# Parental Stress, Maternal Health, and Children’s Vision-Related Quality of Life in Total Childhood Blindness: A Cross-Sectional Study

## TL;DR

This study explores how parental stress and maternal health affect children's quality of life in families with totally blind children in Brazil.

## Contribution

It identifies the interconnectedness of parental stress, maternal health, and children's functional vision in socially vulnerable contexts.

## Key findings

- High levels of parenting stress and maternal health symptoms were found in mothers of totally blind children.
- Children's vision-related quality of life was moderately impaired across age groups.
- Maternal engagement in physical activity and school attendance were linked to better outcomes for children.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Total childhood blindness is a rare but severe condition with lifelong developmental, functional, and psychosocial consequences for affected children and their families.Families of children with total blindness often live in conditions of socioeconomic vulnerability and limited access to specialized rehabilitation and psychosocial support.

Total childhood blindness is a rare but severe condition with lifelong developmental, functional, and psychosocial consequences for affected children and their families.

Families of children with total blindness often live in conditions of socioeconomic vulnerability and limited access to specialized rehabilitation and psychosocial support.

Public health significance—Why is this work of significance to public health?
This study shows high levels of parenting stress and maternal health symptoms among mothers of totally blind children in Brazil, alongside markedly impaired vision-related quality of life in their children.The findings highlight that parental stress, maternal health, and children’s functional vision are closely intertwined, especially in socially vulnerable contexts, and should be addressed together in public health strategies.

This study shows high levels of parenting stress and maternal health symptoms among mothers of totally blind children in Brazil, alongside markedly impaired vision-related quality of life in their children.

The findings highlight that parental stress, maternal health, and children’s functional vision are closely intertwined, especially in socially vulnerable contexts, and should be addressed together in public health strategies.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
Integrating systematic screening for parenting stress and maternal mental health into pediatric ophthalmology and rehabilitation services could help identify families at higher risk and guide targeted support.Public health policies should prioritize multidisciplinary, family-centered care—including psychological, social, and rehabilitative interventions—to reduce parental burden and improve the quality of life of children with total blindness.

Integrating systematic screening for parenting stress and maternal mental health into pediatric ophthalmology and rehabilitation services could help identify families at higher risk and guide targeted support.

Public health policies should prioritize multidisciplinary, family-centered care—including psychological, social, and rehabilitative interventions—to reduce parental burden and improve the quality of life of children with total blindness.

Parental stress is a critical yet understudied dimension of childhood total blindness, a condition that imposes substantial developmental, emotional, and functional challenges on families. This cross-sectional study assessed parenting stress, maternal health symptoms, and children’s functional vision-related quality of life in 81 mothers of children aged 0 to 12 years with total congenital blindness. Parenting stress was assessed in the full sample using the Parenting Stress Index–Fourth Edition (PSI-4). Children’s functional vision-related quality of life was evaluated in age-specific subsamples using the Quality of Family Vision Impact (QFVI-3 for children aged 0–3 years and QFVI-7 for children aged 3–7 years). All participants also completed a sociodemographic and maternal health survey. Total Parent Stress showed moderately elevated percentile scores (mean ≈ 67), with the highest PSI-4 subdomains in Adaptability, Depression, and Health. Approximately 21% of mothers scored within the clinical range for high stress. Maternal symptoms including sadness, insomnia, headaches, forgetfulness, and musculoskeletal pain were significant (all p < 0.01). QFVI global scores indicated moderate impairments in functional vision-related quality of life across age groups. Life Stress demonstrated a small-to-moderate negative correlation with QFVI-7, suggesting that cumulative environmental stressors may adversely affect children’s functional outcomes. Several factors were associated with more favorable outcomes. Among children under three years of age, maternal engagement in physical activity was associated with higher QFVI scores, whereas among children aged 3–7 years, school attendance was associated with higher functional vision-related quality of life scores. In contrast, sociodemographic disadvantage, limited access to educational adaptations, and reduced maternal participation in work or leisure activities were associated with higher levels of parental stress. These findings highlight the importance of multidisciplinary, family-centered care incorporating psychosocial assessment, early stimulation, orientation and mobility support, and maternal mental health interventions in pediatric ophthalmology.