Profile of Stress Factors Associated with Mental Disorders in Children and Adolescents Referred for Evaluation and Treatment to the Free State Psychiatric Complex, 2007

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Children and adolescents in southern Africa have to deal with serious challenges. Large families have been the norm, and children younger than 16 years of age constitute approximately half of the population. Furthermore, over the past four to five decades, children have been exposed to rapid and stressful changes in their environment. Children constantly experience the enormous impact of urbanisation, the break-up of the extended family, migration, industrialisation, racism, divorce and other forms of family disruption, crime, violence and political upheaval. (1)

Mental disorders can have far-reaching effects on the functioning and adjustment of young people. They confer an increased risk of illness and interpersonal and psychosocial difficulties in children and adolescents. (2) Almost any adult psychiatric condition can occur in this age group; for example, anxiety disorders and depression are very common. Substance abuse is increasingly being seen at younger ages. Other disorders in children and adolescents include somatoform and dissociating disorders, gender identity disorder, eating disorder, sleep disorder and intellectual disability. (1) Rossman et al. (3) reported that 13-50% of youth exposed to inter-parental violence qualify for diagnosis of post-traumatic stress disorder (PTSD). In another study on youth in foster care, Lubit (4) found that 42% of those who had suffered physical abuse experienced PTSD.

A wide variety of factors induce stress in children and adolescents. Some of them can be dealt with constructively by means of positive emotional responses and resilience acquired over time. (1) However, a negative response to these factors may result in a number of disorders affecting the endocrine, metabolic and autoimmune systems and may give rise to psychiatric symptoms. These factors also have an effect on the development and growth of the individual. Certain neurological functions may be affected as well and can result in addictive behaviour, fearful reactions and negative changes in the perception of pain. (2) Identification of these factors plays a crucial role in the early diagnosis and effective treatment of patients.

Children are dependent on their caretakers and learn from their relations and experiences in their environments; they are therefore extremely vulnerable to psychosocial and environmental problems. (1) Psychosocial factors are especially prone to elicit suicidal behaviour in adolescents. These include problems with regard to family matters, behaviour, social life and recent exposure to a suicide attempt. Family problems include parental absence, parental abuse and parental substance abuse, a family history of suicide, or conflict with parents. Impulsivity, explosiveness, attention deficit hyperactivity disorder, depression and bipolar disorder are all classified as behavioural problems. Social problems may include academic problems, conduct problems or disciplinary crises, humiliation or socio-economic problems. (5)

Factors that induce stress can be classified into 3 distinct groups, namely predisposing factors, modulating factors and precipitating factors. Predisposing factors are present from birth and include gender, age and race. Modulating factors include age, socioeconomic status, marital status and lifestyle. Precipitating factors are traumatic incidents resulting in major changes in the life of an individual, such as the death of a relative, retirement and divorce. (6)

In a study by Ostberg et al. (7) on the relationship between living conditions and psychosomatic complaints in Swedish schoolchildren, it has been found that girls are more likely than boys to present with headaches and recurrent abdominal pain (RAP) in response to stress. Somatic symptoms like these have repeatedly been shown to be associated with mental distress. Psychiatric disorders can therefore be linked to somatic pain syndromes, and pain and gender can be valuable identification markers for psychological problems. …