PSYCHOSOCIAL FACTORS PREDICTING PSYCHOLOGICAL HEALTH AND EFFICACY OF ACCEPTANCE AND COMMITMENT THERAPY AMONG MOTHERS OF CHILDREN WITH CEREBRAL PALSY IN LAGOS, NIGERIA

Abstract

Cerebral Palsy (CP) is a chronic condition defined as a set of functional limitations due to alterations in the development of central nervous system. Previous studies have shown evidence that caregiving may be a burden to the Psychological Health (PH) of mothers of children with CP. However, little attention is given to psychotherapeutic intervention in managing mothers caring for such children in Nigeria. This study, therefore, investigated the influence of psychosocial factors on psychological health and the efficacy of Acceptance and Commitment Therapy (ACT) among mothers of children with CP in Federal Psychiatric Hospital (FPH), Yaba, Lagos, Nigeria.

Biopsychosocial models and Cognitive Theory guided this study. The study utilized mixed sequential design which combined both qualitative and quantitative methods. Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs) provided qualitative data on psychosocial factors and PH among 20 mothers of CP children. A cross-sectional survey of 80 mothers of CP children purposively selected at Child clinic, FPH, Yaba was conducted. Questionnaires used included Child Behavioural Checklist (α=0.92); Socio-demographic characteristics; Caregivers’ Burden (α=0.86); Social Support (α=0.89); Sleep-quality (α= 0.78); Illness Severity (α=0.88); Parental Knowledge (α=0.67); Psychological Health (α=0.92) and Acceptance (α=0.81) Scales. Pretest-posttest quasi- experimental design was used to assign forty participants with low scores on PH into experimental (20) and control group (20). Treatment focused on establishing defusion, acceptance and increasing value direction goal. Qualitative data were content analysed, while multiple and logistic regressions, ANOVA, and t-test were computed at p 0.05.

Respondents’ mean age was 33.09±7.33 years, while 48.0% participants reported poor psychological health. Mothers of male CP children ( 40.7) expressed better PH than mothers of female CP children ( = 35.7) (F (1,75)=543.35). Mothers of children in young childhood stage ( = 41.9) expressed better PH compared to mothers of infants ( =38.2) and late childhood ( =26.6) (F(1,75)=561.72). Mothers of female children in late childhood stage expressed better PH than mothers of male children in late childhood (F(1,75)=709.91). Social support (t= 6.15) and caregivers' burden (t= -5.57) significantly predicted PH. Social support, caregivers' burden and sleep-quality significantly jointly predicted PH (R2=0.68, F (3,76 )=54.79). Mothers’ age (OR= 1.02, CI: 0.69-1.52) and occupation (OR=4.02, CI:1.16-13.91) predicted PH. Child behavioural problems had a significant influence on PH (t(78)= -2.47). The ACT had significant effect on PH (F(1,36)=7.94) after controlling for severity of illness. Participants in experimental group improved in their PH when compared with those in control group (t (38) = 3.20). Acceptance level of the mothers improved after intervention with a decrease in pretest mean score ( = 31.60) to posttest mean score ( = 24.10). Mothers expressed high caregiving burden, sleeplessness, distress, denial and depression; while their preferred support is financial.

High social support and low caregivers’ burden contributed to the maintenance of psychological health among mothers of children with cerebral palsy in Lagos, Nigeria. Acceptance and Commitment Therapy proved efficacious and therefore should be integrated into the management of psychological health.