Quality of life and prevalence of depression Presentation 25-10-2023.pdf

Quality of life and prevalence of depression Presentation 25-10-2023.pdf

1. QUALITY OF LIFE AND PREVALENCE
OF DEPRESSION AMONG PRIMARY
CAREGIVER OF CHILDREN WITH
CEREBRAL PALSY IN NORTH INDIA
Dr. Neeraj Kumar
Resident,
Department of Pediatrics,
PGIMS Rohtak.

2. INTRODUCTION
•
CP is a condition caused by brain hypoxia that affects body
movements, balance, and posture, with an incidence of 0.2% of live
births.
1
It can result from factors like preterm delivery, congenital
malformations, infections, and genetic abnormalities.
2
•
Parents, especially mothers, of children with disabilities experience
significant stress due to the challenges of caregiving. This stress can
lead to depression and emotional issues.
3,4
•
Early diagnosis and intervention are crucial for improving motor and
cognitive functions in infants with CP and preventing secondary
complications.
5

•
Caregivers, often mothers, in India play a dominant role in the
lifelong care of children with CP. They face the initial stress of
diagnosis, treatment costs, and ongoing caregiving demands.
6
•
Studies suggest that the quality of life (QoL) for mothers of children
with CP is negatively affected, possibly due to the burden of
caregiving and the emotional toll.
7-9

3. OBJECTIVES
•
The findings of this study aim to estimate the quality of life and the
prevalence of depression in primary caregivers (mothers) of children
suffering from CP (Cerebral Palsy).

4. MATERIAL AND METHODS
•
This was an cross-sectional study conducted at Pt. B.D. Sharma
PGIMS, Rohtak. A total of 82 caregivers of children (upto 14 years)
with CP were included in this study.
•
Caregivers with chronic illnesses, difficult family or spouse
relationships, and a history of psychological disorders were excluded
based on history and investigations.
•
Written informed consent was obtained from all participants before
their enrollment in the study.
•
Maternal depression was assessed using the Hamilton Depression
(HAM-D) Rating Scale, a 17-question instrument that categorizes
scores as normal, mild depression, moderate depression, or severe
depression.
•
Data was analyzed using the Statistical Package for Social Sciences
(SPSS) version 28. Statistical tests included t-tests for independent
groups, Chi Square for non-parametric variables, and correlation
analysis using the Pearson correlation test.

5. RESULTS
•
This study includes 82 females divided equally into two groups, 41
mothers of child suffering from CP and 41 mothers having normal
children. No significant difference noted between the ages of mothers
of both groups. (p=0.186)
•
Twenty three (56.1%) of case were boys and 18 (43.9%) of them were
girls as well as 25 (61%) of control group were boys and 16 (39%) of
them were girls which were no significant differences (p=0.402). In
addition, there were no significant difference in case and control
group mothers in job (p=0.068), academic status (p=0.058), number
of children (p=0.051), birth rank (p=0.019).
•
HAM-D
17
scores in mothers having CP children and control mothers
were 00 and 00±00 respectively. There was a significant difference in
HAM-D
17
scores of two groups (p=0.004).
•
It was shown that mothers of children with CP have a 2.08 times
higher chance of developing depression (OR=2.08).

6. RESULTS
•
Twenty-three (56.1%) of mothers in the case group and 30 (73.2%) in
the control group did not have any depression whereas 8 (19.5%) of
mothers in the case group and 2 (4.8%) in the control group were
severe or more depressed. (Table 2).
•
No significant correlation between the severity of disability and the
severity of depression for mothers having CP children was observed
(R=0.24)
•
There were no significant differences in HAM-D
17
scores between
mothers having different type of CP (p=0.309) (Table 3).

•
Table 1: HAM-D
17
scores of mothers in control and case groups.


Control
Mean±SD
Case
Mean±SD
P-value t-value
HAM-D
17
15.79±8.80 20.46±12.72 0.004 -2.917

7. RESULTS
•
Table 2: The severity of depression in mothers of control and case group






•
Table 3: Correlation between depression scores of mothers in case group with the type of
cerebral palsy in their children

Depression Severity Control Case
No depression 30 (73.2%) 23 (56.1%)
Mild depression 5 (12.2%) 5 (12.2%)
Moderate depression 4 (9.8%) 5 (12.2%)
Severe depression 1 (2.4%) 6 (14.6%)
Very severe depression 1 (2.4%) 2 (4.9%)
Total 41(100%) 41 (100%)
Type of CP N Mean Score of depression SD
P-
value
F-value
Spastic Diplegic 19 23.30 5.66
0.376 1.69
Spastic Quadriplegic 6 18.24 6.23
Athetoid 5 16.59 8.90
Spastic Hemiplegic 4 29.84 23.10
Others 7 14.34 16.10
Total 41 20.46
12.72

8. DISSCUSSION
•
The result of this study showed mothers having CP children have
more depressive symptoms, which supports results of previous
studies.
•
A study by Ones K et al.
10
showed that mothers of children with CP
had lower quality of life and high level of depression. The instrument
to evaluate depression was BDI-II.
•
A study by Lambrenos K et al.
11
found that mothers of premature
infants at risk for CP showed similar levels of depression compared to
mothers of infants not at risk for CP during the first year of the child's
life. This suggests that the impact on maternal depression may
become more apparent as high-risk premature infants develop CP
over time.
•
Gotz and Gotz
3
reported some emotional processes are predictable in
parens having children with chronic health conditions.

9. DISSCUSSION
•
In the present study, no significant differences were observed in
disability severity, type of CP, and maternal depression, which is
supported by previous studies (Ones,
10
and Manual,
12
). In conclusion,
having a child with CP can lead to maternal depression. To enhance
the rehabilitation of CP children, it's crucial to support mothers who
play a vital role in their treatment and recovery.
•
Health professionals should consider the psychological well-being of
mothers, and addressing or preventing maternal depression is
recommended to improve the rehabilitation process and achieve better
outcomes for these children.

10. CONCLUSION
•
In an Indian setting, managing CP at home-based care cannot be
achieved without the caregiver’s participation, which is often the
child’s mother.
•
Depression is significantly associated with primary caregivers
because of the increased perceived stress of caregiving.
•
This also affects the mother’s QoL in increasing the proportion of
depression with their children functional imparement.
•
It seems that having a child with CP is probably associated with
higher prevalence and severity of depression in mothers.
•
Treatment and prevention of depression in mothers of children with
CP is highly recommended for improving the rehabilitation process
and achieve better results in these children.

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