PREVALENCE AND PATTERN OF PSYCHOLOGICAL DISORDERS IN FIRST-DEGREE RELATIVES OF CHILDREN WITH CEREBRAL PALSY IN ENUGU, NIGERIA

Abstract

The prevalence and pattern of psychological disorders in the parents and
siblings of children with cerebral palsy in Enugu were studied.
Eighty children with CP, attending the Paediatric Neurology Clinic of the
University of Nigeria Teaching Hospital (UNTH), Enugu, as well as 144 parents
and 129 siblings of these CP patients were studied. The control population
consisted of 144 parents and 129 children matched for age, sex and socio
economic class against the subjects. The bio-data, relevant clinical features, and
socio-economic classes of the patients were documented. The rate of
psychological dysfunction in the parents and siblings of children with CP was
examined using the General Health Questionnaire (GHQ), the Zung Depression
Scale (ZDS) and the Rutter’s Behavioural Scale (Teachers’) for children. These
tests were also administered on controls.
One hundred and thirty eight (19.3%) of the children seen at the
Paediatric Neurology Clinic during the study period had CP.
The CP patients were aged 6-68 months (mean  S.D of 34.2  14.1
months), with 78.8% of them being 4 years or less. The types of CP were
quadriplegia (53.8%), hemiplegia (13.8%), dyskinesia (12.5%), mixed (7.5%),
ataxia (6.3%), hypotonia (2.5%) and bilateral hemiplegia (1.3%). Eighty

percent (80%) of the subjects had associated neurologic deficits. Asphyxia
(42.2%) and severe neonatal jaundice (37.5%) were the main aetiologic factors.
Most of the parents (67.4%) of the patients belonged to the lower
socioeconomic classes IV and V. Eighty – four percent of the parents of children
with CP had psychological morbidity compared to 6.9% of controls (p<0.05).
Eighty-four percent and 33.3% of the parents and controls, respectively, had
depression (p<0.05). Mothers of the children with CP were significantly more
affected than the fathers, with psychological morbidity (using the GHQ) in
70.3% of fathers, compared to 95.0% of the mothers (p<0.05) and depression
(using the ZDS) in 65.6% of the fathers compared to 98.7% of the mothers (p
<0.05). Among the controls, mothers were more affected than the fathers, with
psychological morbidity in 4.7% of the fathers, compared to 8.8% of the
mothers (p<0.05) and depression in 18.7% of the fathers, compared to 45.0% of
the mothers (p<0.05). For the siblings of the CP patients, 5.4% showed
behavioral abnormalities compared with 2.3% of the controls (p>0.05).
The conclusion is that significant psychological morbidity, including
depression occurs among parents of children with CP, with the mothers being
more commonly affected than the fathers. Primary school-age siblings of the CP
patients, do not have significant behavioural abnormalities. However, they do
have higher rates of behavioral abnormalities than controls.

It is recommended that counseling sessions for parents of CP patients be
organized regularly. There is the need for further study of the psychological
impact of CP on older siblings (age ≥ 15 years), the present study being on the
younger siblings (age 5-14 years) only.

PREVALENCE AND PATTERN OF PSYCHOLOGICAL DISORDERS IN FIRST-DEGREE RELATIVES OF CHILDREN WITH CEREBRAL PALSY IN ENUGU, NIGERIA