- Email: [email protected]
Anxiety and depression in mothers of speech impaired children
International Journal of Pediatric Otorhinolaryngology (2003) 67, 1337—1341
Anxiety and depression in mothers of speech impaired children Michael Rudolph, Frank Rosanowski*, Ulrich Eysholdt, Peter Kummer Department of Phoniatrics and Pedaudiology, Erlangen University Hospital, Bohlenplatz 21, D - 91054 Erlangen, Germany Received 15 April 2003 ; received in revised form 13 August 2003; accepted 17 August 2003
KEYWORDS Speech development; Mothers; Anxiety; Depression; HADS
Summary Objective: In the adult population, anxiety and depression are the most frequent emotional disorders. In cases when mothers of speech impaired children are affected by these disorders may significantly influence the development of the child. The purpose of this study was to assess the prevalence of anxiety and depression in mothers of speech impaired children as literature provides only little information on this topic. Methods: Hundred mothers (age 33.4 ± 5.3 years, range: 22—47 years) of 100 preschool children (32 girls, 68 boys; age 4.2 ± 1.5 years, range 1;3—7;7 years) with a speech impairment were investigated. Children with cochlear hearing loss, syndromes or other developmental disorders were excluded from the study. To estimate the prevalence of anxiety disorders and depression in the mothers the German version of the Hospital Anxiety and Depression Scale (HADS) was used. Data from 157 healthy women from the German test manual served as controls. Microsoft® Excel and Matlab® software packages were used for description, analysis, and evaluation. The differences in prevalence rates were tested by χ2 -test and Wilcoxon’s rank sum test. Results: Assessed by the HADS-depression subscale 11% of the mothers of speech impaired children met criteria for depression compared to 2.5% in the control group. The prevalence in the study group was significantly higher (P < 1%). The prevalence of anxiety disorders did not differ from normative data on a significant level (P > 5%). Conclusions: Screening mothers of speech impaired children for depression is of significant clinical interest. For this purpose, the HADS is a suitable test. Further studies are necessary to investigate the influence of speech impairment and its development on the severity and development of mothers’ depression. Up to now, no data exist about how fathers of speech impaired children react emotionally, so this question has to be focused on in future. © 2003 Elsevier Ireland Ltd. All rights reserved.
1. Introduction
∗ Corresponding
author. Tel.: +49-9131-8533145; fax: +49-9131-8539272. E-mail address: [email protected] (F. Rosanowski).
Anxiety disorders and depression are the most frequent mental disorders in general population. Women are affected more frequently than men. Lifetime prevalence rates differ depending on how anxiety or depression are defined and assessed. In large population studies, prevalence of depression
0165-5876/$ — see front matter © 2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijporl.2003.08.042
1338 ranges from 2.6 to 12.7% in men, and 2.5 to 21% in women, respectively. In an urban population, prevalence rates for anxiety disorders of 9.1% in men and 18.1% in women were reported. Prevalence both of anxiety and depression increases with age [1—5]. Parents of children with intellectual disabilities are known to have higher child-related stress than parents of normally developing children. It was assumed that the stress of caring for a child with a profound developmental delay places mothers at risk of suffering from depression [6—8]. One kind of developmental delay with a prevalence of at least 6.5% is an impairment of speech development [9]. One reason for maternal emotional reactions on the speech impairment is the impairment itself which distinguishes the child from its peers and comprises the risk for the child to become an outsider or to develop other disorders like hyperactivity, oppositional defiant behavior and reactive emotional disturbances because of not being able to communicate properly with its social environment [10]. Other possible reasons for mothers to develop an emotional disorder are the necessary treatment of the speech disorder, which may be time-consuming and lead to neglecting other demands of daily life, the feeling of guilt or reproaches from the mothers’ environment and an uncertainty about the prognosis of the speech development. In summary, there are a lot of emotional aspects in mothers of speech impaired children, elicited by the speech impairment of their children or by possible consequences, which may influence the mothers’ emotional well-being. On the other hand, children of mothers suffering from depression were reported to be at risk for speech impairment due to the fact that their mothers tend to communicate less [11]. So speech impairment of a child may either be the reason or the consequence of a maternal emotional disorder. Although emotional disorders are frequent and may be a significant cofactor in mothers of speech impaired children literature provides only little information about the prevalence of the most frequent emotional disorders anxiety and depression in mothers of children with speech developmental disorders. So the purpose of this pilot study was to assess the prevalence of anxiety disorders and depression in mothers of speech impaired children.
2. Subjects and methods Hundred mothers (age 33.4 ± 5.3 years, range: 22—47 years) of 100 pre-school children (32 girls, 68 boys; age 4.2 ± 1.5 years, range 1;3—7;7 years)
M. Rudolph et al. with a speech impairment were investigated. Mothers presented their children in the outpatient department either for the first time (n = 50) or for a follow-up (n = 50). Both subgroups did not differ on a significant level, neither with respect to age distribution of the mothers nor with respect to age distribution and gender of the children. Children with cochlear hearing loss, syndromes or other developmental disturbances were excluded from the study. To estimate the prevalence of anxiety disorders and depression in the mothers, the German version of the Hospital Anxiety and Depression Scale (HADS) was used [3]. The HADS had originally been developed to screen for anxiety and depressive disorders (subscales HADS-D/A and HADS-D/D) particularly in somatically ill patients and was validated in the general population [12]. Each subscale consists of seven items scored from 0 to 3 so that values from 0 to 21 can be achieved for each subscale. The items are based on the criteria for the diagnosis of an anxiety disorder or a depression as defined in the DSM-III-R [12]. For the anxiety scale scores from 0 to 7 are defined as ‘‘non-case’’, scores from 8 to 10 as ‘‘borderline case’’ and scores higher than 11 as ‘‘definite case’’ [12]. The original version provides the same scores for the depression scale. However, some studies recommend lower scores than 11 in order to better screen for depression [3]. For the German HADS version, a cutoff score, i.e. the score which identifies definite cases of depression, higher than 9 is reported to match appropriate values of sensitivity and specificity for screening purposes: cutoff-scores of 11 for anxiety scale and 9 for depression scale provide a sensitivity of 83.3% and specificity of 61.5% [3]. For comparison normative data from 157 healthy women, depicted as control group in the German test manual, were used [3]. Microsoft® Excel and Matlab® software packages were used for description, analysis, and evaluation. The differences in prevalence rates were tested by χ2 -test and Wilcoxon’s rank sum test.
3. Results Eleven percent of the mothers of speech impaired children met criteria for depression, as assessed by the HADS-D with a D-value ≥9 (Fig. 1) compared to 2.5% in the control group [3]. The prevalence of ‘‘definite cases’’ in the study group was significantly higher (χ2 = 7.94, P < 1%). In the anxiety scale, 11% of the mothers of speech impaired children met criteria for a ‘‘definite case’’ with an A-value ≥11 (Fig. 2) compared to 9.6% in the
Anxiety and depression in mothers of speech impaired children
1339
16 14 12 10 n 8 6 4 2 0 0
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 score
Fig. 1 Hospital Anxiety and Depression Scale–—German version, depression subscale: The figure shows the total number of mothers of speech impaired children for every single score in the depression scale. For screening purposes scores from 0 to 8 are defined as ‘‘non-case’’ (䊏), scores ≥9 are defined as ‘‘definite case’’ ( ) of depression. The prevalence of ‘‘definite cases’’ in the study group was significantly higher (χ2 = 7.94, P < 1%) than in the control group [3].
12
10
8
n 6
4
2
0 0
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 score
Fig. 2 Hospital Anxiety and Depression Scale–—German version, anxiety subscale: The figure shows the total number of mothers of speech impaired children for every single score in the anxiety scale. For screening purposes scores from 0 to 7 are defined as ‘‘non-case’’ (䊏), scores from 8 to 10 as ‘‘borderline case’’ (䊐), and scores ≥11 as ‘‘definite case’’ ( ) of anxiety disorder. Both the prevalence of ‘‘borderline cases’’ and the prevalence of ‘‘definite cases’’ did not differ from normative data of the control group [3] on a significant level (P > 5%).
1340 control group [3]. ‘‘Borderline cases’’, i.e. scores of anxiety scale from 8 to 10, were found in 23% of the mothers. In the control group, 20.3% were within the range of ‘‘borderline cases’’ [3]. The prevalence of a suspected anxiety disorder did not differ from normative data on a significant level (P > 5%). Results of mothers presenting their children for the first time and mothers who came for a follow-up did not differ on a significant level, neither with respect to anxiety nor to depression.
4. Discussion Anxiety disorders and depression are the most frequent mental disorders in western societies [3]. Prevalence rates increase with age [4,5]. In case of depression, a linear relation between age and prevalence was reported even to prevail when controlled for multiple variables and factors that eventually explained this relation, like somatic symptoms or impairment [5]. Speech impairment of children may influence the emotional well-being of their mothers on the one hand, and on the other hand, a maternal anxiety disorder or depression may negatively effect the speech development of their children [11]. Literature provides only little information about the coincidence of emotional disorders in mothers and a speech development disorder of their children. So, this study examined the prevalence rates of anxiety disorders and depression in a sample of 100 mothers of 100 speech impaired children. Mothers, whose children were already attending school at the time of investigation, were excluded from the study in order to rule out an influence on the results by other factors than the speech impairment itself. For this reason, mothers of children with cochlear hearing loss and complex or syndromatic developmental disturbances were excluded as well. They have extensively been reported in literature with respect to emotional disorders [13,14]. As the children usually were accompanied by their mothers only their fathers did not take part in this pilot study. However, coping with an impaired child differs between mothers and fathers. Usually mothers take on a larger part of the extra care and practical work the disabled child requires [15,16]. Sometimes, they even have to give up their job and feel unable to pursue their own interests, although this may be counterproductive as employment of the mother may reduce the stress elicited by having a disabled child and helps mothers to focus less on their children [17,18]. Self-realization and a partnership providing emotional support were reported
M. Rudolph et al. to be helpful to cope with the stress of caring for a disabled child [19]. On the other hand, several studies reported fathers of disabled children to have even lower depression scores than mothers [20—22]. So, the mothers’ self-competence may be more related to the parenting role, and therefore, mothers may be more vulnerable when stress and difficulties arise in the parenting domain. However, future studies should focus on emotional aspects in fathers of speech impaired children. The German version of the Hospital Anxiety and Depression Scale (HADS-D) was used to estimate the prevalence rates of anxiety disorders and depression in mothers of speech impaired children. The HADS proved to be suitable for screening purposes, especially in somatically ill persons and generally in persons not being referred because of an emotional disorder in the first place [12]. The HADS-D provides good psychometric qualities with a sensitivity of 83.3% and a specificity of 61.5% [3]. In the present study, the prevalence of a suspected anxiety disorder did not differ from normative data on a significant level. Although mothers worry about their children’s future and acceptation in its social environment, these maternal emotions do not seem to comprise the risk of suffering from an anxiety disorder at least when regarding the entire test group. Obviously, uncertainty about the speech development and its possible consequences does not necessarily result in an increased prevalence of anxiety disorders. The prevalence of depression in mothers of speech impaired children was significantly higher compared to the control group. According to cognitive theories of depression, stressors play an important role both in the onset and the course of depressive disorders [2]. Faced with difficult and stressful life events, most of the affected individuals do not develop a depressive disorder. The impact of a stressful event depends on the meaning the individual attaches to this event. However, in cases when a life-event or stressor threatens or intrudes upon personal issues or concerns that are central to the individual’s self-perception, a depressive order may be elicited [22]. Yet it is widely held that protective factors may be equally important for the way an individual reacts on adverse life events [19]. So, speech impairment of a child may be the reason or the consequence of a maternal emotional disorder. Effects of living with and being socialized by a mother with a depressive disorder were described: Like their depressive mothers, children spoke less than those of healthy mothers and structured investigations proved less speech productivity, vocabulary size and grammatical complexity [11]. For
Anxiety and depression in mothers of speech impaired children therapeutic purposes, it is of minor importance whether the depression of the mother was the reason or the consequence of the speech impairment of her child: A mother positively screened for depression should be examined and receive therapy by a specialist. In this study, the mothers were younger than the women of the control group taken from the test manual. So, as prevalence of depression increases with age it can even be assumed that depression in mothers of speech impaired children is an even more important aspect in this group [5].
5. Conclusions The prevalence of depression in mothers of speech impaired children is significantly higher compared to a control group. Screening mothers of speech impaired children for emotional disorders seems to be of significant clinical interest. For screening purpose, the HADS (-D) is a suitable test. Further studies are necessary to investigate the influence of speech impairment and its development on the severity and development of mothers’ depression. Up to now, no data exist about how fathers of speech impaired children react emotionally, so this question has to be focused on in future.
References [1] H.U. Wittchen, C.A. Essau, D. von Zerssen, J.C. Krieg, M. Zaudig, Lifetime and six-month prevalence of mental disorders in the Munich follow-up study, Eur. Arch. Psychiatry. Clin. Neurosci. 241 (1992) 247—258. [2] D. Clarke, A. Beck, Scientific Foundations of Cognitive Theory and Therapy of Depression, first ed., Wiley, Chichester, UK, 1999. [3] C. Herrmann, U. Buss, HADS-D: Hospital Anxiety and Depression Scale–—Deutsche Version, Verlag Huber, Bern, 1995. [4] H.U. Wittchen, Generalized anxiety disorder: prevalence, burden, and cost to society, Depress. Anxiety 16 (2002) 162—171. [5] E. Stordal, A. Mykletun, A.A. Dahl, The association between age and depression in the general population: a multivariate examination, Acta Psychiatrica Scandinavica 107 (2003) 132—141.
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[6] P. Hoare, M. Harris, P. Jackson, S. Kerley, A community survey of children with severe intellectual disability and their families: psychological adjustment, J. Intellectual Disabil. Res. 42 (1998) 218—227. [7] J. Reddon, L. McDonald, G. Kysela, Parenting coping and family stress. I. Resources for and functioning of families with a preschool child having a developmental disability, Early Child Dev. Care 83 (1992) 1—26. [8] M.E. Warfield, M. Krauss, P. Hauser-Cram, C. Upshur, J. Shonkoff, Adaptation during early childhood among mothers of children with disabilities, J. Dev. Behav. Pediatr. 43 (1999) 112—118. [9] C.A. Boyle, P. Decoufle, M. Yeargin-Allsopp, Prevalence and health impact of developmental disabilities in US children, Pediatrics 93 (1994) 399—403. [10] W. Suchodoletz, T. Keiner, Psychiatric aspects in children with speech disorders, Pädiatrische Praxis 54 (1998) 395— 402. [11] Z. Breznitz, T. Sherman, Speech patterning of natural discourse of well and depressed mothers and their young children, Child Dev. 58 (1987) 395—400. [12] A.S. Zigmond, R.P. Snaith, The Hospital Anxiety and Depression Scale, Acta Psychiatrica Scandinavica 67 (1983) 361—370. [13] U. Horsch, C. Weber, B. Bertram, P. Detrois, Stress experienced by parents of children with cochlear implants compared with parents of deaf children and hearing children, Am. J. Otol. 18 (1997) S161—S163. [14] B. Ryde-Brandt, Mothers of primary school children with Down’s syndrome, Acta Psychiatrica Scandinavica 78 (1988) 102—108. [15] M. Bristol, J. Gallagher, E. Schopler, Mothers and fathers of young developmentally disabled and nondisabled boys: adaptation and spousal support, Dev. Psychol. 24 (1988) 441—451. [16] D. Moes, R. Koegle, L. Schreibman, L. Loos, Stress profiles for mothers and fathers with autism, Psychol. Rep. 71 (1992) 1272—1274. [17] N. Breslau, K.S. Staruch, E.A. Mortimer, Psychological distress in mothers of disabled children, Am. J. Dis. Child. 136 (1982) 682—686. [18] J. McLennan, G.W. Bates, Vulnerability to psychological distress: empirical and conceptual distinctions between measures of neuroticism and negative affect, Psychol. Rep. 73 (1993) 1315—1323. [19] M. Krause, Petermann F. SOEBEK. Göttingen, Bern, Toronto, Seattle: Hogrefe-Verlag für Psychologie, 1997. [20] D. Gray, W. Holden, Psychosocial well-being among the parents of children with autism, Aust. N. Z. J. Dev. Dis. 18 (1992) 83—93. [21] M. Veisson, Depression symptoms and emotional states in parents of disabled and non-disabled children, Soc. Behav. Personal. 27 (1999) 87—98. [22] M.B. Olsson, C.P. Hwang, Depression in mothers and fathers of children with intellectual disability, J. Intellectual Disab. Res. 45 (2001) 535—543.
Anxiety and depression in mothers of speech impaired children Michael Rudolph, Frank Rosanowski*, Ulrich Eysholdt, Peter Kummer Department of Phoniatrics and Pedaudiology, Erlangen University Hospital, Bohlenplatz 21, D - 91054 Erlangen, Germany Received 15 April 2003 ; received in revised form 13 August 2003; accepted 17 August 2003
KEYWORDS Speech development; Mothers; Anxiety; Depression; HADS
Summary Objective: In the adult population, anxiety and depression are the most frequent emotional disorders. In cases when mothers of speech impaired children are affected by these disorders may significantly influence the development of the child. The purpose of this study was to assess the prevalence of anxiety and depression in mothers of speech impaired children as literature provides only little information on this topic. Methods: Hundred mothers (age 33.4 ± 5.3 years, range: 22—47 years) of 100 preschool children (32 girls, 68 boys; age 4.2 ± 1.5 years, range 1;3—7;7 years) with a speech impairment were investigated. Children with cochlear hearing loss, syndromes or other developmental disorders were excluded from the study. To estimate the prevalence of anxiety disorders and depression in the mothers the German version of the Hospital Anxiety and Depression Scale (HADS) was used. Data from 157 healthy women from the German test manual served as controls. Microsoft® Excel and Matlab® software packages were used for description, analysis, and evaluation. The differences in prevalence rates were tested by χ2 -test and Wilcoxon’s rank sum test. Results: Assessed by the HADS-depression subscale 11% of the mothers of speech impaired children met criteria for depression compared to 2.5% in the control group. The prevalence in the study group was significantly higher (P < 1%). The prevalence of anxiety disorders did not differ from normative data on a significant level (P > 5%). Conclusions: Screening mothers of speech impaired children for depression is of significant clinical interest. For this purpose, the HADS is a suitable test. Further studies are necessary to investigate the influence of speech impairment and its development on the severity and development of mothers’ depression. Up to now, no data exist about how fathers of speech impaired children react emotionally, so this question has to be focused on in future. © 2003 Elsevier Ireland Ltd. All rights reserved.
1. Introduction
∗ Corresponding
author. Tel.: +49-9131-8533145; fax: +49-9131-8539272. E-mail address: [email protected] (F. Rosanowski).
Anxiety disorders and depression are the most frequent mental disorders in general population. Women are affected more frequently than men. Lifetime prevalence rates differ depending on how anxiety or depression are defined and assessed. In large population studies, prevalence of depression
0165-5876/$ — see front matter © 2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijporl.2003.08.042
1338 ranges from 2.6 to 12.7% in men, and 2.5 to 21% in women, respectively. In an urban population, prevalence rates for anxiety disorders of 9.1% in men and 18.1% in women were reported. Prevalence both of anxiety and depression increases with age [1—5]. Parents of children with intellectual disabilities are known to have higher child-related stress than parents of normally developing children. It was assumed that the stress of caring for a child with a profound developmental delay places mothers at risk of suffering from depression [6—8]. One kind of developmental delay with a prevalence of at least 6.5% is an impairment of speech development [9]. One reason for maternal emotional reactions on the speech impairment is the impairment itself which distinguishes the child from its peers and comprises the risk for the child to become an outsider or to develop other disorders like hyperactivity, oppositional defiant behavior and reactive emotional disturbances because of not being able to communicate properly with its social environment [10]. Other possible reasons for mothers to develop an emotional disorder are the necessary treatment of the speech disorder, which may be time-consuming and lead to neglecting other demands of daily life, the feeling of guilt or reproaches from the mothers’ environment and an uncertainty about the prognosis of the speech development. In summary, there are a lot of emotional aspects in mothers of speech impaired children, elicited by the speech impairment of their children or by possible consequences, which may influence the mothers’ emotional well-being. On the other hand, children of mothers suffering from depression were reported to be at risk for speech impairment due to the fact that their mothers tend to communicate less [11]. So speech impairment of a child may either be the reason or the consequence of a maternal emotional disorder. Although emotional disorders are frequent and may be a significant cofactor in mothers of speech impaired children literature provides only little information about the prevalence of the most frequent emotional disorders anxiety and depression in mothers of children with speech developmental disorders. So the purpose of this pilot study was to assess the prevalence of anxiety disorders and depression in mothers of speech impaired children.
2. Subjects and methods Hundred mothers (age 33.4 ± 5.3 years, range: 22—47 years) of 100 pre-school children (32 girls, 68 boys; age 4.2 ± 1.5 years, range 1;3—7;7 years)
M. Rudolph et al. with a speech impairment were investigated. Mothers presented their children in the outpatient department either for the first time (n = 50) or for a follow-up (n = 50). Both subgroups did not differ on a significant level, neither with respect to age distribution of the mothers nor with respect to age distribution and gender of the children. Children with cochlear hearing loss, syndromes or other developmental disturbances were excluded from the study. To estimate the prevalence of anxiety disorders and depression in the mothers, the German version of the Hospital Anxiety and Depression Scale (HADS) was used [3]. The HADS had originally been developed to screen for anxiety and depressive disorders (subscales HADS-D/A and HADS-D/D) particularly in somatically ill patients and was validated in the general population [12]. Each subscale consists of seven items scored from 0 to 3 so that values from 0 to 21 can be achieved for each subscale. The items are based on the criteria for the diagnosis of an anxiety disorder or a depression as defined in the DSM-III-R [12]. For the anxiety scale scores from 0 to 7 are defined as ‘‘non-case’’, scores from 8 to 10 as ‘‘borderline case’’ and scores higher than 11 as ‘‘definite case’’ [12]. The original version provides the same scores for the depression scale. However, some studies recommend lower scores than 11 in order to better screen for depression [3]. For the German HADS version, a cutoff score, i.e. the score which identifies definite cases of depression, higher than 9 is reported to match appropriate values of sensitivity and specificity for screening purposes: cutoff-scores of 11 for anxiety scale and 9 for depression scale provide a sensitivity of 83.3% and specificity of 61.5% [3]. For comparison normative data from 157 healthy women, depicted as control group in the German test manual, were used [3]. Microsoft® Excel and Matlab® software packages were used for description, analysis, and evaluation. The differences in prevalence rates were tested by χ2 -test and Wilcoxon’s rank sum test.
3. Results Eleven percent of the mothers of speech impaired children met criteria for depression, as assessed by the HADS-D with a D-value ≥9 (Fig. 1) compared to 2.5% in the control group [3]. The prevalence of ‘‘definite cases’’ in the study group was significantly higher (χ2 = 7.94, P < 1%). In the anxiety scale, 11% of the mothers of speech impaired children met criteria for a ‘‘definite case’’ with an A-value ≥11 (Fig. 2) compared to 9.6% in the
Anxiety and depression in mothers of speech impaired children
1339
16 14 12 10 n 8 6 4 2 0 0
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 score
Fig. 1 Hospital Anxiety and Depression Scale–—German version, depression subscale: The figure shows the total number of mothers of speech impaired children for every single score in the depression scale. For screening purposes scores from 0 to 8 are defined as ‘‘non-case’’ (䊏), scores ≥9 are defined as ‘‘definite case’’ ( ) of depression. The prevalence of ‘‘definite cases’’ in the study group was significantly higher (χ2 = 7.94, P < 1%) than in the control group [3].
12
10
8
n 6
4
2
0 0
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 score
Fig. 2 Hospital Anxiety and Depression Scale–—German version, anxiety subscale: The figure shows the total number of mothers of speech impaired children for every single score in the anxiety scale. For screening purposes scores from 0 to 7 are defined as ‘‘non-case’’ (䊏), scores from 8 to 10 as ‘‘borderline case’’ (䊐), and scores ≥11 as ‘‘definite case’’ ( ) of anxiety disorder. Both the prevalence of ‘‘borderline cases’’ and the prevalence of ‘‘definite cases’’ did not differ from normative data of the control group [3] on a significant level (P > 5%).
1340 control group [3]. ‘‘Borderline cases’’, i.e. scores of anxiety scale from 8 to 10, were found in 23% of the mothers. In the control group, 20.3% were within the range of ‘‘borderline cases’’ [3]. The prevalence of a suspected anxiety disorder did not differ from normative data on a significant level (P > 5%). Results of mothers presenting their children for the first time and mothers who came for a follow-up did not differ on a significant level, neither with respect to anxiety nor to depression.
4. Discussion Anxiety disorders and depression are the most frequent mental disorders in western societies [3]. Prevalence rates increase with age [4,5]. In case of depression, a linear relation between age and prevalence was reported even to prevail when controlled for multiple variables and factors that eventually explained this relation, like somatic symptoms or impairment [5]. Speech impairment of children may influence the emotional well-being of their mothers on the one hand, and on the other hand, a maternal anxiety disorder or depression may negatively effect the speech development of their children [11]. Literature provides only little information about the coincidence of emotional disorders in mothers and a speech development disorder of their children. So, this study examined the prevalence rates of anxiety disorders and depression in a sample of 100 mothers of 100 speech impaired children. Mothers, whose children were already attending school at the time of investigation, were excluded from the study in order to rule out an influence on the results by other factors than the speech impairment itself. For this reason, mothers of children with cochlear hearing loss and complex or syndromatic developmental disturbances were excluded as well. They have extensively been reported in literature with respect to emotional disorders [13,14]. As the children usually were accompanied by their mothers only their fathers did not take part in this pilot study. However, coping with an impaired child differs between mothers and fathers. Usually mothers take on a larger part of the extra care and practical work the disabled child requires [15,16]. Sometimes, they even have to give up their job and feel unable to pursue their own interests, although this may be counterproductive as employment of the mother may reduce the stress elicited by having a disabled child and helps mothers to focus less on their children [17,18]. Self-realization and a partnership providing emotional support were reported
M. Rudolph et al. to be helpful to cope with the stress of caring for a disabled child [19]. On the other hand, several studies reported fathers of disabled children to have even lower depression scores than mothers [20—22]. So, the mothers’ self-competence may be more related to the parenting role, and therefore, mothers may be more vulnerable when stress and difficulties arise in the parenting domain. However, future studies should focus on emotional aspects in fathers of speech impaired children. The German version of the Hospital Anxiety and Depression Scale (HADS-D) was used to estimate the prevalence rates of anxiety disorders and depression in mothers of speech impaired children. The HADS proved to be suitable for screening purposes, especially in somatically ill persons and generally in persons not being referred because of an emotional disorder in the first place [12]. The HADS-D provides good psychometric qualities with a sensitivity of 83.3% and a specificity of 61.5% [3]. In the present study, the prevalence of a suspected anxiety disorder did not differ from normative data on a significant level. Although mothers worry about their children’s future and acceptation in its social environment, these maternal emotions do not seem to comprise the risk of suffering from an anxiety disorder at least when regarding the entire test group. Obviously, uncertainty about the speech development and its possible consequences does not necessarily result in an increased prevalence of anxiety disorders. The prevalence of depression in mothers of speech impaired children was significantly higher compared to the control group. According to cognitive theories of depression, stressors play an important role both in the onset and the course of depressive disorders [2]. Faced with difficult and stressful life events, most of the affected individuals do not develop a depressive disorder. The impact of a stressful event depends on the meaning the individual attaches to this event. However, in cases when a life-event or stressor threatens or intrudes upon personal issues or concerns that are central to the individual’s self-perception, a depressive order may be elicited [22]. Yet it is widely held that protective factors may be equally important for the way an individual reacts on adverse life events [19]. So, speech impairment of a child may be the reason or the consequence of a maternal emotional disorder. Effects of living with and being socialized by a mother with a depressive disorder were described: Like their depressive mothers, children spoke less than those of healthy mothers and structured investigations proved less speech productivity, vocabulary size and grammatical complexity [11]. For
Anxiety and depression in mothers of speech impaired children therapeutic purposes, it is of minor importance whether the depression of the mother was the reason or the consequence of the speech impairment of her child: A mother positively screened for depression should be examined and receive therapy by a specialist. In this study, the mothers were younger than the women of the control group taken from the test manual. So, as prevalence of depression increases with age it can even be assumed that depression in mothers of speech impaired children is an even more important aspect in this group [5].
5. Conclusions The prevalence of depression in mothers of speech impaired children is significantly higher compared to a control group. Screening mothers of speech impaired children for emotional disorders seems to be of significant clinical interest. For screening purpose, the HADS (-D) is a suitable test. Further studies are necessary to investigate the influence of speech impairment and its development on the severity and development of mothers’ depression. Up to now, no data exist about how fathers of speech impaired children react emotionally, so this question has to be focused on in future.
References [1] H.U. Wittchen, C.A. Essau, D. von Zerssen, J.C. Krieg, M. Zaudig, Lifetime and six-month prevalence of mental disorders in the Munich follow-up study, Eur. Arch. Psychiatry. Clin. Neurosci. 241 (1992) 247—258. [2] D. Clarke, A. Beck, Scientific Foundations of Cognitive Theory and Therapy of Depression, first ed., Wiley, Chichester, UK, 1999. [3] C. Herrmann, U. Buss, HADS-D: Hospital Anxiety and Depression Scale–—Deutsche Version, Verlag Huber, Bern, 1995. [4] H.U. Wittchen, Generalized anxiety disorder: prevalence, burden, and cost to society, Depress. Anxiety 16 (2002) 162—171. [5] E. Stordal, A. Mykletun, A.A. Dahl, The association between age and depression in the general population: a multivariate examination, Acta Psychiatrica Scandinavica 107 (2003) 132—141.
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