The relationship between maternal emotional self-disclosure and children's anxiety in the post-COVID-19 era

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Even after the acute phase has passed and the pandemic has subsided, this anxiety persists within families, particularly among mothers, and can be transmitted to other family members. Evidence suggests that self-disclosure and the expression of emotions promote mental health and reduce anxiety. This study aimed to determine the relationship between maternal emotional self-disclosure and children's anxiety in the post-COVID-19 era. Methods: In this cross-sectional correlation study, 305 mothers of elementary school children in Borujerd, Lorestan, Iran, in 2022 were included using a multi-stage sampling method. Data collection tools comprised demographic questionnaires, the Emotional Self-Disclosure Scale, and the Spence Children's Anxiety Scale—Parent Report, all of which were completed by mothers as self-reports. Independent t-tests, one-way analysis of variance, and multivariate regression were employed to analyze the data. Results: After controlling for confounding variables, a significant relationship was found between mothers' emotional self-disclosure and children's anxiety (B = -0.667, P < 0.001). There was a statistically significant difference in mothers' mean emotional self-disclosure scores based on their place of residence, education, occupation, and their spouse's age, education, and occupation, as well as the child's gender, educational level, and age (P 0.05). Conclusions: There was an inverse and relatively strong relationship between maternal emotional self-disclosure and child anxiety. This indicates that an increase in maternal emotional self-disclosure is associated with a reduction in child anxiety. Therefore, in similar crises, it is essential to focus on managing and promoting emotional self-disclosure among mothers, particularly those who are well-educated, employed, reside in urban areas, have younger, well-educated, and employed spouses, and have female children of younger age and lower educational levels. This targeted approach can help reduce child anxiety. Emotional Self-Disclosure Mother Anxiety Child Post-COVID-19 Background Stressful events can lead to mental disorders in both the present and future lives of individuals [ 1 ]. In recent years, the world experienced a widespread pandemic caused by a novel virus known as COVID-19. COVID-19 altered people's lifestyles and modes of communication, resulting in significant disruptions across various countries [ 2 ]. The COVID-19 pandemic had a profound impact on employment, education, and public health, including mental health. To prevent the physical spread of the virus, societal measures such as isolation, quarantine, and social distancing were widely adopted [ 3 ]. Governments imposed restrictions to curb the virus's transmission, including the nationwide closure of universities, schools, and high-traffic areas, and the shift from face-to-face to virtual education. These restrictions led to various societal complications, including economic challenges for families due to job closures, the virtualization of education, and increased mental health issues such as discomfort, depression, anxiety, and severe fear [ 2 , 4 ]. In a study by Chung et al., it was shown that parents' understanding of COVID-19 is associated with an increase in their anxiety [ 5 ]. In Iran, concerns about children attending school and the possibility of contracting COVID-19, particularly with the spread of the Omicron variant during the initial reopening of schools, exacerbated this anxiety [ 6 ]. The lack of an effective and efficient vaccine further heightened the vulnerability of children [ 7 ], leading to increased fear and anxiety among families, especially mothers and elementary school children [ 8 ]. Despite the passing of the acute phase of the pandemic and a reduction in case numbers, anxiety persisted within families during the post-COVID period [ 9 ]. Parents often interpreted minor symptoms such as fever and cough in their children as signs of COVID-19 infection, which caused significant worry [ 10 ]. Increased anxiety has a detrimental effect on overall functioning, occupational and social performance, and mental health, sometimes leading to depression and even suicidal ideation [ 11 ]. Maternal anxiety can be linked to disturbances in the mental, physical, behavioral, and social development of children, as well as academic failure [ 12 ]. A mother's fear and anxiety can have lasting impacts on her child's mental health, potentially causing anxiety in the child. Given the mother's central role in the family, she significantly influences her child's ability to cope with anxiety [ 13 ]. Adaptive coping strategies and supportive family environments can act as protective factors for families experiencing anxiety [ 14 ]. Mothers employ various techniques, such as body relaxation, mental relaxation, muscle relaxation, deep breathing, and distraction, to reduce and manage the stress associated with viral diseases in their elementary school children after returning to school [ 15 , 16 ]. Studies have indicated that emotional self-disclosure is a strategy employed by mothers to alleviate anxiety [ 17 , 18 ]. Emotional self-disclosure involves the process of individuals expressing their feelings, thoughts, beliefs, and attitudes either to themselves or to others. While it may not be possible to avoid negative emotions completely, individuals can potentially exert some level of control over them [ 17 ]. Evidence suggests that engaging in self-disclosure and expressing emotions contributes to mental well-being, reduces anxiety, and enhances overall quality of life [ 14 , 17 , 19 ]. Lenzo et al. explored depression, anxiety, and stress among healthcare workers during the COVID-19 outbreak and its correlation with verbal expression. Their findings suggested that verbal expression of emotions led to a reduction in anxiety and depression among employees [ 19 ]. Similarly, Kim et al. conducted a study investigating the impact of emotional self-disclosure on depression and quality of life among women undergoing in vitro fertilization. They concluded that emotional self-disclosure was associated with reduced depression and improved quality of life among these women [ 17 ]. Moreover, emotional self-disclosure between mothers and their children fosters trust and facilitates more meaningful emotional interactions, thereby enhancing children's resilience and ultimately contributing to their mental well-being [ 20 ]. Overall, the demographic characteristics of individuals significantly influence the utilization of mechanisms to alleviate anxiety [ 21 ]. Hence, it is imperative to identify the demographic traits of mothers who employ such mechanisms, including emotional self-disclosure, and explore their association with children's anxiety levels. Consequently, the current study was undertaken to investigate the correlation between maternal self-disclosure and child anxiety in the post-COVID-19 era. Materials and Methods Study Design This descriptive cross-sectional correlational study involved the participation of 305 mothers with children enrolled in the first to third grades in Borujerd, Lorestan, Iran, in 2022. Ethical Consideration This article has been reviewed and approved by the Research and Technology Vice-Chancellor of Lorestan University of Medical Sciences, with the ethics code IR.LUMS.REC.1401.005. The study objectives were initially elucidated to the participants, and written informed consent was obtained. Participants were reassured that their information would be held in strict confidence and that the findings would be disseminated publicly. Moreover, participants were informed of their right to withdraw from the study at any stage, should they choose to do so. Sample Size Calculation Drawing from a comparable study [ 22 ], the sample size was calculated with a confidence level of 95% (ɑ=0.05), study power set at 90%, and a correlation coefficient of 0.43 (r = 0.43), yielding an initial estimate of 204 individuals. Implementing cluster sampling and factoring in a design effect of 1.5 (Design effect = 1.5), the final sample size was determined to be 305 mothers. The sample size was calculated employing the subsequent formula: $$n={\left[\frac{{z}_{1-\frac{a}{2}}+{z}_{1-?²}}{c}\right]}^{2}+3$$ $$C=0.25?—\text{l}\text{n}⌈\frac{1+r}{1-r}⌉$$ Inclusion Criteria The inclusion criteria comprised the ability to read and write, full cognitive alertness, orientation to time and place, and the capability to accurately complete the questionnaires without errors. Exclusion Criteria Exclusion criteria encompassed being a single parent, having twins or multiple children, experiencing communication disorders (such as deafness), being afflicted with a known incurable and chronic underlying illness (e.g., cancer, diabetes, rheumatoid arthritis), belonging to a vulnerable family unit (e.g., undergoing divorce, grappling with addiction), encountering recent crises such as the loss of a loved one within the preceding three months (as reported by the mother), and providing incomplete responses to the questionnaire items. Sampling Method The sampling method employed in this study was a multi-stage approach combining clusters, stratification, and randomization. Cluster sampling was executed as follows: initially, a roster of educational districts within Borujerd city was obtained from the Department of Education. Subsequently, three elementary schools were randomly chosen from the schools in each district. Each class was regarded as a cluster within each elementary school, and the participating students were selected using a simple random method based on class attendance lists and random number tables, considering the proportion of students in each class relative to the total school enrollment. Sampling was conducted from May through the end of June 2022. Data collection instruments Measurement of Demographic Information To gather demographic data, a 10-question form was employed, covering details such as the child's gender, educational level, and age, along with information regarding the parents' place of residence, age, educational background, and occupation. These details were collected via self-reporting by the mothers. Measurement of Emotional Self-Disclosure The Emotional Self-Disclosure Scale (ESDS) was developed by Snell, Miller, and Belk [ 23 ]. Comprising 40 items rated on a 5-point Likert scale (ranging from "I never tell anyone" to "always tell someone"), this instrument is scored from 0 to 5, with the lowest and highest achievable scores ranging from 0 to 200. Higher scores on the ESDS indicate a greater degree of emotional self-disclosure. The scale consists of 8 subscales, each comprising 5 items: Depression (items 1, 9, 17, 25, 33), Happiness (items 2, 10, 18, 26, 34), Jealousy (items 3, 11, 19, 27, 35), Anxiety (items 4, 12, 20, 28, 36), Anger (items 5, 13, 21, 29, 37), Calmness (items 6, 14, 22, 30, 38), Apathy (items 7, 15, 23, 31, 39), and Fear (items 8, 16, 24, 32, 40). The reliability of the ESDS in Iran was confirmed by Varmaghani et al. through their research, demonstrating a Cronbach's alpha coefficient of 0.95. Furthermore, to assess its construct validity, this study utilized two instruments: the Multidimensional Perceived Social Support Scale and the Emotional Regulation Questionnaire. Results indicated an optimal convergent validity with a correlation coefficient of r = 0.37 between the scores of the ESDS and those of the Multidimensional Perceived Social Support Scale. Additionally, an optimal discriminant validity was observed with a correlation coefficient of r=- 0.22 between the ESDS scores and those of the Emotional Regulation Questionnaire [ 24 ]. In the present study, mothers completed this questionnaire in a self-report format. Measurement of Spence Child Anxiety To assess children's anxiety levels, the Spence Child Anxiety Scale - Parent Form (SCAS-PF) was utilized. Developed by Spence, this questionnaire aims to evaluate anxiety symptoms among children in the general population [ 25 ]. Designed for children aged 3 to 17 years, the SCAS-PF comprises 38 items. Respondents provide answers on a Likert scale ranging from "never" to "always," with scores ranging from 0 to 3, respectively. Scores on this questionnaire range from 0 to 114, with higher scores indicating elevated levels of anxiety in children. The SCAS-PF encompasses six subscales: Separation Anxiety (items 5, 8, 11, 14, 15, 38), Social Anxiety (items 6, 7, 9, 10, 26, 31), Obsessive-Compulsive (items 17, 24, 35, 36, 37), Panic (items 19, 25, 27, 28, 30, 32, 33, 34), Generalized Anxiety (items 1, 3, 4, 18, 20, 22), and Fear of Physical Harm (items 2, 16, 21, 23, 29). The reliability of the SCAS-PF in Iran was investigated by Mousavi, who reported Cronbach's alpha coefficients ranging from 0.62 to 0.89. Additionally, its content validity was confirmed through confirmatory factor analysis, while face validity was verified by a panel of 10 nursing faculty members [ 26 ]. In this study, mothers completed the SCAS-PF in a self-report format to assess their children's anxiety levels. Data Collection Method Upon identification of the children, their mothers were contacted in collaboration with the school principals, and the research objectives were elucidated to them. Subsequently, if the mothers expressed consent and met the inclusion criteria, they were enrolled in the study, and arrangements were made for their participation at the school. Written informed consent was obtained from the mothers prior to their inclusion in the study. Following this, in a conducive environment, mothers completed the demographic questionnaire, Emotional Self-Disclosure Scale, and Spence Parent Form Child Anxiety Questionnaire. Data Analysis After data collection and input into SPSS software version 26, descriptive statistics were employed to summarize the data. This entailed calculating the Mean and standard deviation for quantitative variables and frequency and percentage for qualitative variables. The Kolmogorov-Smirnov test was utilized to assess the normal distribution of the data. Subsequently, independent t-tests, one-way analysis of variance (ANOVA), and multivariate regression were performed to analyze the data. A significance level of P < 0.05 was adopted for all statistical tests. Results Descriptive Statistics The results revealed that 50.8% of the participating children were male, with the majority (34.4%) enrolled in the third grade of primary school. Additionally, a substantial proportion of parents held expertise in education. Specifically, 85.2% of mothers were homemakers, while 48.5% of fathers were self-employed. Moreover, most parents (70.5%) resided in urban areas. According to Table 1 , the average (SD) score of mothers' emotional self-disclosure is 99.57 (51.48). The mean Spence anxiety score for children was 66.58 (SD = 33.59), as illustrated in Table 2 . Analytical Statistics Table 3 presents the comparison of the mean emotional self-disclosure scores among mothers based on demographic characteristics. The results of the statistical analysis indicated a statistically significant difference concerning the mother's place of residence, education level, and occupation, as well as the gender, education level, and age of the child (P < 0.001). Moreover, a significant difference was observed in terms of the mother's age, education level, and the husband's occupation (P 0.05). Regression Results of the Multivariable Model As depicted in the multivariable regression table (Table 4 ), while controlling for other variables such as the child's gender, education, and age, as well as the mother's education level, occupation, place of residence, and the spouse's age, education, and occupation, an increase of one standard deviation in the emotional self-disclosure score of mothers was associated with a decrease of 0.667 standard deviation in children's anxiety scores, as per the Spence scale (B = -0.667, P < 0.001). Table 1 Mean scores and standard deviations for emotional self-disclosure among mothers and its dimensions Variable Mean (SD) Emotional self-disclosure 99.57 (51.48) Depression 12.38 (6.08) Happiness 12.37 (6.51) Jealousy 12.41 (6.64) Anxiety 12.27 (6.81) Anger 12.60 (6.85) Calmness 12.74 (6.85) Apathy 12.34 (6.79) Fear 12.46 (6.76) Table 2 Mean scores and standard deviations of children's spence anxiety scores and its dimensions Variable Mean (SD) Spence child anxiety 66.58 (33.59) Separation anxiety 10.61 (5.40) Social anxiety 10.27 (5.54) Obsessive-compulsive 8.92 (5.06) Panic 14.10 (7.61) Generalized anxiety 10.47 (5.62) Fear of physical harm 8.70 (4.53) Table 3 Comparative analysis of mothers’ emotional self-disclosure mean scores by demographic characteristics Variables N (%) Emotional self-disclosure Mean (SD) df Statistics P value Child gender Boy 155 (50.8) 108.16 (54.17) 303 3 0.003 * Girl 150 (49.2) 90.70 (47.09) Child education First grade 100 (32.8) 91.46 (46.89) 2 4.49 0.012 ** Second grade 100 (32.8) 95.23 (52.84) Third grade 105 (34.4) 111.44 (52.64) Child age 8 years ≥ 211 (69.2) 90.79 (46.76) 303 2.35 0.016 * > 8 years 94 (30.8) 104.96 (53.58) Mother's age 35 years ≥ 161 (52.8) 95.33 (49.61) 303 1.53 0.13 * > 35 years 144 (47.2) 104.32 (53.24) Mother's education Elementary 51 (16.7) 155.98 (44.99) 5 42.83 < 0.001 ** Junior school 31 (10.2) 149.74 (45.48) High school 25 (8.2) 93.92 (51.74) Associate Degree 68 (22.3) 73.95 (32.89) Bachelor 114 (37.4) 79.21 (36.57) Master's degree and above 16 (5.2) 85.37 (34.84) Mother's job Housewife 260 (85.2) 103.77 (53.16) 303 3.48 < 0.001 * Employed 45 (14.8) 75.35 (31.18) Residence Urban 215 (70.5) 77.38 (34.83) 303 15.61 37 years 149 (48.8) 106.24 (53.67) Wife's education Elementary 29 (9.5) 158.65 (42.16) 5 33.03 < 0.001 ** Junior school 46 (15.1) 145.65 (50.52) High school 27 (8.9) 110.04 (55.39) Associate Degree 36 (11.8) 84.75 (44.62) Bachelor 143 (46.9) 78.37 (35.45) Master's degree and above 24 (7.9) 76.67 (33.91) Wife's job Unemployed 7 (2.3) 141.43 (56.49) 3 21.88 < 0.001 ** Freelance 148 (48.5) 93.67 (49.19) Employee 82 (26.9) 77.19 (32.07) Other 68 (22.3) 135.09 (55.07) * : Independent samples t test. ** : One-way ANOVA Table 4 Results of multivariate regression analysis for predicting spence's anxiety scores Predictor variables B Std.Error Standardized Coefficients Beta t P value Emotional self-disclosure -0.458 0.024 -0.667 -19.267 < 0.001 Child gender 0.078 0.045 0.049 1.924 0.055 Child education -0.022 0.066 -0.020 -0.325 0.745 Child age -0.050 0.061 -0.051 -0.816 0.415 Mother's education -0.006 0.033 -0.010 -0.166 0.868 Mother's job 0.103 0.064 0.041 1.603 0.110 Residence -0.476 0.122 -0.246 -3.901 < 0.001 Spouse's age -0.001 0.003 -0.008 -0.329 0.742 Wife's education 0.037 0.030 0.066 1.246 0.214 Wife's job 0.012 0.026 0.012 0.463 0.644 R = 0.918, R 2 = 0.842 and AdjR 2 = 0.837 Discussion The study results indicate a significant association between mothers' emotional self-disclosure and children's anxiety, even after controlling for other variables. Specifically, an increase in mothers' emotional self-disclosure correlates with a decrease in their children's anxiety levels. This finding aligns with the results of Dibaei et al.'s study, which similarly demonstrated that mothers' emotional self-disclosure is linked to reduced anxiety in their children [ 27 ]. Parents who experience difficulties in expressing their emotions and exhibit fluctuations in their behavior may inadvertently induce worry and anxiety in their children. This could stem from potential inconsistencies in parental responses to similar situations or the utilization of inappropriate disciplinary methods due to a lack of emotional regulation. In contrast, mothers who engage in greater emotional self-disclosure tend to foster increased emotional interactions and sharing with their children. Consequently, this enhanced emotional connection may contribute to a reduction in child anxiety by providing a platform for addressing and sharing the child's emotional concerns [ 28 , 29 ]. The disparity observed in the mean emotional self-disclosure scores among mothers varied significantly based on the gender of their children. Specifically, mothers with sons exhibited higher mean scores of emotional self-disclosure compared to those with daughters. This finding resonates with the research conducted by Kaplan and Keys, which indicated that individuals tend to express a greater inclination for emotional self-disclosure with individuals of the opposite gender [ 30 ]. Furthermore, mothers often perceive their sons as playful, endearing, and amusing, which may lead them to allocate more attention to their sons than their daughters [ 31 ]. Moreover, cultural influences, such as societal norms regarding sexual attractiveness, may also contribute to mothers' heightened interest in their sons [ 32 ]. Conversely, Aschoff et al.'s study yielded contrasting results, as no significant relationship was identified between emotional self-disclosure and the recipient's gender [ 33 ]. This discrepancy may stem from several factors, including the age group studied, the larger sample size utilized, and discrepancies in the self-disclosure questionnaire employed. The discrepancy observed in the mean score of emotional self-disclosure among mothers varied significantly based on their child's educational level and age. Specifically, mothers with children of higher age and educational attainment displayed higher average scores of emotional self-disclosure. This finding is consistent with the results reported by Mugo et al., who identified a direct relationship between a mother's emotional self-disclosure and her child's age and educational level, aligning with the present study. The developmental stage of children may influence the inclination for emotional self-disclosure, as those with higher age and education often exhibit greater cognitive and emotional maturity. Consequently, mothers may feel more compelled to engage in emotional self-disclosure with this demographic subgroup, recognizing their advanced level of development [ 34 ]. No significant correlation was observed between the mean score of emotional self-disclosure among mothers and their age. This result is congruent with the findings reported by Dutton and Sotardi, who similarly found no discernible relationship between emotional self-disclosure and age [ 35 ]. It can be inferred that the impact of the COVID-19 crisis induces psychological distress across various age groups, thereby fostering a common desire for emotional self-disclosure as a coping mechanism to alleviate anxiety [ 36 ]. One of the key findings of the present study was the identification of a significant association between the disparity in mean scores of emotional self-disclosure and mothers' education and occupation. Notably, mothers with lower levels of education and those who were homemakers exhibited higher levels of emotional self-disclosure. This aligns with the findings reported by Blose et al., who observed an inverse correlation between emotional self-disclosure and educational attainment and occupational status, which is consistent with the present study. The study posits that women with higher levels of education and employment often navigate multiple social spheres, leading to role strain and a consequent reduction in emotional self-disclosure. This multifaceted engagement may introduce inconsistencies in fulfilling various roles, thereby impeding the expression of emotional experiences [ 37 ]. Conversely, Mejavo and Lu's study did not observe a similar inverse relationship between emotional self-disclosure and educational attainment [ 38 ], which diverges from the present study's findings. This discrepancy may be attributed to differences in the study population, as well as variations in sample size and the methodology employed to measure self-disclosure, notably online surveys utilizing a coding method in their study. The discrepancy observed in the mean score of emotional self-disclosure among mothers varied significantly based on their place of residence, with rural mothers displaying a higher average emotional self-disclosure score than urban mothers. This finding is consistent with the research conducted by Simran and Nambiar, which similarly demonstrated higher levels of emotional self-disclosure among rural residents [ 39 ]. Rural communities often foster greater social interactions and a heightened sense of intimacy and closeness compared to urban settings. Consequently, individuals residing in rural areas may feel more inclined to disclose personal information about themselves, contributing to higher levels of emotional self-disclosure [ 40 ]. A significant correlation was observed between the mean score of emotional self-disclosure among mothers and the age of their spouses, indicating that mothers with older spouses exhibited higher levels of emotional self-disclosure. Similarly, there was a noteworthy relationship between emotional self-disclosure and the educational attainment of mothers' spouses; mothers whose spouses had higher levels of education demonstrated lower levels of emotional self-disclosure. Additionally, the disparity in the mean score of emotional self-disclosure based on the occupation of spouses was also significant, with mothers whose husbands were unemployed displaying higher levels of emotional self-disclosure than those with employed husbands. Numerous scientific studies have corroborated these findings, suggesting that mothers with older, less educated, and unemployed spouses tend to exhibit higher levels of emotional self-disclosure [ 41 – 43 ]. Social support from spouses serves as a protective factor against life's challenges in today's intricate society. However, research indicates that women with older spouses, as well as those with unemployed or less educated partners, perceive less social support from their spouses due to various factors, such as increased spousal fatigue. Furthermore, some women may perceive increased emotional self-disclosure as a means to foster intimacy within their relationships [ 44 ]. Strengths and Limitations and Future Research: The current study aimed to examine the correlation between mothers' emotional self-disclosure and their children's anxiety in Borujerd elementary schools during the post-COVID-19 pandemic period, marking the first investigation of its kind in this context. It is important to note that this study exclusively focused on mothers residing in Borujerd city with children in elementary school's first to third grades. Fathers and families with higher educational backgrounds were not included in the analysis; thus, the generalizability of the findings to these populations is limited. Furthermore, a notable limitation of the study pertained to the reluctance of some parents to participate due to concerns regarding potential COVID-19 transmission, particularly since the researcher was a nurse. To address this limitation, interviews were conducted in private rooms with strict adherence to social distancing protocols and the use of masks by both the mother and the interviewer. Moreover, proper ventilation was ensured by opening doors and windows during the interviews. Despite these measures, it is important to acknowledge the potential impact of this limitation on the study's outcomes. Conclusions The findings indicate that an increase in emotional self-disclosure among mothers may correlate with a reduction in their children's anxiety levels. Emotional self-disclosure facilitates the expression and release of emotions and feelings, thereby bolstering maternal morale and aiding in managing negative emotions. Given the observed relationship between maternal emotional self-disclosure and child anxiety, it is recommended to prioritize interventions aimed at enhancing and fostering maternal emotional self-disclosure to mitigate child anxiety within school settings. This entails encouraging mothers to engage in emotionally expressive behaviors characterized by higher quality and effective management of self-disclosure. Furthermore, despite the stabilization of conditions in the post-Covid period, it was unexpected to observe lower levels of emotional self-disclosure among mothers with specific characteristics, including higher education, urban residency, spouses with younger age, higher education, and employment status, as well as having female children with lower educational levels and younger age. Therefore, it is recommended that children's nurses, health educators, school personnel, and psychologists devote more attention to mothers exhibiting these characteristics and effectively implement strategies to manage and support their emotional self-disclosure. Declarations Acknowledgements The invaluable cooperation extended by the Khorram Abad School of Nursing and Midwifery, Education Department, as well as the staff of Borujerd Elementary School, mothers, and participating children in this study, is deeply appreciated and acknowledged. Author Contributions All authors have thoroughly reviewed and approved the final version of the manuscript. F GH spearheaded the design and execution of the study. HG was tasked with conducting the study and data collection, while RM undertook data analysis and interpretation. FV provided valuable consultation regarding the study design. Funding This study received no financial support from any source . Data Availability The data and materials are available upon request from the corresponding author. Ethics Approval and Consent to Participate This article, designated with project number 2555, stems from a master's thesis project in pediatric nursing, which obtained approval from the Vice President of Research and Technology at Lorestan University of Medical Sciences under the ethics code IR.LUMS.REC.1401.005 . Participants provided written informed consent to participate in this study. Additionally, participants were assured of the confidentiality and anonymity of their information. They were also informed of their right to withdraw from the study without any negative repercussions on their child's education. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. References Thoits PA. Dimensions of life events that influence psychological distress: An evaluation and synthesis of the literature. Psychosocial stress. 1983;33–103. https://doi.org/10.1016/b978-0-12-397560-7.50007-6 . Park SE. 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Inform Technol People. 2023;36(1):433–53. https://doi.org/10.1108/ITP-12-2020-0825 . Lenzo V, Quattropani MC, Sardella A, Martino G, Bonanno GA. Depression, anxiety, and stress among healthcare workers during the COVID-19 outbreak and relationships with expressive flexibility and context sensitivity. Front Psychol. 2021;12:623033. https://doi.org/10.3389/fpsyg.2021.623033 . Chaudhury S, Kirk CM, Ingabire C, Mukunzi S, Nyirandagijimana B, Godfrey K, et al. HIV status disclosure through family-based intervention supports parenting and child mental health in Rwanda. Front public health. 2016;4:138. https://doi.org/10.3389/fpubh.2016.00138 . Effati-Daryani F, Zarei S, Mohammadi A, Hemmati E, Ghasemi Yngyknd S, Mirghafourvand M. Depression, stress, anxiety and their predictors in Iranian pregnant women during the outbreak of COVID-19. BMC Psychol. 2020;8:1–10. https://doi.org/10.1186/s40359-020-00464-8 . Shirzadi P, Shirazi NA, Lashkami ZA. Relationship between corona anxiety in mothers and parent-child interaction and children's aggression during quarantine days. J Family Res. 2020;16(2):139–54. Snell WE, Miller RS, Belk SS. Development of the emotional self-disclosure scale. Sex Roles. 1988;18:59–73. https://doi.org/10.1007/BF00288017 . Varmaghani H, Poursharifi H, Soleimani A, Fathi-ashtiani A. Psychometric properties of the persian version of the emotional self-disclosure scale. J Res Behav Sci. 2020;18(3):371–81. https://doi.org/10.52547/rbs.18.3.371 . Spence S. Spence children’s anxiety scale (parent version). Brisbane, QLD, Australia: University of Queensland; 1999. Mousavi R, Moradi A-R, Farzad V, Mahdavi S. Psychometric properties of the Spence children’s anxiety scale with an Iranian sample. Int J Psychol. 2007;1(1):17–26. Dibaei S, Janbozorghi M, Arefnazar M. The relation between emotional ambivalence and emotional control in mothers and anxiety in children with cancer and the modifying role of children’s sex. J title. 2009;3(1):55–64. Jami ES, Hammerschlag AR, Bartels M, Middeldorp CM. Parental characteristics and offspring mental health and related outcomes: A systematic review of genetically informative literature. Transl Psychiatry. 2021;11(1):197. https://doi.org/10.1038/s41398-021-01300-2 . Adams D, Clark M, Simpson K. The relationship between child anxiety and the quality of life of children, and parents of children, on the autism spectrum. J Autism Dev Disord. 2020;50(5):1756–69. https://doi.org/10.1007/s10803-019-03932-2 . Kaplan DL, Keys CB. Sex and relationship variables as predictors of sexual attraction in cross-sex platonic friendships between young heterosexual adults. J Soc Pers Relat. 1997;14(2):191–206. https://doi.org/10.1177/0265407597142003 . Mothers really love boys more. Available online: https://www.khabaronline.ir/news/98722/ (Accessed on 8 October 2010). Brunning L, McKeever N, Asexuality. J Appl Philos. 2021;38(3):497–517. https://doi.org/10.1111/japp.12472 . Lichtwarck-Aschoff A, Finkenauer C, van de Vorst H, Engels RC. Being mum’s confidant, a boon or bane? Examining gender differences in the association of maternal disclosure with adolescents’ depressive feelings. J Youth Adolesc. 2012;41:449–59. https://doi.org/10.1007/s10964-011-9661-7 . Mugo C, Firdawsi O, Wang J, Njuguna IN, Wamalwa DC, Slyker JA, et al. When they are all grown, I will tell them: Experience and perceptions of parental self-disclosure of HIV status to children in Nairobi, Kenya. BMC Public Health. 2023;23(1):519. https://doi.org/10.1186/s12889-023-15387-3 . Dutton H, Sotardi VA. The impact of student self-disclosure on the stress and wellbeing of tertiary educators during the COVID-19 pandemic. J Furth High Educ. 2023;47(7):966–79. https://doi.org/10.1080/0309877X.2023.2208053 . Chen L, Cheng R, Hu B. The effect of self-disclosure on loneliness in adolescents during COVID-19: the mediating role of peer relationships. Front Psychiatry. 2021;12:710515. https://doi.org/10.3389/fpsyt.2021.710515 . Blose T, Umar P, Squicciarini A, Rajtmajer S. Privacy in crisis: A study of self-disclosure during the coronavirus pandemic. arXiv preprint arXiv: 200409717. 2020. https://doi.org/10.48550/arXiv.2004.09717 . Mejova Y, Hommadova Lu A. Gender in the disclosure of loneliness on Twitter during COVID-19 lockdowns. Front Digit Health. 2023;5:1297983. https://doi.org/10.3389/fdgth.2023.1297983 . Simran S, Nambiar D. Emotional self-disclosure and relationship satisfaction among married adults during Covid-19. Quest Journals Journals Res Humanit Social Sci. 2022;10(6):59–64. Fruhauff KP. Exploring the impact of rural and urban settings on therapist self-disclosure. 2006. Rahardjo W, Mardianti M, editors. College students’ online self-disclosure during COVID-19 pandemic: The role of need for relatedness, passing time, and gender. 3rd Tarumanagara international conference on the applications of social sciences and humanities (TICASH 2021); 2022: Atlantis Press. https://doi.org/10.2991/assehr.k.220404.259 . Lee J, Rajtmajer S, Srivatsavaya E, Wilson S. Digital inequality through the lens of self-disclosure. Proc Priv Enhanc Technol. 2021. https://doi.org/10.2478/popets-2021-0052 . Willemse RP. The perceived impact of unemployment on psychological well-being among unemployed young people in Worcester. University of South Africa; 2015. Sprecher S, Treger S, Wondra JD. Effects of self-disclosure role on liking, closeness, and other impressions in get-acquainted interactions. J Soc Pers Relat. 2013;30(4):497–514. https://doi.org/10.1177/0265407512459033 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 16 Apr, 2025 Read the published version in BMC Psychiatry → Version 1 posted Editorial decision: Revision requested 31 May, 2024 Submission checks completed at journal 28 May, 2024 Editor assigned by journal 28 May, 2024 First submitted to journal 20 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4451170","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":309017292,"identity":"0ec78678-1cc9-424f-8d7c-604df33df244","order_by":0,"name":"Fatemeh Ghasemi","email":"","orcid":"","institution":"Lorestan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Fatemeh","middleName":"","lastName":"Ghasemi","suffix":""},{"id":309017294,"identity":"99f65efb-e618-45a3-8ce8-a200957de5a2","order_by":1,"name":"Fatemeh Valizadeh","email":"","orcid":"","institution":"Lorestan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Fatemeh","middleName":"","lastName":"Valizadeh","suffix":""},{"id":309017295,"identity":"f05ded01-7af8-4d45-9ce0-09a8af0048dd","order_by":2,"name":"Rasool Mohammadi","email":"","orcid":"","institution":"Lorestan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Rasool","middleName":"","lastName":"Mohammadi","suffix":""},{"id":309017297,"identity":"6148f711-a407-4981-9408-7e1249229a3d","order_by":3,"name":"Hanieh Goodarzi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYBACAzDJBsTMjA0HEipADOYGYrUwNz74cAail0gtDOzNhjPbQAwCWswZ2C8++FBmly/fztgmzTuvNpq/HajlR8U2nFosG3iKDWecS7ZsbAZp2XY8d8ZhxgbGnjO3cTvsAE+aNG8bswEzM1jLsdwGoBYgm6CWegM2sJY5x3LnE9bCfgyo5bABDzMj0PsNNbkbCGo5zMMM9MtxAwlmRmAgHzuQuxGo5SBevxxvfwgMsWoD+f7jDw4k1NTlzjt/+OCDHxW4tTAw8xggcw+DyQO41YMA+wNkXh1+xaNgFIyCUTAiAQC/EFjGzqX3ygAAAABJRU5ErkJggg==","orcid":"","institution":"Lorestan University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Hanieh","middleName":"","lastName":"Goodarzi","suffix":""}],"badges":[],"createdAt":"2024-05-20 22:12:54","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4451170/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4451170/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12888-025-06810-7","type":"published","date":"2025-04-16T15:57:48+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":81050912,"identity":"25ac649c-b9bc-4857-9cac-d13de62931ae","added_by":"auto","created_at":"2025-04-21 16:06:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1080169,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4451170/v1/fae602b1-bde4-420d-af9d-11383e35c91a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The relationship between maternal emotional self-disclosure and children's anxiety in the post-COVID-19 era","fulltext":[{"header":"Background","content":"\u003cp\u003eStressful events can lead to mental disorders in both the present and future lives of individuals [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In recent years, the world experienced a widespread pandemic caused by a novel virus known as COVID-19. COVID-19 altered people's lifestyles and modes of communication, resulting in significant disruptions across various countries [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe COVID-19 pandemic had a profound impact on employment, education, and public health, including mental health. To prevent the physical spread of the virus, societal measures such as isolation, quarantine, and social distancing were widely adopted [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Governments imposed restrictions to curb the virus's transmission, including the nationwide closure of universities, schools, and high-traffic areas, and the shift from face-to-face to virtual education. These restrictions led to various societal complications, including economic challenges for families due to job closures, the virtualization of education, and increased mental health issues such as discomfort, depression, anxiety, and severe fear [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn a study by Chung et al., it was shown that parents' understanding of COVID-19 is associated with an increase in their anxiety [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In Iran, concerns about children attending school and the possibility of contracting COVID-19, particularly with the spread of the Omicron variant during the initial reopening of schools, exacerbated this anxiety [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The lack of an effective and efficient vaccine further heightened the vulnerability of children [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], leading to increased fear and anxiety among families, especially mothers and elementary school children [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the passing of the acute phase of the pandemic and a reduction in case numbers, anxiety persisted within families during the post-COVID period [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Parents often interpreted minor symptoms such as fever and cough in their children as signs of COVID-19 infection, which caused significant worry [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Increased anxiety has a detrimental effect on overall functioning, occupational and social performance, and mental health, sometimes leading to depression and even suicidal ideation [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMaternal anxiety can be linked to disturbances in the mental, physical, behavioral, and social development of children, as well as academic failure [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. A mother's fear and anxiety can have lasting impacts on her child's mental health, potentially causing anxiety in the child. Given the mother's central role in the family, she significantly influences her child's ability to cope with anxiety [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdaptive coping strategies and supportive family environments can act as protective factors for families experiencing anxiety [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Mothers employ various techniques, such as body relaxation, mental relaxation, muscle relaxation, deep breathing, and distraction, to reduce and manage the stress associated with viral diseases in their elementary school children after returning to school [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStudies have indicated that emotional self-disclosure is a strategy employed by mothers to alleviate anxiety [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Emotional self-disclosure involves the process of individuals expressing their feelings, thoughts, beliefs, and attitudes either to themselves or to others. While it may not be possible to avoid negative emotions completely, individuals can potentially exert some level of control over them [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Evidence suggests that engaging in self-disclosure and expressing emotions contributes to mental well-being, reduces anxiety, and enhances overall quality of life [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLenzo et al. explored depression, anxiety, and stress among healthcare workers during the COVID-19 outbreak and its correlation with verbal expression. Their findings suggested that verbal expression of emotions led to a reduction in anxiety and depression among employees [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Similarly, Kim et al. conducted a study investigating the impact of emotional self-disclosure on depression and quality of life among women undergoing in vitro fertilization. They concluded that emotional self-disclosure was associated with reduced depression and improved quality of life among these women [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMoreover, emotional self-disclosure between mothers and their children fosters trust and facilitates more meaningful emotional interactions, thereby enhancing children's resilience and ultimately contributing to their mental well-being [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOverall, the demographic characteristics of individuals significantly influence the utilization of mechanisms to alleviate anxiety [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Hence, it is imperative to identify the demographic traits of mothers who employ such mechanisms, including emotional self-disclosure, and explore their association with children's anxiety levels. Consequently, the current study was undertaken to investigate the correlation between maternal self-disclosure and child anxiety in the post-COVID-19 era.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis descriptive cross-sectional correlational study involved the participation of 305 mothers with children enrolled in the first to third grades in Borujerd, Lorestan, Iran, in 2022.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eEthical Consideration\u003c/h2\u003e \u003cp\u003e This article has been reviewed and approved by the Research and Technology Vice-Chancellor of Lorestan University of Medical Sciences, with the ethics code IR.LUMS.REC.1401.005. The study objectives were initially elucidated to the participants, and written informed consent was obtained. Participants were reassured that their information would be held in strict confidence and that the findings would be disseminated publicly. Moreover, participants were informed of their right to withdraw from the study at any stage, should they choose to do so.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSample Size Calculation\u003c/h2\u003e \u003cp\u003eDrawing from a comparable study [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], the sample size was calculated with a confidence level of 95% (ɑ=0.05), study power set at 90%, and a correlation coefficient of 0.43 (r\u0026thinsp;=\u0026thinsp;0.43), yielding an initial estimate of 204 individuals. Implementing cluster sampling and factoring in a design effect of 1.5 (Design effect\u0026thinsp;=\u0026thinsp;1.5), the final sample size was determined to be 305 mothers. The sample size was calculated employing the subsequent formula:\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$n={\\left[\\frac{{z}_{1-\\frac{a}{2}}+{z}_{1-?\u0026sup2;}}{c}\\right]}^{2}+3$$\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Equb\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equb\" name=\"EquationSource\"\u003e\n$$C=0.25?\u0026mdash;\\text{l}\\text{n}\u0026lceil;\\frac{1+r}{1-r}\u0026rceil;$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eInclusion Criteria\u003c/h2\u003e \u003cp\u003eThe inclusion criteria comprised the ability to read and write, full cognitive alertness, orientation to time and place, and the capability to accurately complete the questionnaires without errors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eExclusion Criteria\u003c/h2\u003e \u003cp\u003eExclusion criteria encompassed being a single parent, having twins or multiple children, experiencing communication disorders (such as deafness), being afflicted with a known incurable and chronic underlying illness (e.g., cancer, diabetes, rheumatoid arthritis), belonging to a vulnerable family unit (e.g., undergoing divorce, grappling with addiction), encountering recent crises such as the loss of a loved one within the preceding three months (as reported by the mother), and providing incomplete responses to the questionnaire items.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eSampling Method\u003c/h2\u003e \u003cp\u003eThe sampling method employed in this study was a multi-stage approach combining clusters, stratification, and randomization. Cluster sampling was executed as follows: initially, a roster of educational districts within Borujerd city was obtained from the Department of Education. Subsequently, three elementary schools were randomly chosen from the schools in each district. Each class was regarded as a cluster within each elementary school, and the participating students were selected using a simple random method based on class attendance lists and random number tables, considering the proportion of students in each class relative to the total school enrollment. Sampling was conducted from May through the end of June 2022.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eData collection instruments\u003c/h2\u003e \u003cdiv id=\"Sec10\" class=\"Section4\"\u003e \u003ch2\u003eMeasurement of Demographic Information\u003c/h2\u003e \u003cp\u003eTo gather demographic data, a 10-question form was employed, covering details such as the child's gender, educational level, and age, along with information regarding the parents' place of residence, age, educational background, and occupation. These details were collected via self-reporting by the mothers.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eMeasurement of Emotional Self-Disclosure\u003c/h2\u003e \u003cp\u003eThe Emotional Self-Disclosure Scale (ESDS) was developed by Snell, Miller, and Belk [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Comprising 40 items rated on a 5-point Likert scale (ranging from \"I never tell anyone\" to \"always tell someone\"), this instrument is scored from 0 to 5, with the lowest and highest achievable scores ranging from 0 to 200. Higher scores on the ESDS indicate a greater degree of emotional self-disclosure. The scale consists of 8 subscales, each comprising 5 items: Depression (items 1, 9, 17, 25, 33), Happiness (items 2, 10, 18, 26, 34), Jealousy (items 3, 11, 19, 27, 35), Anxiety (items 4, 12, 20, 28, 36), Anger (items 5, 13, 21, 29, 37), Calmness (items 6, 14, 22, 30, 38), Apathy (items 7, 15, 23, 31, 39), and Fear (items 8, 16, 24, 32, 40). The reliability of the ESDS in Iran was confirmed by Varmaghani et al. through their research, demonstrating a Cronbach's alpha coefficient of 0.95. Furthermore, to assess its construct validity, this study utilized two instruments: the Multidimensional Perceived Social Support Scale and the Emotional Regulation Questionnaire. Results indicated an optimal convergent validity with a correlation coefficient of r\u0026thinsp;=\u0026thinsp;0.37 between the scores of the ESDS and those of the Multidimensional Perceived Social Support Scale. Additionally, an optimal discriminant validity was observed with a correlation coefficient of r=- 0.22 between the ESDS scores and those of the Emotional Regulation Questionnaire [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In the present study, mothers completed this questionnaire in a self-report format.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eMeasurement of Spence Child Anxiety\u003c/h2\u003e \u003cp\u003eTo assess children's anxiety levels, the Spence Child Anxiety Scale - Parent Form (SCAS-PF) was utilized. Developed by Spence, this questionnaire aims to evaluate anxiety symptoms among children in the general population [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Designed for children aged 3 to 17 years, the SCAS-PF comprises 38 items. Respondents provide answers on a Likert scale ranging from \"never\" to \"always,\" with scores ranging from 0 to 3, respectively. Scores on this questionnaire range from 0 to 114, with higher scores indicating elevated levels of anxiety in children. The SCAS-PF encompasses six subscales: Separation Anxiety (items 5, 8, 11, 14, 15, 38), Social Anxiety (items 6, 7, 9, 10, 26, 31), Obsessive-Compulsive (items 17, 24, 35, 36, 37), Panic (items 19, 25, 27, 28, 30, 32, 33, 34), Generalized Anxiety (items 1, 3, 4, 18, 20, 22), and Fear of Physical Harm (items 2, 16, 21, 23, 29). The reliability of the SCAS-PF in Iran was investigated by Mousavi, who reported Cronbach's alpha coefficients ranging from 0.62 to 0.89. Additionally, its content validity was confirmed through confirmatory factor analysis, while face validity was verified by a panel of 10 nursing faculty members [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In this study, mothers completed the SCAS-PF in a self-report format to assess their children's anxiety levels.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eData Collection Method\u003c/h2\u003e \u003cp\u003eUpon identification of the children, their mothers were contacted in collaboration with the school principals, and the research objectives were elucidated to them. Subsequently, if the mothers expressed consent and met the inclusion criteria, they were enrolled in the study, and arrangements were made for their participation at the school. Written informed consent was obtained from the mothers prior to their inclusion in the study. Following this, in a conducive environment, mothers completed the demographic questionnaire, Emotional Self-Disclosure Scale, and Spence Parent Form Child Anxiety Questionnaire.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eAfter data collection and input into SPSS software version 26, descriptive statistics were employed to summarize the data. This entailed calculating the Mean and standard deviation for quantitative variables and frequency and percentage for qualitative variables. The Kolmogorov-Smirnov test was utilized to assess the normal distribution of the data. Subsequently, independent t-tests, one-way analysis of variance (ANOVA), and multivariate regression were performed to analyze the data. A significance level of P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was adopted for all statistical tests.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eDescriptive Statistics\u003c/h2\u003e \u003cp\u003eThe results revealed that 50.8% of the participating children were male, with the majority (34.4%) enrolled in the third grade of primary school. Additionally, a substantial proportion of parents held expertise in education. Specifically, 85.2% of mothers were homemakers, while 48.5% of fathers were self-employed. Moreover, most parents (70.5%) resided in urban areas.\u003c/p\u003e \u003cp\u003eAccording to Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the average (SD) score of mothers' emotional self-disclosure is 99.57 (51.48).\u003c/p\u003e \u003cp\u003eThe mean Spence anxiety score for children was 66.58 (SD\u0026thinsp;=\u0026thinsp;33.59), as illustrated in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eAnalytical Statistics\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the comparison of the mean emotional self-disclosure scores among mothers based on demographic characteristics. The results of the statistical analysis indicated a statistically significant difference concerning the mother's place of residence, education level, and occupation, as well as the gender, education level, and age of the child (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Moreover, a significant difference was observed in terms of the mother's age, education level, and the husband's occupation (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, the results did not exhibit statistical significance concerning the mother's age (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eRegression Results of the Multivariable Model\u003c/h2\u003e \u003cp\u003eAs depicted in the multivariable regression table (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), while controlling for other variables such as the child's gender, education, and age, as well as the mother's education level, occupation, place of residence, and the spouse's age, education, and occupation, an increase of one standard deviation in the emotional self-disclosure score of mothers was associated with a decrease of 0.667 standard deviation in children's anxiety scores, as per the Spence scale (B = -0.667, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean scores and standard deviations for emotional self-disclosure among mothers and its dimensions\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional self-disclosure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99.57 (51.48)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDepression\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12.38 (6.08)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eHappiness\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12.37 (6.51)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eJealousy\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12.41 (6.64)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAnxiety\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12.27 (6.81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAnger\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12.60 (6.85)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCalmness\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12.74 (6.85)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eApathy\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12.34 (6.79)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eFear\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12.46 (6.76)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean scores and standard deviations of children's spence anxiety scores and its dimensions\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpence child anxiety\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66.58 (33.59)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSeparation anxiety\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.61 (5.40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSocial anxiety\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.27 (5.54)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eObsessive-compulsive\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.92 (5.06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePanic\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.10 (7.61)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eGeneralized anxiety\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.47 (5.62)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eFear of physical harm\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.70 (4.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparative analysis of mothers\u0026rsquo; emotional self-disclosure mean scores by demographic characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEmotional self-disclosure\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStatistics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eChild gender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eBoy\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e155 (50.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108.16 (54.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.003\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eGirl\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e150 (49.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90.70 (47.09)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eChild education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eFirst grade\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (32.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91.46 (46.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e4.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.012\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eSecond grade\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (32.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95.23 (52.84)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eThird grade\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105 (34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111.44 (52.64)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eChild age\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e8 years \u0026ge;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e211 (69.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90.79 (46.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.016\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026gt;\u0026thinsp;8 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94 (30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e104.96 (53.58)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eMother's age\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e35 years \u0026ge;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e161 (52.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95.33 (49.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.13\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026gt;\u0026thinsp;35 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e144 (47.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e104.32 (53.24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eMother's education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eElementary\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e155.98 (44.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e42.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eJunior school\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (10.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e149.74 (45.48)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eHigh school\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93.92 (51.74)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eAssociate Degree\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (22.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73.95 (32.89)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eBachelor\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e114 (37.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79.21 (36.57)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eMaster's degree and above\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85.37 (34.84)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eMother's job\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eHousewife\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e260 (85.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e103.77 (53.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eEmployed\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75.35 (31.18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eUrban\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e215 (70.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.38 (34.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e15.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eRural\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90 (29.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e152.60 (45.85)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSpouse's age\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e37 years \u0026ge;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e156 (51.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93.21 (48.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.027\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026gt;\u0026thinsp;37 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e149 (48.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106.24 (53.67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eWife's education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eElementary\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e158.65 (42.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e33.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eJunior school\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (15.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e145.65 (50.52)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eHigh school\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e110.04 (55.39)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eAssociate Degree\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84.75 (44.62)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eBachelor\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e143 (46.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78.37 (35.45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eMaster's degree and above\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.67 (33.91)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eWife's job\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eUnemployed\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e141.43 (56.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e21.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eFreelance\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e148 (48.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93.67 (49.19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eEmployee\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82 (26.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.19 (32.07)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eOther\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (22.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e135.09 (55.07)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e: Independent samples t test.\u003c/p\u003e \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e: One-way ANOVA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of multivariate regression analysis for predicting spence's anxiety scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePredictor variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStd.Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStandardized Coefficients Beta\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmotional self-disclosure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.458\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.667\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-19.267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChild gender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.924\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChild education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.745\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChild age\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.816\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.415\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMother's education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.868\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMother's job\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.603\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.110\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.476\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.246\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-3.901\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSpouse's age\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.329\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.742\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWife's education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.246\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWife's job\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.463\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.644\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eR\u0026thinsp;=\u0026thinsp;0.918, R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.842 and AdjR\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.837\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study results indicate a significant association between mothers' emotional self-disclosure and children's anxiety, even after controlling for other variables. Specifically, an increase in mothers' emotional self-disclosure correlates with a decrease in their children's anxiety levels. This finding aligns with the results of Dibaei et al.'s study, which similarly demonstrated that mothers' emotional self-disclosure is linked to reduced anxiety in their children [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Parents who experience difficulties in expressing their emotions and exhibit fluctuations in their behavior may inadvertently induce worry and anxiety in their children. This could stem from potential inconsistencies in parental responses to similar situations or the utilization of inappropriate disciplinary methods due to a lack of emotional regulation. In contrast, mothers who engage in greater emotional self-disclosure tend to foster increased emotional interactions and sharing with their children. Consequently, this enhanced emotional connection may contribute to a reduction in child anxiety by providing a platform for addressing and sharing the child's emotional concerns [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe disparity observed in the mean emotional self-disclosure scores among mothers varied significantly based on the gender of their children. Specifically, mothers with sons exhibited higher mean scores of emotional self-disclosure compared to those with daughters. This finding resonates with the research conducted by Kaplan and Keys, which indicated that individuals tend to express a greater inclination for emotional self-disclosure with individuals of the opposite gender [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Furthermore, mothers often perceive their sons as playful, endearing, and amusing, which may lead them to allocate more attention to their sons than their daughters [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Moreover, cultural influences, such as societal norms regarding sexual attractiveness, may also contribute to mothers' heightened interest in their sons [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Conversely, Aschoff et al.'s study yielded contrasting results, as no significant relationship was identified between emotional self-disclosure and the recipient's gender [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. This discrepancy may stem from several factors, including the age group studied, the larger sample size utilized, and discrepancies in the self-disclosure questionnaire employed.\u003c/p\u003e \u003cp\u003eThe discrepancy observed in the mean score of emotional self-disclosure among mothers varied significantly based on their child's educational level and age. Specifically, mothers with children of higher age and educational attainment displayed higher average scores of emotional self-disclosure. This finding is consistent with the results reported by Mugo et al., who identified a direct relationship between a mother's emotional self-disclosure and her child's age and educational level, aligning with the present study. The developmental stage of children may influence the inclination for emotional self-disclosure, as those with higher age and education often exhibit greater cognitive and emotional maturity. Consequently, mothers may feel more compelled to engage in emotional self-disclosure with this demographic subgroup, recognizing their advanced level of development [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNo significant correlation was observed between the mean score of emotional self-disclosure among mothers and their age. This result is congruent with the findings reported by Dutton and Sotardi, who similarly found no discernible relationship between emotional self-disclosure and age [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. It can be inferred that the impact of the COVID-19 crisis induces psychological distress across various age groups, thereby fostering a common desire for emotional self-disclosure as a coping mechanism to alleviate anxiety [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne of the key findings of the present study was the identification of a significant association between the disparity in mean scores of emotional self-disclosure and mothers' education and occupation. Notably, mothers with lower levels of education and those who were homemakers exhibited higher levels of emotional self-disclosure. This aligns with the findings reported by Blose et al., who observed an inverse correlation between emotional self-disclosure and educational attainment and occupational status, which is consistent with the present study. The study posits that women with higher levels of education and employment often navigate multiple social spheres, leading to role strain and a consequent reduction in emotional self-disclosure. This multifaceted engagement may introduce inconsistencies in fulfilling various roles, thereby impeding the expression of emotional experiences [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Conversely, Mejavo and Lu's study did not observe a similar inverse relationship between emotional self-disclosure and educational attainment [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], which diverges from the present study's findings. This discrepancy may be attributed to differences in the study population, as well as variations in sample size and the methodology employed to measure self-disclosure, notably online surveys utilizing a coding method in their study.\u003c/p\u003e \u003cp\u003eThe discrepancy observed in the mean score of emotional self-disclosure among mothers varied significantly based on their place of residence, with rural mothers displaying a higher average emotional self-disclosure score than urban mothers. This finding is consistent with the research conducted by Simran and Nambiar, which similarly demonstrated higher levels of emotional self-disclosure among rural residents [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Rural communities often foster greater social interactions and a heightened sense of intimacy and closeness compared to urban settings. Consequently, individuals residing in rural areas may feel more inclined to disclose personal information about themselves, contributing to higher levels of emotional self-disclosure [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA significant correlation was observed between the mean score of emotional self-disclosure among mothers and the age of their spouses, indicating that mothers with older spouses exhibited higher levels of emotional self-disclosure. Similarly, there was a noteworthy relationship between emotional self-disclosure and the educational attainment of mothers' spouses; mothers whose spouses had higher levels of education demonstrated lower levels of emotional self-disclosure. Additionally, the disparity in the mean score of emotional self-disclosure based on the occupation of spouses was also significant, with mothers whose husbands were unemployed displaying higher levels of emotional self-disclosure than those with employed husbands. Numerous scientific studies have corroborated these findings, suggesting that mothers with older, less educated, and unemployed spouses tend to exhibit higher levels of emotional self-disclosure [\u003cspan additionalcitationids=\"CR42\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Social support from spouses serves as a protective factor against life's challenges in today's intricate society. However, research indicates that women with older spouses, as well as those with unemployed or less educated partners, perceive less social support from their spouses due to various factors, such as increased spousal fatigue. Furthermore, some women may perceive increased emotional self-disclosure as a means to foster intimacy within their relationships [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations and Future Research:\u003c/h2\u003e \u003cp\u003eThe current study aimed to examine the correlation between mothers' emotional self-disclosure and their children's anxiety in Borujerd elementary schools during the post-COVID-19 pandemic period, marking the first investigation of its kind in this context. It is important to note that this study exclusively focused on mothers residing in Borujerd city with children in elementary school's first to third grades. Fathers and families with higher educational backgrounds were not included in the analysis; thus, the generalizability of the findings to these populations is limited.\u003c/p\u003e \u003cp\u003eFurthermore, a notable limitation of the study pertained to the reluctance of some parents to participate due to concerns regarding potential COVID-19 transmission, particularly since the researcher was a nurse. To address this limitation, interviews were conducted in private rooms with strict adherence to social distancing protocols and the use of masks by both the mother and the interviewer. Moreover, proper ventilation was ensured by opening doors and windows during the interviews. Despite these measures, it is important to acknowledge the potential impact of this limitation on the study's outcomes.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe findings indicate that an increase in emotional self-disclosure among mothers may correlate with a reduction in their children's anxiety levels. Emotional self-disclosure facilitates the expression and release of emotions and feelings, thereby bolstering maternal morale and aiding in managing negative emotions. Given the observed relationship between maternal emotional self-disclosure and child anxiety, it is recommended to prioritize interventions aimed at enhancing and fostering maternal emotional self-disclosure to mitigate child anxiety within school settings. This entails encouraging mothers to engage in emotionally expressive behaviors characterized by higher quality and effective management of self-disclosure.\u003c/p\u003e \u003cp\u003eFurthermore, despite the stabilization of conditions in the post-Covid period, it was unexpected to observe lower levels of emotional self-disclosure among mothers with specific characteristics, including higher education, urban residency, spouses with younger age, higher education, and employment status, as well as having female children with lower educational levels and younger age. Therefore, it is recommended that children's nurses, health educators, school personnel, and psychologists devote more attention to mothers exhibiting these characteristics and effectively implement strategies to manage and support their emotional self-disclosure.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe invaluable cooperation extended by the Khorram Abad School of Nursing and Midwifery, Education Department, as well as the staff of Borujerd Elementary School, mothers, and participating children in this study, is deeply appreciated and acknowledged.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have thoroughly reviewed and approved the final version of the manuscript. F GH spearheaded the design and execution of the study. HG was tasked with conducting the study and data collection, while RM undertook data analysis and interpretation. FV provided valuable consultation regarding the study design.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no financial support from any source\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data and materials are available upon request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article, designated with project number 2555, stems from a master\u0026apos;s thesis project in pediatric nursing, which obtained approval from the Vice President of Research and Technology at Lorestan University of Medical Sciences under the ethics code IR.LUMS.REC.1401.005\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e Participants provided written informed consent to participate in this study. Additionally, participants were assured of the confidentiality and anonymity of their information. They were also informed of their right to withdraw from the study without any negative repercussions on their child\u0026apos;s education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eThoits PA. Dimensions of life events that influence psychological distress: An evaluation and synthesis of the literature. 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J Soc Pers Relat. 2013;30(4):497\u0026ndash;514. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0265407512459033\u003c/span\u003e\u003cspan address=\"10.1177/0265407512459033\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Emotional Self-Disclosure, Mother, Anxiety, Child, Post-COVID-19","lastPublishedDoi":"10.21203/rs.3.rs-4451170/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4451170/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eFollowing pandemics, including the COVID-19 pandemic, anxiety is prevalent within the general public. Even after the acute phase has passed and the pandemic has subsided, this anxiety persists within families, particularly among mothers, and can be transmitted to other family members. Evidence suggests that self-disclosure and the expression of emotions promote mental health and reduce anxiety. This study aimed to determine the relationship between maternal emotional self-disclosure and children's anxiety in the post-COVID-19 era.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e In this cross-sectional correlation study, 305 mothers of elementary school children in Borujerd, Lorestan, Iran, in 2022 were included using a multi-stage sampling method. Data collection tools comprised demographic questionnaires, the Emotional Self-Disclosure Scale, and the Spence Children's Anxiety Scale—Parent Report, all of which were completed by mothers as self-reports. Independent t-tests, one-way analysis of variance, and multivariate regression were employed to analyze the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAfter controlling for confounding variables, a significant relationship was found between mothers' emotional self-disclosure and children's anxiety (B = -0.667, P \u0026lt; 0.001). There was a statistically significant difference in mothers' mean emotional self-disclosure scores based on their place of residence, education, occupation, and their spouse's age, education, and occupation, as well as the child's gender, educational level, and age (P \u0026lt; 0.001). However, the results were insignificant concerning the mother's age (P \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThere was an inverse and relatively strong relationship between maternal emotional self-disclosure and child anxiety. This indicates that an increase in maternal emotional self-disclosure is associated with a reduction in child anxiety. Therefore, in similar crises, it is essential to focus on managing and promoting emotional self-disclosure among mothers, particularly those who are well-educated, employed, reside in urban areas, have younger, well-educated, and employed spouses, and have female children of younger age and lower educational levels. This targeted approach can help reduce child anxiety.\u003c/p\u003e","manuscriptTitle":"The relationship between maternal emotional self-disclosure and children's anxiety in the post-COVID-19 era","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-10 13:47:37","doi":"10.21203/rs.3.rs-4451170/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-31T09:45:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-28T07:33:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-28T07:33:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2024-05-20T22:11:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b439fdb0-1d60-43e3-8108-7dba6c1690f4","owner":[],"postedDate":"June 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-21T16:01:38+00:00","versionOfRecord":{"articleIdentity":"rs-4451170","link":"https://doi.org/10.1186/s12888-025-06810-7","journal":{"identity":"bmc-psychiatry","isVorOnly":false,"title":"BMC Psychiatry"},"publishedOn":"2025-04-16 15:57:48","publishedOnDateReadable":"April 16th, 2025"},"versionCreatedAt":"2024-06-10 13:47:37","video":"","vorDoi":"10.1186/s12888-025-06810-7","vorDoiUrl":"https://doi.org/10.1186/s12888-025-06810-7","workflowStages":[]},"version":"v1","identity":"rs-4451170","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4451170","identity":"rs-4451170","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}