|Year : 2021 | Volume
| Issue : 2 | Page : 78-83
Gender differences in anxiety, depression, and self-esteem among children of alcoholics
Dayananda Bittenahalli Omkarappa1, Sreevani Rentala2, Prasanthi Nattala3
1 Department of Psychiatric Nursing, Kempegowda College of Nursing, Bengaluru, Karnataka, India
2 Department of Psychiatric Nursing, Dharwad Institute of Mental Health and Neuroscience, Dharwad, Karnataka, India
3 Department of Nursing, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
|Date of Submission||23-Jan-2021|
|Date of Decision||03-May-2021|
|Date of Acceptance||08-May-2021|
|Date of Web Publication||21-Dec-2021|
Dr. Dayananda Bittenahalli Omkarappa
Department of Psychiatric Nursing, Kempegowda College of Nursing, V V Puram, K R Road, Bengaluru - 560 004, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Children growing up in families with alcohol abuse are at high risk for anxiety, depression, and low self-esteem. The published studies mainly focused on the gender difference in behavioral problems among normal children, but only limited studies are focused on gender difference in anxiety, depression, and self-esteem among children of alcoholics (COAs). Materials and Methods: A cross-sectional descriptive survey research design was adopted for the present study. The study was conducted at selected government high school located in Bangalore South. The simple random sampling technique was used to select the participants for the study. COA screening test (modified) and pediatric symptom checklist were used for identifying COAs and behavioral problems. Spence Children's Anxiety Scale, Center for Epidemiological Studies Depression Scale for Children, and Rosenberg Self-Esteem Scale were used to assess anxiety, depression, and self-esteem, respectively. Data were analyzed using Statistical Package for the Social Sciences software package (Version 23). Results: The results showed that there is no statistically significant difference in mean scores of anxiety, depression, self-esteem, separation anxiety, social phobia, obsessive–compulsive problems, and physical injury between boys and girls COAs. Mean scores of generalized anxiety are high in boys compared to girls COAs. Conclusion: The study concluded that there is no gender difference in anxiety, depression, and self-esteem among COAs.
Keywords: Anxiety, depression, self-esteem, gender difference and children of alcoholics
|How to cite this article:|
Omkarappa DB, Rentala S, Nattala P. Gender differences in anxiety, depression, and self-esteem among children of alcoholics. Indian J Psy Nsg 2021;18:78-83
|How to cite this URL:|
Omkarappa DB, Rentala S, Nattala P. Gender differences in anxiety, depression, and self-esteem among children of alcoholics. Indian J Psy Nsg [serial online] 2021 [cited 2022 Jul 1];18:78-83. Available from: https://www.ijpn.in/text.asp?2021/18/2/78/332789
| Introduction|| |
Children raised in alcoholic families have different life experiences than children raised in nonalcoholic families. Children growing up in families with alcohol abuse would expect to have deficits in coping skills, and suboptimal parenting would be expected to contribute to these deficits. Increased levels of conflict, stress within alcoholic families, and dysfunctional family coping will place children of alcoholics (COAs) at an elevated risk for the development of behavioral problems during childhood and adolescents. These children exhibit anxiety, depression, low self-esteem, separation anxiety, social phobia, obsessive–compulsive problems, and physical injury problems more frequently than do children from nonalcoholic families.,
A systematic review conducted by Park and Schepp. to examine the risk of behavioral problems among COAs shows that children growing up in these families are at risk for developing anxiety, depression, suicidal ideation, substance abuse, or interpersonal difficulties during developmental period. Parental alcoholism was associated with a higher risk for major depressive disorder and persistent depressive disorder. A longitudinal study conducted by Pagano et al. shows that history of parental substance use disorder was a significant predictor of relapse of social phobia and panic disorders.
The study conducted by Choi et al. shows that male COAs are increased risk for anxiety and female COAs are increased risk for depression. However, the prevalence of panic disorder, separation anxiety disorder, social anxiety disorder, and generalized anxiety disorder is more among boys compared to girls. The study conducted by Marie and Jennifer found that there is no gender difference in severity of depressive symptoms, self-esteem, and resilience.
The published studies focused mainly on influence of gender difference on behavioral problems among normal children. However, only limited studies are focused on gender difference in behavioral problems among COAs. Therefore, identification of gender difference among COAs helps in providing appropriate intervention so that complications at later stage can be prevented.
| Materials and Methods|| |
A cross-sectional descriptive survey research design was used. The study was conducted at government high school, coming under Bangalore South-I Taluk, India. The children were selected by using simple random sampling and data were collected from June 2017 to February 2018. Power analysis was carried out by using G * Power (G*Power version 18.104.22.168, Institute for Digital Research & Education Statistical Consulting)analysis based on findings of pilot study, by keeping the power of study at 80% (P = 0.05 two-tailed). The power analysis revealed that a total of 188 participants would be sufficient to find the difference between two independent means (two groups). Totally, 200 children were selected for the study. The inclusion criteria include COAs with behavioral problems and aged between 12 and 15 years. The exclusion criteria include children with single parents.
After obtaining formal permission from the concerned authority, recruitment of participants took place at selected government high school. Each child was contacted, and a screening has been done for identifying COAand behavioral problems. Data were collected by using standardized tool. The average time taken by children to complete tool is 50 min.
Children who fulfilled the inclusion criteria were administered the sociodemographic Pro forma, Spence Children's Anxiety Scale, Center for Epidemiological Studies Depression Scale for Children (CES-DC), and Rosenberg Self-Esteem Scale.
- Sociodemographic pro forma: It includes questions on their age, sex, religion, class, father educational qualification, mother educational qualification, father occupation, mother occupation, monthly family income, type of family, number of siblings, and birth order
- Spence Children's Anxiety Scale: The scale was developed by Susan H Spence (1998), it is a self-administered four-point Likert scale containing 38 items, and participants are asked to rate on a 4-point scale comprising never (0), sometimes (1), often (2), and always (3), based on the clinical manifestations. The responses are summed to determine probable scores stretching from 0 to 114, with higher scores representing anxiety severity. A total score of 36 and above is classified as elevated level of anxiety. Reliability for the present study was established by test–retest method (α = 0.92) and split-half method (r = 0.88)
- CES-DC: This scale was developed initially by Laurie Radloff (1977) and is a modified version of the Center for Epidemiologic Studies Depression Scale containing 20-item. Each answer to an item is scored as follows: 0= "Not at all", 1= "A little", 2="Some", 3= "A lot." The items 4, 8, 12, and 16 are formulated positively and scored in the opposite manner. The scores are ranging from 0 to 20 and higher scores indicate severity of depression. The cutoff score of 15 suggests depressive symptoms in children. Reliability for the present study was established by test–retest method (α = 0.93) and split-half method (r = 0.84)
- Rosenberg Self-Esteem Scale: This scale was developed by Dr. Morris Rosenberg (1965) and contains 10-item. The items are answered using a 4-point Likert scale comprising strongly agree (4), agree (3), disagree (2), and strongly disagree (1), and items 2, 5, 6, 8, and 9 are reverse scored. A total score <20 indicates low self-esteem; 20–30 indicates moderate self-esteem; and above 30 indicates high self-esteem. Reliability for the present study was established by test–retest method (α = 0.91) and split-half method (r = 0.81).
The screening tools are as follows:
- COAs screening test (modified): The scale is a subsample of items appearing on the COAs Screening Test, developed by Jones and Pilat, and has been used to screen for COAs. Three or more yes answers indicate COAs
- Pediatric Symptom Checklist: Youth Report (Y-PSC): The Y-PSC consists of 35 items that are rated as "Never (0)," "Sometimes (1)," or "Often (2)" present. The score ranges from 0 to 70. The cutoff score of 30 or higher indicates impairment in psychosocial functioning. All the scales are used in the Indian context and validated by subject experts.
The study protocol was approved from the institution ethical committee. Formal permission was obtained from concerned area Block Education Officer, Head Master, and informed consent was obtained from children and their parents.
Data were analyzed using Statistical Package for the Social Sciences software package ( IBM SPSS 23 version International Business Machines Corporation, New York, US), and the results were presented in table form. Descriptive statistics were used for anxiety, depression, and self-esteem scores. Independent "t" test was used for comparison of means between two groups. Chi-square was used for comparison of demographic data.
| Results|| |
There is no significant difference in demographic characteristics between boys and girls' COAparents, except occupation of mother [Table 1]. Even in the outcome variables, there is no significant difference in mean scores of anxiety, depression, self-esteem, separation anxiety, social phobia, obsessive–compulsive problems, and physical injury between boys and girls COAs. However, the mean scores of generalized anxiety are high in boys compared to girls COA [Table 2] and [Figure 1].
|Figure 1: Comparison of anxiety, depression, and self-esteem between male children of alcoholics and female children of alcoholics|
Click here to view
|Table 1: Comparison of demographic characteristics between male children of alcoholics and female children of alcoholics|
Click here to view
|Table 2: Comparison of anxiety, depression, and self-esteem between male children of alcoholics and female children of alcoholics|
Click here to view
The Chi-square was calculated to find out the association between sociodemographic variables with anxiety, depression, and self-esteem scores at baseline. There was no significant association found between anxiety and selected demographic variables, except occupation of father. There is significant association between anxiety with occupation of father (P < 0.05). Higher rate of anxiety was found in children whose father working in government or private job compared to other categories (P = 0.025) [Table 3]. There were no significant associations found between depression and self-esteem scores with selected sociodemographic variables. There was significant association found between self-esteem with parent who is consuming alcohol.
|Table 3: Association between sociodemographic characteristics with baseline anxiety scores (n=97+98=195)|
Click here to view
| Discussion|| |
Children who are deprived of the parental care and a secure family environment often become vulnerable to a host of psychological problems and psychiatric disorders. The effects of an alcohol use disorder are felt by the whole family. Alcohol use disorders negatively affect emotional and behavioral patterns from the inception of the family, resulting in poor outcomes for the children and adults. The previous studies had revealed that gender plays an important role in shaping behavior among children. Even parental alcoholism also has different effects based on children gender. The present study examined gender difference in anxiety, depression, and self-esteem among COAs. Our findings show that there is no difference in anxiety, depression, and self-esteem among COA between boys and girls. This finding was supported by the findings of Marie and Jennifer that found no difference in depressive symptoms and self-esteem among COAs between boys and girls. The study conducted by Sidhu et al. on impact of parental alcohol dependence on the development and behavior outcome of children shows that there is no significant difference in impact of parental alcoholism on behavioral problems among children. In addition, Fuller-Thomson et al. also found that mean scores of depression are almost equal in male and female COAs.
The empirical evidence suggests that self-esteem was the predictor of academic success, adjustment in life, coping abilities, and problem-solving skills among children. Parental alcoholism effects the development of self-esteem in growing children. The present study found that there is no significant difference in mean scores of self-esteem between male and female COAs. This finding was supported by Pisinger et al.'s study found that boys and girls with parental alcohol problems had same mean scores of self-esteems. Another study by Kim and Lee also found that there is no gender difference in self-esteem among COAs.
With regard to anxiety subscales, the study found no significant difference in separation anxiety, social phobia, obsessive–compulsive problems, and physical injury between boys and girls COAs. These findings were supported by the findings of Pajarn and Theeranate that there is no difference between the male and female children with regard to separation anxiety and obsession problems.
The study has provided preliminary evidence in the Indian context that school setting was ideal place for early screening for behavioral problems and appropriate group intervention can be initiated by healthcare members. The limitations of the study are that, as the data were self-reported, under-reporting or over-reporting of data may have taken place due to the stigma related to mental disorders. Data were not collected from private school, as it was not permitted.
| Conclusion|| |
The health of children is a reflection of the future. Good education is possible only when the child is in good health. With the world's largest youth population, India represents an inspiring demographic dividend that can have lasting impact on the social and economic development of the country. Therefore, early identification of emotional and behavioral problems among COAs can prevent complications in later stage. The study concludes that there is no gender difference in anxiety, depression, and self-esteem among COAs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Jogdand SS, Naik J. Study of family factors in association with behavior problems amongst children of 6-18 years age group. Int J Appl Basic Med Res 2014;4:86-9.
Waldron M, Martin NG, Heath AC. Parental alcoholism and offspring behavior problems: Findings in Australian children of twins. Twin Res Hum Genet 2009;12:433-40.
Omkarappa DB, Rentala S. Anxiety, depression, self-esteem among children of alcoholic and nonalcoholic parents. J Family Med Prim Care 2019;8:604-9.
] [Full text]
Park S, Schepp KG. A systematic review of research on children of alcoholics: Their inherent resilience and vulnerability. J Child Fam Stud 2014;24:1222-31.
Thapa S, Selya AS, Jonk Y. Time-varying effects of parental alcoholism on depression. Prev Chronic Dis 2017;14:E136.
Pagano ME, Rende R, Rodriguez BF, Hargraves EL, Moskowitz AT, Keller MB. Impact of parental history of substance use disorders on the clinical course of anxiety disorders. Subst Abuse Treat Prev Policy 2007;2:13.
Choi DH, Kim JS, Jung JG, Ryou YI, Kim YS, Uh WC. The role of paternal drinking problems in the psychological characteristics of high school students. Korean J Fam Med 2013;34:377-84.
Omkarappa DB, Rentala S. Anxiety, depression, self-esteem among children of alcoholic and non-alcoholic parents. J Family Med Prim Care 2019;8:604-09.
] [Full text]
Haverfield MC, Theiss JA. Parent's alcoholism severity and family topic avoidance about alcohol as predictors of perceived stigma among adult children of alcoholics: Implications for emotional and psychological resilience. Health Commun 2016;31:606-16.
Lander L, Howsare J, Byrne M. The impact of substance use disorders on families and children: From theory to practice. Soc Work Public Health 2013;28:194-205.
Sidhu J, Dutta E, Naphade NM, Shetty JV. The impact of parental alcohol dependence on the development and behavior outcome of children in a tertiary care hospital. Med J DY PatilUniv 2016;9:17-22.
Fuller-Thomson E, B Katz R, T Phan V, P M Liddycoat J, Brennenstuhl S. The long arm of parental addictions: The association with adult children's depression in a population-based study. Psychiatry Res 2013;210:95-101.
Pisinger VS, Bloomfield K, Tolstrup JS. Perceived parental alcohol problems, internalizing problems and impaired parent-child relationships among 71988 young people in Denmark. Addiction 2016;111:1966-74.
Kim HK, Lee MH. Factors influencing resilience of adult children of alcoholics among college students. J Korean Acad Nurs 2011;41:642-51.
Pajarn P, Theeranate C. Impact of parental alcohol consumption on emotional and behavioral problems in children age 3-4 years. J Med Assoc Thai 2012;95 Suppl 5:S6-11.
[Table 1], [Table 2], [Table 3]