Lupine Publishers | Effectiveness of Group Support in Alleviating Anxiety, Depression, Stress Among Amputees in Gaza Strip

 Lupine Publishers | Scholarly Journal Of Psychology And Behavioral Sciences

Abstract

Background: According to Ministry of Health since the beginning of the great marches return (GMR) in March 2018, the number of injured people 35.703, who had amputated limbs was 157 The amputees may experiences body images disturbances, stress, depression, and anxiety, Many reviews and studies done to define the psychological burden of amputations, Social supports received by different amputees is vital in structuring effective treatment plan as a holistic approach in treating these physically disabled patients.

Aim: the objective of current study is to examine the efficacy of peer support group in alleviating the emotions state of Depression, Anxiety and stress among amputees in Gaza strip.

Method: Using semi-experimental (pre, post and follow-up) design, 60 Amputees after assessment using DASS , assigned to Peer Group Support (PGS). and its effect measured on the dependent variable, Emotional state of Depression, Anxiety and Stress. Result: The prevalence of depression in the amputee is estimated to be (%59), anxiety is (59.6%), and stress is (%65.5), The mean score of the patients’ depression, stress and anxiety before intervention was 1.8424 after the intervention of the peers group support in the post test measurements was reduced to 0.8668 compared to that of pretest measurements which is significant in value of (p<0.05).

Conclusion: The results of this study showed that utilizing the peer group support is effective for alleviating the emotional state of depression, stress and anxiety among patients with amputation.

Keywords: Depression; anxiety; stress; peer group support; DASS

Introduction

Most of human being are born as complete whole, mind and body is connected. Unfortunately, this system is sometimes disintegrated by disease or unfortunate accidents. An amputation is a significant loss and can cause many lifestyle changes. Whether the limb is removed as a result of trauma or disease, patients experience a change in their wellbeing, mobility and ability to perform activities of daily living like dressing, toileting and bathing. Amputation is defined as-the surgical or spontaneous partial or complete removal of a limb or projecting body part covered by skin and is one of the most common acquired disabilities [1-4]. In Gaza strip during the last Thirty years ago approximately 1543 were living with amputations through the wars launched by the occupation on the Gaza Strip, and after the start of the Great Marches Return (GMR), which left 157 cases of amputations [5,6], whether it is upper or lower, Individuals with amputations comprise a diverse clinical population, with significant heterogeneity observed in the level, cause, gender, and age distribution of this condition, as well as the degree of disability experienced, both physical and psychosocial [7], The researcher during work with the amputation as supervisor of Psychosocial support unit in community mental health directorate note a various types of psychological complications among the patient who had amputation.

The amputees may experience body images disturbances, anxiety, depression, and post-traumatic stress disorder (PTSD). Many reviews and studies done to define the prevalence of such problems, especially on depression [8]. Unresolved adjustment problems are long-term issues following limb amputation and it may progress into depression if it is not treated adequately [5], The prevalence of depression in the amputee and the general population is estimated to be 28% and 3.6-10.6%, respectively [9-15], Risk factors for depression among amputees include higher levels of pain as well as anxiety. Pedras reported up to 64% amputees experienced anxiety symptoms following the amputation. When depression is accompanied by anxiety disorders, such as post-traumatic stress disorder (PTSD), higher levels of symptomatic distress and higher rates of suicidal behavior are reported [16,4]. This drew the attention of researchers to study some variables on these individuals and try to find a competent therapeutic models fit for Palestinian culture and overcome the challenges of staff shortage, The study used the quasi-experimental approach, and the quasi-experimental approach is related to doing Practical experiments, which are defined an evidence-based measures, are prepared by researchers and linked to the circumstances surrounding specific phenomena, helping to draw some conclusions from the relationships between the variables that affect phenomena [17-19]. The importance of the study is in the aspect that the study deals with, as this aspect carries great importance in both scientific and practical terms, current study aimed to examine the effectiveness of peer support groups on alleviating the emotions state of depression, anxiety and stress among amputees in the Gaza Strip.

Methodology

Study population

The study population includes all Amputees enrolled in Healing the wound program in mental health directorate in Gaza governorate; Figure 1 shows the distribution and percentage of the amputees according to Age.

Figure 1: The Distributions of participants according to age.

Sample

The sample consisted of (60) Amputees, the sample assigned to Peer Group Support (PGS), in the cycle three 2018 of the Healing the wound program, All of them assigned to Peer Group Support.

Questionnaire design and PGS protocol

After reviewing the literature and after interviewing experts who were dealing with similar subject at different levels, all the information that could help in achieving the study objectives were collected, reviewed and formalized to be suitable for this study. After many stages of brain storming, consulting, amending, and reviewing executed by the researchers, DASS scales was adopted to assess the emotional state of depression anxiety and stress, and Protocol of PGS and Socio- demographic questioner were developed.

Results and Discussion

Figure 1 shows. The Distributions of participants according to age, as the age ratio “15-25” equals 30%. The largest percentage was between the ages of “26-35” years, and the lowest percentage was more than “35 years” equal to 11.7%. A paired sample t test was used to detect the differences between the mean scores of the semi-experimental group on (the pre and posttest) and (post and follow up test) on the overall degree of feelings related to (anxiety, depression, and psychological stress) at a level of significance equal to p <0.05 after applying the program. Table 1 illustrates that the level of significance in a measure of feelings related to (anxiety, depression, and stress) in the pre and posttest is less than 0.05, and the results showed that the t value is greater than the critical value of 2, so there are statistically significant differences in the pre and posttest for anxiety, stress, and depression at the level of significance p <0.05 where the value of the statistical significance in all scales equals 0.000 less than 0.05, this result reflect the effectiveness of program in alleviating the emotional state of depression, anxiety and stress, also regarding the level of significance in a measure of feelings related to (anxiety, depression, and psychological stress) in the post-test and follow up test is less than 0.05, and the results showed that the t value is greater than critical value which is equal to 2, That is, there are statistically significant differences in the post-test and follow up test of emotional state of anxiety, stress, and depression at the level of significance p <0.05 where the value of the statistical significance in all scales equals 0.000 less than 0.05, which means, there is a statistical indication that the effectiveness of the program is reduced in alleviating feelings of anxiety, stress and depression in the long run from the implementation of the program.

Compared with the past qualitative research, the current study supported the positive findings regarding the use of peer support with amputation. Recurring themes of decreased loneliness and increased emotional support were previously reported as benefits of peer support which is supported by the findings of the current study, that the emotional state of ( depression, anxiety and stress) was 61.4% in pretest and become 28.8 % (Table 1) this indicates. That is, there are statistically significant differences in the pre and posttest in a measure of feelings related to (anxiety, depression, and stress)., The important role of increased social support in post amputation rehabilitation was commonly identified and was also reported in the current study. Whilst social support increased following participation in a peer support program, it was also an important mediating effect on reduced psychological distress [20]. Previous qualitative research and the findings from the present study suggest that there is an important relationship between peer support, and emotional state of amputees, this result reflect the effectiveness of Peer Group Support in alleviating the emotional state of depression, anxiety and stress, However processes associated with attending the Peer Group Support (as measured by follow up test) The results of the comparison between the posttest and the follow-up test show that the measurement of feelings related to depression, anxiety and stress increased slightly on the follow-up test, but compared to the pre-test we can say that the effectiveness of the program is still ongoing and this rise expresses the need for social support on an ongoing basis [21], which participants found in peer support groups and this is evidence that Peer Group Support are effective in address these feelings. This finding may suggest that the personal benefits obtained, which also indicated by the verbal feedback that the researcher receive it from participant, and the social relationships formed during the group may have continued (and developed) after the intervention ended, And the best evidence for this is that a group of people with amputation who participated in these groups have formed a club of their own in order to continue to provide support to each other. This represents one of the most prominent success stories that this program has achieved. This finding indicates that facilitating Peer Group Support (PGS) may have beneficial implications for amputees [22-27].

Conclusion

Current study showed that the clinician should pay more attention to detect early symptoms psychological distress. also the findings suggest that there are many factors are associated with psychological co morbidity, Compared with the past qualitative research identified in the review, the current study supported the positive findings regarding the use of peer support with amputation [28,29]. Recurring themes of decreased loneliness and increased emotional support were previously reported as benefits of peer support which is supported by the findings of the current study, that the emotional state of ( depression, anxiety and stress) was 61.4% in pretest and become 22.8 % (Table 1), this result reflect the effectiveness of Peer Group Support in alleviating the emotional state of depression, anxiety and stress.

Table 1: Test results illustrate the mean differences in feelings related to (anxiety, depression, and stress) in the quasi-experimental group in the pre and posttest.

Recommendations

Practical implications

The findings from this study suggest that peer group support program may be an effective intervention for improving the psychosocial wellbeing of Amputees. These findings have implications for service-users, clinicians, guidelines and organizations.

Further study

a) Randomize control trial to support the efficacy of Peer Group Support and to compare the result with other type of intervention [6].

b) study to determine the psychological burden of amputations among general amputees population

c) long term study to understand the dynamic of social support and its relation to reengage the amputees in the society.

d) Run study include female with amputation to have more representative result.

e) study the personal treat which may play role in amputees reengagement.

 

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Lupine Publishers | Suicide Attitude and Its Relevant Factors Among Undergraduates

 Lupine Publishers | Scholarly Journal Of Psychology And Behavioral Sciences

Introduction

Suicide is a global public mental health problem, the second cause of death for people aged 15-29 in the world [1], and the first cause of abnormal death for college students in China [2]. The detection rate of suicidal ideation of college students in China is 7.1-41.1% [3,4], and that of attempted suicide is 1.7-4.23% [5- 7], which is 2-4 times that of the general population [8,9], and it is increasing year by year [10]. Suicide attitude is people’s view of suicide phenomenon, which has the characteristics of difference and stability [11]. Suicide attitude has a strong cultural dependence.

Therefore, suicide attitude is also diverse

The most representative views are:

a) suicide is a criminal act.
b) suicide is immoral.
c) suicide is a manifestation of psychosis; and
d) suicide is personal freedom [11,12].

Suicide attitude has an important influence on the suicidal ideation and behavior of oneself or others. Those who hold a negative attitude towards suicide, think that suicide can’t change others and can’t help solving the problem are less likely to commit suicide than those who hold a tolerant attitude towards suicide and think that suicide can change others and help solve the problem [12].

Suicide again is largely caused by others’ discrimination and hostile attitude [13,14]. The hostile attitude of medical staff towards suicide will make those who intend to commit suicide or attempted suicide have mental impedance and hinder treatment. If medical staff pay too much attention to, care about or praise suicide, it may strengthen the suicide idea and behavior of the litigants [15- 17]. In fact, the influence of social attitude on individual suicide behavior is multi axis and multi-faceted. For example, if the society holds a negative and forbidden attitude towards suicide, even considers suicide a crime, and holds an exclusive attitude towards the family members of suicides, it may have a certain restrictive

effect on those who have suicidal thoughts in deciding whether to take action. At the same time, prejudice and discrimination may make the attempted suicide commit suicide again. Suicide attitude is influenced by demographic factors, family factors, personality characteristics, stressful life events and other factors [4,7-9,11,13,17-18]. However, most of the previous studies can only prove that suicide attitude is related to some factors but can neither prove the role of these factors nor explain the relationship between different factors. Because most of the above studies use one-way ANOVA or bivariate simple correlation analysis. Based on the above analysis, this study intends to explore the current situation and major influencing factors of college students’ suicide attitude with a large sample multicenter epidemiological survey model and multiple linear regression analysis.

Subjects and Methods

Objects

Sample Size Estimation

The minimum sample size is calculated by G* Power 3 [19]. As the detection rate of suicidal ideation among domestic college students is 7.1-41.1% [3,7], and the test effect value is at medium level [3,7], that is, d value is 0.50-0.80 [20]. In this study, we set the effect value d = 0.70, the statistical test power 1 - β = 0.80, the type I error probability α = 0.05, and the minimum sample size for the survey is calculated as 786. The minimum sample size is determined as 897 due to a 20% of possible follow-up loss rate.

Sampling

A total of 1000 undergraduates are selected by stratified random sampling from 7 full-time colleges including Guangzhou University, South China Agricultural University, Guangdong University of technology, Guangdong Medical University, Guangzhou Academy of fine arts, Guangzhou Institute of physical education and Zhuhai School of Beijing Technology Institute as the survey objects. The average score of the final evaluation of the research Objects in the last semester is taken as the reference of academic performance, and the top 27% is the excellent group, the last 27% is the poor group, and the middle is the medium group. 935 valid questionnaires were collected, with an effective rate of 93.5%. Among them, there are 464 boys and 471 girls; 351 from countries, 306 from towns and 278 from cities; 184 freshmen, 193 sophomores, 195 juniors, 191 seniors and 172 fifth year students; 241 excellent academicians, 475 middle academicians and 219 poor academicians; 434 have ever had part-time job and 501 have never had part-time job.

Tools

Suicide attitude questionnaire, QSA

It is compiled [21]. There are 29 questions, divided into four dimensions: “attitude to suicidal behavior (its nature) ”, “attitude to suicides (including those who died and attempted suicide) ”, “attitude to the families of suicides” and “attitude to euthanasia”. The Liketer 5-points scoring method is used to score from 1 to 5 points corresponding to“not at all” to “completely yes”. If the total average score or some dimension average score of the scale is less than or equal to 2.5, the object would be considered hold a positive, approval, understanding and tolerant attitude towards suicide (or the dimension content); if the total average score or some dimension average score of the scale is more than 2.5 and less than 3.5, the object would be considered hold a contradictory or neutral attitude towards suicide (or the dimension content); if the total average score or some dimension average score of the scale is more than or equal to 3.5, the object would be considered hold an attitude of opposition, negation, exclusion and discrimination towards suicide (or the dimension content). In this study, the Cronbach's a coefficient of the total scale is 0.875, and the Cronbach's a coefficient of each dimension is 0.787-0.831.

Psychological capital scale for college students, PCSCS

Compiled [22], PCSCS has 45 questions, divided into six dimensions: hope, self-confidence, cooperation, optimism, resilience and gratitude. The liketer 7-points scoring method is used to score from 1 to 7 points corresponding to “completely non-compliant” to “completely compliant”. The higher the total score, the higher the psychological capital. In this study, the Cronbach's a coefficient of the total scale is 0.835, and the Cronbach's a coefficient of each dimension is 0.677-0.804.

General well-being schedule, GWB

It was compiled by Fazio (1977) and revised by Duan Jianhua (1996) into Chinese version [27]. There are 18 items, which are divided into six factors: satisfaction and interest in life, worry about health, energy, melancholy or happy, control of emotion and behavior, relaxation and tension. The higher the score, the higher the happiness. In this study, the Cronbach's a coefficient of the total scale is 0.914, and the Cronbach's a coefficient of each dimension is 0.803-0.864.

Self-compiled questionnaire for general information and living conditions of college students

The CNKI, Wanfang database, VIP database, Baidu, Pubmed and other search engines were used to search the literatures about suicide and suicides among undergraduates (4538 in Chinese and 64410 in foreign). Based on that, the basic contents of the questionnaire were constructed, with a total of 14 items. Combined with the results of 3 collective discussions with 10 representatives of undergraduates and 5 experts in the field of higher education, 3 items were deleted, and 2 items were added. The final questionnaire for general information and living condition of college students consists of 13 items, including gender, grade, school category, major category, academic performance, part-time job, family economic status, place of origin, only child or not, father's education level, mother's education level, father's occupation, mother's occupation, etc.

Results

Descriptive statistics of the total score and factor scores of each scale

It can be seen from Table 1 that the total scores of CSPCS and GWB of college students are (179.98±8.23) and (79.55±5.71), respectively, which are higher than the norm [22,23]. The score of "attitude to suicidal behavior " in QSA was lower than 2.5, the total score of QSA and the other three dimensions were higher than 2.5 but lower than 3.5.

Table 1: Descriptive statistics of the scores of each scale (n=935).

Suicide attitude of college students

On the attitude to the phenomenon of suicide, 24 students hold the attitude of affirmation, recognition, understanding and tolerance, 417 students hold the attitude of contradiction and neutrality, 494 students hold the attitude of opposition, negation, exclusion, and discrimination. On the attitude to suicidal behavior, students people hold the attitude of affirmation, recognition, understanding and tolerance, 638 students hold the attitude of contradiction and neutrality, and one student holds the attitude of opposition, negation, exclusion, and discrimination. On the attitude to suicides, 11 students hold the attitude of affirmation, recognition, understanding and tolerance, 730 students hold the attitude of contradiction and neutrality, 194 students hold the attitude of opposition, negation, exclusion, and discrimination. On the attitude to families of suicides, 89 students hold the attitude of affirmation, recognition, understanding and tolerance, 805 students hold the attitude of contradiction and neutrality, 41 students hold the attitude of opposition, negation, exclusion, and discrimination. On the attitude to euthanasia, 173 students hold the attitude of affirmation, recognition, understanding and tolerance, 705 students hold the attitude of contradiction and neutrality, 57 students hold the attitude of opposition, negation, exclusion, and discrimination.

Multiple stepwise linear regression analysis of factors related to the attitude towards suicide among undergraduates

Variable assignment

First, values are assigned to the possible situations (alternative answers) of demographic and psychosocial classification variables that may affect the total score of QSA, and the results are shown in Table 2.

Table 2: Aariable Assignment.

Multiple stepwise linear regression analysis of factors related to suicide attitude among undergraduates

Taking the total score of QSA and the scores of its four dimensions as dependent variables, respectively, the 6 dimensions of PCSCS, 6 dimensions of GWB and 13 factors that may be related to the total score of QSA (including demographic variables and psychosocial factors) as independent variables, the multiple stepwise linear regression analysis was carried out within 95% confidence interval. From Table 3, it can be found that major category, academic performance, part-time job, mother's occupation, control of emotion and behavior, melancholy and happiness, gratitude, worry about health and resilience, were positively correlated with the total score of QSA (β =. 104 ~. 759, all P < 0.05). Gender was negatively correlated with the total score of QSA(β =-.228, P < 0.05). Seven factors such as part time job, academic performance, gratitude, optimism, resilience, melancholy or happiness, control of emotion and behavior, were positively correlated with the score of attitude to suicidal behavior (β =.155 ~.707, all P < 0.001). Father's education level was negatively correlated with the score of attitude to suicidal behavior (β =-.161, P < 0.05). Six factors such as Major category, part-time job, gratitude, resilience, melancholy or happiness, control of emotion and behavior were positively correlated with the score of attitude to suicides (β=.159 ~.606, all P < 0.01). worry about health was negatively correlated with the score of attitude to suicides (β=-.244, P < 0.01). Part time job, gratitude, cooperation and mother's educational level were positively correlated with the score of attitude towards the families of suicides (β =.106 to.338, P < 0.05), while major category and gender were negatively correlated with the score of attitude towards the families of suicides (β = -.172, -.231; P < 0.01). Mother's occupation, academic performance, part-time job or not were positively correlated with the score of attitude to euthanasia (β=.197 to .285, all P < 0.05), while gender and worry about health were negatively correlated with the score of attitude to euthanasia (β = -. 301, -. 433; P < 0.01).

Table 3: multiple stepwise linear regression analysis of influencing factors related to the total score and scores of the four dimensions of SAQ.

Discussion

In the total score and four dimensions of QSA, more than 44.60% (417 / 935) of college students hold contradictory and neutral attitude, which is consistent with the results of previous literature [7,9,24-26], suggesting that the attitude of college students towards suicide is vague in general. College students lack sufficient cognition of the nature and harm of suicide phenomenon, and they still hope for the role of suicide (whether it can change the behavior of others, whether it can change the progress of the situation, and even solve problems, etc.). This may be due to the fact that college students are in the forming stage of values and world outlook, immature understanding of suicide and immature coping styles when they encounter setbacks. In addition, the popularity of Internet media in recent years and the frequent reports of star suicides make college students have a one-sided understanding of death and blindly imitate it [14]. Multiple stepwise linear regression showed that major category, part-time job, gratitude, mother’s occupation, academic performance, control of emotion and behavior, Melancholy or happy, worry about health and resilience were positively correlated with the total score of SAQ, while gender was negatively correlated with the total score of SAQ.

There is a positive correlation between major category and total score of QSA, which is reflected in the positive correlation between major category and attitude towards suicides and the negative correlation between major category and attitude towards families of suicides, which is consistent with the results of previous studies [7,24,27]. It is suggested that students of different majors have different opinions on the personality characteristics and the consequences of suicide. Compared with students of science and engineering, students of other majors more inclined to think that suicides are cowardly, incompetent, impulsive and irresponsible, so they are more opposed and rejected to suicides, and more sympathetic to the pain of their families. Gratitude is positively correlated with the total score of QSA, which is reflected in the positive correlation between gratitude and the attitude towards suicidal behavior and suicides, and the negative correlation between gratitude and the attitude towards suicides’ families, which is consistent with the results of previous research [28], suggesting that gratitude is helpful to improve college students’ sympathy and understanding for the families of suicides, and make them more inclined to oppose suicidal behaviors and suicides. The positive correlation between control of emotion and behavior and QSA total score is reflected in the positive correlation between control of emotion and behavior and attitude towards suicidal behavior and suicides, which is consistent with the previous research results [12,26,28], suggesting that college students with high ability of control of emotion and behavior are more inclined to think that suicide is an impulsive, irrational and irresponsible behavior, so suicides are not worthy of sympathy [29] and put forward the “stress susceptibility model” from the perspective of neurobiology, and found that different individuals have different responses to the same experience or encounter, which is closely related to the individual’s performance in face-to-face stimulation and how the quality factors interact with the environment. Selfcontrol is the key quality characteristic of interaction between individual and environment. Those with strong self-control ability are more difficult to be disturbed by life events, and they advocate and insist on calm response when encountering life events and solve problems reasonably (control environment).

Conclusion

Melancholy or happy is positively correlated with the total score of QSA, which is reflected in the positive correlation between Melancholy or happy and the attitude towards suicidal behavior and suicides, which is consistent with the results of previous research [30], suggesting that mood can affect attitude. Happy can make college students experience the fun and meaning of life, love and cherish life, and tend to oppose suicidal behavior and suicides; depressed is on the contrary. Resilience is positively correlated with the total score of QSA, which is reflected in the positive correlation between resilience and attitudes towards suicidal behavior and suicides, which is consistent with the results of previous research [28], suggesting that people with different levels of resilience have different evaluations on the nature of suicidal behavior and the quality of suicides. People with high resilience think that individuals can recover from setbacks with their own efforts, and suicide is to avoid problems, not to help solve problems, and suicides are cowardly and irresponsible, so they are against suicidal behavior and suicides. There is a positive correlation between part-time job and the total score of QSA, which is reflected in the positive correlation between part-time job and the scores of four dimensions: attitude to suicidal behavior, attitude to suicides, attitude to suicides’ families, and attitude to euthanasia, which is consistent with the results of previous research [27], suggesting that social practice experience can comprehensively affect the individual’s concept of phenomena related to suicide. Part time job exerts the ability of college students, makes them have a clearer goal and reasonable expectation for their future, have a more objective understanding of themselves, others and society, and have a firmer belief in life. They are more able to deal with life setbacks rationally and cherish life more [31]. Academic performance is positively correlated with the total score of QSA, which is reflected in the positive correlation between academic performance and the score of attitude towards suicidal behavior, and the negative correlation between academic performance and the score of attitude towards euthanasia, which is consistent with the results of previous studies [18,26], suggesting that those with high academic performance can treat life more rationally (not just cherish life). They prefer to face difficulties bravely, actively solve problems, and oppose suicide as a way to solve problems, but they prefer euthanasia as a way to solve end-stage pain.

There is a negative correlation between gender and the total score of QSA, which is reflected in the significant negative correlation between gender and the scores of attitude towards the families of suicides and the attitude towards euthanasia. Female students are more sympathetic to the families of suicides than male students, and more identify with euthanasia, which is consistent with the results of previous studies [7,18,26,27]. It is suggested that gender has a significant effect on suicide attitude. What are the reasons? Whether it is due to the effect of sex hormones [32] or the influence of parenting style [31,32] remains to be proved by follow-up studies. The positive correlation between the occupation of mother and QSA total score is reflected in the positive correlation between the occupation of mother and the score of attitude to euthanasia, which is consistent with the result of previous study [11], suggesting that as the main caregiver, the mother’s view of life and death has an important influence on the attitude of death of children. The reason may be that the mother’s occupation can affect her own attitude to death [8], and then influence the children’s death attitude (euthanasia attitude) through words and deeds. Worry about health is negatively correlated with the total score of SQA, which is reflected in the negative correlation between worry about health and the attitude towards suicides and euthanasia, which is consistent with the result of previous research [17], suggesting that worry about health c may reduce college students’ evaluation of the value of life and make them more inclined to sympathize with and tolerate suicide.

 

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Lupine Publishers | Children in Exploitative Transition: Interface of Child Trafficking, Domestic Workers and Sexual Exploitation, a Case for Uganda

 Lupine Publishers | Scholarly Journal Of Psychology And Behavioral Sciences

Introduction

Transition in life for young people is taking another trajectory from the known trends. Domestic workers (DW) especially girls working as a (maids) in households are less reported about their transition when they leave domestic work. Whereas many studies capture their experiences and clamor for decent and improved working and regulated conditions [1] there hasn’t been any follow up on their lives after domestic work to help enhance knowledge about their previous experience [2-4]. In Uganda alone, 2.3 million are affected by the child labor. It is common to see children working as maids and doing house help [5]. This type of work is spread both in rural and urban centers. Domestic work is, in fact, one of the most common forms of child employment [6]. The numbers giving estimate this problem of DW is still difficult to come and no single factor appears to explain the SEC phenomenon [7]. Girls in domestic work irrespective of any circumstance are vulnerable. The Modified social stress model [4] remind us that if there a many risk and fewer protective factors children will end up adopting high risk behaviors. Children are sometimes under the control of adults whose first concern is not their wellbeing, but their contribution to the happiness of the employer family. The fact that the vast majority of child domestic workers are girls means that vulnerabilities are compounded by gender considerations especially sexual pressures from men in the household [8,9]. The study was interested in exploring the interface of child domestic work and sexual exploitation in rural and urban Uganda.

Methods

The study was descriptive using a cross-sectional design. It was conducted in May and June 2019 to examine the social demographic characteristics, trafficking patterns of children in both formerly in domestic labor and sexually exploitative situations. The study examined a convenient sample of youth 14-24 years who were under rehabilitation in Uganda Youth Development Link (UYDEL) safe space in the rural setting. Setting and data Collection: The rural and urban UYDEL centers provide vocational training, reproductive health services and psycho-social counseling for disadvantaged children and young people. Study participants were recruited at UYDEL centers in the districts of Mubende, Mityana and Luwero. Over the two weeks of data collection period, a total of 270 young people was reached and only 250 consented to the survey. The study adopted largely a quantitative data collection guide. A structured questionnaire was designed with coded responses. The survey utilized ODK survey software and data was collected via tablets. The research assistants were trained on ethical issues. A pre-test exercise was conducted outside the study UYDEL centers. The study revealed that girls who had ever engaged in domestic work longer shared more, and a few did not want to share their past traumatic experiences. The study received approval by UYDEL IRB.

Results

Demographic distribution, family, educational and background of domestic workers. In terms of demographic distribution, majority of the 250 study participants (98.4%) were females and only 4 boys (2%) were males. All had a history of having worked as domestic workers and involved in transactional sex. Majority fell in the age bracket 15-18 years (49%) and those from 19 years above were (50%). The dominant religion were Catholics at (43%) followed Anglicans (20%), Pentecostals and Muslims at (16.4%) each. Interestingly, (60%) of participants had all both parents alive. Only (11%) were total orphans. We noted that slightly over (54%) were from polygamous families and (60%) of participants had dropped out of school at primary level (Table 1). Children from polygamous families are likely to be targeted for domestic work. The presentation of religion by DW was also a true representation of the religious national country picture.

 

Trafficking and Movements of Children to Domestic Work Destination

Understanding trafficking is important to establish how girls ended up in DDW. See Table 2:

Trafficking and Recruitment Half of the girls (50%) confessed to a movement likened to trafficking. The persons responsible for their trafficking were majorly friends, siblings, employer and stranger (42%) followed by parents/guardians. Friends, parents, and pimps also played a very active role in the recruitment to their destinations. Children mentioned that because places of work were distant most of them used varied transportation and urging DW that they will make more money (71%). A few were coerced. DW on arrival in homes are promised education (31%), good life (28%), and good working conditions (22%). Connection of domestic workers to homes and Age of entry It was revealed that (40%) were linked to homes by friends, another (32%) by guardians or parents, (11%) by pimps and another 16% by unknown others. Friends will normally go back and pick another girl in the same village to a home which is looking for a house girl. The study established that almost (78%) of the participants had one or more of her siblings recruited domestic work for pay. Majority of girls recruited entered DW at the age bracket 14-18 almost (70%); followed by 8-13 years (11.2%). See Table 3 below. It is presumed that girls above 14 years can ably do domestic work chores, submissive and interfere less in other home-related issues.

 

Reasons, Nature of domestic work and their experiences

The reasons given by participants for joining DW were to provide for my basic needs (49%) and take care of my family (22%). These two factors alone accounted for (71%) for the reasons to go to work. Another (22%) wanted to go work get money and go back to school. A small (8%) alleges that they are forced by parents to go work in homes as DW. DW are paid an average monthly emolument ranging from shillings 5,000 to 35,000{$9 USD} A dollar rate by June 2019 was 3,700 Uganda shilling to 1 $ dollar). Remittance of money home, Duration in homes and Types of homes The findings revealed that (74%) sent money home regularly between shillings 10,000-30,000 [8$ per month] via a mobile phone and only (7%) were saving. The average time spent working as domestic workers ranged between 1-2 years (81%). Another (16%) persists up to 3 years. It was revealed that 33% of participants had their money paid deducted by employers to pay traffickers using their first salary. Employers who engaged DW vary in their capacity in terms of room space, time and chores. Most homes had three bedrooms (65%) and another (28%) had two rooms a sitting and bedroom. Only (7%) had single rooms were sleeping together. It was revealed that (60%) worked in wall fenced homes. The study established (18%) had sexual relationship with their bosses. Of those who had sexual relationship was “consented’ and another was forced. Sexual relationship resulted in terminating their services, beaten and got pregnant.

Domestic work and transitioning into sexual exploitation and exposure to pornography Many DWs return home to face the same challenges of poverty and escalated vulnerability and have to fend for themselves. The quickest way is to engage in transactional sex with multiple partners. Most of our interviewees (86%) had viewed sexually explicit images and materials via phones followed by television (25%). Fewer materials are accessed through internet, video magazines, bars and lodges (Tables 4-6). Friends (mostly boyfriends and their clients) facilitate accessing sexually explicit images via online (72%). These are the biggest perpetrators.

 

 

Karaoke Groups and Child Sexual Exploitation

Findings showed that a small number had participated in Karaoke activities only (8%), dancing karaoke activities of nude dancing at night in bars; enticed by their friends, sibling and recruited by employers who were mostly men. Most of the training was coached by a peer in the same group. The study participants (58%) mentioned sleeping with clients on their own volition. Others were encouraged by the owner of the group and sleep with 1-2 clients in night and a few sleeps with 3-4 clients. Patrons and fellow peers also prayed on the girls. Participants indicated that there are many other karaoke groups in the area.

Problems Sexual Exploitation And In Karaoke Related Activities

The most sited problem was rape and sexual harassments (42%), followed by poor working condition (11%), no or less pay per show (11%) fights, unwanted pregnancy (11%) and dangers Use of drugs of abuse (5%). The (74%) had ever been arrested largely for moving late at night and fighting (21percent). Also (7.1%) each had been arrested because stealing a phone, idle and disorderly and engaging in commercial sex. Of the 19 girls, 5 had conceived and had children as a result.

Discussion

The study noted that DW appears to be phenomena that still exist and goes on unbated. Girls are the prime target as early as 14 years, out of school and those experiencing economic challenges in homes. Families with many children get rid of children in anticipation that the girls in DW will partially support the family economically. Other siblings are also surrendered to DW irrespective of their parental status. The traffickers who recruit children are normally given a reward or commission. There was a lot of variation in terms of pay not commensurate to the tasks the girls averaging 18 hours with no break. Children on average will work in 1-2 homes in the first two years and move to another home or return home. Wall fenced homes are reported to be recruiting and receiving more children, followed by homes with two rooms. Families living in a single room also employ child domestic workers. The giving pseudo names to DWs makes reaching them very difficult and inhuman mistreatment goes unnoticed and problems. We deduced that domestic workers face a myriad of problems and this leaves them traumatized. A small number end up in forced sexual relationship with their bosses and thus, end up being forced out of the homes, terminate their pregnancies, quit when mistreatment becomes unbearable and almost to human slavery (Miller, 2005). Suicide ideation and unattended mental health needs were also raised. The DW scenario in their homes agrees with the Modified social stress model indicating that if there are many risks the child’s life the girls are likely to engage in risky behavior. Conversely, the more protective factors that are present for girls to inoculate the stress, the less likely the DW to become involved in (Rhodes, et al 1990). Transactional sex, karaoke and use of substance behaviorwas a normalized behavior and, in the end, made the girls more vulnerable to other risks like pregnancy, violence and sexual abuse.

Implications of the Study

This study reveals that some families that are constrained economically will avail the children to anybody including traffickers hoping for a better life in future. Girls will be targeted as a tool for earning supplementary income in city and rural towns; will not work beyond two years, find another place to work or return home. Since the economic situation and other stressors didn’t change, DW become candidates for sexual exploitation and engage with multiple partners in high-risk sexual activities. Online sexual exploitation amongst DW was also an additional gate way to transactional sex. The option of returning DW girls to school is still possible either in mainstream schools or all impediments which will force girls out of school need to be minimized. There is a need to do more public social investments to address negative cultures like polygamy and children as source of money, family livelihood and more interventions that keep girls in schools, have viable empowerment and alternative incomes generating activities. Future studies need to explore the issues of boys as domestic workers as the information about this is still scanty.

 

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