背景:先天性马蹄内翻足(CTEV)是一种先天性畸形,需要每周到医院进行手术和矫正石膏应用,随后是密集的支撑方案,需要多年来多次去医院就诊。众所周知,马蹄内翻足儿童的父母会遭受一系列负面情绪。这项研究的目的是确定特发性CTEV儿童父母的抑郁症患病率和与抑郁症相关的因素。
方法:这项横断面研究连续招募了190名在乔治国王医科大学接受治疗的特发性CTEV患儿的父母。不包括患有无法评估精神状态的父母。这些情况包括头部受伤或精神病史,正在接受精神疾病治疗的父母,持续的慢性疾病,慢性神经系统疾病,和临床确定的智力残疾的父母。记录了某些与父母相关的特征和某些与孩子相关的特征的信息。与父母相关的信息包括父母的年龄和性别,宗教,居住区,家庭中的孩子数量,感知社会支持程度(使用多维感知社会支持量表,MSPSS),教育水平,社会经济地位,DASS21的抑郁子量表评分(抑郁,抑郁焦虑,和应力标度-21),慢性疼痛(视觉模拟量表,VAS),有马蹄内翻足或抑郁症的家族史,以及使用假定压力生活事件量表(PSLES)在过去一年中由重大生活事件引起的压力水平。与儿童有关的信息包括儿童的性别,处理阶段(铸造或支撑),肢体受累(单侧或双侧),畸形的复发,和皮拉尼的畸形得分。使用双变量分析和逻辑回归来确定与DASS21抑郁子量表得分≥10相关的因素。
结果:一百四十五名受试者为男性(76.3%)。登记父母的平均年龄为28.47±4.89岁。DASS-21抑郁量表的平均得分为4.87±6.3。32位父母(16.8%)在DASS-21的抑郁分量表上得分≥10。在双变量分析中,女性性别,作为印度教徒,学习到12年级,复发,MSPSS评分,发现PSLES评分与DASS-21抑郁分量表上的评分≥10分相关。在逻辑回归中,女性性别,缺乏研究生及以上学历,发现MSPSS评分与DASS21评分的抑郁分量表上≥10分显著相关。
结论:特发性马蹄内翻足患儿父母的抑郁症患病率为16.8%。女性性别,缺乏大学教育,在DASS21的抑郁子量表上,感知社会支持(MSPSS)水平与≥10分独立相关。我们建议对马蹄足患儿的父母进行筛查,并将得分异常的儿童转诊给精神科医生以进行确诊。
BACKGROUND: Congenital talipes equinovarus (CTEV) is a congenital deformity that requires weekly visits to the hospital for manipulation and corrective cast application, followed by an intensive bracing regimen requiring multiple visits to the hospital spread over the years. Parents of children with
clubfoot are known to undergo a range of negative emotions. The objective of this study was to identify the prevalence of depression and the factors associated with depression in parents of children with idiopathic CTEV.
METHODS: This cross-sectional study consecutively enrolled 190 parents of children with idiopathic CTEV undergoing treatment at King George Medical University. Parents with conditions that preclude the assessment of mental status were not included. These conditions include a history of head injury or psychiatric illness, parents with ongoing treatment of psychiatric illness, ongoing chronic illness, chronic neurological disease, and parents with clinically established intellectual disability. Information was recorded on certain parent-related characteristics and certain child-related characteristics. Parent-related information included age and sex of the parent, religion, area of residence, number of children in the family, degree of perceived social support (using the Multidimensional Scale of Perceived Social Support, MSPSS), level of education, socio-economic status, depression subscale score of DASS 21 (Depression, Depression Anxiety, and Stress Scale -21), chronic pain (visual analogue scale, VAS), family history of
clubfoot or depression, and level of stress caused by a major life event during the past year using the Presumptive Stressful Life Event Scale (PSLES). Child-related information included the sex of the child, phase of treatment (casting or bracing), limb involvement (unilateral or bilateral), relapse of the deformity, and Pirani score of the deformity. Bivariate analysis and logistic regression were used to identify factors associated with a score ≥10 on the depression subscale of DASS 21.
RESULTS: One hundred forty-five subjects were males (76.3%). The mean age of the enrolled parents was 28.47±4.89 years. The mean score on the depression subscale of DASS-21 was 4.87±6.3. Thirty-two parents (16.8%) had a score of ≥10 on the depression subscale of the DASS-21. On bivariate analysis, female sex, being Hindu, having studied up to class 12th, relapse, MSPSS score, and PSLES score were found to be associated with a score ≥10 on the depression subscale of the DASS-21. On logistic regression, female sex, lack of graduate education and above, and MSPSS scores were found to be significantly associated with a score of ≥10 on the depression subscale of the DASS 21 score.
CONCLUSIONS: The prevalence of depression in parents of children with idiopathic
clubfoot was 16.8%. Female gender, lack of college education, and the level of perceived social support (MSPSS) are independently associated with a score ≥10 on the depression subscale of DASS 21. We recommend screening parents of children with
clubfoot and referring those with abnormal scores to a psychiatrist for a confirmed diagnosis.