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Journal of Integrated Sciences
Volume 3, Issue 1, December 2022
ISSN: 2806-4801
[98]
PREVALENCE OF ANXIETY AND DEPRESSION
AMONG ORPHANS AND NON-ORPHANS IN
NIGERIA:
A COMPARATIVE STUDY
Kafayat A. Azeez, Bela Khan
International Open University
ABSTRACT
Orphanhood is an arduous period, and orphans are more vulnerable
to emotional difficulties because they often lack secured parental
attachment and care that are crucial for healthy emotional
development. The current difficult socioeconomic conditions in
Nigeria also put children and adolescents living with their families
at risk for emotional problems. This study aimed to investigate the
prevalence of anxiety and depression among orphans and non-
orphans in Nigeria. The research sample consisted of 200
participants including 100 orphans and 100 non-orphans aged 8-
18 years (M= 13). The Revised Child Anxiety and Depression Scale-
25 (RCADS-25) was the tool used for data collection. The mean
score of the total sample was calculated. Independent-Samples
T\test was conducted to compare the means of orphans and non-
orphans. Pearson Product Moment Correlation was computed to
correlate total anxiety and total depression scores. The results
showed that there is low prevalence of anxiety and depression
among children and adolescents in Nigeria. Orphans had more
symptoms of both anxiety and depression, compared to non-
orphans. A moderate positive correlation (.570) was found between
levels of anxiety and depression, indicating that there is
comorbidity between both disorders. The research findings are
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Volume 3, Issue 1, December 2022
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discussed in the light of relevant research. Further research that
utilizes larger, nation-wide samples are recommended to extend
this research findings, and timely interventions should be
administered to children experiencing symptoms of depression and
anxiety.
Keywords: Anxiety, Depression, Orphans, Non-orphans.
Corresponding author: Kafayat A. Azeez can be contacted at
kafayat.a.azeez@gmail.com
Acknowledgement: My sincere appreciation goes to Dr
Francesca Bocca, former Head of Psychology Department at
the International Open University (IOU), for her guidance and
incredible support throughout the research journey. I am
greatly indebted to Bela Khan, Senior Lecturer at IOU, for her
supervisory role throughout the research process and reviewing
the research report. I also genuinely appreciate the participants,
their parents, schools, and institutions for selflessly allowing
this research to come to fruition by providing rich and honest
research data.
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Volume 3, Issue 1, December 2022
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1. INTRODUCTION
Childhood and adolescence are critical periods for an
individual’s overall development -- physical, biological,
cognitive, and psychosocial development (Dornan &
Woodhead, 2015); thus, an individual’s experiences in
childhood and adolescence have physical and mental health
consequences that do not only affect the childhood or
adolescence phase, but also the entire life-course of the person
(World Health Organization [WHO], 2014). Research has
demonstrated that internalizing disorders like anxiety and
depression are not only prevalent in adults, but also in children
and adolescents (Slemming et al., 2010). Certain groups of
children such as orphans, those abandoned by their families,
and those nurtured in institutional homes are even more at risk
of developing these psychological disorders than others,
because they often lack family’s love, care, and parental secured
attachment that are crucial for growing into emotionally stable
adults (Earls et al., 2008; Liu, 2006).
Anxiety is defined as an emotional state that is characterized by
persistent feelings of worry, terror, and tension. Individuals with
anxiety disorders usually experience recurring disturbing
thoughts, avoid perceived threatening situations and objects,
and may also have physiological symptoms such as dizziness,
sweating, restlessness, trembling, increased heartbeat etc.
Anxiety disorders are highly comorbid with one another and
with other psychological disorders, especially depression
(Penninx et al., 2021).
Depression is a common and serious mental disorder that is
characterized by persistent feelings of sadness, worthlessness
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or guilt, loss of interest, and inability to experience pleasure in
enjoyable or previously rewarding activities (World Health
Organization [WHO], 2012). In addition to emotional
symptoms, people with depression also usually have physical
symptoms such as trouble sleeping, disturbed appetite, loss of
energy, impaired concentration, and increased fatigue. These
symptoms significantly impair the individual’s ability to live a
rewarding and functional life (Wang et al., 2021).
Orphans in the present study, are children and adolescents aged
18 and below, who have lost one or both parents and are being
fully cared for and raised in institutional homes, with minimal or
no contact with their biological families. Non-orphans, in this
context, are school-going children and adolescents aged 18 and
below who live with both of their biological parents and whose
biological parents are their primary caregivers.
Insecurity, insurgency, and terrorism are major challenges in
Nigeria of today, leading to the loss of many lives and
properties. Many people are rendered homeless, and many
children are now orphans, denied a family’s love and care (Obi,
2015). The numbers of orphans are increasing day-by-day.
However, interventions and support for orphans in Nigeria are
typically geared towards meeting the physical needs of such
children. While meeting their physical needs is crucial, adequate
attention needs to be paid to their psychological well-being as
well. Unfortunately, there is a dearth of research on children’s
mental health and the prevalence of psychological disorders
among orphans and non-orphans in Nigeria. There is also little
awareness on the importance of this critical aspect.
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Early detection and intervention are crucial for recovery and the
prevention of further problems that may ensue if psychological
difficulties are left unaddressed (Groenman et al., 2017).
Consequently, the present study aims to explore the prevalence
of anxiety and depression among children and adolescents in
Nigeria. This research will investigate whether orphans raised in
institutional homes present with more symptoms of anxiety and
depression than non-orphans living with their parents. This
study will also assess if there is comorbidity of anxiety and
depression symptoms among children and adolescents in
Nigeria. The significance of this study is to raise awareness at
the family, institutional, and community levels about the
importance of the mental health of children and adolescents. If
orphans are found to have more symptoms of anxiety and
depression than non-orphans, then measures can be taken to
mitigate the detrimental effects by raising awareness on the
importance of social and emotional support for potentially
vulnerable groups of children. The study outcome will assist
clinicians and counselors in paying attention to the unique
circumstances of orphans and non-orphans during therapies.
This research will also broaden the existing scant body of
research on the mental health issues of children and
adolescents, particularly orphans in Nigeria and other similar
developing countries.
2. LITERATURE REVIEW
2.1 Anxiety and Depression
Karevold et al. (2009) conducted a study to identify the early
predictors and pathways of symptoms of depression and
anxiety in adolescence. They used data from an 11-year
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prospective longitudinal survey in Norway. The relationship
between temperamental (child emotionality and shyness) and
contextual (family adversities, maternal distress, and social
support) predictors was examined using structural equation
modeling. Their findings showed that early risk factors
accounted for 25% variance in covarying symptoms of anxiety
and depression in adolescent girls, and 38% in boys. Child
emotionality partly mediated all the risk factors. Maternal
distress at 18 months predicted heightened levels of anxiety
and depression in early adolescence. Family adversity in
childhood was found to be a significant predictor of depressive
symptoms in adolescence. They concluded that early life
experiences have lasting effects on adolescent internalizing
difficulties.
Moffitt et al. (2007) conducted a prospective longitudinal
cohort study on 1037 participants in New Zealand to examine
the cumulative and sequential co-morbidity of generalized
anxiety disorder (GAD) and major depressive disorder (MDD).
These participants were followed from birth up to age 32 years,
with 96% retention. Research diagnoses of GAD and MDD
were conducted on the participants at various ages. The results
showed that there is a history of anxiety in 48% of lifetime
depression cases, and a history of depression in 72% of lifetime
anxiety cases. 12% of the cohort, in adulthood, had comorbid
MDD and GAD, and 11% of the comorbid group had attempted
suicide. They concluded that the relationship between GAD and
MDD is stronger than previously presumed, and comorbid
cases of both poses a severe mental health burden. They further
asserted that it might be more important to predict overlapping
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symptoms of anxiety and depression than symptoms of either
depression or anxiety alone.
Groenman et al. (2017) carried out a quantitative meta-analysis
of thirty-seven longitudinal studies including over 762,187
participants. The results showed that depression, childhood
conduct disorder, oppositional defiant disorder, and attention-
deficit/hyperactivity disorder (ADHD) significantly increased
the risk of developing substance-related disorders later in life.
They concluded that early detection and intervention are
crucial for children experiencing these disorders in order to
prevent crippling substance-related disorders later in life. This
study indicates that childhood psychological disorders are not
only sometimes persistent, but they may also lead to the
acquisition of other debilitating mental disorders later in life if
left undetected and untreated.
2.2 Anxiety, Depression, and Care Environment
Asides the relationship between anxiety and depressive
disorders, various studies have also examined how different
care environments may impact the prevalence of anxiety,
depression, and other psychological disorders in children and
adolescents. Omari et al. (2021) carried out a prospective
cohort study on 1931 participants in Western Kenya from
2009-2019, to compare the impact of care environment on the
mental health of orphans in institutional care, family-based care,
and self-care on the streets. They found that orphans in all care
environments experienced potentially traumatic events.
However, orphans in institutional care are less likely to be
diagnosed with mental health concerns such as depression,
suicidality, anxiety and post-traumatic stress disorder (PTSD)
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during the follow-up period, compared to orphans in family-
based care. Orphans on the streets were found to be
significantly more likely to be diagnosed with these
psychological problems at any time during the follow-up
periods than the other groups. They recommended that
community mental health supports be made available for
orphans.
Bhatt et al. (2020) conducted a cross-sectional study to
examine the prevalence of depressive symptoms among 602
orphans (13-17 years) living in childcare homes in Nepal. They
used a validated questionnaire and Beck Depression Inventory-
II (BDI-II) to assess depressive symptoms among the
participants. They concluded that there is a high prevalence of
clinically-relevant depressive symptoms among orphans living
in childcare homes. They also concluded that females, victims
of bullying, those with physical health problems, alcohol users,
and those who have low social support are at more risk for
depression; thus, interventions should be focused more on
these groups.
A comparative study was conducted by Shafiq et al. (2020)
using samples of 150 orphans and 150 non-orphans in Lahore,
Pakistan to explore the relationship between anxiety,
depression, stress, and decision-making among orphan and
non-orphan adolescents. Depression, Anxiety & Stress Scales
(DASS) and the Adolescent Decision-Making Questionnaire
(ADMQ) were used for data collection. They used descriptive
statistics, Pearson product moment, independent t/tests and
simple regression analysis to analyze the data. The findings
showed that decision-making is significantly positively
correlated with anxiety, stress, and depression. The results also
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revealed significant gender differences among both orphans
and non-orphans with girls having high anxiety as compared to
boys. They also found that anxiety and depression are more
prevalent in orphans than non-orphans.
Kaur et al. (2018) conducted a descriptive study on the
prevalence of behavioral and emotional problems in 292
orphans and other vulnerable children and adolescents (OVCA)
living in institutional homes in India. They concluded that
orphans and OVCA are more vulnerable to emotional and
behavioral problems; thus, such children should be screened
regularly for these disorders.
2.3 Protective Factors for Anxiety and Depression
Several studies have been carried out to identify protective
factors that act as buffers against developing anxiety,
depression, and other mental disorders even in the presence of
significant risk factors. Oman and Lukoff (2018) reviewed
theories and empirical evidence on the association between
religion and spirituality, and mental health. They found that the
majority of available evidence on this topic support the
important role of religion and spirituality as protective factors
against depression and anxiety for adolescents and adults in the
US and several other countries. They also found that meta-
analyses supported the efficacy of religion/spirituality tailored-
treatments in improving psychological outcomes for individuals
with existing disorders. They concluded that adequate attention
should be paid to integrating religion/spirituality into healthcare
systems, as substantial evidence demonstrates their favorable
effects on mental health in various healthy and clinical
populations.
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Schug et al. (2021) conducted a study on the protective factors
for depression and generalized anxiety in healthcare workers.
They recruited 7765 participants in Germany and assessed
them for symptoms of depression and generalized anxiety,
social support, and optimism, as well as occupational and
sociodemographic factors. They carried out multiple linear
regression analyses to investigate the relationships between
the constructs. It was found that irrespective of demographic or
occupational risk factors, higher levels of social support and
optimism were correlated with lower levels of generalized
anxiety and depression. The researchers concluded that social
support and optimism are vital psychological resources in
preventing and dealing with depression and generalized
anxiety.
Brinker and Cheruvu (2017) also carried out a study in the US
on the impact of perceived social and emotional support in
mitigating depression in adults with adverse childhood
experiences (parental loss or separation, physical or sexual
abuse etc.). They used data from the Behavioral Risk Factor
Surveillance System (BRFSS) involving 12,487 adults with one
or more adverse childhood experience. Logistic regression
models were used for data analysis, adjusting for all possible
confounders. The results showed that individuals who reported
that they always received social and emotional support were
87% less likely to report depression, those who reported that
they sometimes/usually received social and emotional support
were 69% less likely to report depression, compared to people
who reported that they never/rarely received social and
emotional support. They concluded that social and emotional
support are crucial protective factors against depression, and
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that healthcare providers should facilitate the necessary social
and emotional support for individuals with adverse childhood
experiences.
3. METHODOLOGY
A quantitative, research-based study was conducted. The
research was comparative and correlational in nature, as it
compared the level of anxiety and depression of children in
different care environment. It also examined the correlation
between anxiety and depression to check for their comorbidity.
Purposive sampling method (a non-probability sampling
technique) was used for data collection in the study. This
method allowed us to obtain data from the sample population
that were close to hand and possessed the criteria of interest
based on the aims and objectives of the research. The data was
collected by visiting various schools and institutional homes,
and having the best-fit participants manually complete the
questionnaires.
3.1 Sample
A total of 200 participants from the age group of 8-18 years
were selected for the study. The average age of the participants
was 13 years. Of the 200 participants, 100 (50%) were orphans
living in institutional homes and the remaining 100 (50%) were
school pupils living with their families. 102 participants (51%)
were females and 98 participants (49%) were male. 148
participants resided in Lagos state and 52 from other parts of
Nigeria.
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3.2 Measurements
The participants were asked questions via the questionnaire
method. They were asked to state their age, gender, and school
grade on the questionnaire, and they were given questions from
the Revised Child Anxiety and Depression Scale-25 (RCADS-
25), which was used to measure the participants’ level of
anxiety and depression symptoms.
The Revised Child Anxiety and Depression Scale-25 (RCADS-
25)- This scale comprises of 25 items that measure the level of
anxiety and depression in children and adolescents aged 8-18
years, with at least a third-grade reading ability level. Of the 25
items, 10 items measure symptoms of major depressive
disorder (MDD) and 15 items measure symptoms of anxiety
disorders (obsessive compulsive disorder = 3 items, social
anxiety disorder/social phobia = 6 items, panic disorder = 3
items, generalized anxiety disorder = 3 items). RCADS-25 yields
two subscale scores (Total Anxiety and Total Depression) and
an overall internalizing score. Respondents rated each item on
a 4-point Likert scale based on the frequency of symptoms:
0=never, 1=sometimes, 2=often, 3=always. RCADS-25
subscales have good to excellent reliability in clinical settings
(Anxiety = .96, Depression = .80) and school-based samples
(Anxiety = .94, Depression = .79). The scale also has a good
to excellent internal consistency (= .87-.95) and acceptable to
good test-retest reliability (r= .78-.86).
3.3 Inclusion and Exclusion Criteria
Children and adolescents aged 8-18 years who were orphans
living in institutional homes and non-orphans living with their
parents in Nigeria, with at least a third grade reading ability level
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were included in the study. Excluded from the study were
orphans who were having regular contact with their biological
families via weekend or vacation visits; orphans whose duration
of stay in the institutional homes was less than one year; and
children who were suffering from intellectual disability, learning
disabilities or serious medical illnesses that may interfere with
their ability to comprehend and provide accurate responses to
the items on the questionnaire.
3.4 Data Collection Process
Consent forms were sent to schools and institutional homes
beforehand to obtain parents, schools and institutional homes’
permission to have their wards participate in the study.
Afterwards, schools and institutional homes were visited and
the participants were given printed questionnaires to be
manually completed. Some of the younger children (particularly
those within the age range of 8-10 years) required some help in
reading the content of the questionnaire. For this group of
children, the researcher read each item from a spare
questionnaire to the children, then each child circled the option
that best fit their mood and thoughts on their questionnaires.
Data was collected from 4 schools and 3 institutional homes
across Nigeria, between 24th April 2022 to May 8th 2022.
3.5 Validity & Reliability
The primary potential threat to reliability and validity are the
likely errors associated with the use of self-report
questionnaires. Whilst self-report questionnaires are one of the
most prominent assessment tools used in clinical psychology,
they have important limitations (Demetriou et al., 2015). The
respondents may have provided invalid answers to some of the
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questions, especially sensitive ones. They may have responded
in a socially acceptable way, rather than reporting the truth
about their feelings and thoughts (social desirability bias). Also,
some of the respondents may lack clarity about the meanings
of the items and may have given different interpretations to the
questions (Demetriou et al., 2015). Furthermore, some
respondents may have given responses based on their mood at
the time of responding, rather than how they feel over time.
Attitudinal factors such as seriousness about the test and
intrinsic motivation to participate may have also affected the
validity of the responses.
To minimize the occurrence of the above potential threats, the
participants were informed that the purpose of the
questionnaire is to capture their unique experiences, and there
were no right or wrong answers. They were also informed about
the average time to complete the questionnaire, in order to
boost their mental readiness. They were asked to rate their
responses based on their mood and thoughts over at least the
past 2 weeks, not just how they felt at the moment. The shorter
version of the RCADS scales (RCADS-25) was selected to
eliminate certain extraneous variables such as boredom and
mental fatigue. Before the questionnaires were handed over to
the participants, they were briefly enlightened about the
importance of the study in increasing awareness about mental
health of children and adolescents, in order to boost their
intrinsic motivation to complete the questionnaires truthfully
and efficiently. Participants were also assured of the anonymity
and confidentiality of their data. To reinforce this, age, gender,
and school grade were the only demographic data requested to
be written on the questionnaires (no names). Also, the
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questionnaires of each group of children filling at the same time
were submitted to a paper box placed in a corner of the room,
not directly to the researcher or caregivers. Participants were
also told that they were free to ask for clarifications on any of
the questionnaire items, and some participants did ask for
meanings of certain statements, such as “what does it mean to
feel worthless?”
3.6 Ethical Considerations
Key ethical guidelines were abided by throughout this study,
and the rights and safety of the participants were duly
protected as much as possible. The following ethical
considerations were adhered to:
1. Informed Consent: The participants and their
caregivers were clearly informed about the aims and
objectives of the study and how the data obtained will
be used. Consent forms were sent to the schools and
institutional homes beforehand. The participating
schools and institutional homes issued letters to
authorize data collection on their premises. Verbal
consent was also sought from each of the participants
before data was collected, as they were given the
liberty to choose to participate or decline. The
opportunity to ask any questions or clarifications was
also given.
2. Right to Withdraw: The participants and their guardians
were educated on their rights to discontinue
participation and withdraw the data they have provided
at any point in time, without facing any penalty.
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3. Confidentiality: To ensure anonymity as much as
possible, the participants’ names were not recorded,
and the questionnaires were submitted in a paper box
with a pool of other questionnaires. The data obtained
was kept confidential.
4. Anti-Discrimination: Children and adolescents who met
the criteria of interest in schools and institutional
homes were given equal chance to participate, without
any form of religious, gender or racial discrimination.
3.7 Data Analysis
The data for each participant was first coded and inputted into
the excel scoring program (version 3.1) of the developer of
RCADS-25. The scoring program converts the total scores of
each child into T-scores using equations developed through
research, while accounting for gender and grade. The data for
all participants was then compiled in an excel sheet and
exported to SPSS version 28.0 for analysis. The average (mean
score) of the total sample was calculated. The mean scores of
the two sample sub-groups (orphans and non-orphans) were
compared. Pearson Product Moment Correlational statistics
was computed to see if anxiety scores and depression scores
(the two variables put into the analysis) were correlated. The
significance of correlation was verified using Spearman Brown
correlation (Spearman’s rho) and Kendall rank correlation
(Kendall’s tau). P<0.01 was taken as statistically significant.
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4. RESULTS
4.1 Prevalence of anxiety and depression
Table 1 shows the average (mean) scores of the depression
subscale, anxiety subscale, and total internalizing scale of the
total sample of children and adolescents. The depression,
anxiety, and total internalizing mean scores were 54.11, 60.90,
and 59.04 respectively, indicating low prevalence of anxiety
and depression symptoms. T-scores below 65 on the RCADS is
considered to be below clinical threshold (low severity), 65-70
is considered borderline clinical threshold (medium severity),
and scores greater than 70 are above clinical threshold (high
severity). This shows that the prevalence of anxiety and
depression is low among the sample population.
Table 1. Descriptive Statistics
N
Minimum
Maximum
Mean
Std. Deviation
Depression (T-score)
200
31
80
54.11
11.215
Anxiety (T-score)
200
34
80
60.90
10.843
Total Internalizing (T-
score)
200
31
80
59.04
11.114
Valid N (listwise)
200
4.2 Comparison of the levels of anxiety and depression
between orphans and non-orphans
Table 2 shows the average (mean) scores of orphans and non-
orphans on both the anxiety and depression subscale. The mean
anxiety scores of orphans and non-orphans were 62.29 and
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59.51 respectively, while the mean depression scores of
orphans and non-orphans were 58.69 and 49.53 respectively.
This indicates that although both groups (orphans and non-
orphans) have an average score below the clinical threshold,
orphans presented more with symptoms of both anxiety and
depression than non-orphans.
Table 2. Comparison of mean scores on RCADS
Group
N
Mean
Std. Deviation
Anxiety (T-score)
Orphans
100
62.29
10.879
Non-orphans
100
59.51
10.680
Depression (T-score)
Orphans
100
58.69
10.725
Non-orphans
100
49.53
9.768
4.3 The correlation between anxiety and depression
Pearson’s correlation was conducted between the scores of the
Anxiety and Depression subscales of the Revised Child Anxiety
and Depression scale. Table 3 depicts a moderate positive
correlation between the levels of anxiety and depression, r (98)
= .57 p<0.01 indicating that there is comorbidity between
anxiety and depression (i.e., the higher the level of anxiety, the
higher the level of depression, and vice versa).
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Table 3. Correlation between Anxiety and Depression scores
Depression
(T-score)
Anxiety
(T-score)
Depression
(T-score)
Pearson
Correlation
1
.570**
Sig. (2-tailed)
<.001
N
200
200
Anxiety
(T-score)
Pearson
Correlation
.570**
1
Sig. (2-tailed)
<.001
N
200
200
**. Correlation is significant at the 0.01 level (2-tailed).
5. DISCUSSION
The present study was aimed to comparatively investigate the
prevalence of the symptoms of anxiety and depression among
orphans and non-orphans in Nigeria, and to examine if both
disorders are co-morbid. The results indicated that there was
low prevalence of anxiety and depression among children (both
orphans living in institutional homes and non-orphans living
with their families) in Nigeria. Majorly, the literature reviewed
found a high prevalence of anxiety and depression among
orphans. However, few studies supported the finding of this
research. Omari et al. (2021) studied the impact of care
environment on the mental health of orphans, and they found
that orphans living in institutional homes were less likely to be
diagnosed with mental health concerns, including anxiety and
depression, than orphans raised in family-based care and
orphans on the streets. Since the orphans that participated in
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the present study were all being cared for in well-managed
institutional homes, Omari et al. (2021) findings support the low
prevalence of anxiety and depression found in the present
study.
Furthermore, certain evidence-based protective factors may
have also mediated the relationship between the variables
studied. Brinker and Cheruvu (2017) found that social and
emotional support significantly mitigated depression in
individuals with adverse childhood experiences (including
parental loss and separation). Schug et al. (2021) also found that
regardless of demographic and occupational risk factors, social
support and optimism were correlated with lower levels of
generalized anxiety and depression. Nigeria is a collectivist
society with a high sense of community. The orphans attended
different schools in and around the communities, so they got to
relate with other children and adults in the larger community.
The institutional homes also had stable caregivers and low
child-caregiver ratio. While orphanhood was a significant
stressor that was expected to heighten the prevalence of
anxiety and depression, perceived social and emotional support
received by the orphans may have impacted the low prevalence
of anxiety and depression found in the present study.
In addition, another study (Oman & Lukoff, 2018) noted that
religiosity and spirituality are crucial protective factors in the
prevention of psychological disorders, including anxiety and
depression. Generally, there is a high level of spirituality and
religious involvement in Nigeria, with Islam and Christianity
being the two major religions. While the current straitened
socio-economic conditions in the country and orphanhood
were expected to lead to high prevalence of anxiety and
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depression among children and adolescents in Nigeria, belief in
a higher power and involvement in religious activities may have
significantly acted as buffers against symptoms of depression
and anxiety among orphans and non-orphans. Methodological
issues (such as the use of non-probability sampling, participants
giving socially desirable answers etc.) and sociodemographic
variables (e.g., gender differences, age of admission and years
of stay in the institutional homes) not accounted for in this
study may have also caused a variation in the prevalence rate
found in the present study, compared to other similar studies.
Although a low prevalence of anxiety and depression was found
among children in Nigeria (orphans and non-orphans), the
results further indicated that orphans living in institutional
homes had more symptoms of both anxiety and depression
than non-orphans. This finding is in agreement with majority of
previous comparative studies conducted in other countries on
level of psychological distress among orphans and non-orphans,
such as the study of Shafiq et al. (2020) in Pakistan. Shafiq et al.
(2020) also reported that symptoms of anxiety and depression
were found to be more prevalent in orphans than non-orphans.
A positive correlation (.570) was found between anxiety and
depression, indicating that both disorders were co-morbid.
Previous similar studies have also demonstrated significant co-
morbidity between anxiety and depressive disorders. Moffit et
al. (2007) in their longitudinal study found that anxiety and
depression were both cumulatively and sequentially co-morbid.
The co-morbidity between anxiety and depression could be
further justified with the fact that both disorders shared many
common symptoms and had similar environmental and genetic
risk factors. Kalin (2020) asserted that among the internalizing
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disorders, depression and generalized anxiety disorder
appeared to share the highest level of common genetic risk.
6. CONCLUSION
This study attempted to provide an insight into the emotional
problems of children in Nigeria, particularly vulnerable groups
of children such as orphans as there are very few studies on the
psychological distress experienced by this group. The findings
suggested that there was a low prevalence of anxiety and
depression among children and adolescents in Nigeria. While
the prevalence of anxiety and depression was generally below
clinical threshold, orphans living in institutional homes still
presented with more symptoms of both anxiety and depression
than non-orphans living with their families. Anxiety and
depression were found to be positively correlated (comorbid).
In addition, social and emotional support, optimism, stable
caregivers, and religion and spirituality appeared to be
important protective factors against internalizing disorders,
including depression and anxiety.
The research findings have practical and theoretical
implications. Psychologists and counselors dealing with
childhood psychological and adjustment difficulties can gain
insight from this study into developing comprehensive
therapeutic interventions that take into consideration the
unique circumstances of orphans and non-orphans. The
comorbidity found between depression and anxiety disorders
also highlights the importance of assessing the overlapping
symptoms of anxiety and depression (rather than either alone)
since they frequently coexist. The Government and non-
governmental organizations (NGOs) can utilize this research
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findings to create routine mental health assessments and
programs for orphanages and schools. Religious organizations
may also utilize this research in developing faith-based
counseling and mental health programs that incorporates
spirituality to assist children and youths in their community. A
symptoms guideline can also be developed, that orphans’
caregivers and teachers can utilize to watch out for signs of
emotional difficulties, so they can seek appropriate evaluation
and intervention for the children at the budding stage of such
disorders. Researchers can also make use of this research as
supporting literature for studies related to this topic, and as a
base to further explore mental health issues of children and
adolescents.
However, this study has limitations. Although, the Revised Child
Anxiety and Depression Scale (RCADS) is a valid and reliable
tool to measure symptoms of anxiety and depression in children
and adolescents (8-18 years), self-reported assessment tools
are better used in addition to functional neuroimaging or
structured clinical interviews for more accurate diagnosis (Ho
et al., 2020). Also, the sample size was limited to 200
participants and selected through purposive sampling (a non-
probability sampling technique); consequently, the external
validity of the study may be questionable. Furthermore, due to
cultural differences, certain items on the RCADS that are
flagged as symptoms of anxiety and depression may be normal
feelings and thought patterns in some participants’ culture and
religion. Lastly, the difference between the prevalence of
symptoms in orphans and non-orphans may have been
impacted by confounding variables; thus, a causal relationship
between orphanhood, care environment, and symptoms of
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anxiety and depression cannot be established. Further studies
involving longitudinal follow-ups, larger sample size, and more
standardized methodology are recommended to extend this
research findings.
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APPENDICES
Appendix 1: Consent Form
The Department of Psychology at the International Open
University (IOU) supports the practice of protection of human
participants in research. The following will provide you with
information about the study that will help you in deciding
whether or not you wish to have your child/ward participate. If
you agree to have your child/ward participate, please be aware
that you are free to withdraw your child/ward at any point
throughout the duration of the study.
This study aims to investigate the prevalence of anxiety and
depression among children and adolescents residing in Nigeria,
with a comparison between orphans and non-orphans. We will
ask your child/ward to fill out a questionnaire consisting of
questions relating to their thoughts and feelings. All the
information provided will remain confidential and will not be
associated with their names. If for any reason during this study
you or your child/ward does not feel comfortable, they may
stop filling the questionnaire and their information will be
discarded.
Your child/ward’s participation in this study will require
approximately 5-10 minutes.
If you have any further questions concerning this study, please
feel free to contact us via email at kafayat.a.azeez.gmail.com
Your child/ward’s participation is solicited, yet strictly
voluntary. All information will be kept confidential and your
child/ward’s name will not be associated with any research
findings.
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Please indicate with your signature on the space provided
below that you understand your rights and consent to have
your child/ward participate in the study.
Signature of Parent/Guardian
Appendix 2: The Revised Child Anxiety and Depression Scale-
25 (RCADS-25)
Age: ____________ Grade: ____________
Gender: ____________
Please put a circle around the word that shows how often
each of these things happens to you, for at least the past two
weeks. There are no right or wrong answers, so respond
according to your own experiences, rather than how you think
“most people” would respond.
1. I feel sad or
empty
Never
Sometimes
Often
Always
2. I worry when I
think I have done
poorly at something
Never
Sometimes
Often
Always
3. I would feel
afraid of being on
my own at home
Never
Sometimes
Often
Always
4. Nothing is much
fun anymore
Never
Sometimes
Often
Always
5. I worry that
something awful
will happen to
someone in my
family
Never
Sometimes
Often
Always
6. I am afraid of
being alone in
Never
Sometimes
Often
Always
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crowded places
(like shopping
centers, the movies,
buses, busy
playgrounds)
7. I worry what
other people think
of me
Never
Sometimes
Often
Always
8. I have trouble
sleeping
Never
Sometimes
Often
Always
9. I feel scared if I
have to sleep on
my own
Never
Sometimes
Often
Always
10. I have problems
with my appetite
Never
Sometimes
Often
Always
11. I suddenly
become dizzy or
faint when there is
no reason for this
Never
Sometimes
Often
Always
12. I have to do
some things over
and over again (like
washing my hands,
cleaning or putting
things in a certain
order)
Never
Sometimes
Often
Always
13. I have no
energy for things
Never
Sometimes
Often
Always
14. I suddenly start
to tremble or shake
when there is no
reason for this
Never
Sometimes
Often
Always
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15. I cannot think
clearly
Never
Sometimes
Often
Always
16. I feel worthless
Never
Sometimes
Often
Always
17. I have to think
of special thoughts
(like numbers or
words) to stop bad
things from
happening
Never
Sometimes
Often
Always
18. I think about
death
Never
Sometimes
Often
Always
19. feel like I don’t
want to move
Never
Sometimes
Often
Always
20. I worry that I
will suddenly get a
scared feeling when
there is nothing to
be afraid of
Never
Sometimes
Often
Always
21. I am tired a lot
Never
Sometimes
Often
Always
22. I feel afraid that
I will make a fool of
myself in front of
people
Never
Sometimes
Often
Always
23. I have to do
some things in just
the right way to
stop bad things
from happening
Never
Sometimes
Often
Always
24. I feel restless
Never
Sometimes
Often
Always
25. I worry that
something bad will
happen to me
Never
Sometimes
Often
Always
