 |
|
Brief Reports Indian Pediatrics 2001; 38: 1397-1401 |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
M. Srinivasa Raju P.S.S. Russell Thomas John L. Jeyaseelan Alice Cherian
The changing family support, especially in urban areas(1), industrialisation(2), subs-tance abuse(3) and parental psycho-pathology(4) have all been cited as some of the significant factors contributing to the psychopathology seen in children and adolescents. Children of parents with a variety of mental illnesses have been studied and about 40-45% of children of parents with major affective disorders are at significant risk of developing some form of psycho-pathology(5,7) as compared to the 16-20% incidence in children in the general population(8). Psychiatric disorders in childhood are very common in India as in other countries. Intra-familial relationships are subjected to severe stress when a mentally ill person is maintained in the home(4). Identification of the children at risk based on the psychopathology of the parents becomes imperative for primary prevention. In Indian studies, the reported rate of psychopathology among children is 5-15%(9-11). This study was conducted to compare the prevalence and type of psychopathology among children of parents with chronic psychiatric illness with a control group. Subjects and Methods The study population consisted of 50 consecutive families, who fulfilled the selection criteria. Inclusion Criteria These were: (i) Patients with diagnosis of psychiatric disorder with a minimum duration of 2 years; (ii) Patients included in the study should be the parent of atleast one child; and (iii) Child should be in the age group of 4-14 years. Exclusion Criteria These were: (i) Presence of psychiatric illness in both parents; and (ii) Presence of mental retardation in parents. Parents and controls were assessed in detail to confirm any psychiatric diagnosis, by interview and rating by brief psychiatric rating scale (BPRS)(12). The childhood psychopathology measurement schedule (CPMS)(13) was administered to the normal parent of the index group and control parents, to assess the psychopathology in their children and those who obtained a score of more than 10 points in the CPMS scale, were clinically interviewed and rated with Childrens Psychiatric Rating Scale (CPRS) (14). Psychopathology that was looked for included low intelligence, behavioral problems, conduct disorders, anxiety, depression, physical illness with emotional problems and somatization. Odds ratio was calculated for each risk factor studied with 95% confidence interval. Logistic regression analysis was also done. Results The various baseline characteristics were similar in the two groups, except socio economic status. For the 106 index children and 119 controls from the 50 families each, the CPMS scores are given in Table I. Except for special symptoms which consisted of physical illness with emotional problems, there was statistically significant difference between the two groups, in all the variables studied. Disease specific differences were evident in CPMS score. Children of schizophrenic patients showed significant difference in the following items; low IQ with behavioral problems, conduct disorder, anxiety and depression. In depressive illness, except for special symptoms which consisted of physical illness with emotional problems and somatization, all other parameters showed significant differences. Results in patients with bipolar affective disorder were similar to the depressive disorder. Childrens Psychiatric Rating Scale (CPRS) was administrated to all children who scored, ten and above in the CPMS score. All item scores are significantly different between the two groups (Table II). Logistic regression analysis did not show any statistical significance for factors like age, sex, occupation, locality, socioeconomic status, and family size. The only variable that was statistically significant was having one index parent (Table III). Analysis of parents opinion regarding need for psychiatric consultation for the children’s behavior showed that only 15% of index parents thought there was need for psychiatric consultation whereas no control parent thought there was need for consultation. Discussion There are very few studies, which have looked into the psychopathology of children of chronic psychiatrically ill parents (4-7). Majority of parents studied (62%) belonged to the low scoioeconomic status, as compared to the controls (40%). Whether psychiatric illness is commoner among lower socio-economic strata or psychiatric illness causes a downward drift in socioeconomic status, are both a possibility. Depressed parents had the highest number of hospitalizations and this can have severe negative impact, on the other family members especially children. Table I__Comparison of Childhood Psychopathology Measurement Schedule (CPMS) Scores
The children in the index group with parents having psychiatric illness had higher scores of total CPMS, as well as other variables. There are two other studies which have found an increased expression of psychiatric illness in the children of parents with affective disorder(8) and bipolar affective disorder(10). Of the eighteen children of the index group, who had scored over 10 in CPMS, 4 were born to parents with depressive disorder. Children who had a score of 10 or above in CPMS, had high scores in CPRS also. This validates the observation that, children identified as having abnormal behavior by parents had evidence of the same, on an objective assessment also. Other factors studied in these 26 children, namely diagnosis, age, sex occupation, education, locality, socio economic status, family size, duration of the illness, number of hospitalization and length of hospitalization were not found to be significant, in our sample. Fifteen per cent of the index parents felt the need for psychiatric consultation for their children. None of the control parents felt so, though 6.7% of the children in this group had psychiatric problems. The fact that the course of illness in children can be modified or the illness prevented, through successful interventions to specific risk factors in the child and child’s environment including parental illness, makes it important to identify those children at risk. The findings of this study are important in the light of current advances in preventive psychiatry. Contributors: MSR was the primary investigator and collected data. PSSR was the co-guide and revised the initial draft. TJ was responsible for drafing, revising and compiling final version. LJ did statistical analysis and data entry. AC conceived the idea, was the guide and compiled the final version. She will act as the guarantor for the study. Funding: Fluid Research Grant, Christian Medical College and Hospital, Vellore. Competing interests: None stated.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| References | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
