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CLINICAL AND DEMOGRAPHIC PROFILE

CLINICAL AND DEMOGRAPHIC PROFILE OF CHILDREN AND ADOLESCENTS PRESENTING IN A PSYCHIATRIC HOSPITAL

 

Dr. K. Rai, M.D. (Pediatrics), Additional Director; Dr. S. Mohanty, Ph.D, Research Officer and Prof. S. Kumar. M.D. (Psychiatry), Director, Institute of Mental Health and Hospital

 

Abstract

Prevalence of mental disorders among children and adolescents is reported to be 14-20% in various studies.  This study is an attempt to explore changes in the rate, demographic and clinical characteristics of children and adolescents attending a tertiary care psychiatric hospital over a period of five years. The study was conducted at Institute of Mental Health and Hospital Agra. The case records of all cases who attended OPD during January 2005 to December 2009 and the cases who were admitted in the indoor units during the same period were screened to record relevant information on a pre-designed proforma which consisted of identifying information, socio-demographic characteristics and clinical information of the cases. The results suggest that the number of cases seeking treatment is quite low. Boys are significantly higher than the girls and   literate persons are higher than illiterate persons in both OPD and indoor units. A little higher proportion of cases belongs to rural areas and the cases from nuclear families are higher than the cases from joint families.  Majority of the cases had mental retardation and psychotic conditions followed by Bipolar Disorder and Epilepsy.

 

Key Words: Child and Adolescent Psychiatry, Childhood Disorders, Prevalence of Psychiatric Disorders in Children and Adolescents.

 

Introduction

Prevalence of mental disorders among children and adolescents has been reported to be 14-20% in various studies (Brandenburg et al. 1990). A review of 52 studies conducted over past four decades revealed a mean prevalence rate of 15.8% (range 1% to 51%) of childhood psychiatric disorders (Roberts et al. 1998). Studies also reported that prevalence rate of children and adolescent psychiatric disorders is 18.1% in Canada, 20.7% in Germany, 22.5% in Switzerland and 21% in USA. (United States Department of Health and Human Services. Mental Health, 1999)

It is estimated that about 40% Indian population comprises of children and adolescents (Shoba et all. 2005). During the past five decades a number of studies have been carried out in community, schools and clinical settings. Early Indian studies reported prevalence rates of psychiatric disorders among children ranging from 2.6% to 35.6% (.Sethi et al. 1967, Sethi et al. 1972, Verghese and Beig, 1974, Nandi et al. 1975, Lal & Sethi, 1974).

Recent studies using superior methodology have revealed the prevalence rates to be 12.5% in 0 –16 years community based samples of Bangalore, 9.4% in 8—12 years old from a community based sample of Kerala 6.3% in 4—11 years old school children in Chandigarh (Hackett et al.1999). The variations in prevalence rate may be the result of source of sample, classification system and type of instruments used for assessment.

Some studies found that a substantial proportion of individuals who met symptomatic criteria for a diagnosis appear to be functioning normally. Only a small portion (about 5%) of children and adolescents present for psychiatric consultation at clinics and hospitals ( Costello and. Tweed, 1994)

It is observed that most of the children and adolescents presenting at tertiary care psychiatric hospitals present with major psychiatric disorders and intellectual disability. Various clinic based studies from India reported the prevalence of mental retardation-20.6%, epilepsy-20%, conversion disorder-63%, hyperactivity disorder-5% and childhood disorder-6% ( Sidana, 1998) Rai et al. (2009) found that majority of cases are with mental retardation-30.77%, psychosis-28.4%, epilepsy-6.24% and affective disorder-13.31% (Bassa, 1962) Studies also reported wide variations in the prevalence of behavioral (3%-36%) (Bassa, 1962, Chacko, 1964, Murthy et al. 1974, Praveenlal et al 1988, Singh and Gupta, 1970) as well as neurotic disorders. (3.7%-54%) Chacko, 1964; Praveenlal, et al. 1988, Manchanda,1978, Nagaraja, 1967, Raju et al. 1969, Sharma et al. 1980)). There has been increased public awareness, increased access to mental health services in past few years. There is lack of studies which attempted to explore a trend of mental health service utilization by children and adolescents with mental disorders.

Aim

In this context the present study is an attempt to explore changes in the rate, demographic and clinical characteristics of children and adolescents attending a tertiary care psychiatric hospital.

Method

Study was conducted at Institute of Mental Health and Hospital Agra. IMHH is a psychiatric hospital with bed strength of 718 patients and provides highly specialized multi-disciplinary services. A specialty clinic for Children and Adolescent psychiatric patients operates in OPD of the Institute which provides assessment, diagnostic and therapeutic services. The average attendance in OPD for new and old cases is about 250 cases per day.

The study period for the study is from January 2005 to December 2009. The case records of all cases who attended OPD in this period and the cases who were admitted in the indoor units were studied and the relevant information were extracted on a pre-designed proforma which consisted of identifying information, socio-demographic characteristics and clinical information of the cases.

 

Results:

Table-1: Demographic and Clinical Characteristics

Variables

Break Up

2005

2006

2007

2008

2009

OPD

Indoor

OPD

Indoor

OPD

Indoor

OPD

Indoor

OPD

Indoor

Total No. of Cases

390

117

348

152

388

224

424

142

372

215

Gender

Male

238 (61)

72 (61.5)

234 (67.2)

100 (65.8)

247 (63.7)

133 (59.4)

264 (62.3)

99 (69.7)

233 (62.6)

153 (71.2)

Female

152 (39)

45 (38.5)

114 (32.8)

52 (34.2)

141 (36.3)

91 (40.6)

160 (37.7)

43 (30.3)

139 (37.4)

62 (28.8)

Education

Illiterate

169  (43.3)

38 (32.5)

162 (46.6)

47 (30.9)

 172 (44.3)

91 (40.6)

158 (37.3)

59 (41.5)

139 (37.4)

77 (35.8)

Literate

221 (56.7)

79 (67.5)

186 (53.4)

105 (69.1)

216 (55.7)

133 (59.4)

266 (62.7)

83 (58.5)

233 (62.6)

138 (64.2)

Domicile

Rural

205 (52.6)

51 (43.6)

196 (56.3)

89 (58.6)

219 (56.4)

147 (65.6)

266 (62.7)

94 (66.2)

203 (54.6)

104 (48.4)

Urban

185 (47.4)

66 (56.4)

152 (43.7)

63 (41.4)

169(43.6)

77 (34.4)

158 (37.3)

48 (33.8)

169 (45.4)

111 (51.6)

Family Type

Nuclear

243 (62.3)

103 (88.0)

221(63.5)

133 (87.5)

250 (64.4)

187 (83.5)

307 (72.4)

129 (90.8)

237 (63.7)

28 (13.0)

Joint

147 (37.7)

14 (12.0)

127(36.5)

19 912.5)

138 (35.6)

37 (16.5)

117 (27.6)

13 (9.2)

135 (36.3)

187 (87.0)

Religion

Hindu

353 (90.5)

107 (91.5)

310 (89.1)

147 (96.7)

346 (89.2)

206 (92.0)

368 (86.8)

130 (91.5)

334 (89.8)

203 (94.4)

Others

37 (9.5)

10 (8.5)

38 (10.9)

5 (3.3)

42 (10.8)

18 (8.0)

56 (13.2)

12 (8.5)

38 (10.2)

12 (5.6)

Family H/O Psch. Illness

Yes

75 (19.2)

28 (23.9(

68 (19.5)

28 (18.4)

101 (26.0)

58 (25.9)

86 (20.3)

27 (19.0)

76 (20.4)

138 (64.2)

No

315 (80.8)

89 (76.1)

280 (80.5)

124 (81.6)

287 (74.0)

166 (74.1)

338 (79.7)

115 (81.0)

296 (79.6)

77 (35.8)

Age (in years) M & S.D.

13.89 (4.04)

16.33 (2.20)

12.92 (4.20)

15.97 (3.12)

13.37 (4.10)

15.89 (3.12)

14.56 (4.11)

15.05 (3.55)

12.76 (3.87)

12.50 (4.34)

Age of Onset (in years) M & S.D.

9.87 (6.5)

14.90 (3.68)

8.28 (6.19)

13.63 (5.59)

8.11 (6.46)

12.35 (6.65)

10.96 (6.24)

10.72 (7.11)

8.76 (5.70)

9.35 (6.15)

DOI

Up to 6mon

120 (30.8)

68 (58.1)

95 (27.3)

87 (57.2)

87 (22.4)

124 (55.4)

119 (28.1)

53 (37.3)

105 (28.2)

89 (41.4)

Up to 2yr

86 (22.1)

21 (17.9)

61 (17.5)

28 (18.4)

59 (15.2)

22 (9.8)

92 (21.7)

23 (16.2)

98 (26.3)

66 (30.7)

More 2yr

184 (47.2)

28 (23.9)

192 (55.2)

37 (24.3)

242 (62.4)

78 (34.8)

213 (50.2)

66 (46.5)

169 (45.4)

66 (27.9)

Diagnosis

MR

56 (14.4)

2 (1.7)

51 (14.7)

16 (10.5)

77 (19.8)

36 (16.1)

52 (12.3)

42 (29.6)

46 (12.4)

65 (30.2)

MR ASSOCON

60 (15.4)

7 (6.0)

80 (23.0)

13 (8.6)

80 (20.6)

16 (7.1)

68 (16.0)

6 (4.2)

62 (16,7)

29 (13.5)

PSYCHOSIS

116 (29.7)

66 (56.4)

85 (24.4)

73 (48.0)

94 (24.2)

114 (50.9)

128 (30.2)

55 (38.7)

113 (30.4)

43 (20.0)

BD

75 (19.2)

29 (24.8)

53 (15.2 )

38 (25.0)

54 (13.9)

40 (17.9)

66 (15.6)

25 (17.6)

57 (15.3)

39 (18.1)

EPILEPSY

59 (15.1)

10 (8.5)

39 (11.2)

4 (2.6)

43 (11.1)

12 (5.4)

52 (12.3)

6 (4.2)

44 (11.8)

28 (13.0)

OTHERS

24 (6.2)

3 (2.6)

40 (11.5)

8 (5.3)

40 (10.3)

6 (2.7)

58 (13.7)

8 (5.6)

50 (13.4)

11 (5.1)

 

Figure-1 and Table-1 indicates that 348-424 children and adolescents presented in OPD of the Institute in these years. The maximum numbers were present in 2008. 117-224 cases were admitted in the indoor units of the Institute. A little rise in 2007 and 2009 are observed. However, no much significant variations in the magnitude of this segment of the population is seen in study period.

 

 

Figure-2 and Table-1 reveals that there are no marked changes in the number of boys and girls seeking consultation at OPD across five years. In general, number of boys is more than the number of girls in all these years.

 

Figure-3 and Table-1 reveal that the number of illiterate children and adolescents was lesser than the cases that were literate. But there is a little increasing trend in the number of literate cases over the years.

 

Figure-4 and Table-1 reveals that the number of children and adolescents from rural areas were little higher than the cases from urban areas. In the year 2009 the cases from urban areas has increased.

 

Figure-5 and Table-6 shows age-wise distribution of children and adolescents over a period of five years where the mean age of children varies indicating maximum representation of adolescents in the year 2008.

 

 

 

 

Figure-6 and Table-1 reveals that there are no marked changes in the number of boys and girls seeking consultation in Indoor units across five years. The number of boys is more than the girls.

 

Figure-7 and Table-1 reveals that the number of illiterate children and adolescents was lesser than the cases that were literate. But there is an increasing trend in the number of illiterate cases over a period of five years.

Figure-8 reveals that a wide gap in rural vs. urban cases seen in 2007 and 2008 got significantly reduced in 2009 in the indoor units of the Institute.

 

 

Figure-9 shows age-wise distribution of children and adolescents over a period of five years where equal pattern is noticed further explained the fact that the mean age of children was similar for all the years except a little lower average in 2009.

Table-1 reveals that in OPD cases of MR represented 12.3-19.8% of the population, and 15.4-23% cases had MR with associated conditions. There was a little higher representation of MR with associated conditions in 2006 and 2007. The psychotic cases were in the range of 24.2-34.4% and no much variation is seen across the years. Bipolar disorder cases were in the range of 13.9-19.2%. The highest number of Bipolar cases were seen in 2005. Representation of Epilepsy population was in the range of 11.1-15.1% and highest were in 2005.

Table-1 reveals that in Indoor Units cases of MR represented 1.7-30.2% of the population, and a consistent increase is present over the years. The lowest 1.7% was admitted in 2005. 4.2-13.5% cases had MR with associated conditions. A wide variation is seen across the years and highest were admitted in 2009. The psychotic cases were in the range of 20-56.4% and much variation is seen across the years; the lowest number was present in 2009. Bipolar disorder cases were in the range of 17.6-25%. The number has declined in last three years. Representation of Epilepsy population was in the range of 2.6-13% and highest were admitted in 2009.

 

Discussion:

 

Total Number of Cases: The results indicate that only 348 to 424 cases sought OPD treatment in these years and 117 to 224 cases got admitted in indoor units. The prevalence of psychiatric disorders in children and adolescents high and the number of cases seeking treatment is quite low. This result is in conformity to the observations of other researchers. Srinath (Shobha et al. 2005) reported that about 5% of the children and adolescents consult psychiatric facilities for treatment. It points out to the need for massive public awareness and programs such as school mental health to address psychiatric needs of this segment of the population.

 

Gender Distribution: An unequal distribution of gender is observed in both indoor and OPD cases. Boys are significantly higher than the girls. The lower representation of girls in psychiatric services may be a reflection of stigma attached to psychiatric illness.

 

Educational Background: Literate persons are higher than illiterate persons in both OPD and indoor units. This may be because of increased literacy rate and low awareness in illiterate population.

 

Domicile: A little higher proportion of cases belong to rural areas. It may be because alternative psychiatric services remain available in urban areas and the cases of urban domicile might have been presenting more in those services. The lack of psychiatric services in rural areas and because of cost issues, people from rural areas present more in State managed services than the cases from urban areas.

 

Family type: The cases from nuclear families are higher than the cases from joint families. This pattern is reflecting the changes in socio-cultural milieu. There is increasing disintegration of joint family system in our society. Hence, it is natural that the cases would be more from nuclear families.

 

Family H/O Psychiatric Illness: The cases with family history of psychiatric illness are lesser than the cases without such history. The representation of cases with family h/o psychiatric illness was quite similar for OPD and indoor cases from 2005 to 2008 but in 2009 there was a great hike in indoor cases with family h/o psychiatric illness.

 

Age of the Cases: The mean age of the cases ranges 12.50 to 16.33 years. It indicates that most of the cases who present for psychiatric consultation are adolescents. The number of children is few. This may be an indication of failure in detection of psychiatric problems in young children and a common conception that if there is any problem in early childhood that would fade away with the growth and development.

Age of Onset: It is observed that the cases had an onset at the mean age of 8.28 to 14.90 years. This again indicates that the cases with an onset during late childhood and adolescents present for psychiatric consultation. The cases with an onset of illness in early childhood are few.

 

Diagnosis: Majority of the cases had mental retardation and psychotic conditions followed by Bipolar Disorder and Epilepsy. The cases with mental retardation mostly present in the hospital for assessment of their IQ for certification purposes. This is the only facility in Agra and nearby region which provide this services to persons with mental retardation; hence there is high number of cases with MR in the sample.

Psychosis and Bipolar disorders create acute distress in the family members and the conditions are quite severe, hence cases with these conditions are expected to be high in any psychiatric unit in a hospital.

There is a full range of psychotic and neurotic problems prevalent in children and adolescents; but mostly the cases with major psychiatric disorders present for consultation. This clearly point out to the need for mass public awareness and strengthening of child and adolescent psychiatric services in the region to cater to the psychiatric needs of this segment of population.

 

Conclusion: This study clearly indicate that the magnitude of the children and adolescents presenting for psychiatric consultation in a tertiary psychiatric hospital is quite low and most cases are adolescents having severe psychiatric disorders like psychosis and bipolar disorder. This scenario point out to the need of massive public awareness campaign and strengthening of child and adolescent psychiatric services to effective address psychiatric needs of children and adolescents.

 

References

1.        Brandenburg, N.S.A, Friedman, R.M, Silver S.E. (1990) The epidemiology of childhood psychiatric disorders: Prevalence findings from recent studies. Journal of American Academy of Child and Adolescent Psychiatry. 29:76-83.

2.        Bassa, D. M. (1962) An analysis of cases attending psychotherapy centres.Indian Journal of child health ,11,396-402.

3.        Chacko,R. (1964) Emotional disorders in children. Journal of Christian Medical Association of India, 36-42.

4.        Costello E. Tweed, D. (1994)  A review of recent empirical studies linking the prevalence of functional impairment without emotional and behavioral illness or disorder in children and adolescents. Washington DC: Report to the centre for mental health services.

5.        Hackett R, Hackett L, Bhakta P. (1999) the prevalence and associations of psychiatric disorders in children in Kerala, South India. Journal of Child Psychology & Psychiatry; 40:801-7

6.        Lal, N., Sethi, B.B.(1977) Estimation of mental ill health in children in an urban community. Indian Journal of Paediatrics, ,55-64.

7.        Murthy, R.S., Ghosh,A., Verma ,V.K.(1974) Behaviour disorers of childhood and adolescence.Indian Journal of Psychiatry 16:229.        

8.        Manchanda, M. (1978) Neurosis in children. Indian Journl of Psychiatry 166-172.

9.        Nagaraja, J.(1967) Disease Drawings and diagrams.Indian Paediatrics 432-438.

10.     Nandi, D.N, Ajmany, S, Ganguly, H, Banerjee, G, Boral, G.C, Ghosh A, et al.(1975) Psychiatric disorder in a rural community in West Bengal–An epidemiology study. Indian Journal of  Psychiatry; 17: 87-9.

11.     Praveenlal, K., Anandan K.R.,Innan M.(1988) Trichur Medical college child psychiatriy clinic –six months analysis of cases .Child Psychiatry Quaterly 21:71

12.     Rai, K. Mohanty S. and Kumar S. (2009) Sociodemographic characteristics of children and adolescents admitted in a psychiatric hospital. Indian Journal of Psychiatry Supplement

13.     Roberts, R.E, Attkisson, C.C, Rosenblatt, A. (1998) Prevalence of psychopathology among children and adolescents. American Journal of Psychiatry. 155:715–725..

14.     Raju, V. B.,Sunderavalli, N.,Somasunderam, O. Veeraraghaban, G.(1969) Neurotic disorders in children. Indian Paediatrician 296-301.

15.     Sharma, S. N.(1980) Neurosis in children. Indian Journal of Psychiatry, 362-365.

16.     Sethi, B.B, Gupta S.C, Kumar. R. (1967) 300 urban families (A psychiatric survey). Indian Journal of Psychiatry; 9: 280-302.

17.     Sethi, B.B, Gupta, S.C, Kumar R, Kumar P. (1972) A psychiatric survey of 500 rural families. Indian Journal of  Psychiatry; 14: 183-96.

18.     Shoba S., Girimaji, S.C., G. Gururaj, Seshadri, S., Subbakrishna, D.K, Bhola, P and Kumar, N.C. (2005) Epidemiological study of child & adolescent psychiatric disorders Indian Journal of Medical Research. 122, 67-69.

19.     Sidana, A. Bhatia, M .S.and Choudhary, S.(1998) Prevalence and pattern of psychiatric morbidity in children. Indian Journal of Medical Science 52,556-558.

20.     Singh, M..B., Gupta, S.(1970) Behavioural problems as seen in child guidance clinics.Paedtric Clinics of India. 5:145.

21.     United States Department of Health and Human Services. Mental Health: (1999) A Report of the Surgeon General. Rockville, MD, United States Department of health and Human Services, Substance Abuse and Mental Health Sergice Administration, Centre for Mental Health Services, National Institutes of Health, National Institute of Mental Health

22.     Verghese A, Beig (1974) A. Psychiatric disturbances in children: An epidemiological study. Indian Journal of  Medical  Research; 62: 1538-42.