FAMILY Matters: Parental Emotional State Mediates the Association Between Disease Burden and Child Self-Esteem in Pediatric-Onset Multiple Sclerosis.

Pediatric-Onset Multiple Sclerosis (POMS) affects children's physical, cognitive, and emotional state, with consequences for parents as well. Parents of children with chronic illnesses often report elevated stress and psychological distress, yet their role in shaping children's psychological outcomes in POMS remains underexplored. This study examined whether parental emotional state mediates the association between children's disease-related factors and self-esteem. Thirty children and adolescents with POMS (ages 10-18) and their parents participated. Measures included child fatigue, processing speed, disease severity (EDSS), self-esteem, and parental stress and well-being. All participants scored within the low self-esteem range of the Rosenberg Self-Esteem Scale (RSES; M = 15.93, SD = 2.21), indicating reduced global self-worth. Among parents, emotional distress was evident, with 43% of parents meeting cutoffs for stress and low well-being. Mediation analyses revealed that parental stress significantly mediated the association between self-esteem and all three disease-related variables (fatigue: 95% CI = [.002, .059]; processing speed: 95% CI = [.080, 1.382]; EDSS: 95% CI = [- 1.041, -.044]). Parental well-being mediated only the association between processing speed and self-esteem (95% CI = [.076, 1.348]). Findings highlight parental stress as a robust pathway linking child disease burden to self-esteem. Addressing parent emotional state may improve outcomes and promote resilience in youth with POMS.