Self-Esteem, Perceived Stress, and Emotional Distress Among Mothers of School-Age Autistic Children in Sale, Morocco:A Cross-Sectional Psychometric Study Using the RSES, PSS-10, and HADS

Abstract

Background. Caring for a child with autism spectrum disorder is difficult anywhere. In Morocco, it is especially so not because Moroccan mothers are less resilient, but because the support systems that might absorb part of that difficulty are, in many cases, simply absent. Three specialized centers in Sale gave us access to 102 of these women, and what we found in their questionnaire data was striking enough to warrant detailed reporting: self-esteem, stress, and emotional distress were so tightly interwoven in this sample that the correlations between our three instruments approached values one does not typically see outside of laboratory-controlled conditions.

Methods. We kept it real and worked with 102 mothers in Salé who have kids under 12 with an autism diagnosis. Instead of just cold-calling, we met them through three local centers. We used Arabic versions of standard scales, but we made sure they actually made sense for our culture. We weren't just looking for numbers; we wanted to see the real human link between how a mother feels about herself and how she manages to keep her head above water.

Results. Means: RSES = 32.05 (SD = 3.67), PSS-10 = 20.48 (SD = 10.64), HADS = 8.52 (SD = 3.21)—the last sitting at the borderline clinical threshold. All bivariate correlations exceeded r = .87 in absolute value (p < .001). Mothers whose children benefited from AVS school-support showed dramatically more favorable profiles than those without (d = 2.30–2.65 across the three measures). A near-monotonic educational gradient governed outcomes across five attainment levels. Mediation analysis confirmed that perceived stress mediates roughly 80% of the self-esteem effect on affective burden (bootstrapped 95% CI [−0.814, −0.632]).

Conclusion. Self-esteem does not protect these women from distress by some abstract mechanism it protects them by keeping their sense of the situation as manageable rather than overwhelming. When that sense collapses, anxiety and depression follow. Expanding AVS coverage and building self-esteem-focused support into autism care pathways are, on the strength of these findings, priorities that decision-makers in the Rabat–Sale region can no longer treat as optional.