Anxiety and depression among children with chronic diseases

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Abstract

Introduction and aim of the study

Psychiatric morbidity is defined as the presence of handicapping abnormalities of emotions, behavior, and relationships that impede personal and social functioning. Therefore, the present study was designed to argue this issue.

Patients and methods

A total of 60 (32 males and 28 females) patients ranging in age from 5 to 18 years from the Pediatric Department of Benha University Hospital and Mansoura University Pediatric Hospital (Egypt) were included in the present study. Forty patients had chronic (>1 year) diseases such as asthma (nine males vs. 11 females), diabetes mellitus (DM) (11 males vs. nine females), or chronic renal failure (CRF) and were on regular hemodialysis (12 males vs. eight females) whereas the other 20 patients were clinically healthy. Each patient was subjected to full assessment of medical history, and information was obtained on age, sex, education, socioeconomic state sleep pattern and sleep disorders, history of aggression, history of self-esteem, diagnosis with a special focus on onset of disease, duration, frequency, complications, and treatment. Psychological assessment was performed using the Children Anxiety Scale (Arabic version) and the Children Depression Inventory (Arabic version). A written consent was signed by parents. The majority of patients were from low socioeconomic levels and were still in education.

Results

The present results for accompanying psychological morbidities indicated low self-esteem in 25% asthmatic, 25% DM, and 55% of CRF children; social isolation in 25% asthmatic, 30% DM, and 20% of CRF children; sleep disorders in 40% asthmatic, 30% DM, and 70% of CRF children; aggression in 10% asthmatic, 10% DM, and 5% of CRF children; and suicidal thinking in 20% of CRF children. There was a significant increase in anxiety scores in patients with chronic disease compared with the controls (P=0.028), with no significant difference between the different groups of chronic illnesses [50% in asthmatic; 40% in DM; 50% in end stage renal failure (ESRD)]. Nevertheless, 25% of ESRD manifested severe levels of anxiety. There was a significant difference between male and female patients in anxiety among asthmatic and ESRD children as females with chronic diseases showed a higher prevalence of anxiety than males. Anxiety disorders were directly proportional in children of older age without improvement in disease symptoms, being especially evident in asthmatic children; yet, it increased persistently with the other diseases (DM and CRF). Severity and longer duration of the disease indicated a considerable increase in anxiety in patients with complications, where 20% patients with severe ESRD, 10% diabetic patients with complications, and 10% asthmatic patients developed severe levels of anxiety. Concurrent results for depressive disorders indicated a significant increase among patients with chronic diseases (90%) compared with the healthy controls, among whom only 10% presented with mild depression. Yet, there was no significant difference in depression among the three groups (P=0.049), with a significant increase in patients on regular hemodialysis, among whom depression was identified in 80% (55% mild, 15% moderate, and 10% severe). Female patients with chronic diseases showed a higher prevalence of depression than males, with a significant difference between female and male patients on regular dialysis, where severe depression was found in 10% and moderate depression in15%, whereas males showed negative signs of depression. Depression was found to increase with the age of the patients, without any improvement in the disease symptoms in asthmatic patients and patients on regular dialysis. A considerable increase in the incidence of depression was validated as the disease was present for a longer duration, that is, more than 1 year. A similar increase was found among patients on regular hemodialysis and asthmatic patients as 10% with severe ESRD developed severe depression.

Conclusion

The present study shows that children with chronic diseases have significantly more psychological distress than healthy ones.

Recommendations

It is highly recommended that patients with chronic disease undergo continuous follow-up by psychiatrists and medical specialists together with routine screening for anxiety and depression. This may reduce the incidence of complications of asthma, DM, and end-stage renal failure. Again, periodic meeting with parents of children with chronic diseases is advisable to teach them how to deal with the psychological problems to facilitate early detection and management of psychological disorders.

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