Diagnostics of the Current Psychological Status of Children with

Chronic Somatic Diseases

Dilfuza Ilkhamova, Munisa Makhkamova, Jahongir Ortikboev, Laylo Makhkamova

and Mahsuma Nasimjanova

National University of Uzbekistan, Tashkent, Uzbekistan

Tashkent Medical Academy, Tashkent, Uzbekistan

Tashkent Pediatric Institute, Tashkent, Uzbekistan

Keywords

Children, Development, Chronic Somatic Diseases, Psychology, Self-Esteem, Anxiety, Parent-Child

Relationships, Psychosocial Determinants, Rehabilitation.

Abstract This article discusses the findings of a study on the psychological state and personal characteristics of children

with chronic somatic diseases. It is noted that neurasthenic syndrome is predominant among children with

various forms of chronic pathology. Additionally, alterations in self-esteem and psychological well-being of

children due to the impact of the disease were identified. The study emphasizes the significance of timely

psychodiagnostics and correction of psychological disorders to determine the therapy's effectiveness and

ensure successful social and psychological adaptation of afflicted children.

1 INTRODUCTION

In the world, ensuring the health of the population is

not only a social but also an important economic

problem in the context of economic growth. In this

area, special attention is paid to preserving physical,

psychological, and socio-spiritual health from

childhood. In 2013, at the 66th session of the United

Nations, a comprehensive action plan was approved,

which is based on the principle "without mental

health, there is no health at all." The insufficient

resolution of the problems of organizing the provision

of complex psychological assistance and

rehabilitation measures remains one of the urgent

tasks of practical medicine and psychological service.

In the world, based on the fact that chronic somatic

diseases take second place after diseases of the central

nervous system as a factor in mental and social

development delay, special attention is paid to

scientific research on the psychosocial determinants

of the rehabilitation of children with these diseases.

As part of the ongoing scientific research, priority is

given to scientific research in such areas as

identifying the role of psychological and socio-

Corresponding author

2 METHODS

Clinical conversation and observation for preschool

children include several methods, such as the "Balls"

method, which is used to study self-esteem, the

method developed by R. Temml, V. Dorki, and M.

Amen known as "Diagnosis of anxiety," as well as the

method of Rene-Gille referred to as "The kinetic

pattern of the family."

3 RESULTS AND DISCUSSION

At the initial stage of the study, a clinical conversation

was conducted with sick children and their parents.

During this conversation, various aspects were

explored, including the child's psychological history,

the attitude of both the children and their parents

towards the illness, the state of the psychological

climate within the family, the child's interpersonal

relationships, and any psychological complaints. The

results of the clinical interview revealed that the

primary psychological issue among children with

chronic somatic diseases in both age groups is

neurasthenic syndrome, which was observed in 88.5%

106

Ilkhamova, D., Makhkamova, M., Ortikboev, J., Makhkamova, L. and Nasimjanova, M.

Diagnostics of the Current Psychological Status of Children with Chronic Somatic Diseases.

DOI: 10.5220/0012478200003792

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 1st Pamir Transboundary Conference for Sustainable Societies (PAMIR 2023), pages 106-113

ISBN: 978-989-758-687-3

of patients. This syndrome manifested through

decreased mood (74.8%), fatigue (84.4%), reduced

performance (77.7%), sleep disturbances (68.4%), and

diminished appetite (62.9%). These symptoms were

even more pronounced in cases with severe disease

conditions. During the clinical conversation with

parents, primarily mothers, it was discovered that

59.4% of patients experienced an unfavourable family

climate, characterized by frequent quarrels between

adults, poor relationships between parents, and

instances of parental divorce. Additionally, 78.4% of

children reported issues in the interpersonal sphere,

with problems involving siblings (29.3%) or peers

(49.1%). 52.6% of mothers complained about their

child's aggressiveness, while 61.7% noted

hyperactivity and impulsivity, along with difficulties

in concentration and self-regulation. Furthermore,

22.8% of children were described as tearful, and

72.3% of mothers highlighted increased anxiety and

fear in their children. During discussions with parents

and the affected children, it became evident that

chronic pathology significantly complicates the social

interactions of these children. This was particularly

notable in the group of children with a holistic form of

viral hepatitis. Despite this form of hepatitis not being

contagious, parents of healthy children often fear

"infection" due to a lack of knowledge about the

disease's specifics. As a result, they restrict their

children from interacting with those affected, leading

to the isolation of children with a holistic form of

chronic hepatitis from society and the development of

an inferiority complex. It is widely known that a

child's health greatly influences the development of

their personality. Therefore, in the treatment and

psychological correction of negative aspects in the

personal development of sick children, it is crucial to

understand and consider the specific deviations related

to certain diseases. Our study on the personal

development of children included an examination of

their attitudes towards their health, as this aspect is

integral to a person's self-awareness. As per existing

literature and our own research, children with various

chronic diseases tend to develop a particular attitude

towards their illness. Thus, during the clinical

conversation, patients in both age groups were

presented with a self-assessment technique to

determine their awareness of their condition and their

own evaluation of the disease's impact on their

personal characteristics. According to the results of

the "Balls" method in the group of preschool children,

there was a significant decline in self-esteem in all

gradations compared to healthy children. Out of

62.2% of patients with chronic somatic diseases, the

majority rated themselves below the norm in terms of

their "health." When asked why they considered

themselves sick compared to their relatives and peers,

the children mentioned instances of headaches,

abdominal pain, and other limitations that they

experienced. Moreover, 32.8% of children also

perceived their mothers as being unwell due to fatigue,

frequent headaches, and rest periods. In terms of the

"happiness" scale, the concept of happiness in children

with chronic somatic diseases was often associated

with the satisfaction of material needs by their parents.

Children from more affluent families, regardless of

their health, perceived themselves as happier, while

those lacking parental love and attention exhibited

lower self-esteem. Evaluating themselves on the

"good-bad" scale, children were influenced by their

parents' opinions. Parents of the children in the main

group, acting as experts, noted changes in their child's

character and behavior after their illness, which

included hyperactivity, disobedience, stubbornness,

tearfulness, and a weak will. An analysis of the

children's self-assessment in terms of the impact of the

disease on other parameters, such as "happiness" and

"character," revealed that preschool-age children did

not yet associate their character traits and positive

emotions with their illness. Illness for children of this

age was more related to physical limitations, such as

following a restricted diet and avoiding strenuous

activities. In the second age group (8-12 years old), a

similar pattern was observed in the Dembo-

Rubinshtein self-assessment method. After illness,

61.6% of children reported changes in themselves,

leading to low self-esteem in areas such as "mind,"

"health," "happiness," and "character." The reduction

in self-esteem on the "mind" scale was linked to a

decline in intellectual abilities, attention, and memory.

Furthermore, the limitations imposed by the disease,

such as missing school, engaging in sports, and

socializing with peers, contributed to the lowered self-

esteem in the "health" and "happiness" scales.

A significant decrease in self-esteem was observed in

children aged 11-12 years, which corresponds to the

puberty stage. The "health," "happiness," and

"character" scales were particularly affected, with

scores being significantly lower compared to the

control group.

The study of self-esteem in children of primary school

age using the Dembo-Rubinshtein method before and

after illness indicated significant reductions in the

"health," "happiness," and "character" scales in

children with gastroduodenal pathology. (Table 1).

Diagnostics of the Current Psychological Status of Children with Chronic Somatic Diseases

107

Table 1: Self-esteem indicators in a group of children with gastroduodenal pathology using the Dembo-Rubinshtein method,

N=60.

Indicators

Self-esteem before illness

N=60

Self-esteem after illness

N=60

t-criteria

Intelli

ence

6,38

1,29

4,41

1,09

8,288

,000*

Health 8,16 1,25 4,41 0,90 21,184 ,000*

Happiness 8,03 1,18 5,09 0,84 16,400 ,000*

Character 7,74 1,26 5,76 0,60 12,224 ,000*

Note: * statistically significant differences are noted

Children reported that after the illness, their academic

performance declined as they found it challenging to

remember the materials they read. The need for twice-

yearly treatment in hospital conditions often caused

them to miss school, further affecting their academic

performance (Table 1). As observed from the table,

significant statistical differences exist in the self-

esteem indicators of children across the "mind"

(t=8.28; p<0.05), "health" (t=21.1; p<0.05),

"happiness" (t=16.40; p<0.05), and "character"

(t=12.22; p<0.05) scales. It can be concluded that

chronic pathology affects various aspects of a sick

child's personality. These changes in the personal

sphere are fully recognized by the children and

significantly influence the internal perception of their

illness.

In the group of children with chronic viral hepatitis,

there is also a significant decrease in self-esteem

across all scales. As seen in Table 2, there are

statistically significant differences in the "mind"

(t=4.9; p<0.05), "health" (t=13.68; p<0.05),

"happiness" (t=16.40; p<0.05), and "character"

(t=11.5; p<0.05) scales. Children in this group

mentioned that the disease hindered their

participation in sports and complained about memory

deterioration, lethargy, and apathy. When asked why

they rated themselves lower on the "happiness" scale

compared to their healthy peers, they pointed out that

they were deprived of many opportunities and began

to exhibit aggressiveness, irritability, and rudeness in

their character.

Table 2. Self-esteem indicators in a group of children diagnosed with chronic viral hepatitis using the Dembo-Rubinshtein

method, N=60.

Indicators

Self-esteem before illness

N=60

Self-esteem after illness

N=60

t-test

M σ M σ

Mind 6,1 1,53 4,81 1,05 4,902 ,000*

Health 7,14 0,91 4,55 1,06 13,685 ,000*

Happiness 7,41 1,19 4,21 1,28 12,739 ,000*

Character 7,81 1,23 5,3 0,86 11,563 ,000*

Note: * statistically significant differences are noted

If self-assessment studies were conducted before and

after the disease in other nosological groups, they

were carried out only once for children with

cardiovascular diseases. This was due to the early

diagnosis of cardiovascular diseases, and the children

were only able to report their current self-esteem.

Analysing the results of studying the self-esteem of

these children (Table 3), it was observed that the

"health" scale showed the greatest decrease. This is

expected since cardiovascular diseases significantly

affect the physical capabilities of the child, imposing

limitations. The children reported experiencing pain

in the region of the heart, frequent shortness of breath

during physical exertion, and fatigue. When rating

themselves according to the "happiness" scale, they

associated this concept with their health. Further

observations during the tests revealed that these

children exhibited characteristics that set them apart

from children with other diseases. They displayed

traits such as isolation, shyness, self-doubt, and a

strong dependence on their parents. However, if we

consider the indicators of the "character" scale, these

PAMIR 2023 - The First Pamir Transboundary Conference for Sustainable Societies- | PAMIR

108

children rated themselves relatively higher compared

to children from other nosological groups. This could

be attributed to the presence of hyperactivity in many

children with gastroduodenal pathology, as well as

complaints from their mothers regarding their

aggressiveness and irritability. In contrast, children

with cardiovascular diseases were more gentle,

compliant, and reserved, and perhaps they perceive

themselves as having a better character since they

avoid conflicts with others. Below is a comparison of

the results obtained by the Dembo-Rubinstein method

in children with cardiovascular diseases and healthy

children (Table 3). It is essential to note that this

category of children exhibits distinctive

psychological characteristics. They were born with

their diseases and have faced restrictions from an

early age due to their condition. Additionally, their

parents tend to be overprotective, considering them

"weak," "sick," "limited," and "vulnerable."

Naturally, the parental attitudes towards the child's

illness influence the child's perception of their

condition, self-esteem, and self-perception.

Тable 3: Self-esteem indicators in groups of children diagnosed with cardiovascular disease and healthy children using the

Dembo-Rubinshtein method, N=69.

Indicators

Cardiovascular

diseases=33

Healthy children

N=38

t-criteria

M σ M σ

Mind

6,09 1,04 6,58 1,31

-1,703 ,093

Health

4,03 1,02 8,0 0,99

-16,398 ,000*

Happiness

6,06 1,15 7,32 1,28

-4,230 ,000*

Character

6,42 0,67 8,26 0,76

-10,553 ,000*

As can be observed from the table, the self-esteem

indicators of children with cardiovascular diseases

significantly differ from those of healthy children

across the "health" (t=-16.39; p<0.05), "happiness"

(t=-4.2; p<0.05), and "character" (t=-10.5; p<0.05)

gradations. An examination of the self-esteem study

results in healthy children revealed that their self-

esteem in terms of "mind," "health," "happiness," and

"character" corresponds to normal indicators.

Children in this group associated their "happiness"

and "character" ratings more with socio-

psychological factors, such as relationships with

parents, the psychological atmosphere within the

family, and the attitudes of friends. The comparison

of the self-esteem study results among children with

chronic somatic diseases showed significant

differences in self-esteem across all gradations. After

illness, children with chronic pathology noted

changes in their character, such as increased

irritability, a preference for loneliness, and at times,

irascibility and aggressiveness. During conversations,

they repeatedly mentioned fears associated with

eating, anticipating pain in the epigastric region,

medical procedures, and frequent hospitalizations.

Some patients emphasized feelings of despondency

and decreased academic performance, expressing

embarrassment over frequent illnesses. It should be

noted that particularly low self-esteem in all

gradations was observed in severe forms of the

disease, which was prevalent among children with

chronic viral hepatitis leading to liver cirrhosis.

Consequently, it can be concluded that chronic

somatic diseases significantly alter the social

development situation of a child and affect the

formation of their personal characteristics, including

self-esteem and self-attitude. The more severe the

nature of the disease, the poorer the psychological

state of the affected child. Additionally, as the child

grows older, their awareness of the disease increases,

resulting in a clearer yet more complex internal

perception of the illness. The interview and self-

assessment methods revealed that children perceive

the disease not only sensually, in terms of painful

sensations, but also psychologically, as an obstacle

hindering their goals and as a limitation not only in

the physical realm but also in psychological and

social well-being. Correlation analysis of the results

of the Dembo-Rubinstein technique before illness in

children with gastroduodenal pathology

demonstrated a negative correlation between the

"health" and "mind" gradations (p<0.01) (Table 4).

Diagnostics of the Current Psychological Status of Children with Chronic Somatic Diseases

109

Тable 4: Correlation coefficients between indicators of self-assessment before the disease using the Dembo-Rubinshtein

method in the group of children with gastroduodenal pathology, N=60

Indicators Mind Health Happiness Character

Min

-,403** -,115 -,102

Health

-,403** ,238 ,100

Happiness

-,115 ,238 ,176

Character

-,102 ,100 ,176

Note:* - р <0,05 **- р <0,01

The correlation analysis of the results of the Dembo-

Rubinstein technique after illness in children with

chronic gastroduodenitis did not uncover any

significant correlations between the gradations

"mind," "health," "happiness," and "character" (Table

4).

Table 5 reveals that a correlation exists between the

gradations "happiness" and "character" (p<0.01) in

children with chronic viral hepatitis before the

disease.

Таble 5: Coefficients of correlations between indicators of self-assessment before the disease using the Dembo-Rubinshtein

method in the group of children with chronic viral hepatitis, N=60

Indicators Mind Health Happiness Character

Mind

,016 ,053 ,078

Health

,016 ,101 ,208

Happiness

,053 ,101 -,339**

Character

,078 ,208 -,339**

Note:* - р <0,05 **- р <0,01

The correlation analysis of self-esteem indicators in

children with chronic viral hepatitis after illness

indicated a relationship between the gradations

"mind" and "character" (p<0.05) (Table 6).

Таble 6: Correlation coefficients between indicators of self-esteem after illness using the Dembo-Rubinshtein method in the

group of children with chronic viral hepatitis, N=60

Indicators Mind Health Happiness Character

Mind

-,010 ,055 ,316*

Health

-,010 -,027 -,083

Happiness

,055 -,027 ,018

Character

,316* -,083 ,018

Note:* - р <0,05 **- р <0,01

In the group of children with cardiovascular diseases,

no correlations were found between the gradation

indicators. Analysing the results of the study of self-

esteem in healthy children revealed that their system

of self-esteem across the gradations "mind," "health,"

"happiness," and "character" corresponds to normal

indicators. Children in this group associated their

self-esteem ratings on the "happiness" and

"character" gradations more with socio-psychological

factors, such as relationships with parents, the

psychological climate within the family, and the

attitude of friends. Comparing the results of the study

of self-esteem in children with chronic somatic

diseases indicated statistically significant differences

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110

in self-esteem across all gradations (Figure 6). After

illness, children with chronic pathology reported

changes in their character, such as increased

irritability, a desire for loneliness, and occasional

irascibility and aggressiveness. During the

conversations, they repeatedly expressed fears related

to eating and expecting pain in the epigastric region,

medical procedures, and frequent hospitalizations.

Some patients emphasized feelings of disinterest,

decreased academic performance, and

embarrassment over frequent illnesses. The study

results of the psycho-emotional state of sick children

demonstrated that both preschool and primary school-

aged children exhibited high levels of anxiety.

According to the Temple-Amen-Dorkey

methodology for studying anxiety in children,

significant differences were observed in the

indicators of the psycho-emotional state between

groups of children with chronic viral hepatitis,

gastroduodenitis, and healthy children (Table 7).

Table 7. The results of the ANOVA comparison of the anxiety index using R. Tamml, M. Dorki, & V. Amen’s method

between healthy children and those diagnosed with gastroduodenitis and chronic viral hepatitis, N=57

Indicators

Gastroduodenitis N=19

Chronic viral hepatitis

N=19

Healthy

Children N=19

F Level of significance (р)

M σ M σ M σ

Anxiety 35,8 9,8 56,5 9,4 37,4 12,5 22,027 ,000*

Note: * statistically significant differences are noted

According to a qualitative analysis of the results from

the "House-tree-man" methodology, it was revealed

that 84.4% of primary school-age children with

chronic somatic diseases experience a high level of

anxiety and fear. Among children with a prolonged

illness (over 3 years), high levels of anxiety (93.3%)

and fear (80.0%) were particularly characteristic.

Notably, these symptoms became more pronounced

with a severe degree of the disease, and in the group

of children aged 11-12 years (puberty), feelings of

fear and anxiety were primarily associated with their

health condition (anxiety about the future, fear of

death, etc.). In the drawings of children in the control

group, elements of anxiety and fear were rarely

expressed and significantly differed from the

drawings of sick children (p<0.001). Through this

technique, we could also gather information about the

personal characteristics of patients. Sick children,

when compared with their healthy peers, significantly

differed in suspiciousness, irritability, and

helplessness (p<0.001). It is worth noting that the

majority of children with chronic somatic diseases

depicted a hospital or portrayed a sick person as being

at home, which confirms the deep psychological

impact of their illness.

Table 8. Differences in the indicators of the “House. Wood. Man" methodology as per the nosology, N=108

Indicators

Средний ранг

Kruskal-

Wallis test

Significance

level (p)

N=35 Chronic viral

hepatitis N=40

Cardio vascular

disease

N=21

liver

cirrhosis

N=12

Insecurity

34,63 72,00 44,95 70,83 34,034 ,000*

Anxiety

31,74 63,29 63,38 76,04 31,788 ,000*

Self-distrust

50,99 51,55 68,79 49,58 5,797 ,122

Feelings of

inferiorit

27,50 64,14 65,71 81,50 43,534 ,000*

Hostility

33,79 75,94 36,74 74,54 47,303 ,002*

Conflict

31,69 72,81 50,6 66,83 36,629 ,000*

Difficulties in

communication

33,79 57,11 73,88 72,29 30,376 ,018*

Depression

28,47 68,18 55,83 82,50 44,291 ,000*

Note: * statistically significant differences are noted

Diagnostics of the Current Psychological Status of Children with Chronic Somatic Diseases

111

As can be observed from the table, children with

chronic viral hepatitis experience feelings of

insecurity, high anxiety, aggressiveness, a tendency

to conflict, and a decrease in mood. The condition

further complicates when chronic viral hepatitis

progresses to liver cirrhosis. In comparison to

children from other nosological groups, patients with

cardiovascular diseases exhibit a high degree of

anxiety, an inferiority complex, and difficulties in

interacting with others (p<0.001).

The attitude of parents towards a child suffering from

a chronic disease is of great importance, as stated by

various experts (V.V. Nikolaeva, E.P. Kasatkina,

M.A. Zhukovsky). The study results on the parents'

attitude towards their child's illness revealed that

during the initial stage of the illness, parents often

show indifference. However, as the disease worsens

and the child requires hospitalization, parents may

panic and become overprotective, excessively

limiting the child's freedom and even trying to shield

them from their siblings. The parents' attitude towards

the child also depended on the family dynamics, the

number of children, and the child's financial situation.

One of the age-specific characteristics observed in

pubertal children (10-12 years old) is their desire to

assert independence and break free from parental

care. It was found that parents' efforts to restrict the

child's abilities and overprotectiveness, without

recognizing their independence, can lead to

interpersonal relationship issues between parents and

children. Children in this particular age group often

sought help from a psychologist, and their illness was

influenced by problems in interpersonal relationships,

which hindered disease remission. The PARI method

yielded the following results: [The specific results

from the PARI method should be inserted here].

Таble 9: Attitude indicators of the children’s parents using the PARY method (N=30)

Scales Average value min max Standard

deviation

Optimal emotional connection 10,17 6 16 2,7

Excessive emotional distance 16,43 12 19 1,9

Too much focus on the child 17,10 12 19 1,6

During the process of treatment, it was also

uncovered that parents impose excessive demands on

their children, which includes constant and strict

control over the child's diet, behaviour, and

acceptance of medical procedures. This situation, on

one hand, causes a sense of dissatisfaction in the

children, and on the other hand, in preschool-age

children, it leads to stubbornness, disobedience, and a

desire to defy their parents or display high levels of

infantilization.

4 CONCLUSION

Chronic somatic pathology significantly alters the

social development of preschool and primary school-

age children, impacting all aspects of their lives in a

negative manner. In preschool children, their

perception of the illness heavily relies on their

parents' understanding of the condition, often leading

to distorted views. As children grow older and enter

primary school, they begin to comprehend their

illness and assess its impact on their overall quality of

life. The psychological changes in a sick child depend

largely on the nature, severity, and duration of the

disease. More severe and prolonged illnesses have a

greater negative impact on the child's psychosocial

well-being. When implementing psycho-corrective

measures for these children, it is crucial to consider

the specific characteristics of their diseases. For

instance, art therapy, fairy tale therapy, and psycho-

gymnastics have proven to be effective in cases of

chronic viral hepatitis and cardiovascular diseases

among children. The use of fairy tale therapy, game

therapy, and psycho-gymnastics for children with

chronic gastroduodenitis has shown positive results in

alleviating the high levels of fear and anxiety

associated with the diseases and the treatment

process. For children with cerebral palsy, it is

essential to assess their sensory function, orienting-

cognitive reactions, and the development of

emotional connections with others to determine their

developmental opportunities. These children may

exhibit certain characteristics during communication,

such as low emotional responsiveness, lethargy, high

fatigue, and attention instability.

The main focus of rehabilitation for children with

chronic somatic diseases should consider their

attitude towards the illness, their relationships with

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parents and others, and the changes in their psycho-

emotional well-being while taking into account their

overall psychological status. Rehabilitation and

habilitation efforts aimed at these children should aim

to fully restore their participation in society, enhance

their quality of life, and facilitate their social and

psychological adaptation.

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