Common psychological disorders among institutionalized children in rural and urban settings in Kenya

Abstract

Objective To determine the prevalence of psychological disorders among institutionalized orphans in rural and urban settings in Kenya. Design A cross-sectional descriptive method was adopted. Quantitative methods were employed using self-administered questionnaires (ReADS) for the children to identify emotional disorders.The teacher-rated Rutters scale for the identification of emotional and behavioural problems was also used. Focus group discussions were held with selected key staff of the orphanages to gain an understanding of the objectives of the various orphanages and how the orphans viewed the institutions,according to the caretakers. Setting The study was conducted in two study settings in Kenya: urban and rural. The representative study sites for both urban and rural were selected using purposive sampling. Subjects Six hundred and seventy three children aged 8 years and above were interviewed. Teachers were also interviewed regarding their own observations about the children's emotional and behavioural problems. Results Bothorphans and non-orphans had high levels of psychological distress with a statistically significant difference on separation anxiety subscale (p = 0.021). Total orphans had a higher prevalence of depression of 2.9% than non-orphans who had a depression prevalence of 2.6%.Depressionco-existed with obsessive compulsive disorder with a prevalence of 13.4% among non-orphansand 10.4% among total orphans. Separation anxiety prevalence was higher amongnon-orphans (16.7%) and (11.7%) among total orphans, than other categories of children. Childrenin the rural setting were twice more likely to suffer from psychological disorders than the children in the urban setting. There were statistical differences for obsessive compulsive disorder and panic disorder subscales (p = 0.031 and p = 0.040 respectively). Focusgroups discussions revealed that staff in the orphanages cannot easily identify psychologica disturbances. Conclusions Children in institutions have emotional and behavioural problems that need to be identified and managed. Children suffer from depression and other co-morbid illnesses such as obsessive compulsive disorder, generalized anxiety disorder, separation anxiety and social phobiaas early as 8 years and these ought to be recognized early to prevent debilitating psychiatric illnesses later in adulthood. This study concluded that parental deprivation either through death or separation from significantattachment figures was a major factor affecting the psychological well-being of a child. It is important for teachers and other adults to learn how to identify psychological problems in children. From he findings of this study, institutionalization is not the only practical response to the orphancrisis.