BACK GROUND OF THE STUDY:

Birth of a new child in a family is a time for rejoicing and celebration in a family. Parents have so many dreams and aspirations for their newly born child that birth of a child with mental retardation can be a traumatic and shattering event for a family. The feeling of grief and loss that the family goes through is caused by realization that the anticipated normal child they had waited for nine months was never born. ¹

Mothers of these children showed more psychological distress than other member in their families as they are the primary caregivers for their children. The mothers of mentally disabled children showed significantly more psychiatric morbidity and stress than mothers of normal children but fathers did not show the same deleterious effect on psychological health which may be related to the differing responsibility assigned to child rearing for each parent as the literatures showed that fathers are less involved in care giving activities. Research has revealed that psychiatric morbidity (depression, anxiety, experiencing high levels of stress) are common among mothers of mentally disabled children.²

According to ICD-10 and DSM-IV-TR “Mental Retardation can be defined as a significantly sub average general intellectual functioning resulting or associated with concurrent impairment in adaptive behavior and is manifested during the developmental period.”Several hundred causes have been discovered but the cause affecting one-third of the people remains unknown. The three major causes of mental retardation are Down syndrome, fetal alcohol syndrome and fragile X syndrome.³

Literature reports that mental disability produces psychological, physical, social, financial distress to the whole family particularly parents as they are virtually the only constant carers.¹

Parenting a mentally retarded child is not an easy task. Parents having a mentally retarded child experience a variety of psychological stresses related to the child’s disability. Parents especially mothers need every help and encouragement possible in their difficult task which is indeed easier for them while the child is still a baby. An anxious love on the part of the mother may do much to exacerbate the Mental retardation. The birth of a retarded child at home is likely to be one of the most traumatic events experienced in a family.⁴ Hence I had the impetus to move in this direction.

NEED FOR THE STUDY:

According to WHO nearly 83 million of the world's population is estimated to be mentally challenged with 41 million having long-term or permanent disability. It Ranks fourth in the list of leading causes of disability. Population studies have shown that overall prevalence of mild to severe mentally challenged ranges from 2.5 to 5/1000 population.⁵

It is generally considered that 3% of the World population constitutes persons with mental retardation 6 -7.5 million mentally retarded individuals live in the United States.⁵

In 2005 the prevalence rate of mental retardation in India varies from 0.2 to 32.7 per 1000 population. In the year 2009, in India more than 20 million children are suffering with mental retardation. In Karnataka there are around 9.4 lakh mentally challenged persons and out of them 3.67 lakh are children.⁶

According to the National Sample Survey Organization (NSSO) out of 1000 children in the rural areas 31 had some developmental delays whereas in urban areas 9 out of every 1000 children were developmentally delayed. A survey was conducted on children within the age group of 0-14 years. On an average it is found that 2.5 % of all such children are mild and moderately retarded and 0.5% has severe or profound retardation. The NSSO survey estimates that in rural areas the prevalence of mental retardation is 3.1% whereas it is much less at 0.9% in urban settings.⁷

The global burden of diseases indicate that by the year 2020 childhood neuropsychiatric disorder will increase by more than 50% internationally become one of the 5^th most common causes of morbidity, mortality and disability among children in the world. Every year more than 1, 25,000 infants are born who will be diagnosed as mental retardation.⁸

OBJECTIVES:

1. To assess the psychological problems of mothers with mentally challenged children.

2. To find the association between the level of helplessness, hopelessness, sadness, social isolation and agitation of mothers with mentally challenged children with their selected personal variables.

HYPOTHESES:

H₁: There will be significant association between the level of helplessness, hopelessness, sadness, social isolation and agitation of mothers with mentally challenged children and their selected personal variables.

MATERIAL AND METHODS:

Research approach:

Descriptive survey approach.

Reseach design:

Descriptive research design.

Variables of the study:

Research variable: Psychological problems

Selected Personal variables:

Age, religion, education, type of marriage, occupation, number of children, type of family, family monthly income, duration of disability of child and place of residence.

Sources of data:

Setting of the study:

The study was conducted in All India Institute of Speech and Hearing (AIISH) in Mysuru.

Population of the study:

In the present study population comprises of mothers with mentally challenged children.

Sample and sampling:

The sample of present study comprised of mothers with mentally challenged children. In the present study 100 samples were selected.

Sampling technique:

Non probability purposive sampling technique was used for the selection of the sample.

Data collection techniques and instruments:

Description of tool:

Based on the review of literature the following tool were developed:

Section A : Proforma for selected personal variables of mothers with mentally challenged children:

It includes age, religion, education, type of marriage, occupation, number of children, type of family, family monthly income, duration of disability of child and place of residence.

Section B: Self administered Rating scale to assess the psychological problems of mothers with mentally challenged children:

Psychological problems rating scale was used to assess the psychological problems of mothers with mentally challenged children . The rating scale includes feeling of helplessness, hopelessness, sadness, social isolation, and agitation. Three point rating scale consists of 50 questions and each are having three options and the participants are requested to choose one among the options out of 50 items 19 items (2, 4, 5, 6, 7, 8, 9, 11, 16,17, 18, 21, 22, 23, 25, 29, 33, 35, 37) were positive items were graded as follows most of times (0), sometimes (1) and never (2) and remaining 31 items (1, 3, 10, 12, 13, 14, 15, 19, 20, 24, 26, 27, 28, 30, 31, 32, 34, 36, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50) were negative items were graded as follows Most of the times (2), sometimes (1) and never (0)

The total score was 100, which is further divided arbitrarily as follows:

0-25 - No psychological problem

26-50 - Mild psychological problem

51-75 - Moderate psychological problem

76-100 - Severe psychological problem

RESULTS:

Section -1

Description of selected personal variables of mothers with mentally challenged children:

Table – 1-Frequency and percentage distribution of mothers with mentally challenged children according to their selected personal variables. n=100

Sl. No

Sample characteristics

Frequency

Age in years

1.1) 20-30

1.2) 31-40

1.3) 41-50

Religion

2.1) Hindu

2.2) Muslim

2.3) Christian

2.4) Others

Education

3.1) Primary education

3.2) SSLC

3.3) PUC & above

Type of marriage

4.1) Consanguineous

4.2) Non consanguineous

Occupation

5.1) Home maker

5.2) Private

5.3) Government

5.4) Others

Number of children

6.1) 1

6,2) 2

6.3) 3

6.4) 4 and above

Type of family

7.1)Nuclear

7.2) Joint

Family monthly income (in rupees).

8.1) < 5000

8.2) 5001 to 10000

8.3) > 10,001

Duration of disability of child in years

9.1) Birth

9.2) 6 months

10.

Place of residence

10.1)Urban

10.2) Rural

Section -2

Description of psychological problems of mothers with mentally challenged children

Part- a

Table- 2-Frequency and percentage distribution of psychological problems of mothers with mentally challenged children n=100

Sl.No.	Psychological Problems	Frequency	Percentage
1.	No psychological problem	0	0
2.	Mild psychological problem	32	32
3.	Moderate psychological problem	53	53
4.	Severe psychological problem	15	15

Figure no.1 Pie diagram showing the frequency and percentage distribution of level of psychological problems of mothers with mentally challenged children.

The data presented in Table 2 and Fig 1 shows that, majority 53(53%) mothers of mentally challenged children were having moderate psychological problem and 32 (32%) were having mild psychological problem and 15(15%) mothers of mentally challenged were having severe psychological problem.

Table- 3-Mean, Median, Range and Standard deviation of psychological problems scores of mothers with mentally challenged children n=100

Group	Mean	Median	Range	SD
Mothers with mentally challenged children	58.47	58	28-89	±14.74

The data presented in Table 3 shows that the mean scores of psychological problems of mothers with mentally challenged children is 58.47 with SD ± 14.74, ranged from 28-89 and median score is 58.

The data presented in Table 4 shows that majority 59(59%) mothers with mentally challenged children were having high level of helplessness. Majority 44(44%) mothers with mentally challenged children were having moderate level of hopelessness. Majority 53(53%) mothers with mentally challenged children were having mild level of sadness. Majority 38(38%) mothers with mentally challenged children were having high and moderate level of social isolation. Majority 37(37%) mothers with mentally challenged children were having severe and moderate level of agitation.

Table- 5 Mean, Median, Range and Standard deviation of aspect wise psychological problems scores of mothers with mentally challenged children n =100

Aspects	Mean	Median	Range	SD
Helplessness	10.70	11	3-18	± 3.57
Hopelessness	11.72	12	3-20	±3.92
Sadness	10.43	10	1-19	±4.00
Social isolation	12.13	12	1-20	±4.12
Agitation	13.62	14	5-20	±4.06

The data presented in Table 5 shows that the mean helplessness scores of mothers with mentally challenged children is 10.70 with SD ± 3.57, ranged from 3-18 and median score is 11 ,The mean hopelessness scores of mothers with mentally challenged children is 11.72 with SD ± 3.92, ranged from 3-20 and median score is 12 ,The mean sadness scores of mothers with mentally challenged children is 10.43 with SD ± 4, ranged from 1-19 and median score is 10,The mean social isolation scores of mothers with mentally challenged children is 12.13 with SD ± 4.12, ranged from 1-20 and median score is 12 ,The mean scores of agitation of mothers with mentally challenged children is 13.62 with SD ± 4.06, ranged from 5-20 and median score is 14.

Section 3

Association between the level of helplessness, hopelessness, sadness, social isolation and agitation of mothers with mentally challenged children and their selected personal variables

H₀₁: There will be no significant association between the level of helplessness, hopelessness, sadness, social isolation and agitation of mothers with mentally challenged children and their selected personal variables.

To test the association chi-square was computed and the values are presented in Table 6.

Table -6--Association between the level of hopelessness of mothers with mentally challenged children and their selected personal variables. n=100

Sample characteristics

Mild hopelessness

Moderate /severe hopelessness

Chi square value

1. Age in years

1.1) 20-30

1.2) 31-50

4.430^*

2. Religion

2.1) Hindu

2.2) Others

0.008

3. Education

3.1) Primary education

3.2) SSLC and above

0.027

4. Type of marriage

4.1) Consanguineous

4.2) Non consanguineous

0.429

5. Occupation

5.1) House wife

5.2) Private / Government

1.891^#

6. Number of children

6.1) 1

6.2) 2 & above

3.645

7. Type of family

7.1) Nuclear

7.2) Joint

0.000

8. Family monthly income (in rupees)

8.1) < 5000

8.2) > 5001

0.245

9. Duration of disability of child in years

9.1) Birth

9.2) 6 months

1.166

10. Place of residence

10.1) Urban

10.2) Rural

0.246

χ2₍₁₎ =3.84; p<0.05*significant, p>0.05 ; #Yates correction

The data represented in the Table 6 shows that the computed chi-square value is found to have significant association between age and the level of hopelessness at 0.05 level of significance and it was found to be non significant for other variables. Hence research hypothesis H₀₁ is partially accepted.

There will be no significant association between the level of helplessness, sadness, social isolation and agitation of mothers with mentally challenged children and their selected personal variables.

CONCLUSION:

The results of the study revealed that majority of the mothers were having high helplessness, moderate hopelessness, mild sadness, high social isolation and severe agitation. Computed chi-square values were found significant association between the level of hopelessness and their age at 0.005 level of significance and it found not significant with other variables. There is no significant association found between the level of helplessness, sadness, social isolation and agitation of mothers with mentally challenged children and their selected personal variables.

Thus it was concluded that mothers with mentally challenged children were having moderate psychological problems.

REFERENCES:

Rajdeep Kaur, Harish Arora. Attitudes of Family Members Towards Mentally Handicapped Children and Family Burden. Delhi Psychiatry Journal [Homepage on the Internet]. APRIL 2010 [cited 2014 Apr 18];Vol. 13 ( No.1) Available from: http://medind.nic.in/daa/t10/i1/daat10i1p70.pdf

Mohamed G. Al-Kuwari .Psychological health of mothers caring for mentally disabled Children in Qatar. Neurosciences 2007; Vol. 12 (4): 312-317.

Neeraja K.P. Essentials of Mental Health and Psychiatric Nursing. 6^th edition. New Delhi: Japee publications; 2008.

Stein ZA, Susser MW. The epidemiology of mental retardation. Proceedings of the 34^th Symposium of Colts on Research Society, held in the University of Bristol in March 1982. Bristol: Wright; 1984; 21–46.

The Hindu Online edition of India’s National Newspaper.[cited 2008 Dec 09]. Available from: http: // www.hindu.com/ 2004/01/27/stories/2004012710230600

The Delhi Society for the Welfare of Special Child. : Prevalence and incidence of mentally challenged children [homepage on the Internet]. 1998 [cited 2014 Jan 2]. Available from: http://www.dswspecialchildren.org/Info.html

Tregold and Soddy. A text book of Mental Retardation, 9th edition. Williams wood and co. Baltimore; 1983

Received on 29.05.2015 Modified on 26.06.2015

Int. J. Adv. Nur. Management 3(3): July- Sept. 2015; Page 240-244

DOI: 10.5958/2454-2652.2015.00010.4

Aspects	Low		High		Mild		Moderate		Severe
Aspects	f	%	f	%	f	%	f	%	F	%
Helplessness	41	41	59	59	-	-	-	-	-	-
Hopelessness	-	-	-	-	40	40	44	44	16	16
Sadness	-	-	-	-	53	53	36	36	11	11
Social isolation	24	24	38	38	-	-	38	38	-	-
Agitation	-	-	-	-	26	26	37	37	37	37