|Year : 2019 | Volume
| Issue : 1 | Page : 1-5
Relationship between quality of life of children with cerebral palsy and their mothers' depression and anxiety
Rasha H Soliman1, Rahaf Ghazi Altwairqi2, Nourah A Alshamrani2, Abdulrahman Ahmed Al-Zahrani2, Reham Mohammed Al-Towairqi2, Abdullah Hussain Al-Habashi2
1 Department of Microbiology, College of Medicine, Taif University, Taif City, Saudi Arabia; Department of Parasitology, College of Medicine, Suez Canal University, Ismailia, Egypt
2 Ministry of Health Hospitals, Taif City, Saudi Arabia
|Date of Web Publication||16-May-2019|
Dr. Rasha H Soliman
Department of Microbiology, College of Medicine, Taif University, Taif City, Saudi Arabia; Department of Parasitology, College of Medicine, Suez Canal University, Ismailia,Egypt
Source of Support: None, Conflict of Interest: None
Objective: To assess the relationship between maternal anxiety and depression and parent-reported quality of life (QOL) of children with cerebral palsy (CP). Methods: A cross-sectional study was done on 232 mothers of CP children aged 5–18 years. Children QOL and mothers' depression and anxiety were assessed using the Pediatric Inventory Parent Version (PedsQL-P), Beck Anxiety Scale (BAS), and Beck Depression Inventory (BDI), respectively. Results: Different degrees of depression in 55.5% of mothers were noted, and 47.4% and 21.6% had moderate and severe anxiety. The mean value of PedsQL-P scores was 69.35 ± 18.18. A significant negative correlation was found between PedsQL-P and both BAS and BDI scores. Conclusion: CP children's mothers had high prevalence of depression and anxiety that had a negative impact on children QOL. The study calls for interventions to improve the mothers' psychiatric status.
Keywords: Anxiety, cerebral, depression, maternal, palsy, quality
|How to cite this article:|
Soliman RH, Altwairqi RG, Alshamrani NA, Al-Zahrani AA, Al-Towairqi RM, Al-Habashi AH. Relationship between quality of life of children with cerebral palsy and their mothers' depression and anxiety. Saudi J Health Sci 2019;8:1-5
|How to cite this URL:|
Soliman RH, Altwairqi RG, Alshamrani NA, Al-Zahrani AA, Al-Towairqi RM, Al-Habashi AH. Relationship between quality of life of children with cerebral palsy and their mothers' depression and anxiety. Saudi J Health Sci [serial online] 2019 [cited 2020 May 26];8:1-5. Available from: http://www.saudijhealthsci.org/text.asp?2019/8/1/1/256780
| Introduction|| |
Cerebral palsy (CP) is a neurological disorder which affects children posture and control of movements. These disorders make CP children dependent on others to do their activity of daily living.
The burden of caring for a CP child was found to have an adverse effect on parents' physical health and social well-being,, especially to mothers who can suffer from stress and depression when compared to mothers of healthy children. Sensory impairments in CP children's daily activities can have a negative impact on their quality of life (QOL).,, Thus, if parents are not able to meet the challenges of providing care for their CP child due to psychiatric disorders, this leads to poor caregiving and the required level of child functioning will not be achieved.
Worldwide, the prevalence of depression among mothers of CP children was estimated to range from 6% to 40.5%.,
The relationship of maternal psychological health and health-related quality of life (HRQOL) of their CP children was reported in previous studies. One of these studies has found that the lower independency level of the CP children, the higher the mothers' depression. These studies reported a negative correlation between psychological distress among parents and all domains of parent-rated QOL of their CP children., Other studies have found that higher mothers' depression and anxiety levels negatively impacted the HRQOL of their CP children.,, Internationally, limited studies have been done to assess the relationship between parental psychiatric status and the reported QOL for children with CP.
In the Kingdom of Saudi Arabia, CP is the most common neurologic disorder among Saudi children, with a prevalence rate of 23.4/10 000. Saudi mothers were found to play a very active role in the care of their disabled children. Previous studies have found that Saudi mothers of disabled children showed higher scores of anxiety and depression.,
No study was done in Saudi Arabia to assess the relationship between parental psychiatric status and the reported QOL for children with CP. That is why this study aimed to evaluate the impact of maternal anxiety and depression on the HRQOL of their children with CP.
| Methods|| |
Study design and time frame
A cross-sectional study was carried out on a sample of mothers of children with CP who attended the Armed Forces Rehabilitation Center in Taif City, Maternity and Child Hospital in Makkah, and King Fahd Specialist Hospital in Dammam, from July to September 2018.
All mothers of children or adolescents with CP who attended the three settings in the time of the study were asked to participate in the study. After exclusion of the nonrespondents, 232 mothers accepted sharing in the study.
The participants' children were evaluated by a specialized clinician to determine their eligibility for inclusion in the study. The inclusion criteria were as follows: mothers of children and adolescents with CP between 5 and 18 years, who have the cognitive ability to answer the research scales. The exclusion criteria were those mothers who have a history of chronic psychological disorder or depression or were on psychotropic therapy before their children diagnosed with CP.
To assess the prevalence of depression among mothers, Beck Depression Inventory (BDI) was used. It is a 21-item scale where each item was scored from 0 to 3 according to the symptom severity, with a total score ranging from 0 to 63. It was possible to answer with a score that ranged from 0 to 3 (absent, mild, moderate, and severe). The patient was diagnosed as normal if having a score <26, mild depression if the score ranged from 26 to 38, moderate if ranged from 39 to 55, and severe depression if ranged from 56 to 63.
Anxiety prevalence was determined using the Beck Anxiety Scale (BAS). It is a self-report Likert type scale comprising 21 items used to measure the severity of anxiety symptoms in adults. Each item is scored between “0” and “3,” and the scores range between “0” and “63.” Level of anxiety in mothers was determined as follows: score of 0–21 = low anxiety, score of 22–35 = moderate anxiety, and a score of 36 and above = severe level of anxiety.
To assess HRQOL of the CP children, the Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL) was used. It has well-documented reliability and validity in the pediatric field for children with chronic diseases.,, It is a 23-item scale which assess (a) physical functioning (8 items); (b) emotional functioning (5 items); (c) social functioning (5 items); and (d) school functioning (5 items).,
The PedsQL-P asks how much of a problem in each item has been during the last month. All answers are based on a five-point Likert scale (0, not a problem; 1, almost never a problem; 2, sometimes a problem; 3, often a problem; 4, almost always a problem)., Items were then reversed, scored, and linearly transformed to a scale of 0–100 (0 = 100, 1 = 75, 2 = 50, 3 = 25, 4 = 0). Scale scores were calculated as the sum of the items divided by the number of items answered. PedsQL is a fast and easy measurement device, and higher total scores indicate better HRQOL., In the present study, this scale was filled by the participant mother.
Official approvals were obtained from the Research Ethics Committee of Taif University and from the directors of the three settings where the study was done. An explanation of the study nature and aim was given to all participant mothers, and written and verbal consents were obtained from them before sharing in the study.
The data were coded, tabulated, and analyzed using the Statistical Package for the Social Sciences (SPSS, version 20; IBM Corp., Armonk, New York, USA). Qualitative data were expressed as numbers and percentages. Quantitative data were expressed as mean and standard deviation, and Kruskal–Wallis test was used to assess the relationship between variables. Correlation analysis was performed by the Spearman's test, and a P < 0.05 was considered statistically significant.
| Results|| |
The mean age of the participant CP children was 10.23 ± 3.26 years. The prevalence of different types of CP among the studied children was as follows: spastic bilateral hemiplegia (43.1%), spastic unilateral hemiplegia (13.8%), choreoathetoid (13.8%), dystonic (12.5%), ataxic (9.5%), and mixed (7.8). The mean value of BDI, BAS, and PedsQL-P scores was 33.39 ± 12.89, 28.31 ± 11.94, and 69.35 ± 18.18, respectively [Table 1].
|Table 1: Sample scores of Beck Depression Inventory, Beck Anxiety Scale, and Pediatric Inventory Parent Version|
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[Table 2] shows that children who had spastic unilateral hemiplegia had significant higher PedsQL-P scores compared to other children, while children who suffered mixed type of CP had the lowest scores of PedsQL-P.
|Table 2: Pediatric Inventory Parent Version scores in relation to different types of cerebral palsy|
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Among the 232 studied mothers, 55.1% of them showed different degrees of depression (24.1% mild, 25% moderate, and 6% severe depression). As for the prevalence of anxiety, 31% of the mothers showed low anxiety level while 47.4% had moderated anxiety and 21.6% had severe anxiety [Table 3].
|Table 3: Prevalence of degrees of depressions and anxiety among the studied mothers|
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Data analysis showed that a significant negative correlation was found between PedsQL-P and BDI scores (r = −0.537, P ≤ 0.001). In addition, a significant negative correlation was found between PedsQL-P and BAS scores (r = −0.695, P ≤ 0.001) [Table 4].
|Table 4: Spearman correlation between Pediatric Inventory Parent Version, Beck Depression Inventory, and Beck Anxiety Scale Scores|
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| Discussion|| |
In the present work, the prevalence of different types of CP among the studied children was as follows: 43.1% had spastic bilateral hemiplegia; 13.8% had spastic unilateral hemiplegia; 13.8% had choreoathetoid type; 12.5% had dystonic type; 9.5% had ataxic type; and 7.8% had mixed type. This prevalence is in agreement with a previous Turkish study which showed that the most prevalent type of CP among their study group was spastic bilateral hemiplegia, with a prevalence of (43.3%).
Previous studies have found that the psychological status of parents is negatively influenced from the presence of a child with CP at home, and having a child with CP also increases the risk of developing depression in mothers as much as 2.26 times.
The present work showed that among the 232 studied mothers, 55.1% of them had different degrees of depression. This result is consistent with that revealed from previous studies that assessed the prevalence of depression among mothers of CP children.,, One of these studies was a study done in Pakistan where 49.3% of CP children mothers had depression. In the same time, this figure is higher than that reported in other studies.,,,,, One of these studies was a study done in Iran where 44.2% of CP children mothers had depression. On the other hand, the reported prevalence of depression in the present work is lower than that observed in other studies.,, Of these studies was the study done by Sousa and Singhvi, which found that 71% mothers of children with CP were depressed. This variability in the studies' results could be attributed to the usage of different scales to assess depression among the studied mothers.
The prevalence of anxiety reported in the present study (69%) is higher than that reported in other studies. The high level of anxiety and depression among mothers of CP children was attributed to the vulnerability of CP children mothers to mental stress due to their continuous efforts in managing the needs and disability of a CP child. Another explanation can be attributed to the sleeping problems among CP children that can adversely affect the sleep quality of mothers, which is a leading cause of anxiety and depression. In addition, studies have proved that mothers of children with CP have a low QOL compared to mothers of healthy children, a matter that affects their psychological well-being.,
Findings are in agreement with those of the international case–control studies that showed a high prevalence of depression among mothers of CP children compared to mothers of healthy children.,,
The high prevalence of depression among mothers of CP children could also be explained in light that mothers are the main supporter of disable children and have more responsibility than fathers to take care of them, a matter that makes the permanent care of CP children, a stressful condition for those mothers. Furthermore, the need for CP children to routine special care, frequent medical checkups, and continuous physiotherapy treatment modalities which put a psychological burden on the caring mothers., Added to this is the social stigma and discrimination in society toward disabilities, that results in low social relationships of the CP children mothers.
Previous studies have shown a common interaction between parental psychopathology and QOL of the children, as caregivers of children with poor functioning levels and QOL are more at risk of developing psychiatric problems when compared with caregivers of healthy children.
In the present study, a significant negative correlation was found between PedsQL-P and both BDI and BAS scores (P ≤ 0.001). In agreement with our results is that revealed from a previous study which showed a negative correlation between BDI and BAS scores of mothers and the PedsQL-P scores of their CP children.,,,,,
This negative correlation found between PedsQL-P and both BDI and BAS scores was attributed to many factors. First is that depressed mothers were found to be less responsive and attentive to their children needs; they also are poor models for negative mood regulation and problem-solving. Second is the maternal distress that can affect the mothers' proxy-reported QOL as distress can alter the mothers' decision. In addition, distressed mothers may create negative situations for their children and thus leads to poor QOL of their children.,
One of the limitations of this study was using self-reported questionnaires which were prone to recall bias. Another limitation was being a cross-sectional study which showed the relation between variables without concluding a cause–effect relationship. Another limitation is that the study did not assess depression and anxiety of fathers which could have an effect on both maternal mental status and child QOL. The small sample size was also another limitation.
| Conclusion|| |
This study demonstrated a high prevalence of both depression and anxiety among mothers of the studied CP children. In addition, a significant negative correlation was found between PedsQL-P and both BDI and BAS scores. Based on the result of this study, clinicians should understand factors affecting parent-rated HRQOL in children with CP. The study calls for interventions to improve mothers' psychiatric status which can affect the QOL of their CP children. Further research in longitudinal studies should be encouraged to determine the causality among variables. These studies should include larger sample of both parents.
We gratefully acknowledge the support provided by the officials of the studied hospitals for facilitating the administrative aspects of this research. Special thanks to Dr. Abdullah Abdulaziz Al-Hedaithy, Dr. Hatum Abdullah Alsuwat and Dr. Ibtisam Mohammed Alhuzali for their appreciated efforts in data collection. Participant mothers and children deserve special thanks for their cooperation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]