Published by : PROFESSIONAL MEDICAL PUBLICATIONS
October - December 2009 (Part-II)
Mental health morbidity in children:
A hospital based study in child psychiatry clinic
Ayesha Sarwat1, S.M. Inkisar Ali2, Muzamil Shabana Ejaz3
Objectives: To determine the frequency and pattern of mental health morbidity in children attending "Psychiatry Clinic" in Paediatric OPD of a tertiary care hospital.
Methodology: This was a cross-sectional study conducted at psychiatric clinic of Paediatric OPD at civil hospital Karachi. Two hundred children upto the age of 14 years were included in the study. These children were assessed by a semi-structured interview based on P-CHIPS (Child Interview for Psychiatric Syndrome) and diagnosis of various psychiatric illnesses was further confirmed by DSMIV diagnostic criteria.
Results: Psychiatric disorders were more frequent in males 126 (63%) compared to females 74 (37%). Majority of patients affected were between 5-10 years of age (62.5%). Among the psychiatric disorders, oppositional defiant disorders were (20%), ADHD were (17%), elimination disorders and anxiety disorders were (11%) each. Other less frequent psychiatric problems were mood disorder, somatoform disorders, specific developmental disorders, emotional and habit disorders.
Conclusion: Mental health morbidity is an important issue in children attending the psychiatry clinic in the Paediatric OPD. Sensitization of parents, teachers and physicians is required, so that timely referral for psychiatric consultation is ensured before a critical illness develops.
KEY WORDS:Mental Health, Morbidity, Children.
Pak J Med Sci October - December 2009 (Part-II) Vol. 25 No. 6 982-985
How to cite this article:
Sarwat A, Ali SMI, Ejaz MS. Mental health morbidity in children: A hospital based study in child psychiatry clinic. Pak J Med Sci 2009;25(6):982-985.
1. Dr. Ayesha Sarwat,
Department of Psychiatry Civil Hospital Karachi.
2. Prof. S.M. Inkisar Ali,
Chairperson, Dept. of Paediatrics,
Dow University of Health Sciences,
Civil Hospital & Leyari General Hospital, Karachi.
3. Dr. Muzamil Shabana Ejaz,
Assistant Professor, Dept. of Paediatrics,
Dow University of Health Sciences & Civil Hospital, Karachi.
Prof. S.M. Inkisar Ali,
33A/III Golf Course Road, IV Khayaban-E-Jami,
Phase-IV D.H.A, Karachi - Pakistan.
* Received for Publication: June 22, 2009
* Revision Received: October 24, 2009
* Accepted: October 25, 2009
It is a general assumption that children do not suffer from psychiatric disorders. However, it has been observed that childhood psychiatric disorders are more common than expected in the general population.
According to the WHO statistics, prevalence of disabling mental illnesses among children and adolescence attending urban health care centers ranges between 20-30% and 13-18% in rural areas. Out of these children 3-4% are suffering from serious mental illnesses and require treatment.1 Western studies have showed prevalence of 10-12%.2 Most studies from developing countries reported higher prevalence rates for psychiatric problems in children and adolescent than those in western countries. Common psychiatric problems reported in various studies are attention deficit hyperactive disorder (ADHD), Oppositional defiant disorders, conduct disorders, psychosomatic disorders, anxiety and elimination disorders.3-5 ADHD is one of the most frequent psychiatric illnesses reported in the psychiatry clinics. In a study done in Pakistan, ADHD was found in 34% children whereas data from India reported that 6-9% children suffered from this disease.6,7
In developing countries like Pakistan, child and adolescent psychiatric problems are very often neglected. There is lack of specialized inpatient child psychiatric units and awareness regarding mental illnesses at community as well as at the level of medical practitioners and other health care providers is limited. The objective of this study was to determine the frequency and pattern of mental health morbidity in children attending "Psychiatry Clinic" in the Paediatric OPD of a tertiary care hospital.
This is a cross-sectional study conducted at the "Psychiatry Clinic" in Paediatric OPD in Civil Hospital Karachi. The hospital is a tertiary care center providing health services to urban and peri-urban areas of Sindh. Approximately 600 to 800 patients are seen in the OPD daily. Psychiatry Clinic was conducted as a sub-specialty clinic by the authors in Paediatric OPD. Patients were referred from the General Paediatric OPD by the medical officers and the paediatricians.
Two hundred children upto the age of 14 years were seen during the study period of six months. The selected children were interviewed through P-CHIPS (Child Interview for Psychiatric Syndrome). CHIPS is a highly structured interview based on DSM-IV criteria, it screens for presence of 20 psychiatry disorders as well as psychosocial stressors. It can be administered in any setup.8 In this study P-CHIP was administered which is parent version of the interview and useful in cases where child cannot be interviewed. The authors helped the parents in administration of the interview.
Children with suspected Psychiatry problems referred from General Paediatric OPD were included in this study. Children with mental retardation, chronic physical illnesses and neurological diseases viz epilepsy, leukodystrophies, muscular dystrophy were excluded from the study. Patients were provided medicines from the clinic and counselling of patients and families were done in the same setup separately keeping the privacy and confidentiality of patients. Disorders which are not assessed by CHIPS example, pervasive developmental disorders were diagnosed clinically based on DSM-IV criteria. Data analysis was done on SPSS version (10.0). Results are presented as frequencies and percentages where required.
Two hundred children upto the age of 14 years were included in the study. The gender distribution showed that psychiatric disorders are more common in males as compared to females. There were 63% males and 37% females. The age group affected more was between 5-10 years (Table-I).
Among the psychiatric illnesses oppositional defiant disorders were more common, seen in forty (20%) children, followed by ADHD in thirty-four (17%) cases. Elimination and anxiety disorders were present in twenty-two (11%) cases each. Other disorders observed were, mood disorders nineteen (10%), somatoform disorders eighteen (9%), specific developmental disorders ten (5%), pervasive developmental disorders nine (4.5%) and emotional problems eight (4%). Less frequent problems were obsessive compulsive disorders, schizophrenia, tics and tricotillomania (Table-II).
Child psychiatry as subspecialty has started gaining considerable recognition in Pakistan, but services available for children are limited to major cities of the country which comprise 30% of the whole population.9 There are several causes that may contribute to the mental health problems in Pakistan, including interfamily marriages, high rates of birth injuries, economic decline and high rates of unemployment, fragmentation of the family system and loss of religious value.10 The salient feature of the present study was to determine the frequency, age and gender distribution of psychiatric illnesses in children attending psychiatric clinic.
Oppositional defiant disorders lead to distress which has profound impact on the academic, social and occupational functioning of these children.11 In our study Oppositional defiant disorders were found in forty cases. They were found more in males than females. (4:1) and were more common between 5 to 10 years of age. A study done in Lahore showed prevalence of 9.3% for behavioral problems12, whereas another study done in Al-Ain UAE also reported male predominance and mean age of 10 years.13
Another significant disorder was attention deficit hyperactivity disorder (ADHD), it was observed in thirty four cases of the study group. Prevalence of ADHD as shown in western studies is 3-5%.14-15 Few epidemiological studies reported male to female ratio of 4:1, while most of the clinical studies showed the gender ratio of 9:1.16 Data available from Pakistan is scarce but studies from India showed prevalence of 5-10%.17 Few local studies showed that ADHD is more common between 6-10 years of age6, our study also reported the similar findings it was more frequently found between 5-10 years of age.
Elimination disorders were seen in eleven percent children. Mood and anxiety disorders are also one of the common psychiatric problems in children, it is also observed that these disorders are associated with somatization in children and adolescents who cannot express their feelings and depression among them is largely unrecognized and left untreated.18-20 It has also an impact on the academic performance as well as it leads to depression in adulthood.22-24 Manifestations of depression as an anxiety disorder were also found in earlier studies, which showed that male to female ratio for these disorders is equal in children25-26, present study also showed similar results. Other problems found in the current study were schizophrenia, obsessive compulsive disorders and tics.
Limitation of the study: It is a hospital based study which was carried out on a sample size of two hundred. Community based surveys should be carried out on larger scale to find out the depth of the psychiatric problems in children.
Mental health morbidity is an important issue as seen in children attending the "Psychiatry Clinic" in a Paediatric OPD. Most common psychiatric problems found in children are oppositional defiant disorders, ADHD disorders, anxiety and mood disorders.
Community based surveys are required to assess the clear picture of childhood psychiatric problems. Sensitization of parents, teachers and family physicians is required to enable them for playing their role in early recognition and timely psychiatric consultation should be sought before a critical illness develops.
Authors are thankful to Mr. Furqan Baig for the secretarial assistance.
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