.3%), followed by full-time caregivers (43.3%). The majority of the participants had only one child with SEN (73.3%). Most of them reported having exposure to multiple types of SEN (62.0%). Over half of the participants reported that their children had ASD (54.0%), followed by ADHD (51.3%) and speech impairment (38.0%) (Table 1).

Table 1 Respondents’ demographic characteristics and SEN-related characteristics (N = 150)
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Correlations among background variables, psychological variables, and psychological distress

Higher levels of perceived future loss, perceived financial resource loss, perceived fun loss and self-blame were correlated with higher levels of psychological distress (rs ranged from 0.24, p<.01  to 0.40, p < .001). Higher levels of family communication (r = − .33, p < .001) and acceptance (r = − 0.25, p < .01) were correlated with lower levels of psychological distress. However, parental self–efficacy (r = − 0.04) was not significantly correlated with psychological distress(p > .05; Table 2). Regarding background information, having children with different types of SEN was associated with psychological distress (r = 0.23, p < .01), which was then considered as a covariate in the regression analysis. Other sociodemographic and SEN-related variables did not report significant correlations with psychological distress (ps > 0.05, data not tabulated); thus, those background variables were not included as covariates in subsequent analysis.

Table 2 Descriptive statistics and correlations among independent variables and psychological distress (N = 150)
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Hierarchical regression analysis

The variance inflation factor (VIF) was used to check multicollinearity for independent variables in the hierarchical regression. Given that there was no variable reporting a VIF value ≥ 4, there was no problem of multicollinearity. In Block 1, the background variable (having exposure to multiple types of SEN) explained 5.4% of the variance in psychological distress (p < .01), which was positively associated with psychological distress (β = 0.23, p < .01). In Block 2, the three variables of perceived loss in resources explained an additional 15% variance in psychological distress (p < .001). Among the losses, only perceived loss in future control was significantly associated with psychological distress (future control: β = 0.28, p < .01; financial resources: β = 0.01, p > .05; fun: β = 0.15, p > .05). In Block 3, two variables of co** resource were added, which accounted for an additional 6.4% of the variance in psychological distress (p < .01). Only family communication was significantly associated with psychological distress (β= -0.27, p < .001; parental self-efficacy: β = 0.06, p > .05). In Block 4, two variables of co** strategy were added, which accounted for an additional 9.5% of the variance in psychological distress (p < .001). Specifically, lower acceptance (β= -0.18, p < .05) and higher self-blame (β = 0.26, p < .001) were associated with higher levels of psychological distress. The model explained 36.3% of the variance in psychological distress (Table 3).

Table 3 Hierarchical regression analysis examining factors associated with psychological distress (N = 150)
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Discussion

From the perspective of the COR theory, this study examined how perceived resource loss due to COVID-19, intrapersonal and interpersonal co** resources, plus co** strategies contributed to the psychological distress of parents of children with SEN shortly after the COVID-19 pandemic in Hong Kong. We found that one-third of the respondents reported severe levels of psychological distress (K6 ≥ 13), which was comparable with the prevalence of severe psychological distress (K10 ≥ 30, 36.6%) among parents of children with SEN in Malaysia during COVID-19 (Wahab & Ramli, 2022); but much higher than the prevalence (K10 ≥ 30) among the population in Hong Kong during COVID-19 (Chair et al., 2023). Thus, the high prevalence of psychological distress highlighted the importance of examining the factors associated with those parents’ psychological distress. Regarding the sociodemographic correlates, our findings also indicated that having children with multiple types of SEN (e.g., having more than one child having SEN, but with different SEN conditions) contributed to higher levels of psychological distress. Compared with parents of typical children, local parents of children with developmental disorders were found to have higher levels of depressive symptoms during COVID-19 (Chan & Fung, 2022). Parents might have an increased duty of care amid COVID-19 to meet the condition-specific needs of their children, such as handling children’s challenging behaviors, sensory issues and deteriorated conditions (e.g., reading ability) (Wong et al., 2021). The negative association between children’s disability and parental resources has been shown in previous research (Gentile et al., 2023). Considering that children with different conditions have varied demands and draw parents’ resources differently, parents may require more resources to fulfill their caregiving roles based on the specific conditions of their children. Furthermore, having children with multiple types of SEN might be a condition that affects those parents’ perception of conserving other resources and stresses them out during the pandemic. Our findings thereby highlight the importance of paying attention to this vulnerable group and providing timely support, such as emotional coaching.

Perceived loss of resources due to COVID-19 and psychological distress

Our findings indicated that perceived loss of future control due to COVID-19 (e.g., losing hope, sense of instability, and difficulty in controlling the future) significantly contributed to psychological distress among parents of children with SEN in Hong Kong. This result was congruent with previous studies indicating the positive association between perceived loss in future control and probable depression among Hong Kong people (Yu et al., 2023b), and between the perceived loss in hope and psychological distress among people in Israel (Egozi Farkash et al., 2022) during COVID-19. As a result of the uncertainties in class suspension and disrupted SEN-related therapies in the pandemic, those parents had a caregiving burden in assisting in remote classes and managing their children’s behaviors (Chan & Fung, 2022; Navas et al., 2022); worrying about their children’s study progress (Wong et al., 2021); and struggling in balancing their roles in work, housework, and childcare (Navas et al., 2022). Even with the relaxation of most of the pandemic measures during the time of the study, worries about future waves of the COVID-19 pandemic were still apparent in Hong Kong. Therefore, our respondents might still experience these stressors due to unpredictable disturbances in their daily routines. It might explain why the perceived loss in future control was the strongest contributor (out of the three measured) to psychological distress. During the times of loss amid the pandemic, pro-social behaviors can facilitate the change of mindsets which help an individual to deal with the challenges (Ramkissoon, 2022b). Particularly, a theorist posits that adaptive interventions (e.g., psycho-socio interventions for fostering pro-social behaviors) might improve individuals’ mental health (Ramkissoon, 2022a). Thus, as an extension of this study, future studies should also examine whether adaptive interventions contribute to better mental well-being among this vulnerable group when facing the uncertainty of the future.

Perceived loss in fun did not emerge as a significant contributor, despite a significant bivariate correlation with psychological distress. However, it is noteworthy that ‘travel’ was the most commonly-answered activity that participants would like to do with their children after COVID-19 (based on supplementary qualitative data). Many people in Hong Kong think that recreational travel brings them fun (Yu et al., 2023a, b). Hong Kong started to reopen for travel by relaxing most of the travel restrictions, including on-arrival polymerase chain reaction (PCR) test and vaccine pass upon returning to Hong Kong from late December 2022. However, parents of SEN children might still have additional concerns. They might worry about their children contracting COVID-19 because of the emergence of new variants in travel destinations. It was also common for them to consider thoroughly before going for a trip, given that exposure to an unfamiliar environment, long waits and new food could negatively affect their children’s behaviors and emotions (Kohl & Barnett, 2020). ​​Considering that those parents of children with SEN may still hesitate to go on a trip due to the pandemic situations, fostering place affect (i.e., the affective bonds individuals share with the environment settings, including their neighborhood environments) could be particularly crucial. A new conceptual framework suggested that promoting individuals’ pro-environmental behaviors can strengthen their place attachment, thereby improving their well-being in the context of confinement (Ramkissoon, 2020). This confinement amid the pandemic might provide those families with SEN children the opportunity to explore the neighborhood environment in Hong Kong, including the green and blue environment. Given that the place affect interventions might facilitate psychological empowerment by changing the negative emotions of those parents and develo** personal resources to overcome challenges amid the pandemic (Ramkissoon, 2021), future research should also examine whether psychological empowerment contributes to better mental well-being among those parents of SEN children in the context of place confinement.

Although the perceived loss in financial resources had a positive correlation with psychological distress (in a small-to-medium effect size), it did not emerge as a significant contributor to psychological distress in the regression analysis (after considering other factors). From our correlation results, it is interesting to see that household income and employment status had non-significant correlations with psychological distress. These indirectly echoed why perceived loss in financial resources had a less important contribution. Also, despite the perceived loss in financial resources, people in Hong Kong tend to take a pragmatic consumption approach and avoid unnecessary expenses in response to the economic shrinks during COVID-19. Thus, the perceived loss in financial resources might be less important than other types of perceived loss of resources in contributing to psychological distress of those parents.

Our findings supported that COVID-19 has put Hong Kong parents in a stressful situation depleting those resources. The COR theory posits that people tend to prevent the loss of resources because it is more influential than the gain of resources (Hobfoll, 1989). Those parents might sacrifice their leisure time to meet the increased demands of their responsibilities during COVID-19. While those parents encountered difficulties in balancing roles of childcare and work during COVID-19 (Chan & Fung, 2022), the resource loss among those parents (e.g., loss in future control) would deplete their resources, resulting in psychosocial distress (Hobfoll, 1989). According to the COR theory, vulnerable individuals who lack resources tend to invest more efforts to protect and to seek additional resources, making them susceptible to distress (Hobfoll, 1989). Thus, our study implied that timely provision of resources would be important for those parents to meet their needs and to cope with the difficulties in caring for their children with SEN.

Parenting self-efficacy, family communication, and psychological distress

This study did not find a significant association between parenting self-efficacy and psychological distress among those parents. Prior to COVID-19, a study on parents of children with ASD indicated that parenting self-efficacy (measured by Parenting Sense of Competence Scale) was associated with lower maternal depression and anxiety scores (Rezendes & Scarpa, 2011). It is possible that self-efficacy in co** with stressors other than parenting would be more relatable to the psychological distress of those parents during COVID-19. For example, those parents might have stress related to health worries, housework and disrupted lives (Yu et al., 2023a). Our study used the 5-item Brief Parental Self-Efficacy Scale to measure participants’ confidence in co** with their parenting roles (Woolgar et al., 2012), rather than that with other COVID-19-related demands. Thus, more research is needed to understand the roles of self-efficacy in parenting amid pandemic situations in psychological distress among those parents.

Nevertheless, our findings supported that family communication was a more important co** resource contributing to lower levels of psychological distress among those parents. To maintain functioning, family communication provides a method to organize when dealing with stressful situations (Chow et al., 2022; Gayatri & Irawaty, 2022). Particularly, taking care of children with SEN involves family members working together. With the unpredictable disturbance in daily routines and support during COVID-19, those parents might have to cope with different challenges. For example, those parents might need effective communication to discuss the provision of suitable and adequate learning environments at home settings during COVID-19 (Chan & Fung, 2022). Comprehensive discussions on the caregiving and children’s academic plans among the family members may be crucial to make prompt decisions and adjustments, which may explain why family communication was the strongest contributor among the co** resources. In short, our findings highlighted the importance of providing workshops for those parents to improve their communication skills with co-living family members.

Acceptance and self-blaming in association with psychological distress

Even though some studies have found non-significant association between acceptance and psychological well-being in local populations during COVID-19 (Yeung et al., 2023), we found that acceptance was associated with lower psychological distress among parents of children with SEN. A prior qualitative study also found that local parents of SEN children tended to use acceptance co** strategies for their children’s diagnosis and seek support from services/interventions (Wong & Wong, 2021). Considering that the brief COPE acceptance subscale could hardly distinguish between different types of acceptance (Yeung et al., 2023), our findings might be explained by the active acceptance. This type of acceptance is related to more planning and active co** when facing an adverse situation (Nakamura & Orth, 2005). In other words, if those parents actively accept the difficult situations during the pandemic, they may be more likely to face the challenges and adapt to deal with the adversities, contributing to lower psychological distress.

Moreover, a higher frequency of self-blame was associated with higher psychological distress among those parents. Prior studies have highlighted that children’s intellectual/developmental disabilities are being viewed as “bad seeds” and bringing disgrace to family (Mak & Cheung, 2008). Also, parents of children with SEN may be blamed for being the cause of their children’s disability by passing on the unfavorable genes (Chan & Lam, 2018). Therefore, parents of children with SEN tend to keep their children’s conditions a family secret to avoid face loss and potential discrimination from others (Mak & Cheung, 2008). With additional challenges during COVID-19, it is also common for those to blame themselves for not controlling their children’s behaviors well (Chan & Lam, 2018). Research has suggested that self-blame hinder caregivers from resolving the problems and feeling the positive side of their caregiving role (Chan & Lam, 2018), which could lead to poorer psychological well-being. As an extension of the current study, it will be important to further investigate if those parents experienced affiliate stigma and investigate its role in co** resource and mental well-being among this vulnerable group.

Limitations

This study has several limitations. First, this cross-sectional study could not examine the causal relations between the contributors and psychological distress. We suggest a longitudinal study to examine the causal relationships in the future. Second, this study recruited participants through online forums and social media support groups for parents of children with SEN, which might not allow a comprehensive access to the local parent populations. However, recruiting parents through online support groups was one of the commonly-used methods to access parents of children with SEN during COVID-19 (Ye et al., 2021); our sample size was also comparable to those local studies. Third, in line with previous research for parents of children with SEN, most of our respondents were female (Tsibidaki, 2021). Although mothers were usually the main caregivers of SEN children (Tsibidaki, 2021), our findings might have a limited generalizability to the experience of fathers of SEN children. Fourth, in the context of COVID-19, parents might be too busy for their daily obligations, which lowered their interests in research participation. Even though our sample size was regarded as sufficient based on our sample size planning, we acknowledged that the sample size was relatively small compared to other studies in the literature (Wahab & Ramli, 2022). However, it was comparable to some local cross-sectional studies on parents of children with SEN amid COVID-19 (Chan & Fung, 2022). We believe the findings could still be valuable and empirically-acceptable. Fifth, the studied variables only explained a moderate proportion (approximately 36.3%) of variance in psychological distress of those parents, implying that other important contributors might be present. Research has indicated that other individual factors (e.g., parents’ self-stigmatization; Ye et al., 2021) and interpersonal factors (e.g., social isolation; Cheng & Lai, 2023) were linked to adverse psychological outcomes among caregivers of children with SEN. Thus, future studies may consider measuring similar concepts (e.g., social support) with standardized scales (e.g., Social Support Scale; Da Costa et al., 2023), and adding those variables into the regression model to increase the explanatory power. In addition, our study did not measure participants’ characteristics and co** prior to the COVID-19 pandemic. Seeing the potentially substantial changes in everyday life throughout the pandemic among families of children with SEN, we focused more on how the subjective perceptions of changes in resources (from the perspective of the COR approach) might contribute to parental distress. However, considering that our study was conducted shortly after the local pandemic in Hong Kong, we believed that it allowed participants to evaluate the subjective negative impact of the pandemic on different aspects of resources in their lives, thereby possibly capturing their comparisons with pre-pandemic situations. Thus, our findings could still be valuable in understanding how parents’ perceptions of resource loss throughout the pandemic could contribute to their distress.

Implications

This study highlighted how we might understand psychological distress among parents of children with SEN through the conservation of resources perspective. Specifically, the perceived loss of future control, family communication, acceptance and self-blame co** significantly contributed to psychological distress among those parents. This study provided insights into potential COR theory-guided interventions for social work practice. This theory might help conceptualize the intervention categories (e.g., personal characteristics, conditions and objects) and allows social workers to provide resources directed at particular categories efficiently (Hobfoll, 1989). Considering Asian populations share similar cultural values and parenting styles, the impacts of the pandemic on the well-being among parents of children with SEN in the Asian populations may be particularly salient. Those parents of children with SEN in Singapore (Lim et al., 2022) and Malaysia (Wahab & Ramli, 2022), for example, were distressed during the pandemic. Thus, the findings of this study might provide valuable information for social welfare professionals (e.g., social workers) to understand the potential correlates of mental health among this vulnerable group in Asian countries and to design effective interventions for those parents. Given the potential region-specific differences in services available to parents of children with special education needs, future research should also explore more about how the availability of resources from different parties (e.g., school, community, government) could contribute to those parents’ well-being in different countries/regions. Particularly, our findings implied that family-based interventions targeting family communication and parents’ co** strategies may reduce psychological distress among those parents. Previously, a pilot programme of family-focused psychoeducational therapy (including ASD-related knowledge, family communication skills, discussions on family problems and positive co** skills) was also found to reduce negative emotions of parents of children with ASD in China (Zhou et al., 2019). It would be meaningful to explore the adaptation of such interventions in the local and Asian contexts. Equally importantly, our findings also implied that hel** parents of children with SEN use appropriate co** strategies may reduce parental distress. Prior research provides some suggestions for potentially effective interventions for those individuals. Self-compassion intervention, for example, may facilitate the use of acceptance co** and reduce self-blame co** strategies through fostering those parents’ sense of common humanity and connection to others who are encountering similar difficulties that, in turn, reduce the parental distress (Ahmed & Raj, 2023). A feasibility study of a 4-week self-compassion intervention for parents of children with developmental disabilities has been carried out in the United States amid the pandemic, which has provided preliminary efficacy evidence of reducing participants’ distress after the intervention (Ahmed & Raj, 2023). Hence, it will be important for future studies to investigate the role of self-compassion intervention in well-being of this vulnerable group in the local and Asian contexts.

Conclusion

Perceived loss in future control, family communication, acceptance co**, and self-blame co** were found to be significant contributors to psychological distress of parents of children with SEN in the context of COVID-19 pandemic in Hong Kong. Our findings suggested recommendations for potentially effective strategies for interventions to improve those parents to train their skills in co**, family communication, and psychological well-being.