|Year : 2015 | Volume
| Issue : 3 | Page : 158-162
Psychiatric morbidity among a sample of orphanage children in Cairo
Samah H Rabei MD
Department of Psychiatry, Psychiatry Unit, College of Medicine, Misr University for Sciences and Technology, Giza, Egypt
|Date of Submission||03-Aug-2015|
|Date of Acceptance||13-Sep-2015|
|Date of Web Publication||30-Sep-2015|
Samah H Rabei
Department of Psychiatry, College of Medicine, Misr University for Sciences and Technology, 5 Omroo Al Kaysst, 7th District, Nasr City, Cairo
Source of Support: None, Conflict of Interest: None
Children raised in orphanages have increased rates of psychiatric morbidity.
The study aimed to detect psychiatric morbidity and various sociodemographic factors associated with it among children raised in orphanages in Cairo.
Participants and methods
In all, 100 children were recruited from four orphanages: 25 from Nasr City orphanage for preschool girls; 25 from Heliopolis orphanage primary and preparatory boys; 25 from Maadi orphanage for preschool boys; and 25 from Hadaaek Al Kooba primary and preparatory girls. They were assessed using a General Health Questionnaire, a Child Behavior Checklist, a Childhood Trauma Questionnaire, and the Holmes and Rahe stress scale (nonadults) between June and December 2013.
The study found the following: (a) sexual and emotional abuse render the child prone to mental illness (General Health Questionnaire). (b) Change of teachers and orphanages render the child prone to emotional neglect and abuse, reactive attachment, oppositional defiance, and nocturnal enuresis. (c) Reactive attachment and oppositional defiance are more in male children. (d) Depression is more in teens. (e) Male teens are prone to sexual abuse. (f) Conduct and substance abuse is more in male teens. (g) Suicide, post-traumatic stress disorder, and substance abuse are strongly associated with sexual abuse.
This study concluded that there is a high rate of emotional and developmental disorders among orphanage children and are strongly inter-related with sociodemographic characteristics.
Keywords: Abuse, depression, substance abuse
|How to cite this article:|
Rabei SH. Psychiatric morbidity among a sample of orphanage children in Cairo. Egypt J Psychiatr 2015;36:158-62
| A nation of orphans on earth|| |
UNICEF estimates the number of orphans at around 210 million worldwide. The United Nations estimates the number of street children to be 150 million worldwide. UNICEF estimates the number of orphans at around 1 700 000 and street children at around 1 000 000 in Egypt (http://www.childinfo.org/hiv_aids_orphan).
| Deprivation and abuse|| |
Some studies have found that violence in residential institutions is six times higher than violence among foster-care children; children in group care are almost four times more likely to experience sexual abuse than children in family care. According to Foster Care Facts and Statistics (2013) in the UK 'foster children were 7-8 times, and children in residential care 6 times more likely to be assessed by a pediatrician for abuse than a child in the general population'. A study of foster children in Oregon and Washington state found that nearly one-third reported being abused by a foster parent or another adult in a foster home (Hobbs et al., 1999). Studies in the USA have suggested that some foster-care placements may be more detrimental to children than remaining in a troubled home (Karnik, 2000). Fifteen percent of these children commit suicide, 60% of the girls become prostitutes, and 70% of the boys become hardened criminals. Two million children, the majority of them girls, are sexually exploited in the multibillion-dollar commercial sex industry (The State of the World's Children, 2005).
| Psychiatric morbidity|| |
The incidence of depression was double in the Casey study of foster children in Oregon and Washington state. These children were found to have a higher rate of post-traumatic stress disorder (PTSD) compared with combat veterans, with 25% of those studied having PTSD. Children in foster care have a higher probability of having attention-deficit hyperactivity disorder and deficits in executive functioning, anxiety as well as other developmental problems (McCann et al., 1996; Pears and Fisher, 2005; Tarren-Sweeney and Hazell, 2006; Pecora et al., 2009). Institutional autism syndrome: Historically, Spitz described several patterns of behavior in young children in reaction to emotional trauma, loss of primary caregiver, and lack of stimulation. These children developed symptoms that were at least similar to those often found in children with autism. Rutter et al. (2001) examined 165 children adopted from Romania before the age of 4. The children were examined at 4 and 6 years and compared with 52 children of the same age and sex adopted at infancy in the UK. The researchers found that 12% of Romanian adoptees had quasiautistic features (vs. none in the UK sample) that included rocking, self-injury, unusual and exaggerated sensory responses, and problems chewing and swallowing. The investigators found that, with the exception of unusual sensory responses, the rate of autistic-like behaviors in most cases steadily declined after the child entered the adoptive family. In a number of cases, however, the difficulties remained, despite good-quality care in the new home. Aberrant eating among 347 preadolescent children in court-ordered foster and kinship care in New South Wales, Australia, was noticed. A quarter of children displayed clinically significant aberrant eating problems, with no evidence of sex-related or age-related effects. There is a pattern of excessive eating and food acquisition and maintenance behaviors without concurrent obesity (termed food maintenance syndrome), resembling the behavioral correlates of hyperphagic short stature (psychosocial dwarfism) (Tarren-Sweeney, 2006). Bulimia nervosa is seven times more prevalent among former foster children than in the general population (Cook, 2005).
| Participants and methods|| |
This is an observational cross-sectional study.
One hundred patients were recruited from four orphanages:
- twenty-five from Nasr City orphanage for preschool girls;
- twenty-five from Heliopolis orphanage primary and preparatory boys;
- twenty-five from Maadi orphanage for preschool boys; and
- twenty-five from Hadaaek Al Kooba primary and preparatory girls.
The children were assessed using the following tools:
Informed consent was obtained from children and teachers.
- General Health Questionnaire (GHQ).
- The Child Behavior Checklist (CBCL).
- Childhood Trauma Questionnaire.
- Holmes and Rahe stress scale between June and December 2013.
Descriptive statistics were obtained on Excel 2010 (Excel Microsoft).
Analytical associations were determined using SPSS version 22 (IBM) (χ2 -test).
| Results|| |
[Figure 1]a shows that male and female children were equally distributed: 50% were male and 50% were female.
|Figure 1: Figure one shows that males and females are equally distributed 50% males and 50% females andshows that age groups are equally distributed 50% primary children (6-12 years old) and 50% preparatory adolescents (12-18 old)|
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[Figure 1]b shows that age groups were equally distributed: 50% primary children (6-12 years old) and 50% preparatory adolescents (12-18 years old).
[Figure 2] shows that 90% of participants reported emotional neglect and 83% reported emotional abuse; 54% of participants reported physical neglect and 31% reported physical abuse; 12% reported sexual abuse.
|Figure 2: Figure two shows that 90% of participants report emotional neglect and 83% report emotional abuse.54% of participants report physical neglect and 31% report physical abuse. 12% report sexual abuse|
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[Figure 3] shows that 62% of participants scored more than 300 on the Holmes and Rahe scale and 48% were cases according to the GHQ.
|Figure 3: Figure three shows that 62% of participants scored more than 300 on Holmes and Rahe scale and 48% were cases according to the General Health Questionnaire|
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[Figure 4] shows that 28% of participants had anxiety disorder; 12% abused psychoactive substances (including nicotine); 21% had nocturnal enuresis; 20% had depressive episodes; 18% had conduct disorders and 18% had PTSD; 11% had reactive attachment; 9% had oppositional defiant disorder; and 6% had suicidal tendencies.
|Figure 4: Figure 4 shows that 28% of participants has anxiety disorder, 12% abuse psychoactive substances (including nicotine) 21% has nocturnal enuresis 20% has depressive episodes, 18% conduct disorders and 18% Post traumatic stress disorder, 11% reactive attachment, 9% oppositional defiant disorder and 6% had suicidal tendencies|
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(1) Sexual and emotional abuse render the child prone to mental illness.
[Table 1] shows significant association between the scores for emotional and sexual abuse in the Child Trauma Scale (CTS) and scores in the GHQ.
(2) Change of teachers and orphanages render the child prone to emotional abuse and neglect, besides some disorders.
[Table 2] shows significant association between history of change of teachers and scores for emotional neglect and abuse in the CTS and having nocturnal enuresis, oppositional defiance, and attachment disorders according to the CBCL.
|Table 2: Associating changing teachers and presence of abuse and psychiatric disorders in orphans (P = 0.001) |
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(3) Reactive attachment and oppositional defiance are more in male children.
[Table 3] shows significant association between male sex and oppositional defiance and attachment disorders according to the CBCL.
(4) Depression is more in teens.
|Table 3: Associating presence of reactive attachment and oppositional defiance to age group (children) and gender (male) (P = 0.001) |
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[Table 4] shows significant association between ages 12-18 and depressive disorder according to the CBCL.
(5) Male teens are prone to sexual abuse.
|Table 4: Associating age group (teens) and presence of depressive episodes (P = 0.001) |
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[Table 5] shows significant association between ages 12-18 years and male sex and sexual abuse in the CTS.
(6) Conduct and substance abuse is more in male teens.
|Table 5: Associating age group (teens) and gender (male) and presence of sexual abuse (P = 0.001) |
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[Table 6] shows significant association between ages 12-18 years and male sex and conduct and substance abuse disorders according to the CBCL.
(7) Suicide, PTSD, and substance abuse are strongly associated with sexual abuse.
|Table 6: Associating age group (teens) and gender (male) and presence of conduct disorder and poly-substance abuse (P = 0.001) |
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[Table 7] shows significant association between ages 12-18 years and male sex and suicide, PTSD, and substance abuse disorder according to the CBCL.
|Table 7: Associating suicide, sexual abuse PTSD, and poly-substance abuse (P = 0.001) |
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| Discussion|| |
Equal distribution of sex and age groups is due to the random selection of orphanages. In Egypt boys and girls are segregated in orphanages and primary education children are segregated from preparatory adolescents.
Emotional neglect implies a feeling of being unloved and unwanted, including by society. Emotional abuse involves inconsiderate remarks that upset a person, including comments by teachers. Physical neglect mainly involves not being given food or medication, including by society. Physical abuse includes being beaten, including by teachers. Twelve percent reported sexual abuse mainly on streets, by step-parents, distant relatives, and older colleagues.
Sixty-two percent were prone to psychosomatic disorders and 48% were psychiatric cases.
Fawzy and Fouad (2010) reported that the prevalence rate of depression was 21% and that of anxiety was 45% among orphanage children in Sharkia governorate in Egypt. This agrees with the present study's findings in which 28% of participants had anxiety disorder and 20% had depressive episodes.
Musisi et al. (2007) reported that 8.3% of orphans in a sample in Uganda compared with 5.1% of nonorphans had past suicidal wishes (P = 0.30) and more reported past 'forced sex/abuse' (P = 0.05). This agrees with the present study's findings in which 6% had suicidal tendencies.
Koumi et al. (2012) reported that among a sample of orphanage children in Cairo nocturnal enuresis was found in 23.3% and oppositional defiant disorder in 17.36%. Age at first admission, causes of receiving institutional care, and two or more moves between institutions were significantly associated with an increased risk of behavioral and emotional problems (Koumi et al., 2012). This study found that among orphans nocturnal enuresis was 20% but oppositional defiant disorder was 9%.
- Sexual and emotional abuse render the child prone to mental illness.
- Suicide, PTSD, and substance abuse are strongly associated with sexual abuse.
Bos et al. (2011) reported that female sex was protective for virtually all types of psychopathology among children with a history of institutional rearing in a Romanian sample. The seemingly protective effect in girls may be the result of biological differences and cultural practices (Bos et al., 2011). This agrees with the present study's findings:
- Change of teachers and orphanages render the child prone to emotional abuse and neglect, besides some disorders.
- Conduct and substance abuse is more in male teens.
- Reactive attachment and oppositional defiance are more in male children.
- Male teens are prone to sexual abuse.
- No medical records are available for orphans.
- Orphans are at higher risk for sexual abuse and associated PTSD, substance abuse, and suicide. There is no trained social service to report sexual abuse by step-parents and older colleagues in previous institutes.
- Administrative shifting of teachers leads to an absence of a stable figure of attachment for children and no longitudinal awareness of the history of children's behavior.
The authors thank the teachers and participants who were very helpful.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bos K, Zeanah CH, Fox NA, Drury SS, McLaughlin KA, Nelson CA (2011). Psychiatric outcomes in young children with a history of institutionalization. Harv Rev Psychiatry 19:15-24.
Cook R (2005). One in four foster children suffers from post-traumatic stress, study finds. Seattletimes.nwsource.com. [Accessed 1 November 2011]
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]