Self-Esteem, Coping Styles, and Quality of Life in Polish Adolescents and Young Adults with Unilateral Cleft Lip and Palate

Impact of Orofacial Clefts on Oral Health Quality of Life: A Cross-sectional Survey Study in Saudi Arabia

AIM

To evaluate the effect of facial clefts on the dental health quality of life of affected individuals, and to determine whether age and gender affect the oral health quality of life differently.

MATERIALS AND METHODS

The cross-sectional survey included 50 participants (32 females and 18 males) from the northern region of Saudi Arabia, using a reliable and validated questionnaire, the Child Oral Health Impact Profile (COHIP), which measured self-reported oral health-related quality of life (OHRQoL) in children and adults using a five-point Likert scale. Statistical analysis was performed, and results were considered significant if the p-value was less than 0.05.

RESULTS

The highest scores in the oral health domain were related to bad breath and reluctance in speaking or reading aloud in class within the school environment domain, with mean scores of 3.44 ± 1.3 and 3.52 ± 1.2, respectively. Most patients showed apprehension regarding necessary dental treatments (mean = 1.44 ± 0.07). The study found a non-statistically significant difference in tooth discomfort between age groups (p = 0.092), with individuals aged from 20 to 29 experiencing higher levels of discomfort than other age groups surveyed.

CONCLUSION

The two topics with the highest mean scores in the oral health domain and the school environment domain were bad breath and not wanting to speak or read aloud in class. Females reported more discomfort, and there was a substantial association between gender and tooth pain/sensitivity.

CLINICAL SIGNIFICANCE

Understanding the difficulties cleft patients face is crucial, as doing so will enable dentists to encourage and handle these issues more effectively.

Assessment of Self-Esteem and Quality of Life in Patients with Complete Unilateral Cleft Lip and Palate Undergoing Orthodontic Treatment

Objective

To assess the self-esteem and quality of life (QOL) in patients with complete unilateral cleft lip and palate (UCLP) who were undergoing orthodontic treatment.

Materials and Methods

This cross-sectional study was conducted on a total sample of 300 individuals consisted of 150 patients with UCLP (Group I) and 150 normal controls (Group II) with an age range of 10-25 years, who were undergoing comprehensive orthodontic treatment from December 2016 to December 2018. The Self Esteem and QOL were assessed using the Rosenberg Self Esteem scale (RSE) and Modified Paediatric QOL Inventory Scale (M-PQOL), respectively, in Group I and II.

Results

The comparison of overall mean scores of responses to RSE questionnaires showed nonsignificant differences for all the responses and was significant only for RSE 6 and RSE 8 in the age group of 10-15 years and 21-25 years, respectively, and nonsignificant for all other questions in all the age groups. The comparison of overall mean scores of M-PQOL for the total sample showed nonsignificant differences in Group I and II for physical functioning, emotional functioning, and school functioning domain, and were highly significant differences (P ≤ 0.001) in the social functioning domain and M-PQOL 12 and M-PQOL 21.

Conclusions

This study demands a definite need of a psychologist/psychiatrist among the cleft care team to counsel the patients with cleft during orthodontic treatment for motivating them to gain self-respect and acceptance in the society as certain aspects, particularly social functioning domain made them feel different from normal children because of the functional and aesthetic problems.

Adaptation of the Quality of Life Adolescent Cleft Questionnaire for Spanish children and adolescents with cleft lip and/or palate

BACKGROUND

The Quality of Life Adolescent Cleft Questionnaire is a measure of quality of life in cleft lip/palate (CL/P) and includes items on pre-treatment and post-treatment status. Items, however, were originally organized in a factor structure that prevents a formal pre-treatment to post-treatment comparison. Additionally, the questionnaire was tested in older patients.

AIM

We aimed to explore a factor structure that allows a comparison of pre- to post-treatment status in children and adolescents with CL/P.

DESIGN

The sample comprised 60 children and adolescents with CL/P. The scale was divided into two groups of items (24 comparing pre-treatment and post-treatment status and 26 measuring current quality of life). Two different exploratory and confirmatory analyses were conducted (one for each group of items). Sources of criterion validity were investigated with measures of self-esteem and self-efficacy.

RESULTS

The results supported a 6-factor structure for the pre-treatment and post-treatment items. In the second group of items, 9 items were removed due to inadequate functioning and a final 4-factor solution was obtained. The criterion validity of factors was good.

CONCLUSION

The proposed factor solution might be more useful to detect the perceived satisfaction in different areas and can be used in younger patients.

Assessment of dental anxiety using modified dental anxiety scale among adults with cleft lip and/or palate

Objectives

This study aimed to investigate dental anxiety levels among adults with cleft lip and/or palate (CL/P) and compare to adults with no orofacial cleft. The study also intended to find out the impact of cleft severity, gender and age on the perceived dental anxiety.

Methods

The study was composed of a sample of 70 adult participants who received and completed dental treatments. After sending self-addressed envelopes with consent forms and Modified Dental Anxiety Scale (MDAS) to 192 potential participants, 35 participants with CL/P (CL/P group) and 35 participants with no CL/P (control group), agreed to participate. Data were analysed using Mann-Whitney U test. A two-tailed P-value < 0.05 was considered as statistically significant.

Results

54.3% of adults with CL/P (23 females and 12 males, age range from 16 to 72 years) reported normal dental anxiety, while the remaining 45.7% reported moderate dental anxiety. No extreme dental anxiety were recorded in the CL/P group. These results were similar to the control group and there were no significant differences between groups (p > 0.05). Female participants recorded higher median anxiety scores than male participants in the CL/P group, and participants with cleft lip had higher median scores than participants with cleft lip and palate. However, these were not statistically significant.

Conclusion

The results suggest that CL/P did not affect dental anxiety levels for participants with the CL/P as there were no extreme cases and their results were comparable to a general non-cleft sample.

Evaluation of Oral Health-related Quality of Life for Adult Individuals with Cleft Lip and/or Palate Using OHIP-49 and Compared with a Control Group: A Cross-Sectional Study

Objectives:

This study aimed at evaluating oral health-related quality of life (OHRQoL) among adults with cleft lip and/or palate (CL/P) and compared it with adults with no orofacial cleft. The study also intended to find out the impact of cleft severity, gender, and age on the perceived OHRQoL.

Materials and Methods:

The study was composed of a sample of 70 adult participants who received and completed dental treatments: 35 participants with CL/P (CL/P group) and 35 participants with no orofacial cleft (control group) agreed to participate. Each participant completed the Oral Health Impact Profile (OHIP-49) with no missing data. The OHIP-49 data were analyzed using the Mann–Whitney U test, and a P-value <0.05 was considered as statistically significant.

Results:

Adults with CL/P reported higher scores in all the seven subscales of the OHIP-49. These results were statistically significant in physical disability (mean scores of 1.22, p = 0.017) and social disability (mean scores of 0.93, p = 0.046). Females with CL/P recorded better OHRQoL in the handicap domain (p = 0.026). Participants with cleft lip only recorded better OHRQoL compared with those with cleft lip and palate, and that was statistically significant at both the functional limitation (p = 0.003) and the physical pain (p = 0.046). There was a significant positive correlation between increasing age and functional limitation (p = 0.025).

Conclusion:

CL/P negatively affected OHRQoL for adults with CL/P mainly on physical and social disabilities of OHIP-49 when compared with a general non-cleft sample.

Religiosity, spirituality, and self-esteem in adolescents with cleft lip and palate: a correlational study

OBJECTIVE

To evaluate the correlation between religiosity, spirituality, and self-esteem in adolescents with uni- and bilateral cleft lip and palate.

METHOD

Correlational and cross-sectional study developed in a public and tertiary hospital in Brazil between July 2018 and February 2019. The sample comprised 100 adolescents divided into two groups: G1 (unilateral cleft, 50 participants) and G2 (bilateral cleft, 50 participants). For data collection, three instruments were used: Sociodemographic Questionnaire, DUREL Religion index, Rosenberg self-esteem scale. Statistical analysis was performed with the tests Chi-squared, Mann-Whitney, Pearson Correlation, and analysis of linear correlation strength, with a 5% significance level (p ≥ 0.05).

RESULTS

Only organizational religiosity was higher in G1 when compared with G2 (p = 0.03). The overall self-esteem was satisfactory for both groups; however, there was no significant difference between them (p = 0.34). No correlation between religiosity and spirituality with self-esteem were identified for G1 and G2.

CONCLUSION

The adolescents with uni- or bilateral cleft lip and palate presented high levels of religiosity, spirituality, and self-esteem. However, no correlation between these variables was identified.

Evaluation of Quality of Life in Adult Individuals With Cleft Lip and/or Palate

OBJECTIVES

The purpose of the present study was to systematically review literature relating to the quality of life (QoL) in adult individuals with cleft lip and/or palate (CLP) and identify which aspect of QoL adults with CLP find to be the most problematic, in comparison to a general non-cleft population.

DESIGN

Different databases were searched for this review including the Cochrane Central Register of Controlled Trials, Ovid MEDLINE and Embase. Five domains of QoL were identified to evaluate the overall results of these QoL measures. These domains were; physical function, physical pain, psychological implications and self-esteem, self-perception in relation to facial aesthetics, and social function. The studies included underwent critical appraisal and different types of bias were assessed based on the Cochrane handbook for systematic reviews of interventions.

RESULTS

Ten studies were included in this review. The total number of participants was 541. The most common QoL measure for adults with CLP was Short-Form (SF-36). Seven studies out of 10 reported statistically significantly worse scores (P < 0.05) in the psychological implications and self-esteem domains of QoL in adults with CLP, indicating lower QoL in terms of these domains. The least affected QoL domain was physical function. A high heterogeneity was found among the studies, including variation in the QoL measures, types of orofacial clefts, types of treatment and comparison groups.

CONCLUSION

The presence of CLP did seem to negatively affect the QoL for adults with CLP, mainly in terms of psychological implications and self-esteem.

Perception of quality of life by children and adolescents with cleft lip/palate after orthodontic and surgical treatment: gender and age analysis

Background

The quality of life (QoL) of children and adolescents with cleft lip/palate (CL/P) has been shown to be a predictor of good psychosocial functioning in this population group. This study aimed to measure QoL, from the patient´s perception of change produced by the different surgical and orthodontic treatments carried out since early childhood, and if gender and age are modulating the outcome variables results.

Materials and methods

A cross-sectional research study was carried out. The study included 60 patients with cleft lip, cleft palate, or cleft lip/palate, aged between 8 and 18, who were in orthodontic treatment and had undergone at least one surgery. They were asked to complete the Quality-of-Life Adolescent Cleft Questionnaire (QoLAdoCleft), which allows the assessment of the QoL through self-perception of improvement after surgical and orthodontic interventions. In particular, this questionnaire (administered only once), allows the evaluation of self-perception of QoL at the present time and before orthodontic and surgical treatment. This double assessment was carried out for the domains of physical, psychological, and social health. The results were analysed by looking at the interaction of gender and age.

Results

Statistically significant differences were found in the perception of the current QoL in comparison to the retrospective perception in all the dimensions considered. The perception of QoL improved in all cases. The results also showed a moderation of gender in the relation between perception of previous behaviour and social function and actual behaviour and social function.

Conclusion

The results indicated that patients perceived their quality of life had improved as a result of the treatments received, with the highest effect sizes found in the physical health domain. Specifically, the improvement in QoL in behaviour and social function tended to be influenced to a greater extent by perception of previous QoL. In this sense, personalized preventative measures from holistic and biopsychosocial approaches are necessary.

Mothers' Reactions to Seeing Their Children With Cleft for the First Time: A Qualitative Study in Ghana

OBJECTIVE

Studies on the etiology, treatment, and psychosocial effects of clefts among children born with the condition abound. Limited studies, however, have focused on the mothers of these children. This study aimed to explore the immediate reaction of mothers to seeing their children born with a cleft for the first time. Mothers' knowledge of cleft and the support systems available to them were also explored.

DESIGN

Employing a qualitative description approach, data were collected through face-to-face individual in-depth interviews using a semistructured interview guide.

PARTICIPANTS AND RESEARCH CONTEXT

Using the purposive and snowballing sampling techniques, 12 mothers who sought treatment for their children with cleft at a Tertiary health facility in Ghana were selected. The ethical principles outlined in the Declaration of Helsinki were followed during data collection. The data obtained were analyzed applying the technique of thematic analysis.

RESULTS

Mothers' first time reaction to seeing their child born with a cleft was that of sadness, worry, and disappointment. Knowledge of cleft among the mothers was low with most of them knowing more about the condition only after the delivery of their child with a cleft. Mothers received support from family members, health care practitioners, nongovernmental organizations, and their partners.

CONCLUSION

To reduce the psychosocial and emotional effects resulting from mothers giving birth to a child with a cleft, information on the condition should be made available to mothers and primary caregivers early enough.

Saving Face: Patient Strategies to Reduce Stigma and Barriers to Effective Decision-Making Among Children With Cleft Lip

Facial differences associated with cleft lips are often stigmatizing and can negatively impact psychosocial development and quality of life. However, little is known regarding patients' responses to societal expectations of appearance, or how these responses may impact utilization of revision surgery. Thus, patients with cleft lips at least 8 years of age (n = 31) were purposively sampled for semi-structured interviews. After verbatim transcription, first cycle coding proceeded with a semantic approach, which revealed patterns that warranted second cycle coding. The authors utilized an eclectic coding design to capture deeper meanings in thematic analysis. Additionally, survey data from a separate study were examined to evaluate participants' interest in improving appearance. Three major themes emerged, all of which reflected a desire to "save face" when interacting with society: (1) Cultural Mantras, which included societal mottos that minimized the importance of appearance; (2) Toughening Up, wherein the participants downplayed the difficulty of having a cleft; and (3) Deflection, wherein the participants took pride in facial features unrelated to their clefts. Despite these efforts to "save face," 78% of participants expressed interest in improving their appearance in the separate survey data.In conclusion, children with cleft lips try to "save face" when interacting with society by depreciating appearance, making light of clefts, and focusing on non-cleft related features. Paradoxically, many desired improvements of their appearance in an earlier survey. Awareness of these coping strategies is critical, as they may negatively impact surgeon-patient communication and inhibit patients from expressing interest in revision surgery.

"I smile, but Without Showing My Teeth": The Lived Experience of Cleft, Lip, and Palate in Adults

Objective:

To explore and describe the experience of growing up with unilateral cleft lip and palate (CLP) in adults.

Design:

Face-to-face interviews. Giorgi’s phenomenological method was used for analysis.

Participants:

Twenty-one (mean age: 40.8 years) adults treated for unilateral CLP during childhood and adolescence participated in the study.

Results:

Growing up with CLP meant to become aware of bodily otherness. The possible reactions from peers early in life complicated the striving for inclusion outside the close family. Being self-confident, clever in school, physically fit, and having trusted friends represented barriers against teasing and bullying. Nevertheless, the reflected image, in mirrors, windows, and photos, reminded the participants of the objectifying looks from others and often led to bodily adjustments that persisted into adulthood. The trajectory of treatment was not questioned during childhood, and the participants accepted the decisions on care made by experts and parents. Although problems related to the cleft could persist or return after the termination of ordinary treatment, a more hesitant view on the possible benefits of additional surgery was typical in adulthood.

Conclusions:

In retrospect, growing up with a unilateral CLP was found to have been an unquestioned part of the adult participants’ childhood, a burden that they feared would, to some extent, also be passed to their own children. However, the CLP had not prevented them from achieving goals and satisfaction in life. The occurrence of persisting psychological, functional, and esthetic challenges in adults suggests the need for an individualized, lifelong, and multidisciplinary perspective on CLP follow-up.

The Mediating Role of Resilience and Self-Esteem Between Life Events and Coping Styles Among Rural Left-Behind Adolescents in China: A Cross-Sectional Study

Objective: This study aims to explore the association between life events and coping styles, and how resilience and self-esteem mediate the association. Methods: A cross-sectional study was conducted among 981 left-behind adolescents (LBAs) in five junior high schools in Hunan Province, China, from April 13 to April 20, 2020. We utilized self-designed sociodemographic questionnaire, Adolescent Self-Rating Life Events Checklist, Resilience Scale Chinese Adolescent, Rosenberg Self-Esteem Scale, and Simplified Coping Style Questionnaire to assess the mental health of LBAs. Statistic description, Pearson correlation analysis, and structural equation model were adopted to analyze the data. Results: Results revealed that life events could negatively predict resilience (β = -0.29, P < 0.001) and self-esteem (β = -0.39, P < 0.001) and positively predict LBAs' positive coping style (β = 0.28, P < 0.001) and negative coping style (β = 0.21, P < 0.001). Self-esteem could also positively predict the resilience of LBAs (β = 0.62, P < 0.001); resilience could negatively predict the negative coping style (β = -0.21, P < 0.001) and positively predict the positive coping style (β = 0.79, P < 0.001). Life events not only have direct effects on negative coping style (β = 0.21) and positive coping style (β = 0.28) but also have indirect effects on coping styles by affecting resilience (β = -0.29) and self-esteem (β = -0.39). The total effect of life events on coping styles was 0.32, where 34.37% was mediated by resilience and self-esteem. Conclusion: We proved that resilience and self-esteem mediated most of the effects of life events on coping styles. The findings had important implications for interventions to promote mental health of LBAs, particularly the enhancement of resilience and self-esteem.

The role of coping in the association between subclinical psychotic experiences and functioning: A within study replication in two independent adolescent samples

An inverse association between psychosocial functioning and psychotic experiences is now established in both clinical and non-clinical populations, however the mechanisms which drive this are unclear. Adolescents with subclinical psychotic experiences (SPE) are more likely to use maladaptive coping strategies and less likely to use adaptive ones, and maladaptive coping has also been associated with poor functioning. A within study replication in two adolescent samples from the general populations of Melbourne, Australia (n = 723) and Birmingham, United Kingdom (n = 239), was conducted to determine whether the association between SPE and psychosocial functioning is mediated by coping style. SPE were associated with reduced general and family functioning and to a lesser extent with reduced peer functioning. Task-oriented (focusing on solving the problem) and emotion-oriented (negative emotional responses) coping were found to mediate the relationship between SPE and three types of functioning in both the Melbourne and the Birmingham samples. The within study replication consistently found that coping style mediates SPE and psychosocial functioning, despite significant differences in age, gender, functioning, use of coping styles, and level of SPE between the two samples. Longitudinal research is needed to fully understand any causal role coping may play in the relationship between SPE and poor functioning. The results have important public health and clinical implications, and suggest that techniques which increase levels of adaptive coping and reduce levels of maladaptive coping (in particular emotion-oriented styles) may help to break the cycle between SPE, functional decline, and eventual need for care.

The Psychosocial Impact of Cleft in a Western Australian Cohort Across 3 Age Groups

BACKGROUND

Management of a cleft of the lip and/or palate (CL/P) involves a multidisciplinary team approach lasting from birth to potentially postskeletal maturity. This condition is complex, with both medical and psychosocial implications that may place individuals with a cleft at higher risk of developing psychosocial problems.

METHODOLOGY

A self-administered questionnaire was completed by a sample from the Western Australian cleft population comprising 3 age groups: child (n = 100), adolescent (n = 101), and adult (n = 158).

RESULTS

Public speaking, being photographed, special relationships, and participation in school were identified as the areas most impacted by having a cleft. Hearing and speech were reported to have a higher importance than facial and dental appearance. Participants rated support given to them by their parents as the most important, with high ratings for treatment providers. For teasing, the impact of cleft was significantly higher among participants with cleft lip and palate for both the adolescent and adult age groups. There was little significant difference by gender across the variables, which suggests that males are just as likely to require support as females.

CONCLUSION

The impact of a cleft across multiple psychosocial domains needs to be recognized and addressed as part of craniofacial team care across age groups.

Salivary Cortisol Rhythms in Children With Cleft Lip and/or Palate: A Case-Control Study

OBJECTIVE

Knowledge about the stress response in children with cleft lip and/or palate (CL/P) is sparse and the association between the stress response and health-related quality of life (HRQoL) is unknown. Consequently, investigations on the influence of CL/P on the stress response alone and its association with HRQoL are of importance. The purpose was to determine whether salivary cortisol concentration in children with CL/P differs from that in children without clefts (controls) and whether there are any differences in salivary cortisol concentrations between ages, gender, and type of cleft. Furthermore, the final aim was to determine the correlation between salivary cortisol concentration and HRQoL.

DESIGN

The study used a cross-sectional case-control design.

PARTICIPANTS

Ninety-one 5- and 10-year-old children with CL/P and 180 age-matched controls.

MAIN OUTCOME MEASURES

Salivary samples were collected on 2 mornings and 1 evening for each child. Samples were analyzed using a commercial competitive radioimmunoassay and HRQoL was assessed using the KIDSCREEN-52.

RESULTS

Salivary cortisol concentrations were similar in children with CL/P and controls. There was no difference in salivary cortisol concentrations between children with different types of cleft. There was no correlation between cortisol concentration and HRQoL.

CONCLUSION

Five- and 10-year-old children with corrected CL/P seemed not to be more stressed than controls, and there were no correlation to HRQoL. The HRQoL levels - were comparable to that of a European norm population.

Quality of life of individuals with cleft lip and palate pre- and post-surgical correction of dentofacial deformity

Abstract OBJECTIVE To assesses the quality of life and the impact of oral health conditions in the pre- and post-surgical correction of dentofacial deformity of individuals with cleft lip and palate. METHOD Quantitative and prospective study in a referral hospital in the period from June 2011 to May 2013. A total of 50 participants responded the questionnaires World Health Organization Quality of Life - Bref (WHOQOL-Bref) and Oral Health Impact Profile - 14 (OHIP-14), approximately 3 days before and 3 to 12 months after surgery. The "t" test for paired samples and Wilcoxon test were used for statistical analysis with a significance level of 5%. RESULTS After surgery, differences were found in the domains: Physical, Psychological, Environmental and General Questions of the WHOQOL-Bref and domains: Psychological Discomfort, Psychological Disability, Social Disability, Handicap and Overall Score of OHIP-14. CONCLUSION Surgical correction of dentofacial deformity improved quality of life and had positive impact of oral health condition.

“It Doesn't All Just Stop at 18”: Psychological Adjustment and Support Needs of Adults Born with Cleft Lip and/or Palate

Background

Cleft in the lip and/or the palate (CL/P) is considered to be a lifelong condition, yet relatively little is known about the long-term outcomes for patients. Existing literature is largely outdated and conflicted, with an almost exclusive focus on medical aspects and deficits.

Objective

To explore the psychological adjustment and possible support needs of a large number of adults born with CL/P from their own perspective.

Design

Fifty-two individual telephone interviews eliciting qualitative data.

Results

Qualitative analysis identified five themes. Participants reported a range of challenges in relation to discharge from the service, additional surgery as an adult, social and romantic relationships, higher education, vocational achievement, and access to psychological support. The findings imply that most adults with a cleft adjust well to these challenges and report many positive outcomes. For a minority of patients, issues attributed to the cleft may continue to cause distress in adulthood.

Conclusions

Adults with CL/P may require psychological support, information about the heritability of cleft, signposting and referrals from nonspecialists, support regarding further treatment, and opportunities to take part in research and activities. New issues arising in adulthood, such as entering the workplace, forming long-term relationships, and starting a family, may warrant both further investigation and additional support. Further work is needed to identify the factors that contribute to psychological distress and resilience, as well as the timing of particular points of risk and opportunity for personal growth.