Psychiatric illness among child and adolescents attending psychiatry out-patient of tertiary care hospital

 

 

Abstract               Background: Psychiatric illness in children can be hard for parents to identify. As a result, many children who could benefit from treatment don’t get the help they need. Objectives: To study different types of psychiatric morbidities in child and adolescents attending psychiatry outpatient department of tertiary care hospital. Materials and methods: A retrospective analysis of psychiatry department records from 1 June 2017 to 31 December 2017 was carried out. Out of total 7200 patients, 138 child and adolescents who attended OPD of psychiatry department during the study period for the first time and having age 18 years or below were identified from medical records section. Data of patient’s age, sex, residence and diagnosis of all the patients were collected. Data was entered in Excel and analyzed by online Medcalc software for chi-square test, odds ratio and confidence interval. Results: Out of 7200 patients who attended OPD of psychiatry department, case records of 138 children and adolescents whose age 18 years or below were included. The mean age of study group was 12.24±3.35 years, majority of them were 10-18 years age group (80.4%). Male patients (60.9%) were more than female patients (39.1%). Out of 138 child and adolescent patients majority were suffering from mental retardation (26.8%) followed by learning disorder (13%) and seizure disorder (11.6%). Substance abuse (0.7%) was the least common. Conclusion: To conclude, the most common diagnosis was mental retardation, and least common was substance abuse among child and adolescent patients

Key Word: psychiatric illness, child and adolescent, tertiary care

 

INTRODUCTION

Mental health conditions and disorders don't only affect adults; children and adolescents can experience mental health problems too. India has highest population density and population growth figures in world, with children constituting almost 37% of the population. World Health Organization (WHO) estimated that 10-20% of children and adolescents experience mental disorders across worldwide¹. Half of all mental illness have onset in adolescence and suicide is supposed as major cause of death among adolescents². Neuropsychiatric conditions are the leading cause of disability in young people across the globe. Children having mental illnesses face major challenges with stigma, isolation and discrimination, as well as lack of access to health care and education facilities, in violation of their fundamental human rights³. A comprehensive review study of child psychiatric epidemiology in community surveys noted that the number of children and adolescents has risen from 10000 in studies published between 1980 and 1993 to nearly 40000 from 21 studies published between 1993 and 2002^4-5. The results of these studies indicate that about one out of every three to four adolescents is estimated to meet lifetime criteria for a Diagnostic and Statistical Manual of mental Disorders (DSM)⁴. Studies from across the globe shows the prevalence rate 22.5% for 7-16 year olds in Switzerland⁶, while in USA 21.0% for 9-17 year olds⁷ and in Ethiopia 17.7% for 5-15 year olds⁸ The multicentre WHO study on children in four developing countries, including India has reported a prevalence rate of 12-29%.⁹ In addition to this, hospital based studies also provide information on psychiatric morbidity in children^10-11 The common child psychiatric disorders identified in these studies include nocturnal enuresis, mental retardation and hyperkinetic syndrome. There is scarcity of specialized child psychiatric units and lack of awareness in community regarding psychiatric illnesses in pediatric age group. Knowing pattern of psychiatric disorders among these patients would help to increase awareness about these problems. The objective of this study is to determine the pattern of psychiatric disorders in children attending psychiatric out-patient department of tertiary care hospital.

MATERIAL AND METHODS

A retrospective study of six month psychiatry department case files from 1 June 2017 to 31 December 2017 was identified. The information of patients age, sex, residence and diagnosis of all the patients aged 18 yrs and below attending the psychiatry outpatient department (OPD) of Dr. Shankarrao Chavan Government Medical College, Nanded was collected. Our hospital is tertiary care centre in this area. The all cases were diagnosed by consultant psychiatrist using Diagnostic and Statistical Manual of Mental Disorders (DSM). Out of total 7200 patients, 138 child and adolescent patients who attended OPD of psychiatry department of tertiary care hospital during the study period for the first time and having age 18 years or below were identified from medical records section. Data was entered in Excel and analyzed by online Medcalc software for chi-square test, odds ratio and confidence interval.

 

RESULTS

Table 1 shows the distribution of demographic data of the patients evaluated (N=138). Out of 7200 patients who attended OPD of psychiatry department, case records of 138 children and adolescent’s age 18 years or below were included. The mean age of study group was 12.24±3.35 with a range of (3-17years), majority of them were adolescents age ranging from 10-18 yrs (80.4%). Male patients (60.9%) were more than female patients (39.1%). Majority of cases came from a urban background (51.4%). Table 2 shows the distribution of different psychiatric disorders among study population which was found to be maximum in mental retardation (26.8%) followed by learning disorder (13.0%), then by epilepsy with behavioral disturbances (11.6%) and autism (8.7%) respectively. Table 3 shows the distribution of psychiatric diagnosis in relation to the age group. Mental retardation was most common among pre-adolescent and adolescent age group, which was statistically highly significant (p<0.0001). While comparing psychiatric disorders in relation to gender (table 4), mental retardation and learning disorder were common among males while in females mental retardation and autism were common. However no statistically significant association was seen. Table 5 shows distribution of psychiatric illness in relation to residence. Schizophrenia was found to be more common in urban area than rural, which was statistically found significant (p<0.05).

Table 1: Demographic Data

 

Table 2: Distribution of psychiatric disorder among the study population

Table 3: Relationship between age groups and psychiatric disorders

* Highly Significant (p<0.0001)

Table 4: Relationship between Gender and Psychiatric disorders

Table 5: Relationship between Residence and Psychiatric disorders

* Significant (p<0.05)

 

DISCUSSION

This retrospective study was planned to study psychiatric morbidities among child and adolescent patients attending psychiatry outpatient department of tertiary care hospital. Moreover, the average age group of subjects was similar in all referred studies as compared to our study. The average age group of our study was 12.24±3.35 years, whereas 12.86 years in Chikezie et al¹² study, 14.77±2.99 years in Risal et al¹³ study, 15.68+3.73 years in Maan et al¹⁴ study, 14 years in Shakya DR¹⁵ study. In Manisha Chapagai et al¹⁶ study reported 8.85+4.08 years mean age group. In our study, the majority of patients were males than females with respect to frequency and similar results reported by Sarwat A et al¹⁷ and Chaudhary S et al¹⁸. Contrary to this finding , the numbers of females were more than males in Risal A et al¹³ study. Moreover, maximum patients were from urban background in our study this findings is consistence with other studies¹⁵. In this study , the maximum number of patients were mental retardation (26.8%) followed by learning disorder(13%), this may be related to, our hospital is a tertiary care centre in this area and many subjects are referred from peripheral area for IQ assessment and disability certification to get benefit from government. Chapagai et al¹⁶ also noted mental retardation was commonest diagnosis in their study. Contrary to this findings, dissociative / conversion disorder was common in other studies^13-14. Next came seizure disorders with behavioral problems (11.6%) and schizophrenia (8.7%) both these were more in male patients, this is consistent with findings in Chikezie et al¹² study. Least common diagnosis was substance abuse(0.7%) in our study.To conclude, mental retardation is the most common diagnosis among child and adolescent in our study may be due to considering only IQ assessment and disability certification.

Limitations of study

It is hospital based study which was carried out on small sample size, which may not necessarily represent general population of country. Community based surveys should be carried out on larger scale

 

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