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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 38  |  Issue : 2  |  Page : 137-142

Personification of stress, depression, anxiety, and quality of life, among parents of attention deficit hyperkinetic disorder children


1 Department of Psychiatry, PGIMER, Chandigarh, India
2 Department of Paediatrics, PGIMER, Chandigarh, India

Date of Submission19-May-2020
Date of Decision07-Aug-2020
Date of Acceptance01-Sep-2020
Date of Web Publication30-Jun-2022

Correspondence Address:
Dr. Krishan Kumar
Department of Psychiatry, Nehru Block, Cobalt Level-III, PGIMER, Sec 12, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_116_20

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  Abstract 


Introduction: Attention deficit hyperkinetic disorder (ADHD) is a common pediatric condition which contributes to poor quality of life (QoL) among parents of children diagnosed with the same. These parents go through anxiety, stress, depression, and other psychological trauma; face a lot of social taboos and stigma. These entire psychosocial variables affect their day-to-day life functioning, productivity, and psychological health. Thus contribute to poor perceived QoL among these parents. Aim: The study's main objective is, therefore, to see the effect on an ADHD child's parent of their perceived QoL in relation to their psychological wellbeing as measured by their level of stress, anxiety, and depression. Materials and Methodology: A total of 30 parents of children with ADHD were selected as samples from the outpatient section of the PGIMER, Department of Psychiatry, using a purposive and convenient sampling method. Among these parents, QoL was assessed using the WHO QoL (BREF); whereas stress, depression, and anxiety levels were assessed using Depression Anxiety Stress Scale II. Results: Our research findings suggest the mean age of the parents to be 32 years (with the age range of 28–45), with the mean age of the child as 9 years (with the age range of 4–13). Where parents <35 years of age (86.7%); have registered better physical QoL than those over the age of 35. Nonetheless, most parents (73.3%) reported poor perception of QoL. Our research findings also showed that most parents suffer from severe depression (66.7%), stress was also perceived as high among these parents, and parents aged >35 years showed higher anxiety than compared to other age groups. The overall QoL was also found to be negatively correlated with anxiety, stress, and social relationships. The mentioned findings have been discussed further. Conclusion: The overall results of this study showed clearly that most of the parents had perceived serious burden and poor QoL in all areas. The research also indicates that these parents are more distressed, stressful, and depressed. Our research finding indicated that for these parents to keep their lifestyles healthy, they can make a difference by recognizing and embracing the fact that ADHD is more inevitable than the one caused by environmental and/or personal errors. Parents should share their workload, increase their need for assistance and encourage one another to take some time out of the care of the child to have a shift and enhance their QoL.

Keywords: Attention deficit hyperkinetic disorder, caregiver, psychological impact


How to cite this article:
Kumar K, Sharma R, Saini L, Shah R, Sharma A, Mehra A. Personification of stress, depression, anxiety, and quality of life, among parents of attention deficit hyperkinetic disorder children. Indian J Soc Psychiatry 2022;38:137-42

How to cite this URL:
Kumar K, Sharma R, Saini L, Shah R, Sharma A, Mehra A. Personification of stress, depression, anxiety, and quality of life, among parents of attention deficit hyperkinetic disorder children. Indian J Soc Psychiatry [serial online] 2022 [cited 2022 Aug 9];38:137-42. Available from: https://www.indjsp.org/text.asp?2022/38/2/137/349344




  Introduction Top


Attention deficit hyperkinetic disorder (ADHD) is a common pediatric, behavioral, and neuro-cognitive condition characterized by gross motor overactivity, inattention, and impulsivity.[1] The essential feature of ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development. The affected child manifests persistent patterns of behaviors that are more frequent and severe, unlike an unaffected child who may exhibit similar behaviors occasionally.[2],[3]

The prevalence of ADHD among primary school children in India is been reported as 11.32%; and was reported to be higher among the males (66.7%) as compared to the females (33.3%); the prevalence is been found to be higher in the age group 9 and 10 years.[4]

ADHD in the child; has been found to have significant ill effects on primary caregivers/parents, families, and communities. The parents or caregiver are the main providers for each and every child's needs. They are the most vital part of a family system that binds the family together keeping a healthy social, personal, cultural, and moral standard. These parents, however, find it challenging to adapt and maintain a balance in life when challenged due to the existing social stigma and several other associated concerns while raising a child diagnosed with the special condition (ADHD); as these children require more personal, social, cultural, physical and emotional support and considerations. This, in turn, could lead to an increased sense of burden, associated with negative emotions, and a reduced perception of the quality of life (QoL) in an individual or within a family.[5],[6]

Several researchers have found that raising a child with hyperactivity and inattentiveness is highly difficult. Such over-imposed demands on parents/carers and other members of the family can lead to high perceived stress; in terms of social change, financial pressure, and academic decline.[7],[8] Depression,[7] poor child-parent interaction,[9] emotional distress and fatigue[7],[10],[11] are also common among these parents and these factors together lead to a poor perception of QoL[5] among these parents as compared to parents of healthy children.

Mothers of these children have been found to report an increased sense of social burden in terms of restrictions on their social life, time spent on themselves.[12] They have also reported to have increased maternal stress due to less support from extended family members and even fathers, in terms of their involvement in child care, parental discipline, and treatment process. They have also expressed feelings of inadequacy, shame, and guilt.[13]

Following the diagnosis of the child; fathers were more skeptical and could be categorized as either “reluctant believers” or “tolerant nonbelievers” on the basis of their attitude toward ADHD and its treatment.[14]

Thus, the present study is aimed at assessing Indian parents with children diagnosed with ADHD; on their level of stress, depression anxiety, and perceived QoL.

Aims and objectives

There are several Indian studies which show that the life of an ADHD child is significantly affected due to the illness and its associated demands; however how these similar factors affect the life of primary caregiver or their parents are not adequately researched. Thus, the present study aimed to assess the QoL of the parents or primary care along with the level of stress, anxiety, and depression in parents with ADHD child.


  Materials and Methodology Top


The present study is a cross-sectional study. Thirty caregivers/parents with children diagnosed ADHD have been selected using purposive and convenient sampling from the Outpatient section of the Psychiatry Department at PGIMER. The present study was approved by the PGIMER, Institute Ethical Committee.

Inclusion criteria

  1. Parents or caregivers of ADHD children between age 4 and 16 years of either gender
  2. Gave written consent
  3. Could read and comprehend Hindi or English,
  4. Having no psychiatric diagnosis or comorbidity, as per psychiatry evaluation
  5. Nouse of psychoactive substance, as per psychiatry evaluation was included in the study.


All the participants were assessed using following instruments/tools:

Sociodemographic profile

General information such as: age, sex, marital status, education, and occupation were collected from parents.

Depression anxiety stress scale II

This 21-item questionnaire contains three subscales, including depression (seven items), anxiety (seven items), and stress (seven items). The individual responded to the items on a 4-point Likert scale (0 = Never a problem, 1 = Sometimes a problem, 2 = Often a problem, and 3 = Almost always a problem). According to the Depression anxiety stress scale (DASS-21) scoring algorithm, higher scores indicated higher depression, anxiety, and stress. Total score is calculated by summing the scores for each subscale. Moreover, DASS scoring manual have provided cutoff scores for defining normal (0–4 for depression, 0–3 for anxiety and 0–7 for stress), mild (5–6 for depression, 4–5 for anxiety and 8–9 for stress), moderate (7–10 for depression, 6–7 for anxiety and 10–12 for stress), severe (11–13 for depression, 8–9 for anxiety and 13–14 for stress), and extremely severe (>14 for depression, >10 for anxiety, >17 for stress) scores.[15]

WHO quality of life (BREF)

This is a 26-item questionnaire, to provide a broad and comprehensive assessment; one item from each of the 24 facets contained in the WHOQOL-100 has been included. In addition, two items from the Overall QoL and General Health facet have been included. It assesses QoL under four domains; physical health, psychological, social relationship, and environment. There are also two items that are examined separately: Question 1 asks about an individual's overall perception of QoL and question 2 asks about an individual's overall perception of their health. The four domain scores denote an individual's perception of QoL in each particular domain. Domain scores are scaled in a positive direction (i.e., higher scores denote higher QoL). The mean score of items within each domain is used to calculate the domain score. The individual responded to the items on a 5-point Likert scale (1 = Not at all, 2 = Not much, 3 = Moderate, 4 = A great deal, 5 = Completely).[16]

Ethical consideration

The present study was approved by PGIMER, Institute Ethical Committee.


  Results Top


Data analysis was carried out using SPSS Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. Chicago: SPSS Inc. Correlation analysis with t-test analysis was used to base further results and discussion of the present study.

The present study was conducted with an aim to evaluate QoL, depression, anxiety, and stress among parents with children diagnosed with ADHD.

In the present research, results indicated; the mean age of parents to be 32 years 6 months (with range 28–45) with children mean age being 9 years 4 months (with range 4–13 years).[4]

All participants were married and belonged to the Hindu religion. Among the parents, the majority of the participants were mothers (86.7%). One-thirds of the parents (36.7%) were educated up to higher secondary level, one-fifth (26.7%) were educated up to matriculation, and about one-fifth (20.2%) were educated up to primary level. About three-fourth of the participants belonged to middle socioeconomic status (70.0%), living in joint family setup (76.7%). More than half of the participants were from the urban locality (53.3%). The following results of sociodemographic variables are described in [Table 1].
Table 1: Sociodemographic description of parents and children

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Description of parental quality of life

The sub-domain analysis of QoL between parents shows that the mean value of the physical domain is (16.33 ± 2.49), the psychological domain is (12.56 ± 2.84), the social relationship is (8.40 ± 2.48), and the environmental domain is (14.86 ± 2.76); from the above-mentioned score it can be inferred that the overall perceived QoL is low in all four domains; as interrelated. Majority parents also had a low perception of QoL (73.3%); and overall health.[17],[18],[19]

What was interestingly demonstrated in the analysis is that; younger parents report better perceived QoL in the physical domain; (age <35 years: 16.57 ± 2.57; age >35 years: 14.75 ± 0.95; t value 11.692; P value 0.000). The results showed also a poor perception of social life; among these parents [Table 2].
Table 2: Descriptive presentation of parents on quality of life

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Further, detailed analysis to understand the psychological impacts been faced by these parents in terms of depression, anxiety, and stress revealed:

Parents >35 years of age reported significantly greater anxiety than parents <35 years of age (age <35 years of age: 14.69 ± 4.78; age >35 years: 17.00±0.81; t value 2.256; P value 0.032).

The findings also revealed that approximately one-third of participants had moderate and serious anxiety (33.3% each), and one-fifth (20%) recorded extremely severe anxiety.

More than one-fourth participants reported mild-to-moderate stress (26.7% respectively), approximately (36.7%) reported severe stress and (6.7%) reported extremely severe stress.[2],[9],[20],[21]

Majority of parents also reported extremely severe depression (66.7%).[3],[7]

The same has been presented in [Table 3] and graphically presented in [Graph 1].
Table 3: Association quality of life, anxiety, stress with sociodemographic variables of parents

Click here to view



A co-relational analysis of overall QoL; with the domain of disease activity score indicated [Table 3]: A negative correlated of QOL with anxiety and stress. which indicates that if; the level of anxiety or stress decreases the perception of QOL will increase.

The scores of parents with low-income groups were lower than the other two groups. Post hoc comparison revealed that low-income group parents were not satisfied with the environmental conditions they were living in; (High-income Group: 12.83 ± 1.94; middle-income Group: 13.04 ± 2.71; low-income Group: 8.66 ± 3.05; F ratio 3.726; P value 0.037). This finding is in line with an earlier study by Azazy et al.[8]


  Discussion Top


ADHD has significant consequences for the life of a child; it affects all aspects of its development, from schooling to school life, interaction with peers, family life, and self-esteem. Moreover, having a child with ADHD had several implications for their parent's life as well. A parent with an ADHD child faces many struggles and difficulties; emotionally, mentally, and financially. Thus we planned the present study. As per the aim of the study:

our research findings have shown high perceived stress, depression, and anxiety among parents of children with ADHD,[12],[13],[14] the present findings suggest increased demand for parenting, social and personal, associative factors among parents of these children. Research by Deater-Deckard, 2004 and Abidin, 1995;[22],[23] concluded that the magnitude of stress experienced by these parents is primarily based on two aspects: One being the child's characteristics of the disease and the other being the parental variable. Researchers have also revealed similar results over time in relation to parental stress, lifestyle habits, and their lifelong struggle. A similar finding has been revealed from our research.

Our research findings have also showed higher levels of depression, anxiety, and stress in parents with male child than compared to girl child. Although, these findings were not associated significantly. The present finding can reflect to on how our cultural understanding, social foundations, and practices are shaped; and influences our perception of a child's illness and its manifestation on our life. In our society where still, a male child is seen as the precursor of future life, it is bound to parents with such a belief being more anxious, depressed or stressed out. Further analysis of their belief system can give us an understanding of the domain in question. However, it may be speculated and identified at the moment and needs to be further explored by conducting similar research.

Our research findings have also shown that parents perceive high physical strain, which may be attributed to the very nature of illness that demands excessive physical engagement, a lot of physical force, girth, and stamina to handle a child with increased psycho-motor functioning and inattention. Mothers expressed that they feel more physically exhausted, as they have to involve in child care along with performing their daily routine household chores and responsibilities. This could be a constant reason of additional demand over them physically.

Our study result sheds new light on recognizing the essence of perceived tension relating to the age profile of parents of children with ADHD. Where; our study results have shown younger parents reporting on the physical domain a better perceived QoL than those older than 35 years. Age is correlated with physical girth, stamina, and therefore, as a young adult, individuals typically show greater physical endurance and work-related ability than they do when they reach older age. This could, therefore, be attributed to the physical strength of parents in carrying out activities, engaging effectively, and managing their child with ADHD; thus, having a better perception of their adjustment when younger.[8]

These parents “overall QoL has been negatively associated with anxiety and stress which means that managing parents” anxiety and stress will boost their QoL. Furthermore, due to their children's diagnosis of ADHD strong negative correlation between the social interaction domain of QoL and stress was also reported, which indicates that parent's social life are most affected. Social lives of these parents are hampered significantly due to the hyperactivity of their child, and it had a negative impact on them in terms of keeping and maintaining social relationships and abiding by several social obligations. Parents of these children have also reported difficulty in attending social gatherings because of their child's hyperactive behavior, going through social shaming due to same.[9],[10],[11]

Kashdan et al.[24] also found parental depression was significantly associated with children ADHD scores, and similar findings have been indicated in our research where parents have reported a high level of depression.

All of the above findings indicate that these parents can have a better QoL and can lead a balanced life only if appropriate measures are taken to help these parents adapt to effective measures of dealing with the current life circumstances.

Parents, even when understand the behaviors associated with ADHD find it outside parents' control to change it. This contributes to growing feelings of powerlessness and perceived stress in life. Feelings of powerlessness lead parents to become colder, more rejecting, and less warm towards their children. What is somewhat ironic about these findings is that they are believed to have a strong biological cause in children with ADHD, and are justifiably difficult to control for parents and children. This is therefore not shocking that many parents perceive children exhibiting high rates of these behaviors as unresponsive to rectification, and these feelings among parents are also not entirely mistaken, leading to poor understanding of QoL, increased tension, higher levels of anxiety, depression, and social aloofness.


  Conclusion Top


Life with an ADHD child; maybe exasperating, overwhelming, and distressing as children with ADHD find simple tasks of executive function (ability to think and plan ahead, organize, control impulses, and complete tasks) difficult to comprehend and complete in comparison to a child with no such developmental deficit.

Thus, parents or primary caregivers of these children have to focus on developing and enhancing these age-appropriate skills in their child. The added burden of these challenges been faced on a day-to-day level could lead these parents to feel stressed, anxious, worried, and depressed.

What is needed here is a constant force of positivity, compassion with persistence, and plenty of support. This seems to be easier to say than done; our research findings have indicated that even though most parents lived in a traditional family set up; with additional support available, their perception of pressure, social/environmental stress was not less than any other, as previous studies have shown and reported.

Thus, through our research important aspect to be focused on is to help these parents maintain a balanced lifestyle. Parents could bring in a change; by understanding and accepting that the present condition is more inheritable than caused by environmental or their personal mistakes, they should practice empathy toward each other, share the majority workload, increase seeking help and give each other an opportunity to take a time out from child's caretaking.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3]



 

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