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The Romanian Journal of Child and Adolescent Neurology and Psychiatry

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INFLUENCE OF CHILDREN&RSQUO;S NEUROLOGICAL AND PSYCHIATRIC DISORDERS ON FAMILY ENVIRONMENT


Author: Rafaela Stehlic



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The problem considered is to highlight the existence of differences in the level of depression, anxiety and somatization to parents whose children have neurological or psychological disorders and the existence of differences in the level of self-esteem in them and highlighting a specific link between the child`s disorder and marital satisfaction of parents.
The subject matter is of high importance due to the fact that few studies have evaluated the effects of the disease on the child`s parents. The type of disorder which the child is suffering experience triad involving co-interaction between the child and the family that is affected by the disorder.
In the research were used: Scale to measure self-esteem Rosenberg, symptom assessment scale SCL-90 and Scale for Assessment of marital satisfaction.
Regarding the differences between the level of somatization and marital satisfaction among the three groups of parents research results lead us to conclude that these relationships are coincidental and not due to the health of children.
As the self-esteem, anxiety and depression among the three groups of parents research results indicate statistically significant differences between them.



 

Introduction:
The anxieties distressing the future mother are well known, as are the issues that she thinks about when the pregnancy period starts, especially when there have been precedents in the family, or, more seriously, when there are actual reasons for concern. The worries linked to childbirth and the boundless joy lived by the family when everything went normal are well known. Therefore, one may understand why any immediate or ulterior confrontation of the family with a different outcome is a drama. [Milea Ş., 2009].
Indeed, more visible or better disguised, the concern for the child’s health exists and it marks every family’s conduct, and sometimes it makes it particularly sensitive. Therefore, any suffering of the child in general, as well as the one that falls into the category of neurological and psychiatric disorders makes the members of the family think of it as unacceptable. As a result, the family engages in solving a complex of challenging problems [Aubert, Godard et al., 2008], which require it to pass through many stages that are difficult to overcome without appropriate support.
Regardless of the disorder that a child has, it triggers a crisis in the family, feelings of anger, incapacity, vulnerability, guilt, anxiety or depression in parents and involves major changes in the life of each family member. Parents are the ones who modulate how the child perceives the reality of the disease and adapt to everything that this entails and ensure emotional support for their offspring during difficult times.
The degree to which parents are able to modulate the traumatic experiences for the child is dependent on the extent to which they confront their concerns about the child’s illness. Unfortunately, not all parents are able to do so, and the family’s adjustment mechanisms are not always the most appropriate ones. [Mrazek, 2002].
The present study attempts to highlight the effects that the neurological and psychiatric diseases have on these children’s family environment and to what extent the marital relationship of the couple is affected.
Objectives of the research:
Pointing out the main aspects of the research topic addressed in this paper led to highlighting the following objectives:

  • to grasp the differences in the level of self-esteem, somatization, levels of depression and anxiety in the three groups of parents, depending on the health of their children;
  • to assess the marital satisfaction in the parents of children with neurological and psychiatric ailments compared to that in the control group whose children were clinically healthy when questionnaires have been administered.

The group of subjects under investigation:
The present research was carried out by administering three questionnaires to 45 couples (90 subjects) aged 25-50 years from urban and rural areas and who have children diagnosed with neurological or psychiatric disorders and a control group. Based on the existing diagnosis when the questionnaires were administered, the subjects constituted three separate sample groups that were divided equally:

  • 15 couples with children whose primary diagnosis was neurological disorders, namely: muscular dystrophy, spastic quadriplegia and epilepsy partially controlled by medication;
  • 15 couples with children whose primary diagnosis was psychiatric disorders, namely: ADHD, autism spectrum disorder, medium and severe mental retardation and behavioural disorders: Oppositional defiant disorder;
  • 15 couples with children who were clinically healthy at the moment the questionnaires were administered.

Both parents answered the Questionnaires and they had been informed on the test to be administered, for which they had given their consent.
Materials and methods:
In order to achieve the proposed aims and starting from the formulated hypotheses, I used three questionnaires namely: Symptom Checklist-90 SCL-90, Rosenberg’s Self-Esteem Scale and the Marital Satisfaction Scale.

a. Symptom Assessment Scale SCL-90

SCL-90 is a multidimensional inventory for the self-assessment of symptoms developed by Derogatis (1977). This test is a continuation of Hopkins Symptom Checklist (HSCL) which developed from 53 items to 90. This variant comprises a broader spectrum of psychic blames and mental suffering affected by disease. 83 out of the 90 items are included in the following factors: somatization, obsessive-compulsive disorder, socialization, depression, anxiety, hostility, phobic-anxiety, paranoid ideation, psychoses. Dimensioning of the items can lead to the construction of symptom profiles.
SCL-90 test measures the influence subjectively felt by a person through physical and mental symptoms during a seven-day interval. Correlations of the scales are on average r =.45. The confidence we can have in the test profiles may be good for the clinic field.
Test reliability: in the random clinical trials, the internal consistency of each scale is between. 79 and. 89.

b. Rosenberg’s Self-Esteem Scale

Initially, this scale was devised in order to measure the global feeling of personal value and of self-acceptance. The scale is a ten-item scale with items answered on a four point scale - from strongly (1 point) agree to strongly disagree (4 points). Items 2,5,6,8, and 9 are rated vice versa. The scores may vary from10 to 40; elevated scores indicate a high self-esteem. Cronbach Coeficient = 0.85, reported by the author, indicates a good internal consistency, while the test-retest reliability is reported in the author’s studies between 0.85 (at a distance of one week) and 0.88 ( at two-week interval).
When interpreting the results, the following values will be taken into consideration:

  • 10 – 16 points – low self-esteem;
  • 17 – 33 points - medium self-esteem;
  • 34 – 40 points – high self-esteem.

c. Marital Satisfaction Scale

This scale was devised by Graham B. Spanier. The instrument consists of 32 items and was built in order to assess the quality of the relationship, as it was perceived by the marital couple. At the same time, it is a general measurement of satisfaction in the intimate couple by the use of the total scores. Factorial analysis indicates the fact that this instrument measures four aspects of the relationship: dyadic satisfaction (DS), dyadic cohesion (DC), dyadic consensus (DCon) and affective expression (AE).
The subjects must answer each question using several Likert scales, each of them being scored beside the question where it must be applied. The total score adds up the scores obtained in each item and it may range from 0 to 151, the low scores indicating low marital satisfaction while the elevated ones indicate a high marital satisfaction.

Data analysis and interpretation:
The following part of this study will analyse the data quantitatively, an analysis that focuses on outlining the quantitative –numerical relationships between the studied variables, and qualitatively, an analysis that tries to highlight the associations between the variables as well as the differences between the data obtained with information already existing in specialist literature.
In view of checking out the hypotheses of the research, the starter statistical indicators for the variables of the research for the groups of parents, according to the health of their children, have been calculated.
The one – way ANOVA (analysis of variance), which is a particular form of statistical hypothesis testing, was used to verify the hypotheses of the research, since the dependent variables (Somatization, Depression, Anxiety, Self-Esteem and Marital Satisfaction) are defined on an interval scale, and the independent variable ( Children’s Health) is measured on a nominal scale [4].
The data have been processed statistically in the SPSS13 programme (Table I).

Table I. Starter statistical indicators of the research variables for the groups of parents according to their children’s state of health

Hypothesis no. I There are differences in the somatization level among the three groups of parents, depending on the health of the children. To determine whether there are significant differences in the level of somatization among the three groups of parents (based on the health of children) the general indicator F will be calculated [4] (Table II).

Table II. Calculation of indicator F for differences among the three groups of parents concerning the level of somatization.

After checking the first hypothesis using the parametric statistical test one-way ANOVA, a value has been obtained F (2, 87) =.436, at a threshold of statistical significance p>.05 (p =.648), which means that there are no statistically significant differences among the three groups of parents, on the level of somatization. We reject the research hypothesis: there are no differences among the three groups of parents in the level of somatization, any possible differences being due to other causes.
Hypothesis no. 2 The level of depression differs among the three groups of parents according to the health of children. To determine whether there are significant differences in the level of depression among the three groups of parents (based on the health of their children) the general indicator F will be calculated [4] (Table III).

Table III. Calculation of indicator F for differences among the three groups of parents concerning the level of depression.

After checking the second hypothesis using the parametric statistical test one-way ANOVA, a value has been obtained F (2, 87) = 4.535, at a threshold of statistical significance p>.05 (p =.013), which means that there are statistically significant differences among the three groups of parents, on the level of depression.
After processing the data, we can conclude the following:

  • there are no statistically significant differences between parents of children with neurological disorders and the parents of children with psychiatric disorders concerning the level of depression, p>.05 (p =.967);
  • there are statistically significant differences concerning the level of depression in parents of children with neurological disorders and depression levels in parents of clinically healthy children, p≤.05 (p =.021). The level of depression is higher in parents of children with neurological disorders compared to parents of clinically healthy children.
  • there are statistically significant differences between the level of depression in parents of children with psychiatric disorders and those of clinically healthy children, p≤.05 (p =.040). The level of depression is higher in parents of children with psychological disorders than in parents with clinically healthy children.

The second hypothesis is confirmed.
Hypothesis no. 3 There are differences in the level of anxiety among the three groups according to their children’s state of health. To determine whether there are significant differences in the level of anxiety among the three groups of parents (based on the health of their children) the general indicator F will be calculated [4] (Table IV).

Table IV. Calculation of indicator F for differences among the three groups of parents concerning the level of anxiety

After checking the third hypothesis using the parametric statistical test one-way ANOVA, a value has been obtained F (2, 87) = 9.969, at a threshold of statistical significance p>.01 (p =.000), which means that there are statistically significant differences among the three groups of parents, on the level of anxiety
After testing the homogeneity of variance of the three groups of parents on the level of anxiety, a value L has been obtained where L (2, 87) = 2.049, at a statistical significance threshold p>.05 (p =.135), which means that there are no differences in the dispersions, i.e. they are considered to be equal.
We can conclude the following:

  • there are no statistically significant differences between parents of children with neurological disorders and parents of children with psychiatric disorders on the level of anxiety, p>.05 (p =.147);
  • there are statistically significant differences between the level of anxiety in parents of children with neurological disorders and anxiety in parents of the clinically healthy children, p≤.01 (p =.000). The level of anxiety is higher among parents of children with neurological disorders compared with that among parents of clinically healthy children;
  • there are significant differences between the level of anxiety in parents of children with psychiatric disorders and the anxiety in parents of clinically healthy children, p≤.05 (p =.033). The level of anxiety is higher among parents of children with psychiatric disorders compared with that in parents of clinically healthy children.
  • Comparing the extent of the effect for the two types of disorders, we note that the neurological disorders of children compared to psychiatric disorders of children have a greater impact on the parents’ level of anxiety.

Although differences in the level of anxiety among parents of children with disorders (neurological and psychiatric) compared to the anxiety levels in parents of clinically healthy children are statistically significant, the effect size of these differences is small. This means that the size of the effect of children’s disorders on the level of anxiety of their parents is small. [Cohen, apud Sava, 2004]. This means that other factors, in addition to children’s disorders, influence these differences.
The third hypothesis is confirmed.
Hypothesis no. IV It is assumed that there are differences in the level of self-esteem among the three groups of parents, depending on the health of their children (Table V).

Table V. Calculation of indicator F for differences among the three groups of parents concerning the level of self-esteem

After checking the fourth hypothesis using the parametric statistical test one-way ANOVA, a value has been obtained F (2, 87) = 10.764, at a threshold of statistical significance p>.01 (p =.000), which means that there are statistically significant differences among the three groups of parents, on the level of self-esteem.
We may conclude the following:

  • There are no statistically significant differences between parents of children with with neurological disorders and parents of children with psychiatric disorders concerning the level of self-esteem, p>.05 (p = 1.000);
  • There are statistically significant differences between low self-esteem in parents of children with neurological disorders and the level of self-esteem in parents with clinically healthy children, p≤.01 (p =.001). The level of self-esteem is lower in parents of children with neurological disorders compared with that in parents of clinically healthy children.
  • There are statistically significant differences between low self-esteem levels in parents of children with psychiatric disorders and the level of self-esteem in parents with clinically healthy children, p≤.01 (p =.001). The level of self-esteem is lower in parents of children with psychiatric disorders compared with that in parents of clinically healthy children.

Comparing the effect size for the two types of disorders, we noted that neurological that both neurological and psychiatric disorders of the children have the same impact on their parents’ level of self-esteem.
Although differences in levels of self-esteem among parents of children with disorders (neurological and psychiatric) compared to the self-esteem level of parents of clinically healthy children are statistically significant, the effect size of these differences is small [Cohen apud Sava, 2004], which means that the effect of the children’s disorders on the level of their parents’ self-esteem is small. We conclude that other factors underlay these differences.
A fourth hypothesis is confirmed.

Hypothesis no. 5 The level of marital satisfaction among the three groups of parents is different, according to their children’s state of health. To determine whether there are significant differences in the level of marital satisfaction among the three groups of parents (based on the health of their children) the general indicator F will be calculated [4] (Table VI).

Table VI. Calculation of indicator F for differences among the three groups of parents concerning the level of marital satisfaction

Discussions and conclusions:
In this paper, with a view to support the hypotheses formulated in the research, we have tried to highlight that there are differences among the three groups of subjects of the survey regarding the somatization, depression, anxiety, and the existence of differences in the levels of self-esteem and of marital satisfaction in three groups of parents.
Chronic disease in children can be considered a factor of stress, a traumatic event that has an impact both in the short and in the long term, not only on the child but also on the whole family. Thus, in recent decades, research in the field of neurological and psychiatric disorders has shifted from a perspective focused on the patient’s disability and psychopathology to an approach based on the analysis of systems and of the family from the systemic point of view. This new perspective emphasizes the importance of the relationship between the parents’ capacity of adaptation and the way in which a child reacts to illness and treatment.
Caring for a child with a mental health disorder consumes much time, energy and resources on the part of the parents. [Karp & Tanarugsachock, 2000]. The results of a study performed on couples of parents who have children with neurological or psychiatric disorders have revealed: a conflictual communication between partners and lower levels of marital satisfaction. In addition, higher chances of divorce have been reported among parents of children with disorders than among couples who have clinically healthy children [Hodapp and Krasner, 1995]. Besides caring for a child, marital satisfaction can be influenced by other factors, too, such as: the work place environment, the support network, financial security etc. [Rosenzweig and Kendall, apud Lewis M, D. Schonfeld, 2002].
After administering the investigative tools and performing data analysis, only some of the hypotheses in this paper have been confirmed. This helped us to highlight a number of interpretations, which pointed out the presence of significant differences between levels of depression, anxiety and self-esteem in the three groups of parents.
The first hypothesis rejects the research hypothesis: there is no difference concerning the level of somatization among the three groups, any differences being attributable solely to other causes.
The second hypothesis confirmed that there are significant differences in the level of depression among the three groups. More than that, comparing the effect size for the two types of disorders, we note that the neurological disorders in children compared with psychiatric disorders have a greater impact on the level of parental depression.
The third research hypothesis is confirmed, too. Nevertheless, although differences in the level of anxiety among parents of children with disorders (neurological and psychiatric) compared to the anxiety of parents whose children are clinically healthy are statistically significant, the effect size of these differences is small. This means that the effect of children‘s disorders on their parents’ anxiety level is low [Cohen cited Sava, 2004]. Consequently, there may be other factors, in addition to children’s disorders, that influence these differences.
The fourth research hypothesis is also confirmed, there are statistically significant differences in the level of self-esteem among the three groups; comparing the effect size for the two types of disorders, we note that both the neurological and psychiatric disorders of children have the same impact on the parents’ level of self-esteem.
The research hypothesis is not confirmed, which means that there are no differences between the three groups of parents concerning the level of marital satisfaction, any differences being due to other causes and not only to the health of the child.
The difficulties in accomplishing this paper were related to finding the appropriate group of subjects, made up of parents whose children have neurological disorders.
As limitations of the current study, we can mention the small number of subjects that participated in the analysis, while the research itself can be continued on a larger group of subjects. Other psychosocial and family factors with impact on the parents, the couple’s life, the coping mechanisms that they use, etc., may be investigated, too.

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