Psychological Factors Affecting Wellbeing of Students Living with Sickle Cell Anemia in Senior Secondary School in Enugu State
Department of Educational Foundations, Enugu State University of Science and Technology (ESUT), Enugu State, Nigeria
animba.evelyn@esut.edu.ng
Department of Educational Foundations, Enugu State University of Science and Technology (ESUT), Enugu State, Nigeria
Abstract
This study investigated psychological factors affecting wellbeing of secondary school students living with sickle cell anemia in Enugu State. Using an ex-post facto design, 50 senior secondary school students living with sickle cell anemia in public schools were selected through purposive sampling. A researcher-designed questionnaire with Cronbach alpha coefficient of 0.87 was used for data collection. Mean and standard deviation were used to answer research questions. Major findings indicated that stress influences the health condition of students living with sickle cell anemia at a high extent (cluster mean = 2.01). Social support findings showed a low extent cluster mean of 1.88, though individual items revealed that while some students feel accepted and have peer support, there is also a notable tendency to conceal their condition due to fear of stigmatization. The study recommends that schools provide psycho-social support systems including trained counselors, while government should provide better inclusive learning environments for students living with sickle cell anemia.
Keywords
Introduction
Sickle cell anemia (SCA) is a hereditary blood disorder marked by the abnormal sickling of red blood cells, resulting in chronic pain episodes, anemia, fatigue, susceptibility to infections, and organ damage. The disease constitutes a significant public health challenge, particularly in sub-Saharan Africa, where Nigeria accounts for a substantial proportion of the global SCA burden with thousands of affected infants born annually. For students, the implications of living with SCA are particularly complex. Frequent pain crises and hospitalization can disrupt academic attendance and participation, making it challenging to meet school demands. Living with a chronic disease during critical developmental periods such as adolescence can profoundly influence psychological wellbeing, academic engagement, and social functioning. Psychosocial factors such as stress, self-esteem, coping strategies, and perceived social support are known to influence overall wellbeing among individuals living with chronic illnesses.
Psychological Challenges of Sickle Cell Anemia
Persistent pain can expose students with sickle cell anemia to high levels of stress and emotional distress. Recurrent pain episodes and limitations in physical activities may lead to feelings of frustration, helplessness, and social isolation, negatively impacting self-esteem and increasing vulnerability to anxiety and depressive symptoms. Stigma and misconceptions surrounding sickle cell anemia within schools and communities may further compound psychological difficulties. Students living with sickle cell anemia may be misunderstood, labeled as weak, lazy, or frequently absent, which can affect their self-image and peer relationships. Such negative social experiences may diminish perceived social support from classmates and teachers, thereby worsening emotional wellbeing. Conversely, strong family support, understanding school environments, effective coping strategies, and access to psychological and counselling services have been shown to enhance resilience and improve wellbeing among students living with sickle cell anemia.
Methodology
An ex-post facto design was adopted for this study, which was conducted in public secondary schools in Enugu State. The population comprised all senior secondary school students (SS1 to SS3) diagnosed with sickle cell anemia in the State. Purposive sampling technique was used to select 50 students diagnosed with sickle cell anemia who agreed to participate, with assistance from school counsellors. A self-constructed questionnaire titled "Psychological Factors Affecting Wellbeing Students Living with Sickle Cell Questionnaire (PWSCQ)" was used, structured on a four-point Likert scale. The instrument was face validated by three experts from Educational Psychology and Measurement and Evaluation at ESUT. Reliability was established through trial-testing on 10 students with SCA in Ebonyi State, yielding an overall Cronbach Alpha coefficient of 0.83. Mean and standard deviation were used to answer research questions.
Results
Research question one on stress influence revealed an overall cluster mean of 2.01 with standard deviation of 0.82, indicating that students generally agreed that stress influences sickle cell anemia at a high extent. Items such as "I experience sudden pain crises while in school" (mean = 2.00), "I feel sad because of my health condition" (mean = 2.03), "I worry that other students may not understand what I'm going through" (mean = 2.03), and "I miss classes or school events because of my health condition" (mean = 2.02) all showed high extent agreement. Research question two on social support revealed an overall cluster mean of 1.88 with standard deviation of 0.83, indicating a general trend toward low agreement. However, individual items revealed important insights: "I feel accepted by my classmates despite my health condition" (mean = 2.41), "I have close friends in school who understand my condition" (mean = 2.35), and "I hide my health condition from my classmates to avoid discrimination" (mean = 2.35) showed high extent agreement, while items on participation in school activities and feeling isolated showed low extent.
Discussion
The findings confirmed that stress affects secondary school students living with SCA, significantly impairing their daily functioning in school settings. Pain and emotional reactions are recurrent experiences among students with SCA, consistent with previous literature showing that adolescents with sickle cell anemia frequently experience intense pain crises that affect academic performance and emotional wellbeing. For social support, while some students feel accepted and have peer support, there is also a notable tendency to conceal their condition, likely due to fear of stigmatization or misunderstanding. The fear of stigmatization continues to affect the psychological wellbeing and participation of these students in school activities. Gender-wise, male and female students responded similarly, with very close mean scores and standard deviations across all items, reflecting consistency and shared social experiences regardless of gender.
Conclusion and Recommendations
The study established that stress affects the wellbeing of students living with sickle cell anemia at a high extent, with pain episodes and emotional reactions being consistent with clinical expectations of the disease. Social stigma and reduced participation in school activities further compound their psychological vulnerability. A combination of psychosocial counseling, awareness campaigns, and health services is required to address their needs. School administrators should provide regular access to trained counselors to support students living with chronic conditions. Awareness programs should be conducted in schools to reduce stigma and promote empathy among students and teachers. State health and education ministries should collaborate to ensure consistent medical support services for students with chronic illnesses. Teachers should be trained to recognize the psychosocial needs of sickle cell students and offer flexible academic accommodations. Parents should be sensitized on the importance of emotional and social support for their children living with sickle cell anemia.