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Byline: Zaqia Bano, Sabeen Fatima and Iram Naz

Keywords: Orphans, Psychological problems, Stigma.


Orphan-hood brings a large group of emotional wellness vulnerabilities. When an orphan is forced to live in orphan home, he suffers from many problems such as lack of support, emotional bonding, economical problems and poor health. Alongwith all these problems the biggest problem orphans suffer frp, is social stigma. They are discriminated against other children, this stigma has a significant impact on their psychology. This problem leads to many psychological issues. Orphans who reside in orphan homes are more prone to develop depression, anxiety and behavioural problems as compared to other children. Millions of children who lose either one or both parents around the world are growing up in orphan homes, without the affection and care of a family. These homes provide the basic necessities of life but never provide the care, emotional support and sense of self that only loving and caring parents can give.

Findings of many studies showed that family life was important to a child's healthy development. Loss of parents leaves a dark space in a child's later life and without parents children suffer from many psychological problems and get totally damaged. Children in institutional care face many economic and social problems such as poverty, poor physical health, attachment disorder, inadequate social skills. Children living in orphan homes are more prone to develop emotional and behavioral problems1. A study showed that orphanage children face lack of sympathy, seek behavior in negative ways, have poor self-confidence, discriminate affection are likely to rebellion, and are more aggressive than their non-institutionalized children2.

Children in institutional care who are being neglected and are victims of physical abuse, they have many problems internalizing such as anxiety, depression and externalizing such as aggression, impulsivity and behavior problems1. Many researches explained that orphans who reside in orphan homes suffered stigma not only from their relatives but also from other children and community members3-7. Some studies recognized that stigma as an orphan effected the financial conditions of individuals8-11. Stigma has a significant effect on the mental health of orphans. Mainly in developing countries, stigma and disregard are the main challenges that orphans experienced in daily living. One study result found that higher levels of disregarding and stigma are positively correlated with a high level of psychological distress and lower level of emotional well-being.

A mediation analysis indicated that due to stigma and marginalization low level of social support significantly related to lower level of emotional well-being12.


Correlational research design was used in current study. Data was collected from Gujrat, Gujranwala, Sialkot and Lahore, Pakistan from January 2017 to October, 2017. A total of 200 participants selected by using purposive sampling technique. The inclusion criteria was set as adolescent age ranges 12 to 17 years were taken and children whose father or mother or both had died and lived in orphanages were included. Due to this set inclusion criteria all participants from the orphanages were recruited for the study.


A demographic form was used to obtain demographic information about participants. Demographic form included religion, race, age, class, school name, name of orphan home, duration of living in orphanage and family related information.

Orphan Stigma Scale13 is a 36-item self-report instrument designed to measure the stigma of orphans residing in orphan homes, with possible scores ranging from 0 to 144. Each response to an item is scored at 5 point likert. The Orphan Stigma Scales how good internal reliability ([alpha] = 0.912) and test-retest reliability (r = 0.872). The Revised Children's Manifest Anxiety Scale14 (RCMAS-2) is a self-report measure that evaluates anxiety in children and adolescents between ages 6-19 years. This instrument comprises 49 items. Reliability estimates collapsed across the age levels 12 ranged from 0.79 to 0.85 (median = 0.82). Of the 48 coefficient alphas reported across age, race, and sex, 17 alphas fell below 0.80. The Centre for Epidemiological Studies Depression Scale for Children15 (CES-DC) is a 20-item self-report inventory for depression. This measure assesses the symptoms of depression in children and adolescents, ages 6-17 years.

A score of 15 or more indicates considerable level of depression. The CES-DC indicated good internal reliability ([alpha] = 0.86) and test-retest reliability (r = 0.85). Gilliam et al16 Conduct Disorder Scale (CDS) is a tool that is used to assess Conduct Disorder. All 40 items CDS which defined the specific diagnostic behavioral characteristic of individuals with Conduct Disorder of age ranges between 5 and 22 years. These 40 items consisted 4 subscales as follows with four point Likert type response of never observed (0), seldom observed (1), sometimes observed (2) and frequently observed (3). The overall reliability coefficient for the scale is 0.96.



Scale for Children14 and Conduct Disorder Scale16 were translated in Urdu using forward backward translation method for easy comprehension of the participants.


Sample of male and female orphans was collected from various orphan homes of Gujranwala division. A letter of consent was presented to orphan home authorities describing the research project. After getting permission, children were approached in the classrooms with the help of their teachers, and then briefed about the purpose of the study. Children were also assured about the confidentiality of the personal information gathered during the data collection and would only be utilized when required for the sole purpose of our research work. After filling the personal and demographic information as per predetermined research criteria and scale battery were administered. To avoid misunderstanding while reading and interpreting, the questions were read out, one by one, by the researcher. Completion of the questionnaires was followed by a vote of thanks to the participants for their contribution in the study.

Ethical Issues in Research

Privacy and wellbeing of its participants were kept in mind while conducting this study. Consent was signed from authorities of orphan homes before the start of this study. Orphans also had the right to withdraw anytime from their participation without facing any withdrawal costs. During the whole process of this study, researcher followed 4 ethical principles; Integrity, Responsibility, Dignity and Respect for person's rights.

Statistical Analysis

Following statistics were used to interpret data in statistical terminology. Descriptive statistics were used for extracting best statistical view of sample data's characteristics in a summarized way. To study the relation of stigma with mental health issues, linear regression analysis were used. These statistical computations were completed by statistical package for social sciences (SPSS) version 21.0.

Table-I: Frequencies of demographic characteristics of the sample (N = 200).



12 years###53###26.5

13 years###48###24.0

14 years###37###18.5

15 years###25###12.5

16 years###18###9.0

17 years###19###9.5








Orphan name

Sweet home Guj###61###30.5

Model children home###42###21

Noor complex###50###25.0

SOS village Sialkot###47###23.5

Mother alive



Father alive



Table-II: Median and range of scales of the study (N = 200).

Scale###Median###Interquartile Range




Conduct Disorder###34###31.00

Table-III: Summary of linear Regression analysis of stigma as a predictor of anxiety among orphans resides in orphanages.



Table-IV: Summary of linear Regression analysis of stigma as a predictor of depression in orphans resides in orphanages.



Table-V: Summary of linear Regression analysis of stigma as a predictor of conduct disorder among orphans resides in orphanages.




The sample consisted of 200 orphans residing in orphan homes between ranges 12 to 17 years (mean age, 13.82 years). Inclusion criteria comprised or only those children whose father or mother or both had died and who lived in orphanages. In table-III the results showed (R = 0.361, F = 29.250, p<0.001), and explained 0.130% variance in anxiety and the significant p-value shown that it was a significant predictor of anxiety among orphans residing in orphanages (table-I, II and III). In table-IV results indicated stigma (R = 0.295, F = 18.579, p<0.001) explained 0.087 variance in depression among orphans residing in orphanages. Overall results showed significant predictive relationship between stigma of orphanhood and depression. Table-V showed stigma as an insignificant predictor of Conduct Disorder among orphans (R = 0.128; F = 3.191, p = 0.076).


Findings of this research reflect that Stigma is a significant predictor of psychological issues among orphans residing in orphan homes. These findings are consistent with studies conducted previously as results showed negative relationship between stigma and marginalization with emotional well-being and positive correlation with psychological distress12. Further, study results concluded that children residing in orphanages had more mental health problems than children who lived with families16,2. Death of parents makes children helpless and at high risk for physical and psychological issues. The condition becomes worse when they have to live in an orphanage. They are labeled and discriminated by society against other children; this labeling and discrimination ultimately increases many psychological problems for children.

Another study investigated the reason of the psychological distress in orphans, result reported mistreatment, abuse and stigmatization with orphan leads to sever psychological problems17. Another study result also supported our findings. Researchers measured the maltreatment and perceived stigmatization as an orphan. Orphans reported significantly more experiences of neglect, depressive symptoms, posttraumatic stress symptoms, and aggressive behavior in comparison group. Result found positive relationship between neglect, abuse, and stigmatization with orphans which leads to externalizing and internalizing problems. In another study conducted in Tanzania, reported same indications that neglect and stigmatization were related to orphans, depression and perceived stigmatization moderated the relationship between neglect and depression.

It also showed that orphans are at high risk of experiencing neglect, abuse and perceived stigmatization18. First hypothesis was that "stigma would be a significant predictor of anxiety among orphans residing in orphan homes". There are number of studies that support the result of current study, Dabla19 identified that mental health issues are reported by orphanages children which were alarming such as depression was 100%, 80% stress, 100% anxiety and lack of comprehension were also 100%. A study including five orphanages reported depression, anxiety and lack of comprehension. Four orphanages showed stress and psychological issues mainly arising due to distressing circumstances20. Second hypothesis was that Stigma would be a significant predictor of depression among orphans residing in orphan homes was also supported by results; it reflects that Stigma was a significant predictor of depression among orphans residing in orphan homes.

A lot of previous researches have shown positive relationship among stigma and depression, for example, according to Hermenau et al18 evidence show orphans reporting higher signs of depression21,22. Another study also confirms that children in institutions had higher prevalence of clinically significant depression than children lived at home. The findings of the study revealed that 20% of orphans had depression with total mean score (72.65 +- 1.10)23. According to various studies high depression was reported in orphans21,22, they were more internalizing and externalizing problems24,25, than non-orphaned children5,18,21. It was also revealed that orphans have higher depression symptoms, were easily bullied and less likely to have trusted friends than non-orphans20. Third hypothesis "Stigma would be a significant predictor of conduct disorder among orphan resides in orphan homes" was not confirmed by results.

The reason of a nonsignificant result may be because orphans suffered externalizing issues but were less involved in conduct problems due to controlled environment. They were strictly observed and monitored by orphanage administration so, the chances to be involved in conduct behavior became minimal. Though, previous researches exhibited different findings. Behrendt and Serigne27 identified greater suicide risk in orphaned boys. Certain psychological disorders such as depression (45%) and post-traumatic stress disorder (28%) were also evident. Research demonstrates that children raised in deprived environment were at high risk for attention and behavior problem. Finding of the study revealed that orphans had greater emotional and behavioural issues. Van Eerdewegh and others30 noted orphans who lost their parents, 77% children exposed depressive symptoms compared to the nonorphans.

A survey of orphanages in Kashmir with a sample of 140 children indicates that orphans had high prevalence of social phobia, generalized anxiety, separation anxiety, post-traumatic stress disorder, panic disorder, dysthymia, and conduct disorder. There was a high rate of mental health issues, predominantly those of emotional nature among orphanage children20.


It is concluded from the findings of this research that stigma has a significant impact on depression and anxiety. Further, study indicated that a stigma does not have a significant predictive relationship on conduct disorder in the orphans living in Orphanages.


This article is part of an MPhil thesis.


This study has no conflict of interest to be declared by any authors.


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Publication:Pakistan Armed Forces Medical Journal
Date:Jun 30, 2019

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