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European Journal of Social Sciences Volume 8, Number 3 (2009)

Maternal Psychological Distress and Separation AnxietyDisorder in Children

Sakineh MofradDepartment of uman De!elopment " #amil$ Stu%ies, #acult$ of uman Ecolo&$

'ni!ersit$ of utra ala$sia (')

E-mail: [email protected]

Rohani Abdullah

Department of uman De!elopment " #amil$ Stu%ies#acult$ of uman Ecolo&$, '


Bahaman Abu Samah

Department of rofessional De!elopment " *ontinuin&, '


Mariani Bte Mansor

Department of uman De!elopment " #amil$ Stu%ies#acult$ of uman Ecolo&$, '


Maznah Bt Baba

Department of *ounselor E%ucation " *ounselin& s$c+olo&$, '


Abstract

The psychological wellbeing of parents hae consistently been found to be a ma!or riskfactor for child deelopment. "oweer# few studies hae been conducted on parentalpsychological wellbeing in relation to separation an$iety disorder %S&'( in particular. Thecurrent study e$amined the relationship between psychological distress in mothers andS&' symptoms in children. & total of )*+ children in first grade school and their mothersparticipated in the study. S&' was measured using S&&S_, while maternal psychologicaldistress was assessed using "_*/. There was eidence that significant and positierelationship e$isted between maternal an$iety and S&' in children. 0aternal an$iety wasthe main predictor for S&' in this study. The result highlights the psychological constructswhich may be releant for the assessment and interention in children suffering from S&'.

ey!ords" Separation an$iety disorder# psychological distress# childhood an$iety.

#$ %ntroduction

Separation &n$iety is a condition long iewed by researchers and clinicians as a relatiely normal andhealthy process and a basic human disposition. The term refers to a child1s or parent1s concerns

)2+

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regarding the loss of significant others in one1s life %"ock 3 4utz# )55/(. Sometimes# normalseparation an$iety may become intense and disruptie in a child1s life. This condition is referred to asSeparation &n$iety 'isorder %S&'(# which is characterized by inappropriate and e$cessie an$ietyconcerning separation from home or from an attachment figure. The fourth edition of 'iagnostic andStatistical 0anual places S&' as a disorder usually diagnosed at infancy# childhood or adolescence andthe mean age of the onset is age 6.7 years %'S0-89-T: &merican ;sychiatric &ssociation# *+++(.

? )*-)= years at 2.5> and

).2> for adolescents aged )=-) years %&; *+++(. To our knowledge# there has been no publishedepidemiological surey for child and adolescent mental disorders in 8ran# but unpublished researchindicates that adolescent mental disorders in 8ran appro$imates the rates of disturbances reported bydeeloped countries %Ae!atisafa# 0ohammadi# Sharifi# oodarzi# 8zadian# Barhoudian# 0ansouri 30oaghar# *++(.

Separation an$iety deelops from comple$ interactions in the enironment. &lthough geneticfactors contribute to the etiology of an$iety disorders %

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Emotional and psychological wellbeing of parents are important for children. ,hildren ofparents with mental health problems are at greater risk for a range of psychosocial and deelopmentalproblems# and are less likely to benefit from mainstream parenting education efforts. 8mpairments inparental and mental health hae consistently been found to be a ma!or risk factor for childdeelopment? the more seere and chronic the parentHs disorder# the more likely that they will haenegatie impact on their behaior and on the child1s deelopment. ;arents suffering from an$iety haebeen obsered to be highly critical %Dayer et al.# *++? ,ooper# Bearn# illetts# Seabrook 3 ;arkinson#

*++? Iohnson# ,ohen# Fasen 3 Drook# *++? 0anning 3 regoire# *++? Dogels 3 0elick# *++=?Turner# Deidel# oberson-Aay 3 Tero# *++2? 0cDride# Schoppe 3 ane# *++*(. Jnfortunately#relatiely few studies hae been conducted on S&' in particular.

"oweer# findings on the relation between parental psychological disorders and the risk ofdisturbance in children are mi$ed. Frain and Fendall %*+++( found no significant correlations betweenparental an$iety and child an$iety symptoms. Ket# sufficient eidence hae indicated that children whohae parents with an$iety disorder are at a high risk for the disorder %

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clinicians identify unhealthy signals. These symptom dimensions were drawn from the clinical childliterature on S&' and related problems %Eisen 3 Schaefer# *++7(. ;reious studies indicated goodinternal consistency %.5)(# test-retest reliability %./2( with good alidity of the S&&S-, and theysuggested as a useful tool in identifying separation an$iety symptoms %Eisen 3 Schaefer# *++7? "ahn etal.# *++2? "a!inlian# "ahn# Eisen# Cilli-ichardson# eddy# inder 3 pincus# *++2(.

8n this study# we restricted our analyses to oerall scores rather than subscales. The internalconsistency was found to be e$cellent with a ,ronobach1s alpha alue of .5=. The alues obtained for

the *7thand 67thpercentile suggest that 7+> of the respondents had S&&S-, score of between * and/. The inter-correlation analysis on S&&S-,# indicate the correlation coefficient ranged from .+) %norelationship between B,E and B;8( to ./* %high correlation between SS8 and ,E(.

*$&$&$ /eneral )ealth 0uestionnaire+&1 ,/)0+&1.

The "-*/ is a self-administered screening instrument designed for the detection and assessment ofindiiduals with an increased likelihood of psychiatric disorder. The */-item ersion of the " is theonly ersion that proides subscale measures of more specific domains of psychopathology %oldberg3 "illier# )565(. There are four subscales consisting of 6 items in each case# which are labeledpsychosomatic# an$iety and insomnia# social dysfunction# and seere depression. The "-*/ hasbeen studied in a wide range of cultural settings# and factor analysis of "-*/ data has confirmed the

stability of the subscales %Aagyoa# Frol# Szilasioa# Stewart# 'i!k# 3 "euel# *+++? erneke#oldberg# Kalcin 3 Jstun# *+++(. & 4ikert score %+L2( was used for the present study. The scoresranged from + to *) for the each subscales and from + to /= for the total score. The alidity andreliability of the "-*/ ;ersian ersion has been documented in seeral 8ranian publications %&ssadi#Aakhaei# Aa!afi# 3 Bazel# *++6? 0alakouti et al.# *++6? Falafi# "agh-Shenas# 3 of the respondents had scores of between )2 and *. The inter-correlation coefficients between the

subscales are rather high# with the mean correlation being about .7* %range .*)-./7(. &ccording to0alakouti et al. %*++6( the best cut-point for "-*/ was a score of *2 for total score onpsychological distress.

*$($ Procedure

&ll the children were interiewed one to one using S&&S-, in a Guiet room at the child1s school duringschool hours. The instructions were read by the researcher and the children were asked if they had anyGuestions about the Guestionnaire. They were told that there were no correct or incorrect answers butrather it was the answers that were most true for them that were of interest to us and also# theirresponses would remain confidential. The ;ersian language ersion of the "-*/ was alsoadministered to )*+ mothers indiidually.

2$ 3he Results

;articipants were )*+ first graders %=7> boys and 77> girls( and their mothers. The results indicatedthat > of the children had a background of illness at least once. The assessment of mother1sbackground reealed that =6> of the mothers had high school education# *6> had bachelor degree#*+> had elementary education and > had master degree and aboe. &lso# =5> of the mothers wereemployed# and 7)> were unemployed. 8n terms of illness background# the results show 2> of themothers report medical illness and 72> of them report psychological distress at least once. The meanand standard deiation for the total S&&S-, score in the present sample were 67. and )*.#

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respectiely. The mean score corresponds closely to the results Guoted by Eisen and Schaefer %*++7(#who reported a mean alue of 67 for the scale. The mean and standard deiation for the "-*/ totalscore was )5.2 and /.# respectiely %see Table )(. Dased on the S&&S-,# we classified the childrenwith low and high score likelihood of showing S&' symptoms. of them reealed a highlikelihood of showing S&' symptoms. The "-*/ used to measure the general health of the mothers#indicated that 27> of mothers felt unhealthy.

3able #" 0eans# standard deiations# minimum and ma$imum score forS&&S-, and "-*/ %nM)*+(.

Mean S.D. Min. Max. Alpha value

S&&S_, total 67.76 )*.= 7+.++ 5.++ .5*

"-*/ total )5.2= /.2 *.++ 26.++ ./5

;sychosomatic =.6* *.72 ).++ )).++ ./

&n$iety 6.*) =.)= .++ )6.++ .5*Social dysfunction 7.*6 *.6= .++ )*.++ ./2

'epression *.)* *.66 .++ )).++ ./+

3able &" ;earson ;roduct 0oment correlation between S&&S-, total score and"-*/ scales %nM)*+(.

1 2 3 4 5

)( S&&S-, score ).+++ .=7*NN .627NN .+= .22+NN

*( ;sychosomatic symptom ).+++ .=NN .27+NN .27+NN

2( &n$iety symptom ).+++ .*)=N .2*7NN

=( Social dysfunction symptom ).+++ -.+)

7( 'epression symptom ).+++

NN. ,orrelation is significant at the +.+) leel %*-tailed(.

N. ,orrelation is significant at the +.+7 leel %*-tailed(.

;earson ;roduct 0oment correlation was computed to e$amine the relationship betweenmaternal distress and children1s S&'. esults reealed a significant correlation between the oerall

scores %rM .)# p O .+7(. & significant and positie correlation was also found between "-*/ an$ietysubscale and S&' scores PrM +.6=# p O.+7Q. This suggests that a higher leel of an$iety in mothers isassociated with higher leels of S&' symptoms in the children# and ice ersa. &s e$pected# motherswith an$iety were more likely than others to hae a child with S&'. Table * lists ;earson ;roduct0oment correlations between maternal psychological distress and children1s S&'. &fter we classifiedthe mothers and children with those with likelihood symptoms# the result indicated that **> of thechildren who reealed S&' symptoms# had mothers with current psychological distress. ;earsonchisGuare test indicated significant association between maternal psychological distress and separationan$iety symptoms in children R*M 55.)+# p O .+7# phiM .=.

e were interested in assessing the uniGue contributions of the constructs %maternalpsychosomatic# maternal an$iety# maternal social dysfunction# and maternal depression( in e$plaining

the childrens S&' score. To e$amine our hypothesis# a standard multiple regression analysis wasperformed using the following as independent ariables: %a( psychosomatic# %b( an$iety# %c( socialdysfunction# and %d( depression scores. ;reliminary analyses were conducted to ensure no iolation ofthe assumptions of normality and linearity. 0ore so# there was no eidence of multi-collinearitybetween the independent ariables.

3able (" egression analysis with "-*/ scales as predictors and S&&S-, score as dependent ariable.

Model B t p

%constant( ).=5 2+.+6 .+++

;sychosomatic -.*6+ -.+7= -.) .7=*&n$iety *.2* .67/ 5.+5 .+++

)2=

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Social 'ysfunction -.== - .+57 -).=2 .)7

'epression .= .)+) ).=5 .)26

AM)*+# BM 2./*#pM .+++# M .67# *M .7# *M.77# Std. Error /.7)

The regression analysis showed that 67> of the ariation in children1s S&' scores wase$plained by the constructs on maternal distress %B=# ))7M 2./2# p O +.+7(. The results presented inTable 2 reeal that maternal an$iety was the strongest predictor for children1s S&' symptoms %U M .6#

tM 5.)5# p O .+7(.

4$ Discussion and Conclusion

The current study inestigates the association between maternal psychological distress and separationan$iety disorder in children. The first ma!or finding on separation an$iety disorder %S&&S-,(demonstrated a reliable inde$# with acceptable internal consistency for the assessment of separationan$iety symptom among 8ranian children. Thus# this findings suggests that the S&&S-, will be usefulin the assessment of S&' and in the identification of symptoms and dimensions that may be masked by'S0-89-Ts categorization. 0oreoer# the scale may also help in the treatment of S&' by allowingclinicians to obtain specific information aimed at the deelopment of treatment planning# identification

of separation an$iety and the establishment of points of interention.

of mothers had aprobable psychiatric disorder. 8t was hypothesized that parental psychopathology affected familyenironment# and contributed to the deelopment and maintenance of childhood an$iety %Beigon# et. al.*++)(. Therefore# parental psychopathology might influence the presence of childhood an$iety. 8n thecurrent study# 2> of mothers had a background of physical illness and 72> had a background ofpsychological illness. The high rate of illness might be due to e$posure to seeral stressful lifesituations such as 8raG-8ran war# and 8raG-Fuwait war. Such situations could hae affected people#bringing about high leels of an$iety. "oweer# this study did not administer structured psychiatric

interiews to mothers. Therefore# our findings were merely related to maternal symptoms# not maternalan$iety disorders.

The current study adances our understanding of the relationship between family ariables andchildren1s S&'. "oweer# there are limitations that should be addressed. The data were gathered fromonly one parent %mothers(. 8n addition# there was a lack of ariability in participant demographics.

0ost of our sample were primarily 8ranian children from sub-skirt# middle-class families. Therefore# itis unknown whether the findings can be generalized to other samples. &nother limitation within thestudy was that the results were based on parent Guestionnaire data %"-*/(. 8t is unclear whether highleels of maternal psychopathology and low leels of family were as a result of an$ious children orwhether children e$hibit more symptoms of an$iety due to eleated maternal psychopathology. 8n

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summary# the current study proides a closer e$amination of the relations between family ariables andS&' children. Bindings from the present study suggest that family ariables may play an important rolein S&' children. ,linicians might find it helpful to iew S&' in early childhood as a continuing issuefor mother and child and not as a uniGue factor for early school period. 8nterentions addressing bothmother and child1s history might be more useful than those focusing on issues in the child1s life.Burthermore# the results of the current study are based on a nonclinical sample# although# in this study#we found some with obious symptom. &dditional research is needed to e$amine the relationship

between parent and family ariables among an$ious children.8n conclusion# the current study employed a design which attempted to better understand the

uniGue contribution of maternal psychological distress and S&' during early childhood. esearchersmay find the 2=-item child report scale useful in e$amining the condition of children1s early separationan$iety. The results indicate that all measures in maternal psychological distress contributedsignificantly to the prediction of children1s S&' at the age 6 years.

Buture studies are needed to further e$amine the relationship between maternal psychologicaldistress# especially maternal an$iety and child separation an$iety in both clinical and non-clinicalsettings. &dditional information is needed about the role of maternal an$iety in the deelopment andmaintenance of child separation an$iety. Specifically# research should also aim to assess the role ofparents1 psychopathology in child an$iety. Buture research should include more comprehensie

assessment of maternal psychopathology such as standard diagnostic interiew.

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