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Examining of the Relationship between Family Quality of Life, Parenting Stress and Marital Life Satisfaction of Mothers with Children with Special Needs

Year 2025, Volume: 15 Issue: 1, 24 - 39
https://doi.org/10.19126/suje.1459037

Abstract

This study was conducted to examine the relationship between family quality of life, parenting stress and marital life satisfaction of mothers with children with special needs in early childhood. A total of 212 mothers with children with special needs aged 0-8 years participated in the study. The data were collected with "Personal Information Form", "Beach Centre Family Quality of Life Scale", "Parenting Stress Scale" and "Marital Life Satisfaction Scale". As a result of the study, it was determined that there was a negative and significant relationship between marital life satisfaction and parenting stress levels of mothers with children with special needs; a positive and significant relationship between marital life satisfaction and family life quality; and a negative and significant relationship between family life quality and parenting stress levels. In the study, it was concluded that family quality of life differed significantly in favor of working mothers according to their employment status; it did not differ significantly according to the age and education level of the mother. It was determined that the parenting stress of mothers differed significantly in favor of university graduates in the comparison of university graduates with secondary and high school graduates according to their educational levels; it did not differ significantly according to the age and working status of the mothers. It was concluded that marital life satisfaction of mothers differed significantly in favor of mothers in the 20-29 age range according to the age of the mothers; it did not differ significantly according to the mother's education level and employment status. The findings are discussed in the light of the literature and suggestions for further research are given.

References

  • Alpgan, Ö., & Alabay, E. (2021). Investigation of the effect of family quality of life level of parents of children with developmental disabilities on child-parent relationship. Kastamonu Education Journal, 29(4), 219-232. https://doi.org/10.24106/kefdergi.823157
  • Aslanoğlu, M. (2004). Investigation of intra-family relations of parents with autistic, mental, hearing, visual, and physically disabled children. [Unpublished master's thesis]. Dokuz Eylül University.
  • Ardıç, A. (2012). Child with special needs and family. In A. Cavkaytar (Ed.), Family Education and Guidance in Special Education (pp. 19-52). Vize Publishing.
  • Bakır, D. (2020). Examining the effect of self-sensitivity and family support perception on parental stress in parents of differently developing children. [Unpublished master's thesis]. Istanbul Commerce University.
  • Baş, A. B. (2018). Examining the loneliness levels of parents with children with special needs and parents with normally developing children and their relationship with marital satisfaction. [Unpublished master's thesis]. Istanbul Gelisim University.
  • Büyüköztürk, Ş., Kılıç Çakmak, E., Akgün, Ö. E., Karadeniz, Ş., & Demirel, F. (2012). Scientific research methods. Pegem Academy Publications.
  • Cavkaytar, A. (2010). Families with children with special needs. In T. Güler (Ed.), Parent Education (pp. 73-89). Pegem Academy Publications.
  • Ceylan, R. (2004). Investigation of depression and hopelessness levels of mothers of disabled children participating and not participating in integrated education. [Unpublished doctoral dissertation]. Ankara University.
  • Cho, K. S., & Hong, E. J. (2012). A path analysis of the variables related to the quality of life of mothers with disabled children in Korea. Stress & Health, 29(3), 229-239. https://doi.org/10.1002/smi.2457
  • Çelik, E. (2014). The validity and reliability of the Turkish version of the married life satisfaction scale. Cumhuriyet International Journal of Education, 3(4), 1-9. https://doi.org/10.30703/cije.321353
  • Çelimli, Ş. (2009). A comparative study of the processes of family functions of families with children with autism in America and Turkey. [Unpublished doctoral dissertation]. Middle East Technical University.
  • Dalkılıç, M. (2016). Investigation of marital satisfaction, anxiety, relational resilience, and psychological help attitudes of couples with children with autism. [Unpublished master's thesis]. Bahçeşehir University.
  • Dardas, L. A., & Ahmad, M. M. (2014). Predictors of quality of life for fathers and mothers of children with autistic disorder. Research in Developmental Disabilities, 35, 1326-1333. https://doi.org/10.1016/j.ridd.2014.03.009
  • Demiray, G. (2019). Examination of the relationships between quality of life, hopelessness, and resilience in families with children with special needs. [Unpublished master's thesis]. Marmara University.
  • Dokuman, E. (2017). Investigation of marital adjustment and marital satisfaction with state trait anxiety level of parents with disabled children. [Unpublished master's thesis]. Beykent University.
  • Eren-Kanbir, A. (2018). Marital satisfaction in families with disabled children: A qualitative study. [Unpublished master's thesis]. Maltepe University.
  • Gören, A. B. (2016). Mourning process in mothers with disabled children. Cumhuriyet Journal of Theology, 20(1), 225-244. https://doi.org/10.18505/cuid.238980
  • Gülaldı, D. (2010). Investigation of the relationship between parental stress levels of mothers of children with cerebral palsy and autistic children in early childhood and their life satisfaction. [Unpublished master's thesis]. Maltepe University.
  • Güler, A. (2010). Investigation of marital satisfaction of parents with disabled children according to various variables. [Unpublished master's thesis]. Gazi University.
  • Güven, N. (2005). Relationship-related cognitive distortions and the relationship between marital problemsolving skills and marital satisfaction. [Unpublished master's thesis]. Ankara University.
  • Güzeloğlu, B. (2019). Investigation of the relationship between spouse support and family quality of life of parents with children with special needs and their hopelessness and stress levels. [Unpublished master's thesis]. Ankara University.
  • Hartley, S. L., Barker, E. T., Seltzer, M. M., Greenberg, J. S., & Floyd, F. J. (2011). Marital satisfaction and parenting experiences of mothers and fathers of adolescents and adults with autism. American Journal on Intellectual and Developmental Disabilities, 116(1), 81-95. https://doi.org/10.1352/1944-7558-116.1.81
  • Hoffman, L., Marquis, J. G., Poston, D. J., Summers, J. A., & Turnbull, A. (2006). Assessing family outcomes: Psychometric evaluation of the family quality of life scale. Journal of Marriage and Family, 68, 1069-1083. https://doi.org/10.1111/j.1741-3737.2006.00314.x
  • Hoffman, C. D., Sweeney, D. P., Hodge, D., Wagner-Lopez, M. C., & Looney, L. (2009). Parenting stress and closeness: mothers of typically developing children and mothers of children with autism. Focus on Autism and Other Developmental Disabilities, 24(3),178-187. https://doi.org/10.1177/1088357609338
  • Johnson, H. A., Zabriskie, R. B., & Hill, B. (2006). The contribution of couple leisure involvement, leisure time, and leisure satisfaction to marital satisfaction. Marriage & Family Review, 40(1), 69-91. https://doi.org/10.1300/J002v40n01_05
  • Kanat, S. (2020). Examining the relationship between parenting stress and marriage burnout of parents having children diagnosed with cerebral palsy. [Unpublished master's thesis]. Yeditepe University.
  • Kaner, S. (2009). Family participation and cooperation. In B. Sucuoğlu (Ed.), Zihin Engelliler ve Eğitimleri (pp. 352-405). Kök Publishing.
  • Kara, D. Ö. (2016). Investigation of family quality of life, marital adjustment, and subjective well-being of mothers of children with developmental disabilities and normal development. [Unpublished master's thesis]. Bahçeşehir University.
  • Karaduman, H. (2020). Investigation of the perceptions of family quality of life of parents with children with developmental disabilities and parents with children with normal development. [Unpublished master's thesis]. Istanbul Commerce University.
  • Karaman, Z. (2019). Investigation of the levels of spousal support and marital satisfaction perceived by parents with normally developing children and parents with children with special needs. [Unpublished master's thesis]. Dokuz Eylül University.
  • Karasar, N. (2011). Scientific Research Methods. Nobel Publications.
  • Kaymak Özmen, S., & Özmen, A. (2012). Development of parental stress scale. Journal of National Education, 42(196), 20-35.
  • Kaytez, N., Durualp, E., & Kadan, G. (2015). Examining the needs and stress levels of families with disabled children. Journal of Education and Training Research, 4(1), 197-214.
  • Koçhan, A. (2019). Examining the relationship between stress level, stress coping styles, illness burden perceptions, and wisdom awareness levels of parents with disabled children. [Unpublished master's thesis]. Başkent University.
  • Kurşun, Z. (2018). Comparison of stress levels and ways of coping with stress of parents of children with pervasive developmental disorder and children with normal development. [Unpublished master's thesis]. Istanbul Commerce University.
  • Kübler-Ross, E. (2010). On Death and Dying (B. Büyükkal, trans.). April Publishing House.
  • Lopez, V., Clifford, T., Minnes, P., & Quellette-Kuntz, H. (2008). Parental stress and coping in families of children with and without developmental delays. *Journal on Developmental Disabilities,
  • Mannan, H. (2005). Examining family outcomes in early childhood services for families of children with disabilities. [Unpublished doctoral dissertation]. Kansas University.
  • Meral, B. F. (2011). Investigation of family quality of life perceptions of mothers of children with developmental disabilities. [Unpublished doctoral dissertation]. Anadolu University.
  • Meral, B. F., & Cavkaytar, A. (2015). Family quality of life perceptions of families of children with autism. Kastamonu Education Journal, 23(3), 1363-1380.
  • Öztürk, H. (1987). History of Thought and Civilisation. Ülke Yayın Haber Ticaret Limited Şirketi.
  • Özşenel, E. (2017). Comparison of problemsolving skills and marital life satisfaction in marriages of families with and without children with autism spectrum disorder. [Unpublished master's thesis]. Üsküdar University.
  • Park, J., Hoffman, L., Marquis, J., Turnbull, A., Poston, D., Mannan, H., Wang, M., & Nelson, L. (2003). Toward Assessing Family Outcomes of Service Delivery: Validation of A Family Quality of Life Survey. Journal of Intellectual Disability Research, 47(4/5), 367-384
  • Robinson, M., & Neece, C. L. (2014). Marital satisfaction, parental stress, and child behaviour problems among parents of young children with developmental delays. Journal of Mental Health Research in Intellectual Disabilities, 8(1), 23-46. https://doi.org/10.1080/19315864.2014.994247
  • Sayın, Ö. (1990). Sociology of Family. Ege University Press House.
  • Santamaria, F., Cuzzocrea, F., Gugliandolo, M. C., & Larcan, R. (2012). Marital satisfaction and attribution style in parents of children with autism spectrum disorder, down syndrome, and non-disabled children. Life Span And Disability, 15(1), 19-37.
  • Schlebusch, L., Dada, S., & Samuels, A. E. (2017). Family quality of life of South African families raising children with autism spectrum disorder. Journal of Autism And Developmental Disorders, 47(7), 1966-1977. https://doi.org/10.1007/s10803-017-3102-8
  • Shu, B. C., & Lung, F. W. (2005). The effect of support group on the mental health and quality of life for mothers with autistic children. Journal of Intellectual Disability Research, 49(1), 47-53. https://doi.org/10.1111/j.1365-2788.2005.00661.x
  • Söğüt, R. (2019). Comparison of parents of gifted and non-gifted children's perceptions of parenting competence and stress levels. [Unpublished master's thesis]. Gaziantep University.
  • Taşçı, M. (2014). The effects of functional levels and extremity distributions of children with cerebral palsy on parenting stress level. [Unpublished master's thesis]. Abant İzzet Baysal University.
  • Taşköprü, M. (2013). Investigation of the relationship between marital satisfaction and problem solving skills, coping with stress, and marital duration. [Unpublished master's thesis]. Bilim University.
  • Zaidman-Zait, A. (2008). Everyday problems and stress faced by parents of children with cochlear implants. Rehabilitation Psychology, 53(2), 139-152. https://doi.org/10.1037/0090-5550.53.2.139
Year 2025, Volume: 15 Issue: 1, 24 - 39
https://doi.org/10.19126/suje.1459037

Abstract

References

  • Alpgan, Ö., & Alabay, E. (2021). Investigation of the effect of family quality of life level of parents of children with developmental disabilities on child-parent relationship. Kastamonu Education Journal, 29(4), 219-232. https://doi.org/10.24106/kefdergi.823157
  • Aslanoğlu, M. (2004). Investigation of intra-family relations of parents with autistic, mental, hearing, visual, and physically disabled children. [Unpublished master's thesis]. Dokuz Eylül University.
  • Ardıç, A. (2012). Child with special needs and family. In A. Cavkaytar (Ed.), Family Education and Guidance in Special Education (pp. 19-52). Vize Publishing.
  • Bakır, D. (2020). Examining the effect of self-sensitivity and family support perception on parental stress in parents of differently developing children. [Unpublished master's thesis]. Istanbul Commerce University.
  • Baş, A. B. (2018). Examining the loneliness levels of parents with children with special needs and parents with normally developing children and their relationship with marital satisfaction. [Unpublished master's thesis]. Istanbul Gelisim University.
  • Büyüköztürk, Ş., Kılıç Çakmak, E., Akgün, Ö. E., Karadeniz, Ş., & Demirel, F. (2012). Scientific research methods. Pegem Academy Publications.
  • Cavkaytar, A. (2010). Families with children with special needs. In T. Güler (Ed.), Parent Education (pp. 73-89). Pegem Academy Publications.
  • Ceylan, R. (2004). Investigation of depression and hopelessness levels of mothers of disabled children participating and not participating in integrated education. [Unpublished doctoral dissertation]. Ankara University.
  • Cho, K. S., & Hong, E. J. (2012). A path analysis of the variables related to the quality of life of mothers with disabled children in Korea. Stress & Health, 29(3), 229-239. https://doi.org/10.1002/smi.2457
  • Çelik, E. (2014). The validity and reliability of the Turkish version of the married life satisfaction scale. Cumhuriyet International Journal of Education, 3(4), 1-9. https://doi.org/10.30703/cije.321353
  • Çelimli, Ş. (2009). A comparative study of the processes of family functions of families with children with autism in America and Turkey. [Unpublished doctoral dissertation]. Middle East Technical University.
  • Dalkılıç, M. (2016). Investigation of marital satisfaction, anxiety, relational resilience, and psychological help attitudes of couples with children with autism. [Unpublished master's thesis]. Bahçeşehir University.
  • Dardas, L. A., & Ahmad, M. M. (2014). Predictors of quality of life for fathers and mothers of children with autistic disorder. Research in Developmental Disabilities, 35, 1326-1333. https://doi.org/10.1016/j.ridd.2014.03.009
  • Demiray, G. (2019). Examination of the relationships between quality of life, hopelessness, and resilience in families with children with special needs. [Unpublished master's thesis]. Marmara University.
  • Dokuman, E. (2017). Investigation of marital adjustment and marital satisfaction with state trait anxiety level of parents with disabled children. [Unpublished master's thesis]. Beykent University.
  • Eren-Kanbir, A. (2018). Marital satisfaction in families with disabled children: A qualitative study. [Unpublished master's thesis]. Maltepe University.
  • Gören, A. B. (2016). Mourning process in mothers with disabled children. Cumhuriyet Journal of Theology, 20(1), 225-244. https://doi.org/10.18505/cuid.238980
  • Gülaldı, D. (2010). Investigation of the relationship between parental stress levels of mothers of children with cerebral palsy and autistic children in early childhood and their life satisfaction. [Unpublished master's thesis]. Maltepe University.
  • Güler, A. (2010). Investigation of marital satisfaction of parents with disabled children according to various variables. [Unpublished master's thesis]. Gazi University.
  • Güven, N. (2005). Relationship-related cognitive distortions and the relationship between marital problemsolving skills and marital satisfaction. [Unpublished master's thesis]. Ankara University.
  • Güzeloğlu, B. (2019). Investigation of the relationship between spouse support and family quality of life of parents with children with special needs and their hopelessness and stress levels. [Unpublished master's thesis]. Ankara University.
  • Hartley, S. L., Barker, E. T., Seltzer, M. M., Greenberg, J. S., & Floyd, F. J. (2011). Marital satisfaction and parenting experiences of mothers and fathers of adolescents and adults with autism. American Journal on Intellectual and Developmental Disabilities, 116(1), 81-95. https://doi.org/10.1352/1944-7558-116.1.81
  • Hoffman, L., Marquis, J. G., Poston, D. J., Summers, J. A., & Turnbull, A. (2006). Assessing family outcomes: Psychometric evaluation of the family quality of life scale. Journal of Marriage and Family, 68, 1069-1083. https://doi.org/10.1111/j.1741-3737.2006.00314.x
  • Hoffman, C. D., Sweeney, D. P., Hodge, D., Wagner-Lopez, M. C., & Looney, L. (2009). Parenting stress and closeness: mothers of typically developing children and mothers of children with autism. Focus on Autism and Other Developmental Disabilities, 24(3),178-187. https://doi.org/10.1177/1088357609338
  • Johnson, H. A., Zabriskie, R. B., & Hill, B. (2006). The contribution of couple leisure involvement, leisure time, and leisure satisfaction to marital satisfaction. Marriage & Family Review, 40(1), 69-91. https://doi.org/10.1300/J002v40n01_05
  • Kanat, S. (2020). Examining the relationship between parenting stress and marriage burnout of parents having children diagnosed with cerebral palsy. [Unpublished master's thesis]. Yeditepe University.
  • Kaner, S. (2009). Family participation and cooperation. In B. Sucuoğlu (Ed.), Zihin Engelliler ve Eğitimleri (pp. 352-405). Kök Publishing.
  • Kara, D. Ö. (2016). Investigation of family quality of life, marital adjustment, and subjective well-being of mothers of children with developmental disabilities and normal development. [Unpublished master's thesis]. Bahçeşehir University.
  • Karaduman, H. (2020). Investigation of the perceptions of family quality of life of parents with children with developmental disabilities and parents with children with normal development. [Unpublished master's thesis]. Istanbul Commerce University.
  • Karaman, Z. (2019). Investigation of the levels of spousal support and marital satisfaction perceived by parents with normally developing children and parents with children with special needs. [Unpublished master's thesis]. Dokuz Eylül University.
  • Karasar, N. (2011). Scientific Research Methods. Nobel Publications.
  • Kaymak Özmen, S., & Özmen, A. (2012). Development of parental stress scale. Journal of National Education, 42(196), 20-35.
  • Kaytez, N., Durualp, E., & Kadan, G. (2015). Examining the needs and stress levels of families with disabled children. Journal of Education and Training Research, 4(1), 197-214.
  • Koçhan, A. (2019). Examining the relationship between stress level, stress coping styles, illness burden perceptions, and wisdom awareness levels of parents with disabled children. [Unpublished master's thesis]. Başkent University.
  • Kurşun, Z. (2018). Comparison of stress levels and ways of coping with stress of parents of children with pervasive developmental disorder and children with normal development. [Unpublished master's thesis]. Istanbul Commerce University.
  • Kübler-Ross, E. (2010). On Death and Dying (B. Büyükkal, trans.). April Publishing House.
  • Lopez, V., Clifford, T., Minnes, P., & Quellette-Kuntz, H. (2008). Parental stress and coping in families of children with and without developmental delays. *Journal on Developmental Disabilities,
  • Mannan, H. (2005). Examining family outcomes in early childhood services for families of children with disabilities. [Unpublished doctoral dissertation]. Kansas University.
  • Meral, B. F. (2011). Investigation of family quality of life perceptions of mothers of children with developmental disabilities. [Unpublished doctoral dissertation]. Anadolu University.
  • Meral, B. F., & Cavkaytar, A. (2015). Family quality of life perceptions of families of children with autism. Kastamonu Education Journal, 23(3), 1363-1380.
  • Öztürk, H. (1987). History of Thought and Civilisation. Ülke Yayın Haber Ticaret Limited Şirketi.
  • Özşenel, E. (2017). Comparison of problemsolving skills and marital life satisfaction in marriages of families with and without children with autism spectrum disorder. [Unpublished master's thesis]. Üsküdar University.
  • Park, J., Hoffman, L., Marquis, J., Turnbull, A., Poston, D., Mannan, H., Wang, M., & Nelson, L. (2003). Toward Assessing Family Outcomes of Service Delivery: Validation of A Family Quality of Life Survey. Journal of Intellectual Disability Research, 47(4/5), 367-384
  • Robinson, M., & Neece, C. L. (2014). Marital satisfaction, parental stress, and child behaviour problems among parents of young children with developmental delays. Journal of Mental Health Research in Intellectual Disabilities, 8(1), 23-46. https://doi.org/10.1080/19315864.2014.994247
  • Sayın, Ö. (1990). Sociology of Family. Ege University Press House.
  • Santamaria, F., Cuzzocrea, F., Gugliandolo, M. C., & Larcan, R. (2012). Marital satisfaction and attribution style in parents of children with autism spectrum disorder, down syndrome, and non-disabled children. Life Span And Disability, 15(1), 19-37.
  • Schlebusch, L., Dada, S., & Samuels, A. E. (2017). Family quality of life of South African families raising children with autism spectrum disorder. Journal of Autism And Developmental Disorders, 47(7), 1966-1977. https://doi.org/10.1007/s10803-017-3102-8
  • Shu, B. C., & Lung, F. W. (2005). The effect of support group on the mental health and quality of life for mothers with autistic children. Journal of Intellectual Disability Research, 49(1), 47-53. https://doi.org/10.1111/j.1365-2788.2005.00661.x
  • Söğüt, R. (2019). Comparison of parents of gifted and non-gifted children's perceptions of parenting competence and stress levels. [Unpublished master's thesis]. Gaziantep University.
  • Taşçı, M. (2014). The effects of functional levels and extremity distributions of children with cerebral palsy on parenting stress level. [Unpublished master's thesis]. Abant İzzet Baysal University.
  • Taşköprü, M. (2013). Investigation of the relationship between marital satisfaction and problem solving skills, coping with stress, and marital duration. [Unpublished master's thesis]. Bilim University.
  • Zaidman-Zait, A. (2008). Everyday problems and stress faced by parents of children with cochlear implants. Rehabilitation Psychology, 53(2), 139-152. https://doi.org/10.1037/0090-5550.53.2.139
There are 52 citations in total.

Details

Primary Language English
Subjects Inclusive Education
Journal Section Articles
Authors

Halil İbrahim Sağlam 0000-0002-3341-2576

Zeynep Çam Alegöz 0000-0001-6419-9934

Early Pub Date April 16, 2025
Publication Date
Submission Date March 26, 2024
Acceptance Date January 7, 2025
Published in Issue Year 2025 Volume: 15 Issue: 1

Cite

APA Sağlam, H. İ., & Çam Alegöz, Z. (2025). Examining of the Relationship between Family Quality of Life, Parenting Stress and Marital Life Satisfaction of Mothers with Children with Special Needs. Sakarya University Journal of Education, 15(1), 24-39. https://doi.org/10.19126/suje.1459037
AMA Sağlam Hİ, Çam Alegöz Z. Examining of the Relationship between Family Quality of Life, Parenting Stress and Marital Life Satisfaction of Mothers with Children with Special Needs. SUJE. April 2025;15(1):24-39. doi:10.19126/suje.1459037
Chicago Sağlam, Halil İbrahim, and Zeynep Çam Alegöz. “Examining of the Relationship Between Family Quality of Life, Parenting Stress and Marital Life Satisfaction of Mothers With Children With Special Needs”. Sakarya University Journal of Education 15, no. 1 (April 2025): 24-39. https://doi.org/10.19126/suje.1459037.
EndNote Sağlam Hİ, Çam Alegöz Z (April 1, 2025) Examining of the Relationship between Family Quality of Life, Parenting Stress and Marital Life Satisfaction of Mothers with Children with Special Needs. Sakarya University Journal of Education 15 1 24–39.
IEEE H. İ. Sağlam and Z. Çam Alegöz, “Examining of the Relationship between Family Quality of Life, Parenting Stress and Marital Life Satisfaction of Mothers with Children with Special Needs”, SUJE, vol. 15, no. 1, pp. 24–39, 2025, doi: 10.19126/suje.1459037.
ISNAD Sağlam, Halil İbrahim - Çam Alegöz, Zeynep. “Examining of the Relationship Between Family Quality of Life, Parenting Stress and Marital Life Satisfaction of Mothers With Children With Special Needs”. Sakarya University Journal of Education 15/1 (April 2025), 24-39. https://doi.org/10.19126/suje.1459037.
JAMA Sağlam Hİ, Çam Alegöz Z. Examining of the Relationship between Family Quality of Life, Parenting Stress and Marital Life Satisfaction of Mothers with Children with Special Needs. SUJE. 2025;15:24–39.
MLA Sağlam, Halil İbrahim and Zeynep Çam Alegöz. “Examining of the Relationship Between Family Quality of Life, Parenting Stress and Marital Life Satisfaction of Mothers With Children With Special Needs”. Sakarya University Journal of Education, vol. 15, no. 1, 2025, pp. 24-39, doi:10.19126/suje.1459037.
Vancouver Sağlam Hİ, Çam Alegöz Z. Examining of the Relationship between Family Quality of Life, Parenting Stress and Marital Life Satisfaction of Mothers with Children with Special Needs. SUJE. 2025;15(1):24-39.