DOI: https://doi.org/10.

53350/pjmhs2216818
ORIGINAL ARTICLE

Severity of Depression in Mothers of children suffering from Cerebral

Palsy
AYESHA GOHEIR1, ALAMZEB JADOON2, SYEDA SHAZMINA FAYYAZ3, NAZMA KIRAN4, NAVEED AKHTAR5, ZIA QAMAR6
1
Assistant Professor of Physiology, Rai Medical College, Sargodha, Pakistan
2
Assistant Professor of Physiology, Nowshera Medical College, Nowshera (K.P), Pakistan
3
House Officer, PAF Hospital, Sargodha, Pakistan
4
Associate Professor of Pathology, Rai Medical College, Sargodha, Pakistan
5
Professor of Anatomy, Rai Medical College, Sargodha, Pakistan.
6
Senior Registrar, Pulmonology Department, Ayub Teaching Hospital, Abbottabad.
Correspondence to Dr. Alamzeb Jadoon, Email: [email protected], Phone: 03008550585

ABSTRACT
Background: Cerebral palsy (CP) is the most common cause of motor disability in children with worldwide having incidence of 2
per 1000 live births. Children with CP have motor disability, decreased ability to walk, poor feeding and limited exposure to
sunlight. Malnutrition, behavior challenges and motor deficits in CP children are common causes of depression in their mothers.
Aim: The present study focused to estimate the severity of depression in mothers, looking after the children suffering from
severe CP and to compare their depression scoring with the scores of mothers having healthy children.
Methods: The cross-sectional comparative study included 21 mothers having children suffering from severe CP and 21 controls
(Mothers of normal children). Depression was calculated by the Beck Depression Inventory (BDI).
Results: A statistically significant difference was observed between the mean scores of BDI II between the two groups
Conclusion: Results revealed that mothers having CP children are more depressed than mothers having healthy children. It
imitates the importance of psychiatric, social and family support to mother along with the treatment of the child.
Keywords: CP, depression, BDI II.

INTRODUCTION The present study intended to explore the effects of CP on

maternal depression and to compare their scores with the healthy
Cerebral palsy (CP) is brain paralysis caused by the brain hypoxia controls. The results obtained highlighted the need of psychiatric
which affects body movements, balance and posture with support to improve the quality of life of child, parents, and family.
incidence of 2 per 1000 live births1 .Increased risk is associated The study also enlightened the need of proper antenatal checkups
with preterm delivery, congenital malformations, intrauterine and the deliveries to be conducted in a tertiary care hospital. The
infections, fetal growth retardation, multiple pregnancies, placental results obtained highlight the need for psychiatric support to the
abnormalities, prolonged labor and instrumental delivery. However, mothers along with the treatment of the child.
1-2% cases of CP are due to genetic abnormalities2. The disorders
of movement appear in early stages of life along with delayed
MATERIALS AND METHODS
milestones, diminished intellect and motor disability3.
Early diagnosis and intervention help to improve infant motor This was a Cross-sectional comparative study. The study was
and cognitive functions and protect from secondary complications4. approved by Ethical review board of the University of Health
In severe cases, CP can be detected soon after birth, but average Sciences Lahore and the Institutional review board (IRB) of
age of diagnosis is two years. For those with milder symptoms, a Children hospital / Institute of Child Health Lahore.
diagnosis may not be confirmed until the brain is fully developed at The study was conducted in Lahore, the provincial capital of
three to five years of age. The average age of diagnosis for a child Punjab, Pakistan. Subjects were recruited from the Children
with CP is 18 months5. Type of manifestation and extent of hospital, Lahore. A total of 42 mothers of middle class family, with
disability depends upon area of brain involved. The motor function age up to 40 years were included in this study. They were further
deficits limit the daily doings of life and may accompany cognitive, subdivided into two groups, 21 subjects having children suffering
speech, behavior, sensory impairments and behavioral difficulties from CP and 21 mothers having normal children were included
which can affect family functioning and over all wellbeing of child after written and informed consent. Gross Motor Functional
and family member6,7. Greater parental stress has been found to Classification System (GMFCS) level V was taken as severe CP in
be related with higher levels of behavioral problems in children8,9. children and diagnosed by doctor of the developmental pediatrics
A study carried out by using Self Report Questionnaires in department19,20. All pregnant or lactating mothers, using steroid
Bangladesh showed that the mothers of CP children are therapy, oral contraceptive pills or medication for depression,
susceptible to develop stress10. BDI-II used in our study is also a Widows and females with difficult relations with family and spouse
self-report 21 item questionnaire having 81% sensitivity and 92% and any other chronic medical condition were excluded based
specificity21,23. It is translated into multiple languages worldwide. In upon history and investigations. Sample size was calculated by
the current study Urdu version of the inventory was WHO calculator version 2.021, derived on basis of a previous
administered24,25.Mothers having a CP child are more prone to study15. The purposive sampling technique was used.
depression than the mothers having apparently healthy children11 . Well known self-report questionnaire with acceptable
Depression have negative impact on one’s feelings, views and psychometric properties were utilized after consultation with the
actions12,13. It is the frequently occurring psychopathology14. consultant psychiatrist. Depressive symptoms were assessed
Mothers with CP child are more predisposed to to depression. using BDI-II- U21,22. Data regarding the demographic profile of
Depression and anxiety was testified in 71% mothers with CP subjects, past medical or drug history and family history, was
children, compared to 33% in the control group11. Studies showed collected on carefully designed datasheets. History about antenatal
that mothers having CP children were high risk group for visits, duration of pregnancy, mode of delivery, the delayed cry of
depression and need psychiatric help15,16,17,18. the newborn, infections in neonate and family history of CP was
This study was conducted to calculate depression in mothers also taken to rule out the cause of CP. Questionnaire regarding
taking care of children. data and depression scoring was filled by the subjects or
------------------------------------------------------------------------------------ researcher under supervision of the psychologist.
Received on 11-03-2022 All the data was entered into Microsoft Excel data sheet and
Accepted on 29-07-2022 analyzed using the SPSS 25. Mean±S.D or median±interquartile

18 P J M H S Vol. 16, No. 08, August 2022

 A. Goheir, A. Jadoon, S. S. Fayyaz et al

range was given for the quantitative variables. Frequencies and and positive correlation with GMFCS scores in the CP child.
percentages were given for qualitative variables. Graphs were Presence of CP child in a family is associated with maternal
presented for variables. Shapiro-Wilk test was applied to check the depression, musculoskeletal pain and negatively impacts the
normality of data. Mann-Whitney test was applied to compare BDI quality of life30,31. Increased psychological strain can be the
scores between the two groups. A p-value of ≤ 0.05 is taken as triggering factor for the development of depression among mothers
statistically significant. of CP children. Detailed history suggests that possible factors
causing stress in mothers included in our study could be because
RESULTS of disable child, behavioral problems or any other ailment
associated with the child, limited leisure time, improper sleep, lack
This study included 42 females divided equally into two groups. No of family support, the social or economic burden.
significant difference existed between the ages of mothers of both This study highlighted the need of psychological and social
groups (p= 0.103) help for the mother taking care of CP children and emphasized on
All the participants included in the study belonged to the the need for the provision of proper medical facilities to the mother
middle class. All had satisfactory relationship with their husband during pregnancy, during delivery and after birth.
and other people in the family. Among cases, only 2 children
reported CP in their first-degree relatives. Out of total 21 cases, CONCLUSION
13(61.9%) cases of CP reported prolonged labor and 8(38%)
children were delivered at home by a midwife (dai). Mothers taking care of CP children are more depressed as
Both groups were compared for the parameters included in compared to the mothers taking care of healthy children. Females
the study. The BDI scores for mothers taking care of children should have proper antenatal and post-natal visits to doctor for
suffering from CP were higher than in mothers taking care of evaluation and care of mother and newborn. Education of family
healthy children that was found significant (Mann Whitney U test, and society about the need for psychological help and need of
p=0.011) (Table 1). social and family support to the mother having CP child, is highly
All the mothers of CP children (group I) reported depression of recommended.
some severity, 17(80.95%) had minimal depression, 3(14.28%) Conflict of interest: Nil
had mild depression and 1(4.76%) had moderate depression.
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