Self-concept and psychiatric comorbidity in a sample of Egyptian adolescents with secondary nocturnal enuresis

Abstract

Objective Enuresis is a common problem in children and adolescents that can be troubling for them and their families. The potential effect of enuresis on the synthesis of identity and self-concept in children and adolescents is still poorly understood. This study aimed to evaluate the probable impact of secondary nocturnal enuresis on the self-concept of Egyptian adolescents. Participants and methods Forty patients aged 10-18 years with a diagnosis of secondary enuresis and 40 control children of the same age range were recruited. A validated Arabic version of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) in addition to the Child Behavior Check List (CBCL) and an Arabic-translated and validated version of the Piers-Harris Children's Self-Concept Scale were applied to evaluate the sample. Results After statistical adjustment for differences in intelligence quotient and socioeconomic status, youth with enuresis showed lower school, social, and total competence scores on CBCL but higher scores in all CBCL problem parameters. Adolescents with enuresis scored lower than control adolescents in all six subscales of the Piers-Harris Children's Self-Concept Scale in addition to the total score. Linear regression was used to adjust the results for significant differences between the two groups regarding intelligence quotient, socioeconomic status, CBCL school competence, CBCL total problems, and diagnosis of attention-deficit hyperactivity disorder and conduct disorder according to the MINI-KID interview. Differences in three subscales - behavior, intellect, and physical appearance - in addition to the total score were still significant after adjustment. Comparison between youth with nocturnal enuresis versus those with combined-type enuresis yielded no significant differences. Conclusion Older children and adolescents with enuresis suffer from high internalizing and externalizing problems, and low competence levels. They also suffer from low self-esteem that is most probably the result of enuresis itself and not due to low competence levels or behavioral problems. Further research is needed to determine the effect of treatment on the self-concept of these children.