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      Prevalence of psychological distress among parents of children with intellectual disabilities in Malawi

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          Abstract

          Background

          Children with intellectual disabilities are common and are increasing in number as more children survive globally. In stark contrast to the 1–3% prevalence of intellectual disability in children globally (reported by WHO), studies from Malawi provide alarmingly high rates (26%). We know that the prevalence of psychological distress is as high as 50% in parents of children with intellectual disabilities in Europe and the US. No such studies have yet been conducted in Africa. This study is aimed at determining the prevalence and risk factors for psychological distress among parents of intellectually disabled children in Malawi.

          Methods

          This quantitative cross-sectional study was conducted in January and February 2015. One hundred and seventy mothers and fathers of children with intellectual disabilities as diagnosed by psychiatric clinical officers were randomly sampled from two selected child disability clinics. The Self-Reporting Questionnaire (SRQ) was used “as measure for psychological distress and questions on socio-demographic variables were administered to all consenting participants.” Data was coded, cleaned and analyzed using STATA.

          Results

          70/170 (41.2%) of parents of children with intellectual disabilities reported psychological distress. Univariate and multivariate analysis showed that area of residence ( P < 0.05), low socio-economic status ( P < 0.05), knowledge of the disability of one’s child ( P < 0.05), low confidence in managing the disabled child ( P < 0.05), increased perceived burden of care ( P = 0.05), and having no sources for psychological support ( P < 0.05) significantly predicted psychological distress among the parents for children with disabilities.

          Conclusion

          There is huge burden of psychological distress among parents of intellectually disabled children in Malawi. Psychosocial interventions are urgently needed to support parents of children with intellectual disability in Malawi.

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          Most cited references31

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          The epidemiologic transition: a theory of the epidemiology of population change. 1971.

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            Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. A study on the accuracy of patients' self-reports and on determinants of inaccuracy.

            The object of the study is to investigate the (in)accuracy of patients' self-reports, as compared with general practitioners' information, regarding the presence of specific chronic diseases, and the influence of patient characteristics. Questionnaire data of 2380 community-dwelling elderly patients, aged 55-85 years, on the presence of chronic non-specific lung disease, cardiac disease, peripheral atherosclerosis, stroke, diabetes, malignancies, and osteoarthritis/rheumatoid arthritis were compared with data from the general practitioners, using the kappa-statistic. Associations between the accuracy of self-reports and patient characteristics were studied by multiple logistic regression analyses. Kappa's ranged from 0.30 to 0.40 for osteoarthritis/rheumatoid arthritis and atherosclerosis, to 0.85 for diabetes mellitus. In the multivariate analyses, educational level, level of urbanization, deviations in cognitive function, and depressive symptomatology had no influence on the level of accuracy. An influence of gender, age, mobility limitations, and recent contact with the general practitioner was shown for specific diseases. For chronic non-specific lung disease, both "underreporting" and "overreporting" are more prevalent in males, compared to females. Furthermore, males tend to overreport stroke and underreport malignancies and arthritis, whereas females tend to overreport malignancies and arthritis. Both overreporting and underreporting of cardiac disease are more prevalent as people are older. Also, older age is associated with overreporting of stroke, and with underreporting of arthritis. The self-reported presence of mobility limitations is associated with overreporting of all specific diseases studied, except for diabetes mellitus, and its absence is associated with underreporting, except for diabetes mellitus and atherosclerosis. Recent contact with the general practitioner is associated with overreporting of cardiac disease, atherosclerosis, malignancies and arthritis, and with less frequent underreporting of diabetes and arthritis. Results suggest that patients' self-reports on selected chronic diseases are fairly accurate, with the exceptions of atherosclerosis and arthritis. The associations found with certain patient characteristics may be explained by the tendency of patients to label symptoms, denial by the patient, or inaccuracy of medical records.
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              Self-reports of health care utilization compared to provider records.

              This study compares self-reports of medical utilization with provider records. As part of a chronic disease self-management intervention study, patients completed self-reports of their last six months of health care utilization. A subgroup of patients was selected from the larger study and their self-reports of utilization were compared to computerized utilization records. Consistent with earlier studies, patients tended to report less physician utilization than was recorded in the computerized provider records. However, they also tended to report slightly more emergency room visits than were reported in the computerized utilization records. There was no association between demographic or health variables and the tendency toward discrepancy between self-report and computerized utilization record reports. However, there was a tendency for the discrepancy to increase as the amount of record utilization increased. Thus, the likelihood of bias caused by differing demographic factors is low, but researchers should take into account that underreporting occurs and is likely to increase as utilization increases.
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                Author and article information

                Contributors
                charles.masulani@sjog.mw
                felixkauye@yahoo.com
                m.j.gladstone@liverpool.ac.uk
                dmathang@mac.medcol.mw
                Journal
                BMC Psychiatry
                BMC Psychiatry
                BMC Psychiatry
                BioMed Central (London )
                1471-244X
                24 May 2018
                24 May 2018
                2018
                : 18
                : 146
                Affiliations
                [1 ]St. John of God Mental Health Services, Malawi, Box 744, Mzuzu, Malawi
                [2 ]ISNI 0000 0001 2113 2211, GRID grid.10595.38, Department of Community Health, , University of Malawi College of Medicine, ; P/Bag 860, Blantyre, Malawi
                [3 ]ISNI 0000 0004 1936 8470, GRID grid.10025.36, UK Department of Women and Children’s Health, Institute of Translational Medicine, , University of Liverpool, Alder Hey Children’s NHS Foundation Trust, ; Liverpool, UK
                Author information
                http://orcid.org/0000-0001-8676-1713
                Article
                1731
                10.1186/s12888-018-1731-x
                5968565
                29793452
                ed2bca8b-dded-40dd-8f97-1c69908a8196
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 25 October 2017
                : 9 May 2018
                Funding
                Funded by: Wellcome Trust (UK)
                Award ID: 087547/Z/08/Z
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Clinical Psychology & Psychiatry
                prevalence,psychological distress,parents,intellectual disabilities

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