Parent and teacher based epidemiological survey of psychiatric morbidity amongst school children in Karachi, Pakistan

According to the World Health Organisation (WHO), about 10-20% of children worldwide have mental health problems. Substantial research literature, mostly from developed and developing countries, suggests a complex socioeconomic framework of risk factors operating in multiple contexts that are central to children’s lives, namely family, school, and neighbourhood. There is limited evidence on child mental health problems and associated risk factors in Pakistan. The aim of this study was two fold, to estimate the prevalence of common psychiatric disorders as well as to determine the socioeconomic risk factors of emotional and behavioural problems among Pakistani school children. A two-phase cross sectional survey of 5-11 year-old children attending mainstream public, private and community schools in Karachi was carried out. In the first screening phase, broad morbidity rates were measured using the Strength and Difficulties Questionnaire (SDQ). A total of 968 parents and 793 teachers participated in the study. In the second phase, 100 children were randomly selected for a detailed diagnostic interview using the Kiddie Schedule of Affective Disorders & Schizophrenia for School-Age Children (K-SADS--IV-R). Results indicated a weighted prevalence of 17% common child psychiatric disorder among primary school children in Pakistan. The pattern of psychiatric disorders found in Karachi resembled those identified in other parts of the world, with a preponderance of behavioural disorders, followed by anxiety and mood disorders. Logistic regression analysis reported that poor physical health, male gender, urban neighbourhood, head of family other than father figure, government and community school type, lower teacher’s qualifications, less teaching experience, poor child school attendance and academic performance were significantly associated with likely child mental health problems in Pakistan. This exploratory study suggests estimates of child psychiatric disorders in Pakistan are slight higher than other countries. It also highlights the importance of socio- economic determinants of child mental health problems and points out the necessity of planning and establishing service networks to meet children’s mental health needs.