Students of both sexes aged 6 to 20 years and having
vision below 3/60 were included. Those with comorbid deafness/dumbness or
other physical disability were excluded. Tools were Socio-demographic data
sheet, General Health Questionnaire (GHQ)-60 [5] Hindi translation and
Diagnostic Interview Schedule for Children (DISC-P) Parent version [6].
Ethical approval was obtained from the Institute’s ethical committee and
informed consent was taken from the concerned authorities of all four
schools as well as the respective guardians.
Each student was interviewed individually, and personal
data sheet and socio-demographic information were filled up. Questions
from GHQ-60 were asked along with options and answer sheet was marked
accordingly. The scoring was done by Binary code method and children who
scored 7 or above were included for diagnostic assessment. DISC-P was
applied to the guardians of the children; diagnosis was made using
Diagnostic and Statistical Manual of Mental Disorders–IV (DSM-IV) criteria
[7].
Chi square and Z test were applied to compare
socio-demographic and clinical variables between students with and without
psychiatric diagnosis for categorical and continuous variables,
respectively. Pearson’s correlation was used to detect any association
between socio-demographic and clinical variables and psychiatric
diagnosis.
Ninety-two students with visual impairment were
included for the study. Table I shows socio-demographic and
clinical variables of the sample. Only one child had a family history of
mental illness.
After screening with GHQ-60, 14 students (9 males and 5
females) scored above the cut-off marks on whom DISC-P was applied by
interviewing the primary care taker. Eight children fulfilled the DSM-IV
criteria for psychiatric diagnosis. Remaining 6 students had sub-threshold
anxiety and depressive symptoms. The overall prevalence of psychiatric
morbidity was found to be 8.69%; 8.47% and 9.09% for males and females,
respectively.
The specific psychiatric diagnoses included 4 cases of
generalized anxiety disorder, one case of dysthymia, two cases of
dysthymia with elimination disorder (nocturnal enuresis) and 1 case of
conduct disorder.
No significant difference was noted in terms of
socio-demographic and clinical variables between those with and without
psychiatric diagnosis. There was no significant correlation between
socio-demographic and clinical variables and psychiatric diagnosis.
Discussion
We used GHQ-60 as screening instrument, avoiding
shorter versions for intensive examination. We screened the entire
population of visually impaired students of Ranchi city, which is the
major strength of our study.
The reported prevalence of psychiatric disorders in
normal children and adolescents in community is 12.8% [8] whereas our
study found 8.69%. This difference could be the fallout of our
school-based approach since children with severe problems either fail to
start schooling or drop out early. In India, only 0.5 to 1% of visually
impaired children are able to attend any school [2]. Visually impaired
children in community, who are lacking opportunities for schooling, might
be suffering from greater psychiatric morbidity. We also excluded any
additional impairment which could explain slightly lower prevalence. Among
psychiatric diagnoses, GAD and/or dysthymia totalled 7 out of 8 (87.5%),
showing a predominance of internalizing over externalizing disorders [9].
A previous Ethiopian study [10] also found 4.7%
psychiatric morbidity among visually impaired people with majority having
internalizing disorders. Likewise, an Indian study [11] reported that 7%
of blind subjects had psychiatric morbidity with pre-eminence of
internalizing disorders.
High anxiety at early age may be an outcome of
psychological effect of visual impairment. The high prevalence of anxiety
can be attributed to various environmental risks to which a visually
impaired child is exposed to. This may be associated with cognitive biases
like negative interpretation, memory bias, information processing bias,
lower threshold for threat perception and higher rates of negative
emotion, which are prevalent in childhood anxiety [12]. Visually impaired
children are exposed to adverse environmental situations, but association
between impairment and cognitive biases has not yet been studied.
The results of our study can not be generalized to all
visually impaired children, as subjects of this study were getting
education in a special school having a better support system. This
highlights the need to include samples from general population in future,
along with a matched control group, a larger sample size, quality of life,
disability and burden of various mental disorders, and follow-up studies
to know the longitudinal course of the disorders.
Acknowledgment: We are thankful to the school
administration of St Micheal Blind School, Bahu Bazar; Government Blind
School for Boys, Harmu; Brajkishore Balika Blind School, Bariyatu; and,
Satyadev Blind School, Kuchu, Ormanjhi; Ranchi, Jharkhand, for granting
permission and the help provided for this study.
Contributors: AKB, VV and SS collected,
analyzed and interpreted the data and performed literature review and
drafted the manuscript. VKS designed the study, supervised data collection
and analysis. He also revised and approved the final manuscript.
Funding: None.
Competing interests: None stated.
What This Study Adds?
• Prevalence of psychiatric morbidity among
visually impaired students of Ranchi was found to be 8.69%, with
predominance of anxiety and depressive disorders.
• The prevalence of psychiatric morbidity in
visually impaired students is similar to those without such
impairment.
|
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