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Background: Children with recognized, diagnosable mental and neurological disorders are in addition prone to emotional and behavioral problems which transcend their specific diagnostic labels. In accessing care, these children are almost invariably accompanied by caregivers (usually mothers) who may also have mental health problems, notably depression. The relationship between child and maternal psychopathology has however not been sufficiently researched especially in low and middle income countries. Methods: Mothers (n = 100) of children receiving care at the Child and Adolescent Clinic of a Neuropsychiatric Hospital in Abeokuta, Nigeria took part in the study. To each consenting mother was administered a sociodemographic questionnaire and the Patient Health Questionnaire, while information regarding their children (n = 100) was obtained using the Strengths and Difficulties Questionnaire. Data analysis was done with the Statistical Package for Social Sciences (SPSS) version 16. Results: The mean ages of the mothers and children were 40.4 years (SD 4.7) and 11.6 years (SD 4.1), respectively. Among the children, 63 % had a main diagnosis of seizure disorder. Regardless of main diagnosis, 40 % of all the children had a comorbid diagnosis. Among the mothers, 23 % had major depressive disorder. A quarter (25 %) of the children had abnormal total SDQ scores. A diagnosis of major depressive disorder in mothers was associated with poor total SDQ scores and poor scores in all SDQ domains except the emotional domain for the children. Major depressive disorder among the mothers was associated with not being married (p = 0.004; OR = 0.142, 95 % CI 0.037-0.546) and longer duration of the child’s illness (p = 0.039, OR = 1.165, 95 % CI 1.007-1.346). Conclusion: The study showed notable rates of depressive illness among mothers of children with neuropsychiatric disorders. Marked rates of emotional and behavioral disorders were also found among the children. Associations were found between maternal and child psychopathology. Mothers of children with neuropsychiatric disorders should be screened for depressive illness.
The study was conducted at the Child and Adolescent Clinic (CAC) of the Neuropsychiatric Hospital, Aro, Abeokuta, Ogun State, Nigeria. The Child and Adolescent Clinic became functional in 2007 and is run by the Child and Adolescent Unit of the Hospital which is managed by three consultant psychiatrists. Resident doctors rotate through the unit, with a locum consultant neurologist seeing patients at the clinic once a week. There is a full complement of twenty multidisciplinary staff providing care in the clinic including doctors, nurses, occupational therapists, speech and language therapists, and pharmacists, with access to social workers, psychologists and physiotherapists. Clinics are run twice a week, with an average of 25 children seen at each clinic. A brief review of the records showed that 90 % of carers are Mothers, and as much as 60 % of children seen have epilepsy, either occurring alone or comorbidly with another disorder. Other commonly seen disorders include intellectual disability, autism spectrum disorders, attention deficit hyperactivity disorder, mood disorders, and early onset psychosis. The study population comprised mothers of children receiving treatment at the CAC. Included mothers were those whose children had illness of longer than 6 months’ duration, and who were the primary caregivers (meaning those who were living with the child receiving treatment, were financially responsible for the care of the child, and were called upon in emergencies involving the child). Mothers with prior lifetime history of mental illness (who had been diagnosed with mental illness at any time before the study, either before or after the child was born), or who reported having a family history of mental illness, were excluded. This was done given that a number of mothers may have suffered depression even without having a child with a mental or neurological illness, and the study design tried to exclude such to better address the question of a relationship between maternal depression and child psychopathology. The study participants were recruited using a systematic random technique. On every clinic day, a random start was picked by a simple ballot from the first two children presenting at the clinic. Thereafter, alternate children accompanied by the Mother were picked. Those who were not accompanied by their Mothers, or for whom consent was not obtained, were replaced by the next suitable mother. This process gave ten mothers to be interviewed per clinic day, or twenty per week, over a period of 5 weeks in March through April, 2015. Three instruments were used to collect data. These were: The PHQ and the SDQ are available in Yoruba, the language widely spoken in the study area. The Yoruba versions were required because of the assumption that not all subjects would be fluent in English. Participants were recruited from among mothers of children presenting at the CAC. On the designated clinic days, Mothers to be recruited into the study were picked from the pool presenting on each clinic day. They were approached on the morning of the clinic while waiting for their children to be seen. Those who provided consent were recruited. All mothers were given the socio-demographic questionnaire, PHQ-9 and SDQ to fill while awaiting consultation. Mothers who were unable to read or write had the questionnaire read to them by the investigator. Ethical approval for the study was obtained from the Health Research Ethics Committee of the Neuropsychiatric Hospital, Aro Abeokuta. All mothers signed written consent forms after the nature, purpose and scope of the study had been explained to them. Verbal assent was also obtained from the children, who were physically present when their mothers were being interviewed. Although the children were not interviewed directly, their mothers were required to supply information about them. No age limit was adopted for this. A spreadsheet was used for initial data recording from the various instruments. The prevalence of depression and socio-demographic variables was presented using descriptive statistical measures such as means (with standard deviations) and frequency tables. On the PHQ, a score of 5 and above (out of a total of 27) was considered as screen positive for any depression, while a cut-off score of 10 and above was adopted as screen positive for major depressive disorder (MDD) only. This followed the cut-off points reported by Adewuya et al. [25] for minor and major depressive disorders respectively. The relationship between maternal depression and child emotional/behavioral problems was tested using Chi squares, t tests and correlations as appropriate. Scores for emotional/behavioral problems among the children, assessed by the SDQ, were computed as total scores and subscale scores for emotional, conduct problems, hyperactivity, peer problems and prosocial subscales [26]. The 25 items in the SDQ are divided into these 5 subscales with 5 items each. Items in each subscale are scored (0–10) after which the scores are categorized as normal, borderline or abnormal. A total score (0–40) is also generated from four out of the five subscales (excluding the prosocial subscale). However, inferential analysis for SDQ scores was done using raw scores (quantitative variables). For variables significantly associated with screening positive for major depressive disorder, logistic regression analysis was done. Similarly, linear regression was done for variables associated with scores on the SDQ. Tests were two-tailed, with level of significance set at p < 0.05. Statistical analysis was done using version 16 of SPSS.
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