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- Johansson Niemelä, Birgitta, 1948-, et al.
(author)
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A Clinical Report : Mental health, Self-esteem and Social Interaction in Adolescents with CL/P in the Context of Re-constructive Surgery
- 2011
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In: Depression and anxiety (Print). - 1091-4269 .- 1520-6394. ; 1:102
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Journal article (peer-reviewed)abstract
- Background:Self-esteem in children and adolescents with deviances in function and appearance has been studied with diverse results. The effect of cleft lip/ and palate on mental health, self-esteem and social interaction were studied in the context of reconstructive surgery. Comparing parents’ and children’s’ self-esteem reports was also of interest. Exploring these differences could help the understanding of future mental health in patients with CL/P and their need for reconstructive surgery. Methods:A descriptive study within an in-patient setting, Plastic Surgery Clinic, Uppsala University Hospital. Twenty-six CL/P patients between 13 and 19 years of age and their parents answered a specific condition questionnaire specially adapted for this study and Beck’s Youth Inventories the day before reconstructive surgery. Results:Mental health was affected while self-esteem was on a median-high level for this CL/P group. Parents rated their children to have higher self-esteem as they grew older. However, females reported a diminished level from primary to secondary school age. Attention on CLP was high. Twenty-three adolescents, or 85 % of resondents, wanted to change their appearance, Conclusion:Mental health was affected by CL/P, especially for those children that had been bullied. Specifically, the wish to change appearance was associated with high level of anxiety and depression. The specific condition questionnaires proved to be more informative than the standardized measure regarding self-esteem under development for the sake of differentiating between parent-adolescent estimation of self-esteem.
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| 2. |
- Johansson Niemelä, Birgitta, 1948-, et al.
(author)
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Mended But Not healed : Somatic and Mental Health 10 Years after Leg Lengthening with Ilixarov
- 2014
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In: Depression and anxiety (Print). - : OMICS Publishing Group. - 1091-4269 .- 1520-6394. ; 3:2
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Journal article (peer-reviewed)abstract
- Objective: To study the somatic and mental health in patients who had leg lengthening (LL) in a 10-year follow-up and to compare it with the 1 year-follow-up. Earlier studies have demonstrated severe maladaptive reactions in children and adolescents on a short term basis but also that they tolerate it without sustained psychological impact. Cohort sequential longitudinal studies, in which individuals from different age groups are followed over time, are needed to tease apart aging and cohort effects. Methods: This was a prospective study with 28 patients, mean age of 20, who had undergone leg lengthening (LL) between 1997-2005 at the Department of Pediatric Orthopedics, Uppsala University Hospital. The somatic health was studied by a structured medical assessment of the reconstructed leg and an interview focused on the patient’s experiences of surgery, outcome and function. The mental health was studied by Beck depression- and the State-Trait Anxiety Inventories and a specially designed questionnaire for patient with LLI. Results: When the patients rated their mental health, 20 were within a normal level and 7 had symptoms of depression. Patients’ self-esteem was on a median level. Those who had scored highly on the depression inventory also had high levels on both State- and Trait anxiety scale. Conclusion: One fourth of the patients reported themselves to be depressed at the 10-year follow-up, while 7% of the patients were depressed one year after LL. Self-esteem results for the cohort were on a median level, both one and ten years after LL. Interview data demonstrated that the majority of patients were preoccupied with their LLI and more psychological support during the lengthening period would have been desirable. From available data we cannot conclude that the leg lengthening per se caused the depressive symptoms in the patients.
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| 3. |
- Johansson Niemelä, Birgitta, 1948-
(author)
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Mental Health in Children Undergoing Reconstructive Surgery : Studies on Self-Esteem and Social Interaction
- 2008
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Doctoral thesis (other academic/artistic)abstract
- While the functional and anatomical aspects of reconstructive surgery in children with leg length inequality (LLI), prominent ears (PE) and cleft lip and palate (CLP) have been studied in detail, the psychological aspects of surgery have been less explored. The benefit of a changed appearance and function on self-esteem and ability to social interaction are other areas where information is lacking. The aim of this thesis is to examine, during the process of reconstructive surgery, the mental health, self-esteem and social interaction of children with defects in appearance and function.Children, aged 6-16 years, with LLI (n=27) and PE (n=31) were invited to participate in interviews and psychological assessments by filling in a battery of questionnaires and tests (depression; anxiety; self-esteem; cognitive ability; and behaviour) before Ilizarov and otoplasty surgery and one year after. Parents filled in a child symptom check list and a state and trait anxiety questionnaire. Another six adolescents with CLP and their parents participated in interactive interviews with the aim of identifying relevant psychological issues for individuals with this condition. These issues were subsequently used to create new questionnaires. Being different, the development of self-esteem and social interaction were the central themes of the questionnaires designed after the interview study. The new questionnaires were explored in a retrospective study on other adolescents (n=26) with CL/P and their parents. Beck’s Youth Inventories (BYI) was used as comparative data.The LLI group had significantly lower mental health and self-esteem scores than the control group before surgery. The leisure activity level in both patient groups was low according to parents’ report before surgery. The mental health scores of both patient groups (LLI and PE) were improved after reconstructive surgery, but self-esteem was not affected. The questionnaires for CL/P patients proved to be useful in the exploration of self-esteem from a developmental perspective and in the search for strengthening factors of social interaction. Self-esteem was average or high on group level for adolescents with CL/P compared to BYI measure. Parents rated their adolescents to have higher self-esteem than the adolescents themselves. Females had a less positive development of self-esteem, there was an interaction effect between the female and male patients’ evaluation of self-esteem by higher age. Even a minor appearance defect like PE may affect mental health negatively. There were no adverse psychological effects one year after surgery in LLI and PE patients, rather, there were signs of improved mental health. Adolescents with CL/P have an anticipated risk of more mental health problems and especially those individuals who have been bullied. Cleft teams and Child and Adolescent Psychiatric Clinics should be attentive and offer psychological support to those individuals most affected by their conditions.
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