Musisi Seggane, Kinyanda Eugene, Nakasujja Noeline, Nakigudde Janet
Department of Psychiatry, Faculty of Medicine, Makerere University, Kampala.
Afr Health Sci. 2007 Dec;7(4):202-13.
This study investigated the emotional and behavioral problems of orphans in Rakai District, Uganda, and to suggest interventions. Studies, elsewhere, have shown orphans to have high levels of psychological problems. However, in Uganda such studies are limited and no specific interventions have been suggested.
The study employed a cross-sectional unmatched case control design to compare emotional and behavioral problems of 210 randomly selected primary school-going orphans and 210 non-orphans using quantitative and qualitative methods employing standardized questionnaires, Focus Group discussions and selected Key Informant interviews. All children were administered Rutter's Children's Teacher Administered Behavior Questionnaire to measure psychological distress and a modified version of Cooper's Self-Report Measure for Social Adjustment. Standardized psychiatric assessments were done on children scoring > 9 on the Rutter's Scale, using the WHO-ICD-10 diagnostic checklists.
Both orphans and non-orphans had high levels of psychological distress as measured using Rutter's questionnaire but with no significant statistical difference between the two groups (Rutter score > 9; 45.1% & 36.5% respectively; p= 0.10) and no major psychiatric disorders such as psychotic, major affective or organic mental syndromes. Psychological distress was associated with poor academic performance (p=0.00) in both groups. More orphans than non-orphans had more common emotional and behavioral problems, e.g., more orphans reported finding "life unfair and difficult" (p=0.03); 8.3% orphans compared to 5.1 % of the non-orphans reported having had past suicidal wishes (p=0.30) and more reported past "forced sex / abuse" (p=0.05). Lastly, the orphans' social functioning in the family rated significantly worse compared to the non-orphans (p= 0.05). Qualitatively, orphans, compared to non-orphans were described as "needy, sensitive, isolative with low confidence and self-esteem and who often lacked love, protection, identity, security, play, food and shelter." Most lived in big poor families with few resources, faced stigma and were frequently relocated. Community resources were inadequate.
In conclusion, more orphans compared to non-orphans exhibited common emotional and behavioral problems but no major psychiatric disorders. Orphans were more likely to be emotionally needy, insecure, poor, exploited, abused, or neglected. Most lived in poverty with elderly widowed female caretakers. They showed high resilience in coping. To comprehensively address these problems, we recommend setting up a National Policy and Support Services for Orphans and Other Vulnerable Children and their families, a National Child Protection Agency for all Children, Child Guidance Counselors in those schools with many orphans and lastly social skills training for all children.
本研究调查了乌干达拉凯区孤儿的情绪和行为问题，并提出干预建议。其他地方的研究表明，孤儿存在高水平的心理问题。然而，在乌干达，此类研究有限，且未提出具体的干预措施。
本研究采用横断面非匹配病例对照设计，使用标准化问卷、焦点小组讨论和选定的关键 informant 访谈等定量和定性方法，比较 210 名随机抽取的小学适龄孤儿和 210 名非孤儿的情绪和行为问题。所有儿童均接受了用于测量心理困扰的鲁特儿童教师管理行为问卷和库珀社会适应自我报告量表的修订版。对鲁特量表得分>9 的儿童，使用世界卫生组织 ICD - 10 诊断清单进行标准化精神病学评估。
使用鲁特问卷测量，孤儿和非孤儿的心理困扰水平都很高，但两组之间无显著统计学差异（鲁特得分>9；分别为 45.1%和 36.5%；p = 0.10），且没有诸如精神病、重度情感障碍或器质性精神综合征等主要精神疾病。两组中心理困扰均与学业成绩差相关（p = 0.00）。与非孤儿相比，更多孤儿存在更常见的情绪和行为问题，例如，更多孤儿表示觉得“生活不公平且艰难”（p = 0.03）；8.3%的孤儿报告曾有过自杀意愿，而非孤儿为 5.1%（p = 0.30），更多孤儿报告曾有过“强迫性行为/虐待”（p = 0.05）。最后，与非孤儿相比，孤儿在家庭中的社会功能评分显著更差（p = 0.05）。从定性角度看，与非孤儿相比，孤儿被描述为“贫困、敏感、孤僻，缺乏信心和自尊，经常缺少爱、保护、身份认同、安全感、玩耍、食物和住所”。大多数孤儿生活在资源匮乏的贫困大家庭中，面临耻辱，且经常搬迁。社区资源不足。
总之，与非孤儿相比，更多孤儿表现出常见的情绪和行为问题，但没有主要精神疾病。孤儿更有可能在情感上贫困、缺乏安全感、贫穷、被剥削虐待或被忽视。大多数孤儿与老年丧偶女性照料者生活在贫困中。他们在应对方面表现出很高的复原力。为全面解决这些问题，我们建议为孤儿及其他弱势儿童及其家庭制定国家政策和支持服务，为所有儿童设立国家儿童保护机构，在孤儿较多的学校配备儿童指导顾问，最后为所有儿童提供社交技能培训。
