The Mental State of Parents in Diseases of Young Children

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Abstract

Objectives. Children’s illnesses negatively affect their mental and physical development, causing anxiety and psychological discomfort to parents, since increased demands are placed on parental care. In turn, the discomfort of the parents increases the risk for the normal development of the child. In the Yaroslavl region, about 7% of all younger aged children are hospitalized annually. Of these, 97% are initial, 8% are in serious condition. Researchers describe relatively stable psychological characteristics of parents of sick children. In order to psychologically optimize the treatment process, the previously undescribed psychological state of mothers of infants hospitalized with their children in the Yaroslavl Oblast Children’s Clinical Hospital health care institution was investigated.

Methods. The sample consisted of 34 women hospitalized with their children under 3 years of age. Using the “Layout of the mental state” method by A.O. Prokhorov, three mental states were assessed: the actual state at the time of the research, the habitual state and the state at the onset of the child’s disease. The state of health of the child was also assessed by the respondents on a scale from 0 to 10. The data covering the period of 2019—2023 hospitalizations of the children of early age were used.

Results. The actual mental states reported by respondents were significantly worse than their habitual ones, according to descriptor groups Psychic Processes and Feeling. The actual mental states were better than the ones at the onset of disease, according to descriptor groups Psychic Processes, Physiological Reactions, Feeling and Behavior. The evaluation of a child’s health is associated only with a change in the state of the group of Mental processes descriptors (Kendall’s Tau 0.30; z = 2.4; p-value = 0.02).

Conclusions. Two opposite changes in the mental state of mothers during hospitalization of children were revealed: the worsening compared with the usual state, improvement in the mental state compared to the onset of the child’s disease. Changes in mental state in seven of the eight groups of descriptors are independent of the parents’ assessment of the child’s health at the time of the examination. A small sample implies a special assessment of the sustainability of the results.

General Information

Keywords: young children; hospitalization; parents; awareness of child’s illness; mental state; actual state; psycho- logical discomfort; anxiety

Journal rubric: Research of ASD

Article type: scientific article

DOI: https://doi.org/10.17759/autdd.2024220107

Received: 02.02.2024

Accepted:

For citation: Solondaev V.K., Pisareva M.V. The Mental State of Parents in Diseases of Young Children. Autizm i narusheniya razvitiya = Autism and Developmental Disorders, 2024. Vol. 22, no. 1, pp. 52–57. DOI: 10.17759/autdd.2024220107.

Full text

Introduction

Children are ill quite often in early childhood. Authoritative manuals on developmental psychology emphasize the direct negative impact of illness on the child [4; 7], and modern research shows a very complex interaction of biological, social, and psychological factors affecting their development. According to our study, the age up to 3 years is the period of the maximum sensitivity of the system of mental development to negative influences [9].

An explicitly psychological factor — the disruption of the mother’s relationship with her partner — Y.E. Shmatova et al. refer to parental risk factors for children’s health [11]. V.K. Yuryev et al. describe the reasons for mothers’ refusal to breastfeed, which, in our opinion, have an exclusively psychological basis: the child’s refusal to breastfeed and the mother’s reluctance [12]. Y.F. Lakhvich and O.O. Leonovich show that frequently ill children more often than healthy children develop insecure types of attachment to their mothers [6]. 

T.D. Vasilenko et al., on the contrary, show an increase in the risk of psychosomatic disorders in children with insecure attachments to the child on the part of the mother [1]. The data of T.D. Vasilenko et al. correlates with the data of T.V. Drobysheva and M.A. Romanovskaya about the difficulty of empathy in children raised at an early age by a nanny [3]. Anxiety, guilt, and wariness were revealed by A.O. Velmatova and N.D. Semenova in mothers of frequently ill children [2]. Anxiety and depression are described by E.G.M. Aizlewood et al. in parents of children with gastro-esophageal reflux [13].

The negative experiences of parents are not only the psychological consequences of children’s disease. According to M.N. Bishop et al., a child’s illness creates increased demands on parental care, so the strong negative experiences of parents can be considered an additional risk factor for the child [14]. A direct connection of parents’ mental well-being with overcoming the consequences of neonatal brain damage [17] and congenital heart disease [16] in children has been shown. According to T.G. Kuznetsova and E.A. Rodina [5], parents’ self-regulation of experiences related to the child’s illness may be hampered by the inconsistency of parental perceptions of child development.

A.O. Prokhorov’s research shows that the mental state performs the functions of subject’s self-regulation and behavior regulation [8]. The mental state is much more dynamic than the listed type of attachment, empathy, anxiety. The state is more closely connected with the actual situation and is more accessible to self-regulation. The subject of our study was the mental state of parents of young children in a situation of the child’s illness. The work was conducted in the Yaroslavl Regional Children’s Clinical Hospital (RCCH) on the basis of the informed voluntary consent of the subjects and with the approval of the ethical committee of the P.G. Demidov Yaroslavl State University.

Methods

34 women hospitalized in RCCH with children under 3 years of age participated in the study. The age of the subjects was from 18 to 45 years old. The mean age is 28.5; standard deviation 5.9. The educational level of the subjects: basic general education 1 person; secondary education 11 persons; higher education 23 persons. The median age of the children of the subjects was 2.5 months; boys 20 persons; girls 14 persons.

A.O. Prokhorov’s “Layout of Mental State” method was used to assess the mental state of mothers [8]. The method contains 40 descriptors of the mental state, divided into four groups of 10 indicators: mental processes, physiological reactions, experiences, and behavior. Each indicator has 11 levels of expression.

Subjects were asked to evaluate three mental states: 
  1. Current state at the time of the study.
  2. Normal (background) mental state.
  3. The state at the moment of onset of the child’s illness.

It was also offered to rate the child’s state of health on a scale from “0 = extremely ill” to “10 = completely healthy”.

In addition to a sample study of the mental state of the subjects who are with their children on inpatient treatment, the statistics of the hospitalization of children in 2019—2023 were analyzed according to the data of the electronic system of medical records of RCCH.

Results and Discussion

Having evaluated the distribution of hospitalization data in the R software package [15] using the one-sample Wilcoxon test, we obtained the following values of our indicators of interest:

An average of 2174 young children are hospitalized annually in RCCH, representing about 7% of all young children in the region. Of these, 97% are hospitalized initially and 8% are hospitalized in serious condition.

In other words, early childhood hospitalization is a fairly common factor affecting mental development.

Assessments of mothers’ mental states, according to the scheme of the author of the “Layout of Mental State” method [8], were summarized by four groups of descriptors; the average score was calculated. Then, for each subject, two characteristics of the change in state were calculated separately: estimates of the normal (background) state were subtracted from the estimates of the current state; estimates of the state at the time of the onset of the disease were subtracted from the estimates of the current state.

We chose this processing scheme because mental state does not imply a common reference point for all subjects. The range of mental states experienced in connection with a child’s health is very wide and varied, which makes it difficult to recognize them in comparison with states of other origins [10]. Therefore, generalized assessments of each of the three states are in themselves less informative than the nature of their changes. In the “Layout of Mental State” method, subjectively positive state characteristics are presented at the right pole of the scale. An increase in scores for each of the four groups of descriptors indicates a positive change in state, and a decrease — a negative one.

The distributions of state score differences were evaluated statistically using the Wilcoxon test for related samples in the R software package [15]. The results are summarized in Table 1.

Table 1

Differences in Mental States of Parents in a Situation of Child’s Illness

 

Comparable States, Decreasing — Subtracting

State Descriptor Group

Point Estimate of the Median of Differences

Wilcoxon Test Value, Achieved Level of Significance

Current Normal (Background)

Mental Processes

–0,85

V = 97, p = 0,002

Physiological Reactions

–0,15

V = 222, p = 0,44

Experience

–1,20

V = 147, p = 0,01

Behavior

–0,70

V = 150, p = 0,03

Current — State at the Onset of the Illness

Mental Processes

1,65

V = 584, p < 0,001

Physiological Reactions

1,65

V = 566, p < 0,001

Experience

2,40

V = 578, p < 0,001

Behavior

1,50

V = 537, p < 0,001

Quartiles of the distribution of child health assessments: 25% of the sample up to 3; 50% of the sample up to 7; 75% up to 9. This distribution generally corresponds to the statistics of hospitalizations and indicates a fairly adequate assessment of children’s health by their parents.

The relationship between changes in the mental state of mothers and their assessment of child health was assessed using the Kendall rank correlation coefficient. Of the eight possible relationships (two changes in four descriptor groups), only one was statistically significant. The current mental state according to the Mental processes descriptor group is as positive as the state at the onset of the disease as the child’s health at the time of the examination is rated higher: Kendall’s Tau 0.30; z = 2.4; p-value = 0.02.

The results show that the current state experienced by the subjects in a situation of hospitalization with young children differs quite significantly both from their normal (background) state and from the state at the moment of the onset of the illness. And these differences are opposite.

The current state is experienced by the subjects as subjectively worse than the normal state. But the median changes in three of the four groups of state descriptors are statistically significantly different from zero. With the Bonferroni correction for multiple comparisons, we can speak of only two significant differences (mental processes and experience).

Compared to the state at the onset of the disease, the current state of the subjects is significantly more positive. For all four groups of state descriptors, the median changes are statistically significantly greater in modulus than the change in the current state compared to the background.

The results show that mothers’ state changes are related to both a situation of inpatient treatment and the awareness of the child’s illness. The awareness of the child’s illness more strongly changes the mental state of the subjects than a treatment situation. At the same time, changes in the mental state of mothers are not related to their assessments of the child’s health at the time of examination, which creates psychological prerequisites for difficulties in the interaction between parents and medical personnel. A negative change of the state itself creates difficulties in interaction. And the lack of connection of the state with health assessment hinders the evaluation of the work of medical personnel aimed at improving health.

Let us illustrate the practical significance of the results with a hypothetical example. A young child, crawling around the house, receives an injury that requires hospitalization. Inpatient treatment is objectively favorable, the child is discharged for outpatient rehabilitation, which is also successful. Restrictions of the child’s motor activity, inevitable at the stages of inpatient treatment and rehabilitation, are removed. But parents, who deeply and severely experience their child’s trauma out of connection with the assessment of his or her health, may, firstly, distort or not follow the recommendations of medical professionals under the influence of a negative state. Second, parents may “prophylactically” restrict their child’s motor activity after treatment is completed. In such a situation, we can talk about difficulties in the course of treatment and the long-term consequences of the trauma. Consequences that arise under the influence of psychological factors, but which in some cases manifest themselves physically. How can this be avoided? In our opinion, the psychological optimization and psychological support of the treatment process is required.

Negative mental states experienced by parents are natural and, in many respects, functionally necessary, as are medical restrictions of the child’s activity. The issue is different the correspondence of the parents’ state to what is acceptable and useful for the child in a particular situation. In most situations, it is possible to achieve that the parents’ condition does not worsen the child’s condition, and that the parents do not block the child’s spontaneous options for the compensation of negative experiences.

Limitation of the Study

The main limitation of the presented study is the small sample size: 1.5% of the total number of annually hospitalized young children.

Conclusions

The study revealed two opposite changes in the mental state of parents (mothers) during the hospitalization of young children: worsening compared to the normal state, improvement compared to the onset of the disease. Changes in mental state in seven out of eight groups of descriptors were independent of the parents’ assessment of the child’s health at the time of the examination.

The limitation of the conducted study requires a special assessment of the stability of the obtained results. In case that the stability of the results is confirmed, research in several directions is possible: the identification of the parameters of the states associated with psychological problems during treatment; the assessment of the nosological specificity of the parents’ states; the description of the nature of the relationship between the parent’s and the child’s state.

References

  1. Vasilenko T.D., Zemzyulina I.N., Selin A.V. et al. Sem’ya i psikhosomaticheskoe zdorov’e rebenka [The family and the child’s psychosomatic health]. Vestnik Rossiiskogo fonda fundamental’nykh issledovanii: Gumanitarnye i obshchestvennye nauki = Russian Foundation for Basic Research Journal: Humanities and Social Sciences, 2017, no. 1, pp. 112—121. (In Russ., abstr. in Engl.)
  2. Vel’matova A.O., Semenova N.D. Osobennosti vzaimootnosheniya v diade “mat’-rebenok” v sem’yakh s chasto boleyushchimi det’mi: Chast’ 1: Postanovka problemy [Peculiarities of the relationship in the mother-child dyad in families with frequently ill children. Part 1. Problem statement]. Sovremennaya terapiya v psikhiatrii i nevrologii = Current Therapy in Psychiatry and Neurology, 2020, no. 3-4, pp. 38—39. (In Russ., abstr. in Engl.)
  3. Drobysheva T.V. Romanovskaya M.A. Osobennosti sotsial’no-psikhologicheskikh svoistv lichnosti v zavisimosti ot uslovii rannei sotsializatsii v sem’e [Features of socio-psychological personality traits depending on the conditions of early socialization in the family]. Novoe v psikhologo-pedagogicheskikh issledovaniyakh = New in psychological and pedagogical research, 2016, no. 3, pp. 83—97. (In Russ., abstr. in Engl.)
  4. Сraig G., Baucum D. Psikhologiya razvitiya [Human Development]. Saint Petersburg: Publ. Piter, 2019. 940 p. ISBN 978-5-4461-1013-1. (Transl. from Engl. into Russ.)
  5. Kuznetsova T.G., Rodina E.A. Rannyaya pomoshch’ detyam i ikh sem’yam: voprosy soprovozhdeniya v obrazovatel’nom protsesse [Early assistance to children and their families: issues of support in the educational process]. Nepreryvnoe obrazovanie = Lifelong education, 2022, no. 2, pp. 4—8.
  6. Lakhvich Yu.F. Leonovich O.O. Privyazannost’ k materi chasto boleyushchego rebenka na raznykh etapakh ontogeneza [Attachment to the mother in a frequently ill child at different stages of ontogenesis]. Adukatsyya і vykhavanne = Education and upbringing, 2021, no. 8, pp. 59—62.
  7. Martsinkovskaya T.D., Maryutina T.M., Stefanenko T.G. et al. Psikhologiya razvitiya: uchebnik dlya studentov vysshikh psikhologicheskikh uchebnykh zavedenii [Developmental Psychology: Textbook for psychology students]. Moscow: Publ. Akademiya, 2007. 528 p. ISBN 978-5-7695-4471-2.
  8. Prokhorov A. O. Mental’nye reprezentatsii psikhicheskikh sostoyanii [Mental representations of mental states]. Moscow: Publ. Psychology Institute of the Russian Academy of Sciences, 2021. 186 p. DOI:10.38098/mng.2021.005
  9. Solondaev V.K., Koneva E.V. Vnutrisistemnye vzaimosvyazi i zakonomernosti psikhicheskogo razvitiya detei i podrostkov (na materiale sel’skoi vyborki) [Intrasystem Relations and Patterns of Children and Adolescents Psychological Development (in the Rural Sample)]. In Printsip razvitiya v sovremennoi psikhologii [The development principle in current psychology]. Moscow: Publ. Psychology Institute of the Russian Academy of Sciences, 2016. Pp. 394—415. ISBN 978-5-9270-0326-6.
  10. Solondaev V.K., Koneva E.V., Lyasnikova L.N. Recognition of One’s Own Mental State by Parents of Children-patients. Klinicheskaya i spetsial’naya psikhologiya = Clinical Psychology and Special Education, 2017, vol. 6, no. 2, pp. 64—82. DOI:10.17759/cpse.2017060206
  11. Shmatova Yu.E., Razvarina I. N., Gordievskaya A.N. Interkogortnyi analiz roditel’skikh faktorov riska razvitiyu rebenka na pervom godu zhizni [Inter-Cohort Analysis of Parental Risk Factors for Development of Infants]. Analiz riska zdorov’yu = Health Risk Analysis, 2023, no. 2, pp. 115—129. DOI:10.21668/health.risk/2023.2.11
  12. Yur’ev V.K., Moiseeva K.E., Alekseeva A.V. Osnovnye prichiny otkazov ot grudnogo vskarmlivaniya [Main Reasons for Refusing Breastfeeding]. Sotsial’nye aspekty zdorov’ya naseleniya = Social aspects of population health, 2019, no. 2. 1 p. DOI:10.21045/2071-5021-2019-65-2-5
  13. Aizlewood E.G.M., Jones F.W., Whatmough R.M. Paediatric gastroesophageal reflux disease and parental mental health: Prevalence and predictors. Clinical Child Psychology and Psychiatry. 2023. vol. 28. no. 3. P. 1024—1037. DOI:10.1177/13591045231164866
  14. Parenting Stress, Sleep, and Psychological Adjustment in Parents of Infants and Toddlers with Congenital Heart Disease. M.N. Bishop, J.E. Gise, M.R. Donati, C.E. Shneider, B.S. Aylward, L.L. Cohen. Journal of Pediatric Psychology. 2019. vol. 44. no. 8. P. 980—987. DOI:10.1093/jpepsy/jsz026
  15. R: The R Project for Statistical Computing [Web resource] / R Foundation for Statistical Computing. Vienna, 2024. URL: https://www.R-project.org/ (Accessed 04.02.2024).
  16. The association between parent stress, coping and mental health, and neurodevelopmental outcomes of infants with congenital heart disease. S.D. Roberts, V. Kazazian, M.K. Ford, D. Marini, S.P. Miller, V. Chau, M. Seed, L.G. Ly, T.S. Williams, R. Sananes. Clinical Neuropsychologist. 2021. vol. 35. no. 5. P. 948—972. DOI:10.1080/13854046.2021.1896037
  17. Understanding Early Childhood Resilience Following Neonatal Brain Injury from Parents’ Perspectives Using a MixedMethod Design. T.S. Williams, K.P. McDonald, S.D. Roberts, R. Westmacott, N. Dlamini, E.W.Y. Tam. Journal of the International Neuropsychological Society. 2019. vol. 25. no. 4. P. 390—402. DOI:10.1017/S1355617719000079

Information About the Authors

V. K. Solondaev, PhD in Psychology, Associate professor, Department of General Psychology, Faculty of Psychology, P.G. Demidov Yaroslavl State University, Yaroslavl, Russia, ORCID: https://orcid.org/0000-0003-4156-5262, e-mail: solond@yandex.ru

Marina V. Pisareva, Head pediatrician of the Yaroslavl region, Deputy Chief Physician for Outpatient and Polyclinic Work, Yaroslavl Regional State Children’s Clinical Hospital, Yaroslavl, Russia, ORCID: https://orcid.org/0000-0002-6486-9149, e-mail: Pisarev73@mail.ru

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