Researchers at Case Western Reserve University previously had found that mothers of children dependent on life-supporting medical technology are at risk for depression. In a new study, the researchers discovered factors that significantly contribute to the condition.

Three major factors emerged as triggers for depression: The mothers tended to be younger, didn’t have partners to help them and lacked the personal resourcefulness skills that could have helped them cope, report Valerie B. Toly, assistant professor, and Carol Musil, the Marvin E. and Ruth Durr Denekas Professor at Case Western Reserve’s Frances Payne Bolton School of Nursing.

Their findings, which build on the original 2012 study, are reported in “Factors Related to Depressive Symptoms in Mothers of Technology-Dependent Children” in Issues in Mental Health Nursing. The goal is to devise strategies to help an estimated 600,000 mothers caring for children on such life-supporting technology as ventilators, feeding tubes and supplemental oxygen.

In the first study, which involved 103 mothers with medical “technology-dependent” children, the researchers found that the mothers who were best at balancing a normal home life with meeting the child’s need were less likely to suffer from depression.

Forty percent of the participants showed elevated levels of depressive symptoms that could impact both the child’s and family’s health and required psychological interventions. About half of this group was at increased risk for suicide.

In the new study, 75 of the 103 mothers from the original research still were caring for technology-dependent children and participated at the 12-month follow-up. The mothers ranged from 22 to 66 years old, with children between nearly 2 and 17 years old.

Sixty percent of the children depended on at least two life-supporting technologies. Nearly half of the children had neuromuscular conditions that required significant physical exertion from their mothers to care for them.

The researchers considered such factors as the age of the children and their mothers, whether the moms had partners to help them with the responsibility, household income and the number of hours of care the children required. The study also considered whether personal and social resourcefulness played a role in helping mothers cope.

According to Toly, it was the first study to analyze resourcefulness skills in mothers caring for technology-dependent children. Social resourcefulness involves harnessing help-seeking skills, such as knowing how to find or ask for help when needed. Personal resourcefulness includes self-help skills, such as organizing daily activities and using positive self-talk to reduce negative thinking. Both skills aid in physical and mental wellbeing.

Researchers say the next step is to find ways to build these personal resourcefulness skills in mothers to help them cope.

“We cannot do anything about the mother’s age or her partner status,” Toly said, “but we can help with personal resourcefulness skills.”

Since the first study, Toly conducted a pilot that tested a promising four-week resourcefulness intervention. It included an individually tailored education session to teach resourcefulness skills, plus reinforcement through daily journal writing to describe applying the skills in their daily lives. She plans to further test the approach.