|Year : 2021 | Volume
| Issue : 1 | Page : 10-14
Depression and behavior problems among children residing at welfare hostels and orphanages
Sai Kiran Pasupula1, Madhavi Kodali2, Therissa Benerji3, Krishna Mohan Parvathaneni4
1 Assistant Professor, Department of Psychiatry, Guntur Medical College, Guntur, Andhra Pradesh, India
2 Associate Professor, Department of Psychiatry, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, Andhra Pradesh, India
3 Associate Postgraduate, Department of Psychiatry, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, Andhra Pradesh, India
4 Associate Professor and HOD, Department of Psychiatry, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, Andhra Pradesh, India
|Date of Submission||30-Oct-2020|
|Date of Acceptance||14-Jan-2021|
|Date of Web Publication||03-Mar-2021|
Dr. Madhavi Kodali
Department of Psychiatry, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Context: Childhood-onset of depression is often associated with childhood family adversity, parental neglect, and problematic peer relationships. Emotional and behavioral problems and high rates of depression were more common in orphans when compared to nonorphan.
Aim: The aim was to study and compare the depression and behavioral problems among children residing at welfare hostels and orphanages.
Materials and Methods: This study is a cross-sectional and descriptive study. Three welfare hostels and four orphanages run by nongovernment organizations were approached, and children between the ages of six and fourteen were recruited. Children residing at home were taken as controls. Children's Depression Rating Scale and Rutter's Behavior Scale for Children were applied to assess depression and behavioral problems, respectively.
Statistical Analysis Used: Statistical analysis was done using Epi Info software.
Results: Depression is found to a greater extent among children in the orphanages' group than in the welfare group. Rutter's score ≥9 was observed in 15%, 8.3%, and 5% of children in the welfare hostels' group, orphanages' group, and controls' group, respectively.
Conclusions: The prevalence of depression is found to be more among orphanage children, followed by children residing at welfare hostels compared to the control group. Behavior problems are more among children residing at welfare hostels than children residing at orphanages.
Keywords: Behavior problems, depression, orphanages, welfare hostels
|How to cite this article:|
Pasupula SK, Kodali M, Benerji T, Parvathaneni KM. Depression and behavior problems among children residing at welfare hostels and orphanages. Arch Ment Health 2021;22:10-4
|How to cite this URL:|
Pasupula SK, Kodali M, Benerji T, Parvathaneni KM. Depression and behavior problems among children residing at welfare hostels and orphanages. Arch Ment Health [serial online] 2021 [cited 2021 Jul 25];22:10-4. Available from: https://www.amhonline.org/text.asp?2021/22/1/10/310726
| Introduction|| |
Depression is a common mental illness worldwide affecting people across all age groups, including children. The prevalence of major depression among children (9–17 years of age) has been estimated to be 5%, and at any given time, up to 15% of children and adolescents have some symptoms of depression. In children of age group 3 to 17 years, the prevalence of depression is reported as 3.2%, and the diagnosis of depression is more common with increased age. The annual incidence rate of depression in India is found to be 1.61/1000 children. The point prevalence of the depressive disorder in children and adolescents in India ranges from 1.2% to 21% as per the clinic-based studies and 0.1%–6.94% as per the studies conducted in the Indian community.
Children diagnosed with depression commonly have another psychiatric problem as comorbidity. About 75% of children with depression have anxiety, and 47.2% present with behavior problems. Earlier studies from India have noted the prevalence rates of behavior problems to be 6.3%–12.5%., A survey conducted in the US has revealed that 7.4% of children have a diagnosed behavior problem. Behavioral problems are known to be associated with poor academic performance in school-going children.
Childhood-onset of depression is often strongly associated with childhood family adversity, parental neglect, and problematic peer relationships., Emotional and behavioral problems and high rates of depression were more common in orphans compared to nonorphan.,,
A study on institutionalized children in Japan revealed that children with low scores of secure attachment showed higher depressive symptoms. Institutionalized adolescents and children exhibited a high prevalence of depression and a positive correlation of externalizing and internalizing behaviors with depression.,
As limited data are available regarding depression and behavioral problems among children residing at welfare hostels and orphanages from this part of the country, the present study is taken up with the aim to study and compare the occurrence of depression and behavioral problems among children residing at welfare hostels and orphanages.
| Materials and Methods|| |
This study is a cross-sectional and descriptive study carried out after obtaining approval from the Institution's Ethical Committee. Three welfare hostels and four orphanages run by nongovernment organizations located in the catchment area of our hospital were approached, and permission for the study was obtained from the concerned authority. Informed consent was obtained from the caretaker, and confidentiality was maintained. Students between the ages of 6 and 14 residing at the welfare hostels and orphanages were recruited for the study by systematic random sampling. Children residing at home and attending regular schools were taken as a control group. Children with intellectual disability were excluded from the study. Students were approached at the hostel premises, and sociodemographic details were taken from both the student and the caretaker using a structured questionnaire. Rutter's Behavior Scale for children was applied to assess the behavioral problems. It has 26 items, and the scoring is done on each item as “certainly applies,” “applies somewhat,” or “does not apply.” The scores are indicated as 1, 2, or 0, and children scoring 9 or more on the total are considered to show evidence of some disorders. Children's Depression Rating Scale (CDRS) developed by Poznanski, Cook, and Carroll was applied to assess depression among children. A score of 30 was taken as significant depression, and scores in the 20–30 range were considered borderline depression.,
Statistical analysis was done using Epi Info software, and data were tabulated.
| Results|| |
Sixty children, each residing in welfare hostels, orphanages, and those living with parents (controls), were selected for participation in the study and assigned to three groups.
The sample characteristics are summarized in [Table 1].
The mean age of the sample is 12 years. The mean age of those in the welfare hostels' group, orphanages' group, and controls' group is 12.68 years, 11.58 years, and 11.75 years, respectively. The sample consisted of more male children (n = 111, 61.6%) in all the three groups in our study. Most of the children in the control group (n = 51, 85%) had siblings, whereas in the welfare hostels' group, 11 children (18.3%) had siblings. Children of all the three groups have access to education and most of them were studying standard VI.
Results of the Children's Depression Rating Scale
Depression in all the three groups was assessed by applying the CDRS. The mean CDRS score of the sample is 20.22. The mean CDRS scores of the welfare hostels' group, orphanages' group, and controls' group are 20.48, 21.15, and 18.8, respectively. In the orphanages' group, 13 children (21.7%) had a CDRS score >20, of which four children (6.7%) had a CDRS score in the 20–30 range (borderline depression). The majority (76.9%) of the children from the orphanage group with depression were girls. Only 3 (33.1%) boys had depression in the orphanage group as summarized in [Table 2] and [Table 3].
A CDRS score of >30 (significant depression) was observed in 8 (13.3%), 9 (15%), and 3 (5%) children in the welfare hostels' group, orphanages' group, and controls' group, respectively. Depression is found to a greater extent among children in the orphanages' group than the in welfare group. In comparison, depression is found least among children living with their parents (control group).
Results of the Rutter's Behavior Scale for Children
Problem behaviors in all the three groups were assessed by applying the Rutter's Behavior Scale for Children. The mean Rutter's Behavior Scale score of the sample is 7.45. The mean Rutter's Behavior Scale score of the welfare hostels' group, orphanages' group, and control' group is 8.033, 6.9, and 7.45, respectively. Rutter's score ≥9 was observed in 9 (15%), 5 (8.3%), and 3 (5%) children in the welfare hostels' group, orphanages' group, and controls' group, respectively. Of the total sample, problem behaviors were found more often in males (n = 12, 10.8%) than females (n = 5, 7.2%), as shown in [Table 4] and [Table 5].
| Discussion|| |
In the current study, depression and behavioral problems have been assessed in the children residing in welfare hostels, orphanages, and those living with their parents. Depression was found to a greater extent among children in the orphanages' group (21.7%) than the welfare group (13.3%), whereas depression is found least among children living with their parents (5%). On the contrary, a study from Japan noted that 43.4% of the institutionalized children were in a depressive state, with the highest depression score among children who have both parents and lowest among orphans. A study conducted at Rajasthan, India, revealed a low prevalence of depression (2.33%) in school-going children residing with their parents.
Institutionalization could be a risk for depression as it may be considered as a type of parental deprivation, and the shift-work system of the caregivers in the institution may also result in a lowered sense of belonging among the children.,
In the present study, 21.6% of the children residing in orphanages had presented with depression, of which 15% showed significant depression and 6.7% had borderline depression, which was similar to findings of earlier studies,, whereas a few studies have reported a higher prevalence of depression (24%–36%) in children residing in orphanages.,,
The majority (76.9%) of the orphanage residing children with depression were girls as per the observations of this study, which in accordance with the research done by Ibrahim et al. High prevalence of depression among girls may be attributed to the factors such as the existing culture where there is a preference of boys over girls and the problems faced by girls in everyday life due to their social status relative to boys.,
In the current study, behavioral problems were more commonly seen in the children residing at welfare hostels (15%) when compared to those living in orphanages (8%) and the control group (5%). Similar results were reported by Ravneet et al. Higher rates of behavioral problems (33%–56%) have been reported by Zohra SL et al., Rahman et al., and Shanthi and Jeryda Gnanajane Eljo.,, by using the childhood behavioral checklist or strengths and difficulty questionnaire for assessment.
| Conclusions|| |
The prevalence of depression is found to be more among orphanage children, followed by children residing at welfare hostels compared to the control group. Behavior problems are more among children residing at welfare hostels than children residing at orphanages.
The above findings reflect the need for caretakers to be sensitized to detect children with these problems in the early stages. Hence, periodic assessment of these children and appropriate interventions are recommended to alleviate the suffering.
Strengths of the study
Standardized instruments and a structured sociodemographic data questionnaire were used for collecting information from the caretakers and parents. The data collection procedure was uniform as only one examiner interviewed the subjects, hence, reducing interobserver bias.
Limitations of the study
A major limitation of this study is that it was conducted in the institutions and orphanages located in the catchment area of our hospital, so the results cannot be generalized. Caretakers' lack of awareness about the behavioral problems of their children living at institutions might have distorted the data provided by them. Further research can be undertaken to assess the role of psychosocial issues and identify the importance of factors such as living conditions, emotional support, and history regarding abuse in these children.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Shaffer D, Gould MS, Fisher P, Trautman P, Moreau D, Kleinman M, et al
. Psychiatric diagnosis in child and adolescent suicide. Arch Gen Psychiatry 1996;53:339-48.
Shashi KB, Subhash CB. Childhood and adolescent depression. Am Fam Physician 2007;75:73.
Ghandour RM, Sherman LJ, Vladutiu CJ, Ali MM, Lynch SE, Bitsko RH, et al
. Prevalence and treatment of depression, anxiety, and conduct problems in US children. J Pediatr 2019;206:256-67.e. 3.
Malhotra S, Kohli A, Kapoor M, Pradhan B. Incidence of childhood psychiatric disorders in India. Indian J Psychiatry 2009;51:101-7.
] [Full text]
Sandeep G, Venkatesh R, Akhilesh S, Ruchita S. Depression in children and adolescents: A review of Indian studies. Indian J Psychol Med 2019;41:216-27.
Srinath S, Girimaji SC, Gururaj G, Seshadri S, Subbakrishna DK, Bhola P, et al
. Epidemiological study of child & adolescent psychiatric disorders in urban & rural areas of Bangalore, India. Indian J Med Res 2005;122:67-79.
Malhotra S, Kohli A, Arun P. Prevalence of psychiatric disorders in school children in Chandigarh, India. Indian J Med Res 2002;116:21-8.
Akpan MU, Ojinnaka NC, Ekanem EE. Academic performance of school children with behavioural disorders in Uyo, Nigeria. Afr Health Sci 2010;10:154-8.
Hill J, Pickles A, Rollinson L, Davies R, Byatt M. Juvenile- versus adult-onset depression: Multiple differences imply different pathways. Psychol Med 2004;34:1483-93.
Jaffee SR, Moffitt TE, Caspi A, Fombonne E, Poulton R, Martin J. Differences in early childhood risk factors for juvenile-onset and adult-onset depression. Arch Gen Psychiatry 2002;59:215-22.
Shiferaw G, Bacha L, Tsegaye D. Prevalence of depression and its associated factors among orphan children in orphanages in ilu abba bor zone, South West Ethiopia. Psychiatry J 2018;2018:7.
Abdulkhaliq YA, Ali FA, Abdullah SA, Turki AA, Wafa DA, Ashwaq YA, et al
. Prevalence of depression among children and adolescent in orphanages. Int J Med Res Prof 2017;3:271-3.
Musisi S, Kinyanda E, Nakasujja N, Nakigudde J. A comparison of the behavioral and emotional disorders of primary school-going orphans and non-orphans in Uganda. Afr Health Sci 2007;7:202-13.
Yazawa A, Takada S, Suzuki H, Fujisawa TX, Tomoda A. Association between parental visitation and depressive symptoms among institutionalized children in Japan: A cross-sectional study. BMC Psychiatry 2019;19:129.
Vinnakota A, Kaur R. A study of depression, externalizing, and internalizing behaviours among adolescents living in the institutional homes. Int J App Basic Med Res 2018;8:89-95.
] [Full text]
Dell'Aglio DD, Hutz CS. Depression and school achievement of institutionalized children and adolescents. Psicol Reflex Crít 2004;17:351-77.
Rutter M. A children's behaviour questionnaire for completion by teachers: Preliminary findings. J Child Psychol Psychiatry 1967;8:1-1.
Elva OP, Stephen CC, Bernard JC. A depression rating scale for children. Pediatrics 1979;64:442-50.
Shanahan KM, Zolkowski-Wynne J, Coury DL, Collins EW, O'Shea JS. The Children's depression rating scale for normal and depressed outpatients. Clin Pediatr (Phila) 1987;26:245-7.
Pollak SD, Nelson C, Schlaak MF, Roeber BJ, Wewerka SS, Wiik KL, et al
. Neurodevelopmental effects of early deprivation in post-institutionalized children. Child Dev 2010;81:224-36.
Barone L, Dellagiulia A, Lionetti F. When the primary caregiver is missing: investigating proximal and distal variables involved in institutionalized children's adjustment. Child Abuse Rev 2015;25:454-68.
Nagy F, Amira F. Psychosocial and developmental status of orphanage children: Epidemiological study. Curr Psychiatry Rep 2010;17:61-5.
Ibrahim A, El-Bilsha MA, El-Gilany AH, Khater M. Prevalence and predictors of depression among orphans in Dakahlia's orphanages, Egypt. Int J Collab Res Intern Med Public Health 2012;4:2036-43.
Mushtaq AM. Psychiatric disorders among children living in orphanages – Experience from Kashmir. JK Pract 2006;13:53-5.
Demoze MB, Angaw DA, Mulat H. Prevalence and associated factors of depression among orphan adolescents in Addis Ababa, Ethiopia. Psychiatry J 2018;2018:doi: 10.1155/2018/5025143.
Starr LR, Davila J. Excessive reassurance seeking, depression, and interpersonal rejection: A meta-analytic review. J Abnorm Psychol 2008;117:762-75.
Ravneet K, Archana V, Sanjibani P, Manasa RV. A descriptive study on behavioral and emotional problems in orphans and other vulnerable children staying in institutional homes. Indian J Psychol Med 2018;40:161-8.
Zohra SL, Sadia M, Ehsan US, Naveed ZJ. Behavioral problems among children living in orphanage facilities of Karachi, Pakistan: Comparison of children in an SOS Village with those in conventional orphanages. Soc Psychiatry Psychiatr Epidemiol 2011;46:787-96.
Rahman W, Mullick MS, Pathan MA. Prevalence of behavioral and emotional disorders among the orphans and factors associated with these disorders. Bangabandhu Sheikh Mujib Med Univ J 2012;5:29-34.
Shanthi K, Jeryda Gnanajane Eljo JO. Emotional and behaviour problems of institutionalized street children. Indian J Appl Res 2014;4:135-7.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]