Indmedica Home | About Indmedica | Medical Jobs | Advertise On Indmedica
Search Indmedica Web
Indmedica - India's premier medical portal

Indian Journal of Community Medicine

Prevalence of Psychiatric Morbidity Among 6 to 14 Year old Children

Author(s): Anita, DR Gaur, AK Vohra*, S. Subash**, Hitesh Khurana*

Vol. 28, No. 3 (2003-07 - 2003-09)

Deptts. of S.P.M. & Psychiatry*, Pt. B.D.S. PGIMS, Rohtak
**Deptt. of Neurosurgery, UCMS & GTB Hospital, Delhi

Abstract:

Research question: What is the prevalence of psychiatric morbidity among 6 to 14 years old children?

Objectives: l) To study the prevalence of psychiatric disorders in children of 6-14 years of age in rural and urban areas. 2) To study the pattern of psychiatric disorders and associated socio-demographic variables.

Study design: Cross-sectional.

Setting and Participants: 400 children each from urban and rural field practice areas under the department of Social and Preventive Medicine, PGIMS, Rohtak.

Statistical analysis: Percentages, Chi-square test.

Results: Prevalence of Psychiatric disorders in children was found to be 16.5%. Conduct disorder was the most common psychiatric disorder observed (4.5%) in these children followed by mental retardation (3.25%). Prevalence was more in male children (18.37%) than in female children (14.44%), more common among scheduled caste children (18.4%), also in children who belonged to nuclear families (17.35%).

Key Words: Children, Psychiatric morbidity, Urban and rural areas

Introduction:

Mental health is the balanced development of an individual's personality and emotional attitudes which enable him to live harmoniously with his fellow men, mental health is not exclusively a matter of relation between persons, it is also a matter of relation of the individual towards the community he lives in, towards the society of which the community is a part and towards the social institution which for a large part guides his life, determine his way of living, working, leisure and the way he earns and spends his money, the way he sees happiness, stability and security1.

Children are the most important asset and wealth of a nation. Healthy children make a healthy nation. The children under 15 years of age constitute about 40% of the population and school aged children i.e. 6 to 14 years age constitute 22% of children population2. The child is not a miniature, but an individual in his own right. The quality of childhood one has lived will determine the ultimate nature of adulthood. The foundations of child's social attitude and skills are laid in the home. Now a days, because of the rapid industrialization and urbanization, majority of young couples are employed, so unavoidably they get less time to look after their children. Under these circumstance, emotional, behaviour and psychiatric problems are on the rise3.

It is surprising to note that there are only few studies about childhood psychiatric disorders from India. Most of the epidemiological surveys have not mentioned about childhood psychiatric disorders (Ganguli, 2000 Murlimadhvan), whereas, the surveys that have mentioned about child psychiatric disorders have reported a wide variation (20-33%) in the prevalence rates (Jiloha & Murthy 1981, Lal and Sethi 1977, Nandi et al 1975, Deivasigamani 1990).

Material and Methods:

The study was undertaken during 2001-02. The sample of 800 children was drawn from children in the age group of 6 to 14 years including rural and urban both from field practice areas of department of SPM, PGIMS, Rohtak. 400 children from each area were selected using systematic random sampling technique. The study was carried out in two phases. In phase-I, all children in the selected sample were subjected to a screening for psychiatric symptoms by interviewing the parents or the key informant of the children using Hindi version of Childhood Psychopathology Measurement Schedule (CPMS)4.

CPMS is an India adaptation of Achenback's child behaviour check list (1983) consisting of 75 symptoms yielding 'Yes' or 'No' response from the interviewee. The sensitivity and specificity of the tools is 82% and 87% respectively and has been found be valid and reliable tool for screening psychiatric morbidity among Indian children. A score of 10 or above indicates the possibility of psychiatric morbidity in children. The children screened positive for psychiatric morbidity were subjected to diagnostic assessment using Diagnostic Interview Schedule for Children (DISC)5 in the second phase. The diagnosis was generated as per criteria laid down in ICD-106 (WHO, 1992).

Results:

The sample consisted of 400 children each from urban and rural areas.

Table I: Age-wise distribution of children.

Children
Age (Years) Urban Rural Total
No. (%) No. (%) No. (%)
6 53 (13.25) 59 (14.75) 112 (14)
7 62 (15.5) 73 (18.25) 135 (15.88)
8 60 (15) 56 (14) 116 (14.5)
9 53 (13.25) 35 (8.75) 88 (11)
10 45 (11.25) 32 (8) 77 (9.62)
11 44 (11) 38 (9.5) 82 (10.25)
12 33 (8.25) 46 (11.5) 79 (9.87)
13 35 (8.75) 35 (8.75) 70 (8.75)
14 15 (3.75) 26 (6.5) 41 (5.13)
Total 400 400 800

Age wise distribution of children from both rural and urban areas in shown Table I.

Table II: Sex distribution of study population.

Sex Rural
No.(%)
Urban
No.(%)
Total
No.(%)
Male 222 (55.5) 197 (49.25) 419 (52.38)
Female 178 (44.5) 203 (50.75) 38 1 (47.62)
Total 400 (100) 400 (100) 800 (100)

Table II depicts the sex distribution of rural and urban children.

Table III: Prevalence of psychiatric problems amongst children.

Problem Rural
(n=400) No.(%)
Urban
(n-400) No.(%)
Total
(n-800) No.(%)
Mental retardation (MR) 16 (4) 10 (2.5) 26 (3.25)
Conduct disorder (CD) 19 (4.75) 17 (4.25) 36 (4.5)
Anxiety (Anx.) 7 (1.75) 16 (4) 23 (2.87)
Depression (Dep) 1 (0.25) 2 (0.5) 3 (0.37)
Psychotic symptoms (Psy-Dis) 8 (2) 7 (1.75) 15 (1.87)
Enuresis 5 (1.25) 4 (1) 9 (1.13)
Somnambulism 3 (0.75) 6 (1.5) 9 (1.13)
Pica 2 (0.5) 5 (1.25) 7 (0.88)
Somatization (SOM) 1 (0.25) 3 (0.75) 4 (0.5)
Total 62 (15.5) 70 (17.5) 132 (16.5)

X2=0.445, df =1, p=0.5049.

167 (78 rural and 89 urban) children were screened positive for psychiatric disorders on CPMS. On interview of these 167 children with the help of DISC, 132 (62 rural and 70 urban) fulfilled one or more ICD-10 criteria for psychiatric disorders giving an overall prevalence of 16.5%, however, the prevalence was slightly higher in urban (17.5%) than in rural area. Conduct disorder was the most common psychiatric disorder in urban (4.25%) as well as in rural area

Table IV: Sex-wise distribution of psychiatric problems among children.

Disorder Male
(n=419)
Female
(n=381)
Total
(n=800)
No. % No. % No. %

MR

12

(2.86)

14

(3.67)

26

(3.25)

CD

27

(6.44)

9

(2.36)

36

(4.5)

Anxiety

12

(2.86)

11

(2.89)

23

(2.87)

Depression

2

(0.48)

1

(0.26)

3

(0.37)

Psy-Dis

10

(2.39)

5

(1.32)

15

(1.87)

Enuresis

6

(1.43)

7

(1.84)

13

(1.62)

Somnambulism

3

(0.72)

5

(1.31)

8

(1)

Pica

2

(0.48)

2

(0.52)

4

(0.5)

SOM

3

(0.72)

1

(0.26)

4

(0.5)
Total 77 (18.37) 55 (14.44) 132 (16.5)

X2=2.25, df =1, p=0.1336.

Psychiatric disorders were more common in male children (18.37%) than among female children (Table IV).

Table V: Caste-wise distribution of psychiatric problems

Disorder Higher caste
(n=468)
Backward caste
(n=207)
Scheduled caste
(n=125)
Total
(n=800)
MR 15 (3.21) 8 (3.86) 3 (2.4) 26 (3.25)
CD 19 (4.05) 4 (1.93) 13 (10.4) 36 (4.5)
Anxiety 17 (3.63) 3 (1.45) 3 (2.4) 23 (2.87)
Depression 3 (0.64) 0 (0) 0 (0) 3 (0.37)
Psy-Dis 11 (2.35) 2 (0.97) 2 (1.6) 15 (1.87)
Enuresis 6 (1.28) 4 (1.93) - - 10 (1.25)
Somnambu. 7 (1.49) 1 (0.48) - - 8 (1)
Pica 4 (0.85) 2 (0.97) 1 (0.8) 7 (0.87)
SOM 3 (0.64) 0 (0) 1 (1.8) 4 (0.5)
Total 85 (18.16) 24 (11.6) 23 (18.4) 132 (16.5)

X2 =4.88, df = 2, p-0.0870 (non-significant).

Caste-wise distribution of these children shows that the prevalence of psychiatric disorders was observed to be 18.4% in children who belonged to scheduled caste followed by higher caste (18.16%0) and backward caste (11.6%).

Psychiatric disorders were found to be more prevalent in children belonging to nuclear families (17.35%) than joint families (15.58%). The difference was, however, not significant.

Diagnostic breakup of psychiatric disorders among these children suggest that eldest born child was the most commonly affected (21.17) followed by middle (14.45), youngest (13.25) and then the only child (9.62) and the difference between them was found to be statistically significant (p=0.0247).

Table VI: Birth order wise distribution of psychiatric disorders amongst children.

Birth Order
Disorder Eldest (n=326) Middle (n=173) Youngest (n=249) Only child (n-52) Total (n=800)
MR 13 (3.99) 9 (5.2) 4 (1.61) - - 26 (3.25)
CD 24 (7.36) 6 (3.47) 5 (2.0) 1 (1.92) 36 (4.5)
Anxiety 11 (3.37) 4 (2.31) 6 (2.41) 2 (3.85) 23 (2.87)
Depression 1 (0.31) 1 (0.58) 1 (0.4) - - 3 (0.37)
Psy-Dis 9 (2.77) 2 (1.16) 4 (1.61) - - 15 (1.87)
Enuresis 4 (1.23) 1 (0.58) 6 (2.41) - - 11 (1.38)
Somnambulism 3 (0.92) 2 (1.16) 4 (1.61) - - 9 (1.13)
Pica 1 (0.31) -   4 (1.61) - - 5 (0.63)
SOM 3 (0.92) 1 (0.58) -   - - 4 (0.5)
Total 69 (21.17) 26 (15.02) 34 (13.65) 3 (5.77) 132 (16.5)

X2 =9.37, df = 3, p=0.0247.

Discussion:

Community based prevalence studies are rare although school based and hospital based studies are available, the prevalence of childhood psychiatric disorders in our community based study has come out to be 16.5%.

Regarding pattern of these psychiatric disorders, conduct disorder was found to be 4.5% similar to that observed by Butter et al (1975)7. In this study, prevalence of anxiety was observed to be 2.87 as compared to 6.6% observed by Singhal et al (1988)8. The reason being that the present study was carried out in community, whereas, Singhal et al studied the morbidity in hospital setting. Mental retardation was observed to be 3.25%, which is similar to that observed by Deivasigamani (1990)9. Preponderance of conduct disorder in boys is a widely reported phenomenon across cultures. Apart from this difference, there may be a difference in the norm of accepted standard of behaviour in boys and girls. Aggressive behaviour in boys is as a rule tolerated while in girls it is discouraged.

Children belonging to lower social class were at increased risk of psychiatric disorders because the factors such as complicated pregnancy and parturition, malnutrition, exposure to environment stimulation due to ignorance and negligence of child care are associated with socio-economic status10.

Belonging to a nuclear family was found to be conducive to generation of mental disorders in children, probably due to relative lack of attention paid to them in the absence of grandparents, uncles, aunts etc. Thus they might have been emotionally deprived.

Psychiatric disorders were more prevalent in eldest born children. This could be one of the fact that the eldest child is more vulnerable to parental coerciveness, over protection and strictness11.

Conclusion:

In view of above, it is highly imperative that such epidemiological studies should start early in childhood and carried longitudinally for development of preventive, promotive and curative programme in the community.

References:

  1. Park K. Textbook of Preventive and Social Medicine. 16th edition, Jabalpur: Banarsidas Bhanot Publishers: 2000 p.580.
  2. Ministry of Health and Family Welfare. Health Information of India 1995-96. New Delhi: Directorate General of Health Services; 1996. p.15.
  3. Malhotra S, Malhotra A, Verma V. Child Mental Health in India. 1st ed. New Delhi: Macmillan India Limited; 1992.
  4. Malhotra S, Verma VK, Verma SK, Malhotra A. Childhood Psychopathology Measurement Schedule: Development and Standardization. Indian J Psychiatry 1988; 30(4): 325-31.
  5. Shaffer D, Schwabstone M, Fischer P, Cohen P, Piaientini J, Davies M, et al. The diagnostic Interview Schedule for Children - Revised Version (DISC-R). Preparation, Field Testing, Interrates, Feasibility and Acceptability. J Am Acad Child Adolesc Psychiatry 1993; 32: 643.
  6. WHO. Classification of mental and behavioural disorders, Clinical descriptions and diagnostic guidelines, 10th edition. WHO, Geneva, 1982.
  7. Butter M, Cox A, Tupling C. The prevalence of psychiatric disorders. Br J Psychiatry 1975; 126: 493-509.
  8. Singhal PK, Bhatia MS, Balkrishna, Dhar NK, Mullick DN, Bohra N. Psychiatric morbidity. Indian J Paediatrics 1988; 55: 575-9.
  9. Deivasigamani TR. Psychiatric morbidity in primary school children - An epidemiological study. Indian J Psychiatry 1990; 32(3): 235-40.
  10. Naligan GA, Kolvin I, Scott D, MCI, Garside RF. Born too soon or too small. Clinics in Developmental Medicine; London: William Heinemann Medical Books; 1976.
  11. Rutter M, Tizard J, Whitmork K, editors. Education, Health and Behaviour. Longmans: London; 1970
Access free medical resources from Wiley-Blackwell now!

About Indmedica - Conditions of Usage - Advertise On Indmedica - Contact Us

Copyright © 2005 Indmedica