Abstract
This study was undertaken to determine the extent and nature of depressive symptoms exhibited by black South African children during hospitalisation for orthopaedic procedures. Social factors associated with the risk for depression, in response to hospitalisation, were also examined. Pre- and post-test assessments were conducted on a sample of 30 children, aged between 6 and 12 years. The assessment entailed a structured interview, together with the following psychometric instruments: A Global Mood Scale, a Depressive Symptoms Checklist, a Hospital Fears Rating Scale and a Self Report Depression Rating Scale. A large proportion of the children were rated by ward sisters as showing high levels of depressive symptomatology two weeks after admission to hospital. As expected, discrepancies were found between adult and child self-ratings of depression. The results of this study indicate that hospitalisation for orthopaedic child patients is associated with the development of depressive symptomatology. It is suggested that emphasis be placed on the development of supportive programmes and procedures aimed at maximising children's coping responses to hospitalisation, particularly for children who find themselves isolated from their communities and families, as a result of both centralised health services and poor socio-economic conditions.
Highlights
Several studies have indicated that illness and hospitalisation are risk factors for the developm ent of depression in children, in cases of multiple admissions or prolonged hospitalisation (Blumberg, 1977; Bowlby, 1960; Rutter, 1979, Spitz, 1945; Trad, 1987)
Children are separated from parents, siblings, peers and fam iliar environments. This separation deprives them of the psychological and social support necessary for adaptation to the strange surroundings and events, and sometimes to pain and discomfort. This social and psychological deprivation frequently leads to grief and feelings of loss, with subsequent depressive symptomatology (Lambert, 1984)
According to the psychoanalytic perspective, the experience of surgery may evoke fantasies in children, of being attacked, mutilated, castrated or punished (Freud, 1952). These fantasies may be reinforced through misunderstandings of normal hospital or surgical procedures, as perceived by a frightened or confused child
Summary
Several studies have indicated that illness and hospitalisation are risk factors for the developm ent of depression in children, in cases of multiple admissions or prolonged hospitalisation (Blumberg, 1977; Bowlby, 1960; Rutter, 1979, Spitz, 1945; Trad, 1987). According to a recent review, at least 20% of children admitted into hospital display some degree of behaviourial or emotional disturbance (Yap, 1988). Children are separated from parents, siblings, peers and fam iliar environments This separation deprives them of the psychological and social support necessary for adaptation to the strange surroundings and events, and sometimes to pain and discomfort. According to the psychoanalytic perspective, the experience of surgery may evoke fantasies in children, of being attacked, mutilated, castrated or punished (Freud, 1952). These fantasies may be reinforced through misunderstandings of normal hospital or surgical procedures, as perceived by a frightened or confused child
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