Socio-Demographic Co-relates of Psychiatric Disorders
http://www.100md.com
《美国医学杂志》
1 Department of Community Medicine, Maulana Azad Medical College, New Delhi; V.M. Medical College, Solapur, Maharashtra, India
2 Department of Community Medicine, Maulana Azad Medical College, New Delhi; 1V.M. Medical College, Solapur, Maharashtra, India, India
Abstract
Abstract. Objective: To find out the magnitude of probable psychopathology in children and study association of psychopathology with demographic, developmental and social factors. Methods: Childhood Psychopathology Measurement Schedule (CPMS) was used to measure the magnitude of probable psychopathology in 620 children from an urban slum of Miraj (Maharashtra). A second schedule recorded demographic, developmental and social factors. Results: CPMS score >10 was observed in 102 children (16.5%). It was significantly higher in children aged 7-10 years, in males, belonging to lower socioeconomic status, large families, being first born, having low birth weight (LBW); body mass index (BMI) less than 18.5. Low maternal education and alcohol abuse in father also had significant association with CPMS score >10. Conclusion: Findings suggest a need to educate the community about psychological implications of LBW, large family size and overcrowding in children. Improving maternal education and controlling alcoholism could help in reducing childhood psychopathology. [Indian J Pediatr 2005; 72 (5) : -398]
Keywords: Children; CPMS; Psychopathological disorders
Mental disorders are among the most burdensome of all classes of disease because of their high prevalence, chronicity, early age of onset and resulting serious impairment and disability.[1] Worldwide, mental disorders accounted for 22% of all Disability Adjusted Life Years (DALYs) lost in 1998. They account for 10% of global burden of disease and expected to rise to 15% by 2020. Five out of the 10 leading causes of disability worldwide are mental health problems.[2]
Unlike physical illness, which in most of the cases has clear-cut symptomatology, any deviation from normal mental development or behaviour in children may not be easily identified by the parents except from grave observable changes. Studies done in both developing and developed countries have shown similar prevalence rates of psychopathology among children emphasizing the universality of the problem. However, there is tremendous apathy towards mental health problems among medical administrators and decision-makers in developing countries.[3]
Majority of the studies on the magnitude of mental health problems have been conducted either on adult population, or some specific group of children like those attending child guidance clinics. The present study was undertaken to estimate the magnitude of childhood psychopathology in an urban slum area of Miraj in Maharashtra.
Material and Methods
0A cross-sectional study was carried out during March 2001 to December 2001 in Sanjay Nagar, a slum area in Miraj, Maharashtra. The total population of the slum was about 4500, of which 1250 were children aged between 4-14 years. The sample size required for the study was estimated based on the prevalence rate of 13.4% observed by an ICMR study,[4] with an allowable error of 20%. Based on this, it was estimated that 620 children would be required for the study.
A list of all 1250 children aged 4-14 years was prepared of which 620 children were selected by random sampling method. Socio-economic status was assessed by modified Kuppuswamy classification.[5]
The tools used in this study were: (1) Childhood Psychopathology Measurement Schedule (CPMS) developed and standardized by Malhotra et al[6] and (2) another schedule consisting of questions pertaining to demographic, developmental, social factors of the children which was prepared separately and pre-tested before final administration. All the children were clinically examined and anthropometric measurements were also taken.
CPMS contained 74 questions pertaining to 8 factors viz. low intelligence with behavior problems, conduct disorders, anxiety, depression, psychotic symptoms, special symptoms, physical illness emotional problems and somatization. Each question was directed to the mother regarding the child's behaviour during past one year. These answers were scored on two-point scale i.e '0' if that particular behavior is not present and '1', if present. Those children who scored 10 or more on this score were considered positive for psychopathological disorders and those scoring less than 10 were considered normal. Using this cut off score, the sensitivity for detecting probable psychopathogical disorders reported by authors was 82% and specificity 87%.[6]
Data was collected by interviewing the mothers of children at their homes after taking informed consent. Data was tabulated and Chi-Square test was applied to find the association of probable psychopathologic disorders with demographic, developmental, and social factors. "p" value less than 0.05 was considered significant.
Results
0It was observed that prevalence of psychopathological disorders was highest in children aged 7-10 years, more in males than females, in children of low socio-economic status, living in overcrowded dwellings (p<0.05), and slightly higher among children belonging to joint families (p>0.05) (Table 1).
Discussion
0Prevalence rates of psychopathological disorders reported by different studies on Indian population vary from 5.8% to 33.7%.[7]-[11] A study conducted by WHO in four developing countries (1981) including India in Haryana state showed prevalence of 21%.[9] A study by ICMR (2001) showed prevalence to be 13.4% in the age group 0-16 years.[4] Though the clinical diagnosis of the cases in the present study was not done, the prevalence of psychopathological disorders was found to be comparable (16.5%) to that of the ICMR study. This finding suggests that screening by CPMS could be utilized for rapid assessment of psychopathological status in children in the community, where facility for psychiatric consultation is not available. The other studies reported higher prevalence rate of psychiatric disorders.[8-11] This difference could be due to differences in the age group, instrument used and methodology.
It was noticed in the present study that the most affected age group was 7-10 years. This may be related to the exposure of the child to new environment at school and the mothers' perception of any resultant undesired change in behaviour as abnormal.
Males were significantly affected more than females. Similar findings were found in several studies. [4, 7, 11] Although no clear-cut reason has been established, yet it is felt that male preponderance may be due to psychological or biological factors. Also, greater attention is often paid to the male children and the parents notice any abnormal behaviour earlier resulting in early reporting.[11]
The prevalence increased as the socio-economic status lowered, the highest in lower class. Most studies agree on this finding. [8, 10, 12, 13] More number of cases were found in joint families and in large sized families. Some authors did not find significant difference in the prevalence rate by the type of family [8,10] whereas in one study[7] more cases were found in nuclear families. Significant association was found between overcrowding and psychopathological disorder in children. Leclair et al[14] also observed similar finding. Overcrowding is a psychosocial stress, leading to psychosomatic and mental disorders especially in children.
In the present study, majority of the cases were significantly first born. Offord DR[15] also reported similar observation. The eldest child is especially at a disadvantage in lower socio-economic strata. He is introduced to the adult economic or social responsibilities with little or no transitional period left between childhood and adulthood. Such conditions may predispose the eldest child to psychological problems.
Significant difference was found in the number of cases who were born with low birth weight as compared to normal birth weight. Pharoah et al[16] also found similar observation. However, it is also documented that favorable social and environmental factors are predictive of catch up growth in cognitive and behavioral development in low birth weight infants.[17] It was seen that prevalence was higher in children with BMI less than 18.5. Several workers have associated malnutrition with retardation of psychological milestones. Nutritional deficiency along with lack of social and environmental stimulation predisposes the child to psychological under development. [8,18]
Maternal education is significantly associated with psychopathological disorders in children, prevalence being highest in off springs of illiterate mothers. Education and awareness increases her perception of any developmental or behavioral deviance of the child at an earlier stage when it is still amenable to treatment rather than at a later stage when a deviance becomes established.
Majority of the cases were brought up in strict environment. However, this did not have any significant effect on the mental health status of the children. Many workers have reported the ill effects of corporal punishment or hostility in any other form on the psychological development of the child.[19]
Significant association was found between prevalence of psychopathologic disorder and separation and its duration from one or both the parents, prevalence being highest in children with prolonged separation (more than 3 months). Separation experience may cause persistent defects in the ability to form relationships and intellectual functioning may get impaired. Separation causes not only physical loss but also deprivation. It has been reported that loss of parenting at age between 6 months to 5 years has been considered as the most vulnerable group where disruption of attachments with parents is of great significance.[20]
Prevalence rate was significantly high in children of alcoholic fathers as compared to non-alcoholic fathers. Alcohol abuse by father may have multidimensional effect such as inadequate attention to the child, parental conflicts etc. and moreover, the child may consider it as a socially approved habit. Other authors supported this finding.[14] Working status of mother did not have any significant effect on psychological development of a child dispelling the myth that even temporary separation of a child from his mother creates a psychosocial hazard. Good quality day-care and a working mother are compatible with secure parent child relationship.
The present study findings highlight the association of childhood psychopathology with several socio-demographic and developmental factors, which needs consideration while planning for implementation of mental health programme in the community.
Conclusion
0The prevalence of psychopathological disorders in children was 16.5%. Psychopathological disorders were more prevalent among children aged 7-10 years, males, children of low socio-economic status, joint family, children with low birth weight, BMI less than 18.5. There was a correlation between psychopathological disorders in children with literacy level of mother and alcohol intake of father
References
1. WHO International Consortium of Psychiatric Epidemiology. Cross-sectional comparisons of mental disorders. Bull WHO 2000;78:413-426.
2. Brundtland GH. Mental health in the 21st century. Bull WHO 2000; 78 : 411.
3. Wig NN. WHO and mental health - a view from developing countries. Bull WHO 2000; 78 : 502-503.
4. Indian Council of Medical Research. Epidemiological study of child and adolescent psychiatric disorders in urban and rural areas. ICMR Bull 2001; 31 : 54-55.
5. Kulkarni AP, Baride JP. Textbook of Community Medicine, 1st edn. Mumbai: Vora Medical Publications 1998. p.14-32.
6. Malhotra S, Varma VK, Verma SK, Malhotra A. Childhood Psychopathology Measurement Schedule: Development and Standardization. Indian J Psych 1988; 30 : 325-331.
7. Verghese A, Beig A. Psychiatric disturbance in children - an epidemiological study. Indian J Med Res 1974; 62 : 1538-1542.
8. Lal N, Sethi BB. Estimate of mental ill health in children of an urban community. Indian J Pediatr 1977; 44 : 55-64.
9. Giel R, de Arango MV, Climent CE et al. Childhood Mental disorders in primary health care: results of observations in four developing countries. Pediatrics 1981; 68 : 677-683 .
10. Deivasigamini T R. Psychiatric morbidity in primary school children - an epidemiological study. Indian J Psych 1990; 32 : 235-240.
11. Banerjee T. Psychiatric morbidity among rural primary school children in West Bengal. Indian J Psych 1997; 39 : 130-135.
12. Chadda RK. Psychiatric morbidity in primary school children - a clinic based study. Indian J Pediatr 1995; 62 : 77-81.
13. Shenoy J, Kapur M. Prevalence of scholastic backwardness among five to eight-year old children. Indian J Psych 1996; 38 : 201-207.
14. Leclair JA, Innes FC. Urban ecological structure and perceived child and adolescent psychological disorders. Soc Sci Med 1997; 44 : 1649-1659.
15. Offord DR. Child psychiatric disorder: prevalence and perspectives. Pediat Clin N Amer 1985; 8 : 637-652.
16. Pharoah PD, Stevenson CJ, Cooke RW, Stevenson RC. Prevalence of behavior disorders in low birth weight infants. Arch Dis Child 1994; 70 : 271-274.
17. Wolke D. Psychological development of prematurely born children. Arch Dis Child 1998; 78 : 567-570.
18. Barness LA, Curran JS. Nutrition - Malnutrition. In Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 16th edn. Singapore; Harcourt Asia PTE Ltd.; 2000:169-172.
19. Elliman D, Lynch MA. The physical punishment of children. Arch Dis Child 2000; 83 : 196-198.
20. Srinivasan TN, Raman KJ. Early child parent separation and risk for childhood psychopathology. Indian J Psych 1987; 31 : 283-289(Rahi Manju, Kumavat AP, G)
2 Department of Community Medicine, Maulana Azad Medical College, New Delhi; 1V.M. Medical College, Solapur, Maharashtra, India, India
Abstract
Abstract. Objective: To find out the magnitude of probable psychopathology in children and study association of psychopathology with demographic, developmental and social factors. Methods: Childhood Psychopathology Measurement Schedule (CPMS) was used to measure the magnitude of probable psychopathology in 620 children from an urban slum of Miraj (Maharashtra). A second schedule recorded demographic, developmental and social factors. Results: CPMS score >10 was observed in 102 children (16.5%). It was significantly higher in children aged 7-10 years, in males, belonging to lower socioeconomic status, large families, being first born, having low birth weight (LBW); body mass index (BMI) less than 18.5. Low maternal education and alcohol abuse in father also had significant association with CPMS score >10. Conclusion: Findings suggest a need to educate the community about psychological implications of LBW, large family size and overcrowding in children. Improving maternal education and controlling alcoholism could help in reducing childhood psychopathology. [Indian J Pediatr 2005; 72 (5) : -398]
Keywords: Children; CPMS; Psychopathological disorders
Mental disorders are among the most burdensome of all classes of disease because of their high prevalence, chronicity, early age of onset and resulting serious impairment and disability.[1] Worldwide, mental disorders accounted for 22% of all Disability Adjusted Life Years (DALYs) lost in 1998. They account for 10% of global burden of disease and expected to rise to 15% by 2020. Five out of the 10 leading causes of disability worldwide are mental health problems.[2]
Unlike physical illness, which in most of the cases has clear-cut symptomatology, any deviation from normal mental development or behaviour in children may not be easily identified by the parents except from grave observable changes. Studies done in both developing and developed countries have shown similar prevalence rates of psychopathology among children emphasizing the universality of the problem. However, there is tremendous apathy towards mental health problems among medical administrators and decision-makers in developing countries.[3]
Majority of the studies on the magnitude of mental health problems have been conducted either on adult population, or some specific group of children like those attending child guidance clinics. The present study was undertaken to estimate the magnitude of childhood psychopathology in an urban slum area of Miraj in Maharashtra.
Material and Methods
0A cross-sectional study was carried out during March 2001 to December 2001 in Sanjay Nagar, a slum area in Miraj, Maharashtra. The total population of the slum was about 4500, of which 1250 were children aged between 4-14 years. The sample size required for the study was estimated based on the prevalence rate of 13.4% observed by an ICMR study,[4] with an allowable error of 20%. Based on this, it was estimated that 620 children would be required for the study.
A list of all 1250 children aged 4-14 years was prepared of which 620 children were selected by random sampling method. Socio-economic status was assessed by modified Kuppuswamy classification.[5]
The tools used in this study were: (1) Childhood Psychopathology Measurement Schedule (CPMS) developed and standardized by Malhotra et al[6] and (2) another schedule consisting of questions pertaining to demographic, developmental, social factors of the children which was prepared separately and pre-tested before final administration. All the children were clinically examined and anthropometric measurements were also taken.
CPMS contained 74 questions pertaining to 8 factors viz. low intelligence with behavior problems, conduct disorders, anxiety, depression, psychotic symptoms, special symptoms, physical illness emotional problems and somatization. Each question was directed to the mother regarding the child's behaviour during past one year. These answers were scored on two-point scale i.e '0' if that particular behavior is not present and '1', if present. Those children who scored 10 or more on this score were considered positive for psychopathological disorders and those scoring less than 10 were considered normal. Using this cut off score, the sensitivity for detecting probable psychopathogical disorders reported by authors was 82% and specificity 87%.[6]
Data was collected by interviewing the mothers of children at their homes after taking informed consent. Data was tabulated and Chi-Square test was applied to find the association of probable psychopathologic disorders with demographic, developmental, and social factors. "p" value less than 0.05 was considered significant.
Results
0It was observed that prevalence of psychopathological disorders was highest in children aged 7-10 years, more in males than females, in children of low socio-economic status, living in overcrowded dwellings (p<0.05), and slightly higher among children belonging to joint families (p>0.05) (Table 1).
Discussion
0Prevalence rates of psychopathological disorders reported by different studies on Indian population vary from 5.8% to 33.7%.[7]-[11] A study conducted by WHO in four developing countries (1981) including India in Haryana state showed prevalence of 21%.[9] A study by ICMR (2001) showed prevalence to be 13.4% in the age group 0-16 years.[4] Though the clinical diagnosis of the cases in the present study was not done, the prevalence of psychopathological disorders was found to be comparable (16.5%) to that of the ICMR study. This finding suggests that screening by CPMS could be utilized for rapid assessment of psychopathological status in children in the community, where facility for psychiatric consultation is not available. The other studies reported higher prevalence rate of psychiatric disorders.[8-11] This difference could be due to differences in the age group, instrument used and methodology.
It was noticed in the present study that the most affected age group was 7-10 years. This may be related to the exposure of the child to new environment at school and the mothers' perception of any resultant undesired change in behaviour as abnormal.
Males were significantly affected more than females. Similar findings were found in several studies. [4, 7, 11] Although no clear-cut reason has been established, yet it is felt that male preponderance may be due to psychological or biological factors. Also, greater attention is often paid to the male children and the parents notice any abnormal behaviour earlier resulting in early reporting.[11]
The prevalence increased as the socio-economic status lowered, the highest in lower class. Most studies agree on this finding. [8, 10, 12, 13] More number of cases were found in joint families and in large sized families. Some authors did not find significant difference in the prevalence rate by the type of family [8,10] whereas in one study[7] more cases were found in nuclear families. Significant association was found between overcrowding and psychopathological disorder in children. Leclair et al[14] also observed similar finding. Overcrowding is a psychosocial stress, leading to psychosomatic and mental disorders especially in children.
In the present study, majority of the cases were significantly first born. Offord DR[15] also reported similar observation. The eldest child is especially at a disadvantage in lower socio-economic strata. He is introduced to the adult economic or social responsibilities with little or no transitional period left between childhood and adulthood. Such conditions may predispose the eldest child to psychological problems.
Significant difference was found in the number of cases who were born with low birth weight as compared to normal birth weight. Pharoah et al[16] also found similar observation. However, it is also documented that favorable social and environmental factors are predictive of catch up growth in cognitive and behavioral development in low birth weight infants.[17] It was seen that prevalence was higher in children with BMI less than 18.5. Several workers have associated malnutrition with retardation of psychological milestones. Nutritional deficiency along with lack of social and environmental stimulation predisposes the child to psychological under development. [8,18]
Maternal education is significantly associated with psychopathological disorders in children, prevalence being highest in off springs of illiterate mothers. Education and awareness increases her perception of any developmental or behavioral deviance of the child at an earlier stage when it is still amenable to treatment rather than at a later stage when a deviance becomes established.
Majority of the cases were brought up in strict environment. However, this did not have any significant effect on the mental health status of the children. Many workers have reported the ill effects of corporal punishment or hostility in any other form on the psychological development of the child.[19]
Significant association was found between prevalence of psychopathologic disorder and separation and its duration from one or both the parents, prevalence being highest in children with prolonged separation (more than 3 months). Separation experience may cause persistent defects in the ability to form relationships and intellectual functioning may get impaired. Separation causes not only physical loss but also deprivation. It has been reported that loss of parenting at age between 6 months to 5 years has been considered as the most vulnerable group where disruption of attachments with parents is of great significance.[20]
Prevalence rate was significantly high in children of alcoholic fathers as compared to non-alcoholic fathers. Alcohol abuse by father may have multidimensional effect such as inadequate attention to the child, parental conflicts etc. and moreover, the child may consider it as a socially approved habit. Other authors supported this finding.[14] Working status of mother did not have any significant effect on psychological development of a child dispelling the myth that even temporary separation of a child from his mother creates a psychosocial hazard. Good quality day-care and a working mother are compatible with secure parent child relationship.
The present study findings highlight the association of childhood psychopathology with several socio-demographic and developmental factors, which needs consideration while planning for implementation of mental health programme in the community.
Conclusion
0The prevalence of psychopathological disorders in children was 16.5%. Psychopathological disorders were more prevalent among children aged 7-10 years, males, children of low socio-economic status, joint family, children with low birth weight, BMI less than 18.5. There was a correlation between psychopathological disorders in children with literacy level of mother and alcohol intake of father
References
1. WHO International Consortium of Psychiatric Epidemiology. Cross-sectional comparisons of mental disorders. Bull WHO 2000;78:413-426.
2. Brundtland GH. Mental health in the 21st century. Bull WHO 2000; 78 : 411.
3. Wig NN. WHO and mental health - a view from developing countries. Bull WHO 2000; 78 : 502-503.
4. Indian Council of Medical Research. Epidemiological study of child and adolescent psychiatric disorders in urban and rural areas. ICMR Bull 2001; 31 : 54-55.
5. Kulkarni AP, Baride JP. Textbook of Community Medicine, 1st edn. Mumbai: Vora Medical Publications 1998. p.14-32.
6. Malhotra S, Varma VK, Verma SK, Malhotra A. Childhood Psychopathology Measurement Schedule: Development and Standardization. Indian J Psych 1988; 30 : 325-331.
7. Verghese A, Beig A. Psychiatric disturbance in children - an epidemiological study. Indian J Med Res 1974; 62 : 1538-1542.
8. Lal N, Sethi BB. Estimate of mental ill health in children of an urban community. Indian J Pediatr 1977; 44 : 55-64.
9. Giel R, de Arango MV, Climent CE et al. Childhood Mental disorders in primary health care: results of observations in four developing countries. Pediatrics 1981; 68 : 677-683 .
10. Deivasigamini T R. Psychiatric morbidity in primary school children - an epidemiological study. Indian J Psych 1990; 32 : 235-240.
11. Banerjee T. Psychiatric morbidity among rural primary school children in West Bengal. Indian J Psych 1997; 39 : 130-135.
12. Chadda RK. Psychiatric morbidity in primary school children - a clinic based study. Indian J Pediatr 1995; 62 : 77-81.
13. Shenoy J, Kapur M. Prevalence of scholastic backwardness among five to eight-year old children. Indian J Psych 1996; 38 : 201-207.
14. Leclair JA, Innes FC. Urban ecological structure and perceived child and adolescent psychological disorders. Soc Sci Med 1997; 44 : 1649-1659.
15. Offord DR. Child psychiatric disorder: prevalence and perspectives. Pediat Clin N Amer 1985; 8 : 637-652.
16. Pharoah PD, Stevenson CJ, Cooke RW, Stevenson RC. Prevalence of behavior disorders in low birth weight infants. Arch Dis Child 1994; 70 : 271-274.
17. Wolke D. Psychological development of prematurely born children. Arch Dis Child 1998; 78 : 567-570.
18. Barness LA, Curran JS. Nutrition - Malnutrition. In Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 16th edn. Singapore; Harcourt Asia PTE Ltd.; 2000:169-172.
19. Elliman D, Lynch MA. The physical punishment of children. Arch Dis Child 2000; 83 : 196-198.
20. Srinivasan TN, Raman KJ. Early child parent separation and risk for childhood psychopathology. Indian J Psych 1987; 31 : 283-289(Rahi Manju, Kumavat AP, G)