Perceptions, Buffering Resources, and Self-Determination: An Investigation into the Psychological Health of Adolescents Living with Congenital Limb Deformity in Ghana

Abstract

The current study examined factors that influence the psychological health of adolescents with congenital limb deformity in Ghana. Adolescents with congenital limb deformity (AWCLD) experience a plethora of physical, psychological, and social effects of a disfiguring birth defect. Amputation, a procedure theorized to promote psychological health by increasing functional ability and minimizing disfigurement, further adds to the burden of congenital limb deformity. Body image and self-perception are usually very fragile in adolescence, which is the period between age 10 and 24, and negatively impact adolescent psychological health. Adolescents with a disfiguring disability may consequently experience more challenges affecting interpersonal relationships and participation in social activities during this transition from childhood. This study adopted a concurrent mixed-method approach to investigate predictors of psychological health outcomes of a sample of 50 adolescents, aged between 12 and 24, with congenital limb deformity in Ghana. The quantitative aspect of the study tested 5 hypotheses, and compared amputee and non-amputee participants across body image and symptoms of psychological distress. It also examined relationships between social support, coping strategies and psychological distress. The qualitative approach explored perceptions, lived experiences, and social activities of 15 AWCLD to corroborate and cross-validate the quantitative findings. Statistical analyses revealed that amputees and non-amputees had similar functional ability, similar body image, and self-esteem, as well as similar psychosocial experiences of CLD. However, there was a significant difference in their levels of distress, where non-amputees experienced more distress symptoms of depression, and interpersonal sensitivity than amputees. This finding was interpreted and attributed to the experience of stigma-related issues by non-amputee participants in the qualitative study. Social support from family, significant others and friends buffered AWCLD from the effects of CLD, and coping strategies varied among participants, with older adolescents engaging less in emotion-regulation coping. In Psychological Health of Adolescents with CLD

general, findings support the theoretical framework of the study, namely, the Broaden and Build Theory of Positive Emotions, the Buffering Effects of Social Support Theory, and the Self-Determination Theory, which underscored the buffering roles of positive emotions, social support, coping strategies, as well as self-determination, in significantly influencing psychological health outcomes, and suggests that the integration of Self-Determination Theory in disability studies may change the dominant negative narrative. Further inquiry into the role of sociocultural perceptions of deformity in fostering self-determination and self-development in the physically-disabled is recommended.