Icelandic Scientists Validate a New Tool to Detect Parental Burnout

Parental burnout has quietly become one of the most consequential yet under-recognised health challenges facing modern families, and researchers in Iceland have now taken a significant step toward confronting it. In a study published in the Scandinavian Journal of Occupational Therapy, a team from the University of Akureyri translated, adapted and validated the Parental Burnout Assessment for Icelandic use, creating a psychometrically robust instrument known as the PBA-IS. The work, led by Helga Sif Pétursdóttir with colleagues Eva Halapi and Björg Thordardottir, involved 1,110 parents from across the country and provides clinicians with a reliable means of identifying parents at risk of, or already experiencing, a condition linked to sleep disorders, addictive behaviours, suicidal thoughts, and even child neglect and violence.

Parental burnout differs fundamentally from work-related burnout, despite sharing some surface symptoms. Unlike employment, parenting offers no clock-out boundary, no weekend, and no formal resignation procedure. The role is continuous, ever-present, and often takes precedence over every other responsibility in adult life. Occupational scientists have noted that the parenting role encompasses more than one hundred distinct occupations, spanning the fulfilment of children’s fundamental, developmental and social needs. When these overlapping demands are frequently interrupted and never fully discharged, perceived health suffers. Chronic stress within the parental role can accumulate until it produces the four dimensions that define parental burnout: exhaustion in one’s parental role, a contrast with one’s previous parental self, feelings of being fed up with the parental role, and emotional distancing from one’s children.

The Parental Burnout Assessment, originally developed by Roskam and colleagues on the basis of testimonies from burned-out parents, measures these dimensions through 23 items rated on a seven-point Likert scale from never to every day, yielding a maximum score of 138 points. Established cut-off scores allow clinicians to distinguish risk from diagnosis: a score of 53 or higher indicates a parent at risk, while 86 or above suggests burnout. The instrument’s four-factor structure has been validated in numerous countries and translated into languages including Finnish, Swedish, Polish and Chinese. The Icelandic team followed a rigorous cross-cultural adaptation protocol, obtaining permission from the original authors, conducting independent forward translations by two occupational therapists and an expert with more than two decades of field experience, reconciling the drafts, back-translating into English with native speakers, and consulting the National Queer Organisation of Iceland to ensure culturally sensitive terminology.

The translation process also incorporated cognitive interviews with five parents deliberately selected to represent diverse family structures, including mothers and fathers, single-parent households, families with one to four children of varying ages, different educational levels, and both working and non-working parents. Because all participants comprehended the items similarly, no additional interviews were required. The final Icelandic version preserved all 23 items in their original order. Data collection then proceeded through two convenience sampling channels: paediatric nurses at ten child health centres across Iceland distributed study information with a QR code for a web-based questionnaire, and the study was promoted through Icelandic social media groups. Data were gathered over four weeks in March and April 2023, and the study received approval from the National Bioethics Committee of Iceland.

After applying inclusion criteria requiring at least one child living at home and residence in Iceland, the final analytical sample comprised 1,063 parents, of whom 88.9 percent were mothers. Most participants were married or cohabiting, nearly half lived in the capital region, and more than two-thirds held university degrees. The mean age was 35.3 years for women and 37.3 years for men. The researchers assessed structural validity using confirmatory factor analysis with a diagonally weighted least squares estimator, chosen because tests of multivariate skewness and kurtosis indicated that normality could not be assumed. They compared a one-factor model, a four-factor model and a second-order model in which an overall burnout factor explains the relationships among the four subscales.

The results provided strong support for the original four-factor structure. The comparative fit index and Tucker-Lewis index exceeded 0.95 for both the four-factor and second-order models, and post-hoc modification of residual covariances brought the root mean square error of approximation down to 0.059 and the standardised root mean square residual to 0.044. Standardised factor loadings for the first-order model ranged between 0.7 and 0.9, while second-order loadings reached between 0.90 and 0.96, all significant at the 0.001 level. Internal consistency was excellent, with Cronbach’s alpha reaching 0.96 for the total scale and values above 0.9 for the exhaustion and contrast subscales, though the three-item distancing subscale showed the lowest reliability. One item concerning lost direction in the parental role showed cross-loadings with the exhaustion dimension, which the authors attribute to nuances in translation and suggest could be improved with slight rephrasing.

Prevalence estimates from the Icelandic sample were striking. Using the recommended cut-offs, 10.1 percent of parents scored between 53 and 85 points, placing them at risk of parental burnout, while 3.8 percent scored 86 or higher, meeting the threshold for burnout. This overall rate is lower than figures reported in some other European countries such as Finland and Poland. Notably, the gap between mothers and fathers was smaller than in much of the previous international literature, with burnout rates of 3.6 percent among mothers and 2.7 percent among fathers. The researchers suggest this may reflect Iceland’s progressive family policies, which promote active father involvement in early childcare through generous parental leave arrangements. Older parents also exhibited lower burnout levels, consistent with the idea that accumulated life experience fosters a more balanced perspective on parenting challenges.

The study went beyond validation to explore which factors predict burnout, drawing on the Value and Meaning in Occupation model, a framework used in Scandinavian burnout rehabilitation that examines how personal factors, environment and the perceived value of daily activities shape occupational engagement. A hierarchical three-step regression analysis revealed that demographic variables alone explained only 1.6 percent of the variance in burnout scores. Adding the number of children at home and the presence of a child with special needs raised explained variance to 7.7 percent. The decisive contribution came from perceived support, personal causation and parental diagnosis, which together lifted the final model to 43.9 percent of explained variance. Personal causation, a core concept in occupational therapy referring to an individual’s sense of self-efficacy and perceived capacity, correlated strongly and positively with burnout, meaning that parents who doubted their own abilities scored substantially higher on the burnout measure.

The findings carry practical weight for clinical practice. Single parents, non-working parents receiving disability benefits or rehabilitation pensions, parents of children with special needs, and parents with diagnoses such as ADHD, ADD or autism all showed elevated burnout levels, while perceived support emerged as a clear protective factor. The authors argue that occupational therapists are uniquely positioned to help, because parental burnout rarely arises from a single cause but from a complex accumulation of occupational imbalances that compound over time. By assessing individual, task and environmental factors holistically, therapists can help parents reduce stressors, strengthen coping skills and rebuild their sense of capacity within the parenting role. The PBA-IS now enables early identification in Icelandic clinical settings, supporting interventions that reduce stress, promote mental health and enhance wellbeing for entire families. Future research, the team suggests, should pursue more diverse samples, validate a shorter five-item screening scale for use in child health services, and develop occupational therapy-specific instruments for measuring personal causation in parents.

Subject of Research: Cross-cultural translation and psychometric validation of the Parental Burnout Assessment for Icelandic parents

Article Title: Icelandic translation, adaptation and validation of the Parental Burnout Assessment (PBA-IS)

Article References: Pétursdóttir, H. S., Halapi, E., & Thordardottir, B. (2025). Icelandic translation, adaptation and validation of the Parental Burnout Assessment (PBA-IS). Scandinavian Journal of Occupational Therapy, 32(1), Article 2453479. https://doi.org/10.1080/11038128.2025.2453479

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2453479

Keywords: parental burnout, Parental Burnout Assessment, psychometric validation, Iceland, occupational therapy, confirmatory factor analysis, personal causation, parental stress, cross-cultural adaptation, mental health, perceived support, Scandinavian Journal of Occupational Therapy