1. Background
Nocturnal enuresis (NE) is defined as involuntary urination at night in children above 5 years (1). This common problem has an overall high prevalence in different age groups of children, ranging from 1.6% to 15%. The prevalence of NE is estimated at 15% in 5-year-old children, 7% in 8-year-old children, and 1% in 15-year-old children (2). Also, the ratio of boys to girls is 1.4 to 1.
NE is classified into primary enuresis (75%), when nocturnal urinary continence has not been achieved since birth, and secondary enuresis (25%), when bed-wetting occurs in a child with at least 6 months of nighttime dryness (3). Moreover, it can be classified into nonmonosymptomatic (accompanied by daytime urinary symptoms) and monosymptomatic (without daytime urinary symptoms) (4, 5). The aim of the present study was to evaluate primary NE, which is either monosymptomatic or nonmonosymptomatic.
Intelligence is defined as an individual’s cognitive ability to learn different subjects. It is associated with IQ, abstract thinking, consciousness, planning, memory, problem-solving, and creativity (6). Similar to intelligence deficits, NE can result in severe mental disorders, academic failure, and reduced self-confidence in children (7, 8). There are some suggestions about psychological problems in parents of children with NE (9), which may be due to parents’ frustration, loss of emotional intelligence and skills, and difficulties with their parental roles (10).
2. Objectives
There is no information about the intelligence-related aspects of NE in Farsi-speaking countries, especially Iran. In addition, no studies have been performed on the psychosocial or behavioral problems of children with NE in Iran. Therefore, the aim of this study was to evaluate the correlation between parents’ emotional intelligence and NE in children.
3. Methods
3.1. Study Setting
This hospital-based, case-control study was conducted in the pediatric clinic of Amir-Kabir hospital in Arak, Iran.
3.2. Study Population
We recruited a total of 200 children, within the age range of 5 - 16 years. The sample size was selected, based on other similar studies. In total, 100 children with NE were allocated to the case group, and 100 healthy children were included in the control group. Children in each group were selected via randomization. For this purpose, the participants were asked to select between 1 (case group) and 2 (control group); the groups were equal in terms of demographic information.
3.3. Measurements
After selecting the participants, history of mental and physical status was thoroughly examined in children. In addition, demographic information, including age, gender, number of children in family, occupation, educational level of parents, and family’s economic status, was collected by the researcher from the families. Also, the global emotional quotient inventory (EQ-i) was compelted by the parents. The responses were scored on a 5-Likert scale (strongly agree, agree, neutral, disagree, and strongly disagree).
The EQ-i consists of 5 scales, 15 subscales, and 90 questions. This questionnaire has been replicated in 3 steps in Iran, and the number of questions was reduced from 117 to 90 (6). The reliability of this questionnaire has been examined using parallel or peer methods; its reliability was reported at 93% based on Cronbach’s alpha. The subscales include emotional self-awareness, problem-solving, happiness, independence, stress tolerance, self-actualization, emotional awareness, realism, interpersonal relationship, optimism, self-respect, continence, flexibility, responsibility, and sympathy.
3.4. Inclusion and Exclusion Criteria
Infants with NE diagnosis, based on the diagnostic and statistical manual of mental disorders (DSM-IV-TR) criteria, were included in the study. On the other hand, children with mental retardation and brain problems, such as epilepsy, autism, hydrocephalus or structural abnormalities (abnormal ultrasounds), psychiatric disorders, and diseases of the kidney and urinary tract were excluded. Moreover, subjects who were unwilling to cooperate or continue the study were eliminated, in addition to parents with schizophrenia, severe mental retardation, or mental disorders.
3.5. Ethical Considerations
Ethical issues including plagiarism, data fabrication, and double publication were completely observed by the authors. In addition, the ethics committee of Arak University of Medical Sciences approved the study protocol.
3.6. Statistical Analysis
Data analysis was conducted by measuring the mean, standard deviation, and frequency of quantitative variables. The analyses were conducted via Chi square and independent t tests in SPSS version 21 to compare the mean values of parameters between the groups. The significance level was considered as P < 0.05.
4. Results
Based on the results, we find a correlation between NE in children and emotional intelligence of parents. As presented in Table 2, the groups were homogenous in terms of demographic information. Age (P = 0.052), child’s gender (P = 0.557), father’s education (P = 0.984), mother’s education (P = 0.901), father’s occupational status (P = 0.689), mother’s occupational status (P = 0.972), economic status (P = 0.479), and living area (P = 0.755) were not significantly different between the groups.
Table 1.The Average Score of Emotional Intelligence of Parents in the Case (n, 100) and Control (n, 100) Groups
| Variables | Case | Control | Total | P Value |
|---|---|---|---|---|
| PS, mean ± SD | 16.37 ± 3.86 | 22.28 ± 2.42 | 19.32 ± 3.14 | 0.001 |
| HA, mean ± SD | 16.45 ± 3.79 | 22.32 ± 2.52 | 19.38 ± 3.15 | 0.001 |
| IN, mean ± SD | 16.48 ± 3.76 | 22.16 ± 2.41 | 19.32 ± 3.09 | 0.001 |
| ST, mean ± SD | 18.95 ± 4.86 | 25.24 ± 2.45 | 22.08 ± 3.65 | 0.001 |
| SA, mean ± SD | 18.92 ± 4.86 | 24.99 ± 2.60 | 21.95 ± 3.73 | 0.001 |
| EA, mean ± SD | 18.96 ± 4.87 | 25.17 ± 2.52 | 22.07 ± 3.69 | 0.001 |
| RE, mean ± SD | 18.94 ± 4.88 | 25.00 ± 2.50 | 21.97 ± 3.66 | < 0.001 |
| IR, mean ± SD | 18.90 ± 4.86 | 25.16 ± 2.60 | 22.03 ± 3.73 | 0.001 |
| OP, mean ± SD | 18.83 ± 4.94 | 25.03 ± 2.57 | 21.93 ± 3.75 | < 0.001 |
| SR, mean ± SD | 18.81 ± 4.92 | 25.07 ± 2.55 | 21.94 ± 3.73 | < 0.001 |
| CO, mean ± SD | 18.82 ± 4.94 | 25.10 ± 2.60 | 21.96 ± 3.77 | < 0.001 |
| FL, mean ± SD | 18.82 ± 4.97 | 25.13 ± 2.50 | 21.98 ± 3.74 | < 0.001 |
| RE, mean ± SD | 18.84 ± 4.96 | 24.96 ± 2.57 | 21.79 ± 3.76 | 0.001 |
| SY, mean ± SD | 18.84 ± 4.96 | 25.05 ± 2.45 | 21.95 ± 3.71 | < 0.001 |
| SE, mean ± SD | 18.81 ± 2.89 | 25.06 ± 2.54 | 21.93 ± 2.71 | < 0.001 |
Table 2.The Demographic Information of the Case (n, 100) and Control (n, 100) Groups
| Variables | Case | Control | Total | P Value |
|---|---|---|---|---|
| Age, mean ± SD | 8.42 ± 2.59 | 8.36 ± 3.14 | 7.89 ± 2.91 | 0.052 |
| Gender | 0.557 | |||
| Male | 44 | 43 | 87 | |
| Female | 56 | 57 | 113 | |
| Father’s education | 0.984 | |||
| Under diploma | 7 | 7 | 14 | |
| Diploma | 43 | 45 | 88 | |
| Associate’s degree | 2 | 3 | 5 | |
| Bachelor’s degree | 36 | 33 | 69 | |
| Master’s degree and higher | 12 | 12 | 24 | |
| Mother’s education | 0.901 | |||
| Under diploma | 14 | 17 | 31 | |
| Diploma | 42 | 42 | 84 | |
| Associate’s degree | 1 | 0 | 1 | |
| Bachelor’s degree | 40 | 39 | 79 | |
| Master’s degree and higher | 3 | 2 | 5 | |
| Father’s occupation | 0.689 | |||
| Employee | 44 | 42 | 86 | |
| Employer | 44 | 49 | 93 | |
| Self-employed | 12 | 9 | 21 | |
| Mother’s occupation | 0.972 | |||
| Employee | 32 | 31 | 63 | |
| Employer | 15 | 16 | 31 | |
| Self-employed | 16 | 14 | 30 | |
| Housewife | 37 | 39 | 76 | |
| Economic status | 0.479 | |||
| < 250 USD | 7 | 4 | 11 | |
| 250 - 500 USD | 50 | 57 | 107 | |
| > 500 USD | 43 | 39 | 82 | |
| Living area | 0.755 | |||
| Urban | 89 | 90 | 179 | |
| Rural | 11 | 10 | 21 |
As presented in Table 1, all indicators of emotional intelligence were significantly different between the case and control groups (P = 0.001). The mean ± SD values of these factors are presented in Table 1. The subscales included problem-solving (P = 0.001), happiness (P = 0.001), independence (P = 0.001), stress tolerance (P = 0.001), self-actualization (P = 0.001), emotional awareness (P = 0.001), realism (P < 0.001), interpersonal relationship (P = 0.001), optimism (P < 0.001), self-respect (P < 0.001), continence (P < 0.001), flexibility (P < 0.001), responsibility (P = 0.001), sympathy (P < 0.001), and self-expression (P < 0.001), all of which were significantly different between the groups.
5. Discussion
In the present study, we compared the nephrotoxic effects of gentamicin and amikacin. It was revealed that the emotional intelligence of parents with healthy children was higher than that of parents of children with enuresis. As there are no thorough studies in this area, we discuss some of the most relevant studies.
Bruyne et al. in a study on stress and problematic behaviors of parents and children with NE evaluated 110 children without NE as the control group and 78 children with NE as the case group. They reported that parents, especially mothers of children with NE have more stress and problematic behaviors (11). Moreover, Das et al. conducted a study to evaluate the improvement of depression after sacral nerve stimulation for the treatment of voiding dysfunction. They concluded that unresolved voiding symptoms have significant impacts on the psychological and physical aspects of quality of life. Also, sacral nerve stimulation could improve depression and health-related quality of life (12).
Furthermore, Chang et al. conducted a study on 89 children with NE. They evaluated parenting stress and its association with NE in children of a Chinese population. They found that primary NE was associated with more parenting behavioral problems and greater stress in the Chinese population (13). Yousefichaijan et al. in a case-control study evaluated attention deficit-hyperactivity disorder (ADHD) in children with primary monosymptomatic NE. They evaluated 200 children with and without NE and showed that the inattentive type of ADHD was significantly more common in children with primary monosymptomatic NE (14).
Rushton et al. noted that reactions of parents to NE in children could complicate the efforts of treatment (15). Moreover, Vaillant et al. evaluated 73 men with the mean IQ of 80 in the age range of 14 - 65 years. They found that men with reactionary low IQ were more likely to be productive and use mature defense mechanisms (16). Additionally, Taylor et al. investigated factors, influencing emotional intelligence in addiction-related behaviors among university students. They found that stress management abilities were the most important factors in the symptomatology of addiction-related behaviors in both genders (17). Considering the few clinical studies on the impact of parents’ emotional intelligence on NE in children, further studies are required in this area. Therefore, we recommend studies with larger sample sizes.
The main limitation of this study was incomplete questionnaires by the parents. However, the participants agreed to cooperate with the study, as we explained the impact of NE on nervous and urinary systems, as well as other body systems.
5.1. Conclusion
The results showed a correlation between emotional intelligence of parents and NE of children. NE was more frequent in children of parents with higher emotional intelligence, compared to parents with lower emotional intelligence. Therefore, we can reduce the duration of NE by improving the emotional intelligence of parents.
