Psychological Disturbances in Indian Children with Atopic Eczema

Abstract

Although the link between atopic dermatitis (AD) and emotional disturbance is well known, there have been only a few studies assessing the extent of these disturbances in affected children and the problems experienced by their parents. Furthermore, these studies are mostly from western countries, where atopic dermatitis is seen in a more severe form than in India. The purpose of this study was to determine whether there is an excess of psychological disorders in Indian children with AD as compared to healthy controls and whether their mothers showed higher levels of emotional or mental distress than a comparison group. Twenty-two children, aged 3-9 years, with atopic dermatitis, twenty age and sex matched controls, and their mothers were selected for the study. The personalities of the mothers were assessed from a standard and valid questionnaire, the Hindi adaptation of Personality Trait Inventory, which explored nine areas of the maternal personality and mental distress as well as negative traits of some of these. The two groups were compared using the Chi-square test. To assess the psychopathology of the children, the mothers were made to answer parts of a valid, well-developed questionnaire, the Childhood Psychopathology Measurement Schedule, which enabled the assessment of the following factors: low intelligence with behaviour disorders, conduct disorders, anxiety, and depression. The means of each factor in both the groups were compared using the Students' t-test. Out of all the maternal personality traits, an increased number of mothers of affected children, 13 (59%) were found to be submissive as compared to the mothers of the controls i.e. 2 (10%), which was statistically significant (p<0.01). The children with AD had a higher frequency of low intelligence with behaviour disorders (5.9+/-2.9) as compared to controls and also of conduct disorders (2.1+/-1.4), which were both statistically significant (p<0.01). The results of this pilot study, although small in number, suggest that increased psychological disorders are observed in Indian children with AD as compared to controls, despite the fact that the disease is of a milder variety in this country as compared to its western counterparts. More mothers of children with AD were submissive, which could contribute to the psychological disorders and maintenance of eczema in the children. We suggest that children with AD may benefit if such psychological dimensions are considered as a part of their treatment.

Association of atopic dermatitis with depression, anxiety, and suicidal ideation in children and adults: A systematic review and meta-analysis

“…Studies were grouped into 3 categories according to the end points: (1) depression, (2) anxiety, and 3suicidal ideation. In the first category, 42 studies were included 7,9,10,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][34][35][36][37][38][39][40][41][42][44][45][46][47][48][49][50][51][52]54 ; in the second category, 44 studies were included 7,10,[13][14][15][16][17][18][19][23]<...>…”

“…23,25 A total of 19 studies were included in the qualitative analysis. [34][35][36][37][38][39][40][41][42][44][45][46][47][48][49][50][51][52]54 Most either found an association between patients with AD and depression 34,[36][37][38][39][40]44,[46][47][48][49][50] or reported a higher mean score 41,51,52,54 according to the assessment tool used to diagnose depression. A Korean cross-sectional study found a positive association between childhood AD and depression (N = 3192 [P = .0003]).…”

“…A total of 31 studies were included in the qualitative analysis. 14,15,[33][34][35][36][37][38][39][40][43][44][45][46][47][48][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68] Most found a positive association between AD and anxiety [34][35][36][37]39,40,[44][45][46][47][56][57][58]61,62,67,68 or reported a higher mean score according to the assessment tool used for diagnosing anxiety. 15,33,38,54,55,59,63,65,…”

Epidemiology and clinical features of atopic dermatitis in India

“…[29] In a small matched case-control study involving children between 3 and 9 years of age, it was observed that AD children were more prone for low intelligence with behavior disorders and conduct disorders. This was notwithstanding the milder nature of the disease in Indian patients.…”

Dry Skin in Childhood and the Misery of Eczema and Its Treatments

“…There was no difference in the degree of social support experienced by the eczema families in this study. A small study from India ( n = 22) found that an increased number of mothers of affected children, 59%, were submissive when compared to 10% in the control group ( p < 0.01) [ 53 ] .…”