**4. Methods**

This study included 69 patients (32 females, 37 males) who applied to Gazi University Faculty of Dentistry Department of Orthodontics with CL/P and their mothers' participation. In order to conduct the study, the ethics committee approval dated 09.05.2017 and numbered 77,082,166-604.01.02 was obtained from Gazi University Ethics Committee.

Exclusion criteria for the study:


Inclusion criteria for the study:

Individuals with CL/P aged 6–18 years and their mothers participated in the study voluntarily. The mean age of individuals with CL/P was 14 ± 3.9 years. Patients were divided into two groups as children and adolescents. Twenty-nine patients between the ages of 6 and 12 (mean age 9 ± 1.8 years) were included in the children group, and 40 patients between the ages of 13–18 (mean age 16.3 ± 1.7 years) were included in the adolescent group. Also, mothers of these patients were divided into two groups as mothers of children and mothers of adolescents. The purpose and content of the study were explained to the volunteer individuals and their mothers in detail and the surveys related to the study were asked to be answered individually.

As a data collection tool, a total of six surveys, three for patients with CL/P and three for their mothers were used. Also, additional questions were asked to the mothers in order to obtain sociodemographic descriptive information. The following surveys were applied to the patients with CL/P:


The Kid-KINDL scale (KINDer Lebensqualitätsfragebogen: Children Quality of Life Questionnaire) developed by Ravens-Sieberer and Bullinger [24], which consisted of 24 items and six subdimensions (physical well-being, emotional

well-being, self-esteem, family, friends and school) was used to evaluate the generic quality of life in children. The scores obtained from the scale vary between 0 and 100. The scale does not have any cut-off point, and high scores indicate good quality of life [25]. There are three versions of the KINDL scale, which are based on self-report used in different age groups. These include Kiddy-KINDL for children aged 4–7 (version implemented via interviewer), Kid-KINDL for children aged 8–11 and Kiddo-KINDL for adolescents aged 12–16 [24]. In this study, Kid-KINDL scale was applied for the children group and Kiddo-KINDL version was used for the adolescent group.

The Coopersmith Self-Esteem Inventory is available in three versions: school form (8–15 years), adult form (16 years and older) and short form. The original forms, the school form and the adult form, consist of 58 items and the short form consists of 25 items. Fifty of the items are related to self-esteem and eight of them are related to lie scale; false items are used to measure the defensive attitude of individuals [26, 27]. The original form of this scale consisting of 58 items was used in our study. In the scale, items showing high self-esteem have a score of two and items showing low selfesteem have a score of 0. The scores that can be obtained from the scale vary between 0 and 100. In this scale, a score below 50 indicates a low self-esteem level while a score above 50 is considered as high self-esteem level [28].

In this study, 'the Depression Scale for Children' developed by Kovacs [29] was used to measure the depression scores of children. This is a self-assessment scale consisting of 27 items that can be applied to children aged 6–17 years. Each item receives 0, 1 or 2 points depending on the severity of the symptom. The reverse items in the scale are scored reversely. The maximum score is 54. The higher the score, the more severe depression [30]. The cut-off score is suggested as 19 [29, 31]. Those with a scale score of 19 or higher were considered pathological [32].

Three surveys were applied to the mothers:


The SF-36 Quality of Life Scale is a 36-item test that the individual answers by himself/herself in order to obtain information about the general health status of the individual.

In the present study, "The Rosenberg Self-Esteem Scale" developed by Morris Rosenberg [33] was used to assess the self-esteem levels of mothers of patients with CL/P. The Rosenberg Self-Esteem Scale consists of 12 subscales. However, while the first subscale aimed to measure self-esteem directly, the other subscales were designed to measure situations thought to be related to self-esteem [34]. In the reliability and validity study conducted by Korkmaz [34] for the adaptation of the Rosenberg Self-Esteem Scale to adult individuals, the mean values of women for the 12 subunits of the scale were reported.

"The Beck Depression Scale" was used to assess the depression levels of mothers of patients with CL/P. This is a 21-item self-assessment scale which measures the symptoms of characteristic attitude and the cognitive, emotional and motivational tendencies in depression [35]. The scores to be obtained from the scale range from 0 to 63 and scores of 17 and above indicate the presence of depression [36].

*Assessment of Psychosocial Functioning among Patients with Cleft Lip/Palate and Their Mothers DOI: http://dx.doi.org/10.5772/intechopen.111667*

#### **4.1 Statistical analyses**

Statistical analysis were performed using the IBM-SPSS (International Business Machines—Software Package for Social Sciences) Statistics software (version 23.0; IBM, Armonk, NY, USA). Comparison of cleft types and age, education and income levels of mothers between groups were performed using Chi-Square analysis. Mann– Whitney U test was used for comparisons between the groups. Pearson correlation analysis was performed to determine the relationship between the D1-self-esteem subscale and other subscales of the Rosenberg Self-Esteem Scale. P-value <0.05 was considered statistically significant.
