Prevalence and Severity of Depression among Mothers of Disabled Children in Palestine. A Descriptive, Aanalytical, Cross Sectional Study

Abstract

Introduction: Mothers of children with disabilities often experience greater stress and emotional demands than other mothers do. Mothers of children with disabilities showed also more psychological distress than other member in their families, as they are the primary caregivers for their children. Childhood disability often imposes a social and emotional burden for children and their families. Aim: The aim of the study is to assess the prevalence and severity of depression among mothers of disabled children in the north of the West Bank in order to establish baseline data and suggest recommendations to policy makers and professional workers. Subjects and Methods: A descriptive, analytical kind (cross sectional) study. Two hundred mothers were included in the study divided in two groups, including 100 mothers of children with disabilities (age range, 2-16years) as a study group, and 100 mothers of normally developing children (age range, 2-16 years) as a control group. There were 47%  girls and 53% boys of  the children in the control group and there were 38%  girls and 62% boys of the children in the study group. These children have different diagnoses with a 10% down syndrome, 18% hearing disabilities, 7 % physical disability, 11% speech disorders, 18% autism, 14% mental retardation, 12% cerebral palsy and 10 % other disorders.  The mothers’ average ages in the study group and control group were 32.6 (SD±6.3) and 31(SD± 5.7) years, respectively. A demographic information form and Beck Depression Inventory were administered to mothers of these children who met the inclusion criteria. The assessments were performed during children´s treatment in rehabilitation centers. Results: The prevalence of depression was higher among mothers caring for disabled children than mothers of non-disabled children in the control group. Fifty four percent of mothers of disabled children had a mild to severe level of depression and 18% of them suffered from moderate to severe depression as derived from Beck Inventory score. When we compare between the study and control groups, the study reveals that there are many factors that increase the prevalence of depression among mothers in the study group compared to control group which include: child’s age <10 years, mother’s age <40 years, middle and low income, and un-employment. On the other hand there was no association in the study group between mothers´ depression score and mothers´ age, child age, educational level of the mothers, family style and family income. For the control group (mothers of normally developing children) 15% of them had a mild to severe level of depression and 2% had moderate to severe depression and there was a significant correlation between mothers´ depression score and mother´s age (p=0.010). There was a relation between mothers depression score and family income, but it was not statically significant (p=0.07).The result of this study indicates that there was a significant difference between mothers’ depression score with respect to having or not having disabled children (u=1911, p<0.01).The mothers of children with physical disabilities (mean rank was 60.36) and cerebral palsy (mean rank was 58.67) have a higher depression score than mothers with children of other kinds of disabilities, and the lowest level of depression score was for mothers whose children have down syndrome, which had a mean rank of 38.45. Conclusion: The results of this study indicate that 54% of the mothers of disabled children had various degrees of depression, with 18 % suffering from severe depression. For the mothers with non-disabled children, 18% had various degrees of depression, which is within the normal statistics (12-25%) (WHO, 1990). In study group the study reveals that the disability itself tend to be consider as a strong factor in the same group to increase the prevalence of depression, in contrary in control group the study reveals that there are many factors to increase the prevalence of depression among mothers which include: mothers age>40, child age >10, low family income and low educational level. When we compare between the study and control groups, the study reveals that there are many factors to increase the prevalence of depression among mothers in the study group compared to control group which include: child’s age <10 years, mother’s age <40 years, middle and low income, and un-employment. Recommendations: Early recognition of depression symptoms in mothers of disabled children should be of great concern for health care providers. The effective rehabilitation programs should provide ample opportunity for repeated follow-up interviews that not only offer information about children's disabilities but also psychological support for mothers. Shifting the rehabilitation services from child-centered to family-centered services through providing supportive services is recommended. Keywords: disabled children, depression, Beck depression inventory, extended family, nuclear family.