Psychiatric Morbidity among a Sample of Orphanage Children in Cairo

Prevalence of attention-deficit hyperactivity disorder in children, adolescents and adults in the Middle East and North Africa region: a systematic review and meta-analysis

OBJECTIVES

To systematically estimate the overall prevalence of attention-deficit hyperactivity disorder (ADHD) in children, adolescents and adults across the Middle East and North Africa (MENA) region.

DESIGN

Systematic review and meta-analysis conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement.

DATA SOURCES

Medline and Scopus databases were comprehensively and systematically searched between 1990 and February 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included all cross-sectional or cohort studies that diagnosed ADHD using validated diagnostic tools (eg, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, ADHD rating scales and ADHD diagnostic interview) or non-validated tools (eg, brain imaging techniques, computerised cognitive tests and quantitative electroencephalography).

DATA EXTRACTION AND SYNTHESIS

Two reviewers performed the data extraction independently using standardised data collection sheet. Newcastle-Ottawa Scale was used to assess the quality of the included studies. Individualised and pooled event rate and upper and lower limit at 95% CI were calculated according to the ADHD cases and the total sample size using a random-effect model. The subgroup prevalence analyses according to ADHD subtypes, gender, MENA country and age were also performed.

RESULTS

A total of 63 articles met the inclusion criteria involving 849 902 participants. The overall prevalence of ADHD was 10.3% (95% CI 0.081 to 0.129). The prevalence rate ranged from 1.3% (Yemen) to 22.2% (Iran). Subgroup analyses showed that the prevalence in adults was 13.5 and 10.1 in children and adolescents. Males exhibited significantly higher prevalence compared with females as these were 11.1% and 7%, respectively. Attention-deficit subtype was significantly the most prevalent (46.7%) compared with hyperactivity/impulsivity (33.7%) and combined types (20.6%).

CONCLUSION

The overall prevalence of ADHD was high in the MENA region. It is crucial to allocate more attention and resources towards the prevention and treatment of ADHD in children, adolescents and adults within the region.

Intervention Model for Orphan’s Emotional and Behavioral Problems: A Scoping Review

BACKGROUND: As many as, 45% of orphaned children and adolescents living in orphanages experience behavioral and emotional problems. Several literature reviews on the intervention of emotional and behavioral problems in orphan children and adolescents have been widely conducted. However, there is paucity in the reviews of emotional and behavioral problem interventions in the orphan group based on the type of group approach used in published articles. AIM: This study aimed to synthesize the results on the interventions of emotional and behavioral problems in orphan children and adolescents aged 7–20 years who live in institutions or orphanages. METHODS: This research was a scoping review. This review used three databases comprising PubMed, Science Direct, and Wiley Library Online. The inclusion criteria were experimental research designs and cohort studies, published in the 2009–2019, discussed emotional and behavioral problem’s intervention in orphan, and written in English. The exclusion criteria were that the research subjects had severe mental and psychosocial disorders such as autism, mental retardation, and mental disorders. The authors used three categories of keywords; the first keyword and its synonym were “intervention, treatment.” The second keyword focused on behavioral problems, which was “behavioral difficulties,” and the third keyword focuses on population and place, “orphan, institutions orphans, orphanages.” The article selection stage is described in detail in the flow diagram of Preferred Reporting Items for Systematic Reviews and Meta-Analysis. The critical appraisal stage used the checklist from Joanna Briggs Institute. RESULTS: Ten articles were found and selected for review. The main emotional and behavioral problems experienced by orphan children and adolescents include depression, anxiety, and low self-esteem, feelings of anger, and trauma. Other problems related, functional disorders, life satisfaction, the probability of suicide, and early (prodromal) symptoms of psychosis, also arise. There were six types of interventions given to overcome emotional and behavioral problems in orphan children and adolescents, but the interventions that are most often given are cognitive therapy, educational support, complementary, and alternative medicine. The approaches in groups that are often used in this review are the support group and the teaching-learning group. The combination of two or more approaches in one intervention can increase the success or effectiveness in overcoming emotional and behavioral problems. CONCLUSIONS: Depression, anxiety, low self-esteem, feeling anger, and trauma are main problems for orphans. To address these emotional and behavior problems, it is necessary to combine several interventions and a combination of group-based approaches.

Formation and disruption of bonds between caregivers and institutionalized children

OBJECTIVE

to understand the perspective of caregivers about the formation and disruption of bonds with institutionalized children.

METHOD

a qualitative research that used as a theoretical framework the Attachment Theory and the Symbolic Interactionism, and the Grounded Theory as methodological framework. Participating in the study were 15 female caregivers of children aged zero to three years, from a child care institution in the south of Brazil, from April to July 2015.

RESULTS

three categories were elaborated: "Experiencing the formation of bond and attachment"; "Disrupting with the established bonds and detaching"; "Learning how to work with formation and disruption of bond".

FINAL CONSIDERATIONS

we need to think of ways to minimize the negative effects formation and disruption of bonds. In this sense, active listening and the offer of psychological support favor the sharing of experiences and the emotional strengthening of the female caregivers.

Prevalence of Depression and Its Associated Factors among Orphan Children in Orphanages in Ilu Abba Bor Zone, South West Ethiopia

Introduction

Orphans are the special group of children who are generally deprived and prone to develop psychiatric disorders even those reared in well-run institutions. These children and adolescents living as orphans or in stigmatized environments are vulnerable because of the loss of parent figures. The HIV/AIDS epidemic has contributed to a drastic increase in the number of orphans and vulnerable children and other causes in sub-Saharan Africa. However, little is known about the prevalence of depression and associated factors among orphanage children in areas such as Ethiopia.

Objective

The aim of this study was to assess the prevalence of depression and its associated factors among orphans in Ilu Abba Bor Zone orphanages, 2016.

Methods

An institutional based cross-sectional study was conducted among orphan children in orphanages at Mettu and Gore. A total of 220 orphans were included from the two orphanages and make the response rate of 98.2%. Pretested semistructured questionnaire was used for interviewing the study participants. The collected data were coded, entered into EPI-INFO 7.0. Software, and exported to SPSS version 20 for statistical analysis. The strength of association between variables was assessed using crude and Adjusted Odds Ratio by running logistic regression and the cut-off point for declaring statistical significance was P- value <0.05 or 95% confidence interval which does not contain the null value.

Results

A total of 216 orphan children were interviewed with response rate of 98.2%. The overall prevalence of depression was 24.1%. The mean age of participants was 14.2 years ± 9.90 SDs and range from 11 to 17 years. Sex [Adjusted Odds Ratio = 3.29, 95% CI (1.41, 7.46)]; age [Adjusted Odds Ratio=2.09,95% CI (3.7; 5.01)]; duration of stay in foster care [Adjusted Odds Ratio= 2.08 (1.01; 8.33)]; previous physical abuse [Adjusted Odds Ratio= 3.1 (2.1; 5.06)]; having medical illness [Adjusted Odds Ratio=1.94,95% CI (2.01;3.56)]; orphan status [Adjusted Odds Ratio=2.5,95% CI (1.62; 3.56)]; and suicidal tendency [Adjusted Odds Ratio= 4.8 (3.41; 9.03)] were independent predictors of depression among orphans in orphanages.

Conclusion and Recommendations

Prevalence of depression was high among orphans and this finding suggests that screening for depression and mental and psychological care should be integrated into routine health care provided to orphans and that there is a further need to establish preventive measures against depression.

A Descriptive Study on Behavioral and Emotional Problems in Orphans and Other Vulnerable Children Staying in Institutional Homes

INTRODUCTION

Orphans and the other vulnerable children and adolescents (OVCA) living in institutional homes are more prone to behavioral and emotional problems than others as they are deprived of a family's love and care. There is a dearth of studies focusing on the psychological health of these children in India. Hence, we have conducted a cross-sectional descriptive study to explore the behavioral and emotional problems in these institutionalized children.

MATERIALS AND METHODS

The sample consisted of 292 orphans and OVCA in institutional homes of Visakhapatnam city. The sociodemographic data were collected using a semi-structured questionnaire. The Strengths and Difficulties Questionnaire (SDQ) with impact supplement was used to assess the behavioral and emotional problems in them.

RESULTS

In our study, 49 (16.78%) out of 292 children and adolescents were found to be having behavioral and emotional problems. Factors such as age, sex, reason for being in the institute, age of admission, and years of stay in the home were all seen to be significantly associated (P < 0.05) with emotional and behavioral problems. Conduct problems (34.90%) were found to be most prevalent followed by peer problems (15.80%), emotional problems (14.70%), hyperactivity (8.60%), and low prosocial behavior (3.40%).

CONCLUSION

The present study shows that the orphans and OVCA in institutional homes are vulnerable to behavioral and emotional problems. The screening for conduct problems, emotional problems, hyperactivity, and peer problems needs to be done at a regular basis for these children. Given the paucity of data in this regard, several multicenter studies also need to be done to get an overall comprehensive view of these problems.

Epidemiological patterns and correlates of mental disorders among orphans and vulnerable children under institutional care

PURPOSE

The objective of the study was to estimate the prevalence, comorbidity and socio-demographic correlates of common mental disorders among orphan and vulnerable children (OVCs) in residential care.

METHODS

The Youth Self Report (YSR) instrument was adapted for use and administered to 630 OVCs aged 10-18 years in four institutions operating within the Eastern province of Kenya. We estimated the prevalence of YSR syndromes and used logistic regression analyses to examine socio-demographic factors associated with each disorder.

RESULTS

The prevalence of any mental disorder according to YSR syndrome scale was 30.8% (95% CI 27.1-34.6). Female gender and older children were less likely to be associated with risk of scoring in the clinical range of the mental disorders. The presence of multiple mental problems was seen among 16.7% of the children. Of the 16.7%, 5.6% had one comorbid mental disorder and 11.1% had three to eight mental disorders.

CONCLUSION

We found a high prevalence of mental disorders and co-occurring disorders among the OVCs in residential institutions in Kenya. There is need for an alternative approach that can reach out to critical numbers of children for screening and public health, rather than purely clinical approach. The capacity for these institutions should also be regulated and more efforts focusing on improving the quality of care in the facilities taken into account at all times.

Improving care quality and preventing maltreatment in institutional care - a feasibility study with caregivers

Institutionalized children in low-income countries often face maltreatment and inadequate caregiving. In addition to prior traumatization and other childhood adversities in the family of origin, abuse and neglect in institutional care are linked to various mental health problems. By providing a manualized training workshop for caregivers, we aimed at improving care quality and preventing maltreatment in institutional care. In Study 1, 29 participating caregivers rated feasibility and efficacy of the training immediately before, directly after, and 3 months following the training workshop. The results showed high demand, good feasibility, high motivation, and acceptance of caregivers. They reported improvements in caregiver–child relationships, as well as in the children’s behavior. Study 2 assessed exposure to maltreatment and the mental health of 28 orphans living in one institution in which all caregivers had been trained. The children were interviewed 20 months before, 1 month before, and 3 months after the training. Children reported a decrease in physical maltreatment and assessments showed a decrease in mental health problems. Our approach seems feasible under challenging circumstances and provides first hints for its efficacy. These promising findings call for further studies testing the efficacy and sustainability of this maltreatment prevention approach.

Systematic review of the epidemiology of attention deficit hyperactivity disorder in Arab countries

Objective:

To assess the epidemiology of attention deficit hyperactivity disorder (ADHD) in Arab countries, and identify gaps for future research.

Methods:

We searched PubMed from July 1978 to July 2014 and reviewed local journals with cross-referencing. The keywords we used were ADHD, diagnosis, prevalence, incidence, factor, diagnosis, rate, risk, and each of the names of the 22 Arab countries (Jordan, Egypt, Lebanon, Saudi Arabia, and so on). Studies were eligible for inclusion if they investigated the epidemiology of ADHD in any Arab country, and were published in English. The search was conducted from 2nd to 5th August 2014 in King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

Results:

A total of 22 articles were included in the review. Twenty studies were cross-sectional and found the prevalence of ADHD ranged between 1.3-16%, prevalence of hyperactive type ADHD between 1.4-7.8%, and the prevalence of inattention type between 2.1-2.7%. Only 2 case-control studies investigated potential risk factors. Evidence extracted from these studies shows a significant association between ADHD and male gender, previous psychiatric illness in the family, vitamin D deficiency, poor school performance, sleep problems, and nocturnal enuresis.

Conclusion:

The prevalence of ADHD in Arab countries is comparable to reports in North America, Africa, and other countries of the Middle East. Longitudinal studies are needed to investigate the prognosis and determinants of this condition in the Arab world.