The impact of children's health on maternal mental health has been the subject of considerable research, but to examine this relationship, many have focused on specific child diagnoses. Using the National Survey of Child's Health, 2003, this study assessed the broader implications of mothers' caregiving for children with a variety of special health care needs. Screening questions from the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services, piloted for the first time in this national sample, formed the basis of special needs criteria. The relationships among special needs and mothers' mental health and anxiousness about their child's outcomes were assessed within the framework of the stress process. A comparative analysis using a sample from the National Health Interview Survey, 2004 and 2005, further enhanced exploration of selected structural strains related to mothers' depressive symptoms in a similar context.

Results of this study indicate that children's special needs are significantly associated with mothers' mental health and well-being. Perceived coping had a consistently strong positive effect, rendering the impact of special needs on maternal mental health nonsignificant and partially mediating the relationship with anxiousness; however, coping did not buffer this relationship. A child's regular source of care positively affected maternal mental health. It buffered the effect of special needs for mothers of children with 1 to 2 special needs, but this buffering effect was not seen for mothers of children with more needs. The relationship between children's needs and mothers' mental health was mediated by neighborhood support, but this moderator only buffered the effects of needs for mothers of children with 3 or more needs. The significance of sociodemographic variables, such as poverty, employment, and being a single mother, underscored the importance of structural environments and contexts of social stress on mothers' well-being. Children's special health care needs should be further examined within the framework of the stress process to better explicate their relationship with maternal mental health.