CHILDREN'S DEPRESSION INVENTORY AS A RELIABLE MEASURE FOR POST-IRAQI INVASION KUWAITI YOUTH, THE

This study examined the reliability of the Children's Depression Inventory (CDI, in Arabic form Kovacs, 1980) among elementary, middle, and high school students in Kuwait. The subjects (N = 2,299. ages 9-17) were selected from six districts across Kuwait. Children completed the CDI as a depression measurement tool with respect to gender and age. The overall alpha reliability coefficient for the CDI is 0.85. Girls attained higher and statistically more significant mean scores than did their male counterparts. The results indicate that the CDI shows reliability and internal consistency for use in Kuwait as a measure of childhood depression.

Keywords: Children's Depression Inventory, reliability, Kuwait.

Since the 1960s, research on depression has grown rapidly. Episodes of major depression in children last about 10 months on average and may have psychotic or melancholic features associated with them (Kovacs, Obrosky, Gatsonis, & Richards, 1997). The patterns of symptoms seen in childhood depression are similar to those seen in adults with similar affective, cognitive, behavioral, and somatic complaints (Kaslow, Rehm, & Siegel, 1984). In addition, there appears to be little variability in the associated features of the disorder across a life span (Kovacs, 1996b). Similarities exist in terms of the presence of a persistent and serious depressive mood, the presence of vegetative signs and symptoms including sleep disturbances, appetite disturbances, energy disturbances, impairment in concentration and attention, and decreased interest in usual activities (Preskorn, Weller, Hughes, Weller, & Bolte, 1987). In this manner, childhood depression is very similar to major depressive disorders in adults.

The term depression covers a wide range of phenomena, ranging from normal sadness through grief and depressive symptoms to the severe forms of depressive psychosis (Abdel-Khalek, 1993). The effects of trauma are unpleasant and difficult to estimate (AbdulLatif, 1995). Among the frequently reported effects of trauma on children, depression is recognized to be one of the most commonly noted (Armsworth & Holaday, 1993; Green, 1986; Williams, 1990). For some children, the emotional and behavioral consequences of traumatic events or situations that are perceived as life- threatening can interfere with developmental progress and daily performance (Al-Balhan, 1998). Children who experience Post-Traumatic Stress Disorder (PTSD) may exhibit increased anxious, depressive, aggressive and violent behavioral patterns.

Children's behavioral responses to war are varied. Four hundred and eighty children completed the Croatian version of the Children's Depression Inventory (CDI; Kovacs, 1985) and the Mood Scale (Clyde, 1963). Both refugees and local children showed more depressive symptoms on the CDI in comparison with the children of the same age assessed before the war in Croatia. Displaced children manifested more negative emotions (especially sadness and fear) than did their local peers, based on self-report as well as on parent and teacher reports.

In a related study, to determine the prevalence of PTSD and depression in a sample of 99 Cambodian youths (18-25) living in the refugee camps along the Thai-Cambodian border, extremely high rates of depressive disorders were found which were interpreted as related to the repatriation to Cambodia. PTSD in this sample appeared to be specifically related to earlier war trauma, while depressive symptoms appeared more related to subsequent stressors (Savin, Sack, Clarke, Mess, & Richart, 1996). In another study, 61 randomly selected children in the Tibetan Children's Village in India were interviewed for symptoms of PTSD and major depressive disorder (MDD). The survey assessed the prevalence of posttraumatic stress disorder and major depressive disorder in children who escaped from Tibet and found refuge in India. Of these, 11.5% met criteria for DSM-IV for PTSD and the same proportion met criteria for MDD (Servan-Schreiber, Le Lin, & Birmaher, 1998). Finally, Arroyo and Eths (1995) studied the impact of civil strife on Central American children aged preschool to adolescence. They found that the children suffered from PTSD adjustment disorders, separation anxiety, conversion disorder and depression. Similar findings were reported in a study of Chilean survivor children (Becker, Castillo, Gomez, Kovalsky, & Liza, 1989).

When Kuwait was invaded by Iraq in 1990, the citizens suffered inhumane acts of violence. UNICEF's Dr. James Gabarino (1992), President of the Erikson Institute, entered Kuwait on a UNICEF mission immediately after the conflict ended with the intention of assessing the emotional trauma which the children had suffered during seven months of warfare and occupation. A majority of these children had experienced a traumatic event - many had seen dead bodies, often someone known to them, hanging from lampposts or dumped in their neighborhood. Others had lost a close relative.

As in other wars of our time, more than half the Kuwaiti children displayed what appeared to be psychological effects of traumas, such as repetitive dreams related to a traumatic event, generalized fear of enemy soldiers and, among young children, uncontrollable crying and sleep disturbances. Nearly all the boys who were examined wanted to become soldiers when they grew up, while the girls wanted to become doctors or nurses - ambitions reflecting a wish to protect the family or the country in the future. All the children were emotionally unbalanced. The physical imbalance showed itself in such symptoms as fear, headache, stomachache, pain in arms and legs, eating problems, tics, and sleep disturbances. A few suffered from a more general fear, but most of the children were afraid of concrete things or events such as new situations, darkness, war, bombs, weapons, aircraft, water, heights, and of sleeping alone. The sleep disturbances were difficulty in falling asleep, nightmares, or interrupted and restless sleep. The children were often depressive with a tendency to anxiety, dejection, passivity, helplessness, guilty conscience or thoughts of death. Several children had a tendency to revert to a more childish behavior. Jacobs (1991) reported that most of them had learning and concentration difficulties at school, and many had conflicts with friends, parents, brothers and sisters. Jacobs states further that this compendium sums up the traumatic effects of conflict upon children. Such disorders might result from wars in any country causing children to suffer permanent damage, affecting their development and their long-term prospects for a normal, fulfilling life.