Published: 2020-05-22

Psychiatric morbidity in children attending child guidance clinic in a tertiary care teaching hospital

Ramya C., Pavan Kumar K., Karthik S.


Background: Mental health and its related problems are growing concerns over the world. The early onset of emotional and behavioral problem in the young children is related to a variety of health and behavior problems in adolescence and later life as well. Most of these children present to Pediatric outpatient clinics owing to the Stigma and lack of awareness. The aim of the study is to find out the pattern and prevalence of psychiatric morbidity in children presenting to pediatric outpatient clinics.

Methods: It is a cross sectional, point prevalence study of children who have attended Child Guidance Clinic of Pediatric Department in a tertiary care teaching hospital October 2019 to January 2020. Clinical and demographic details was collected in a semi-structured proforma and the details were analyzed.

Results: A total of 114 children were analyzed during the study period and this study comprised of 62 boys and 52 girls. Most of the children belonged to the age group of 11-15 years (51%) followed by the ages of 6-10(29.8%). Most common reason for consultation was change in behavior, school refusal and poor academic performance. The most common diagnosis made was Dissociative Conversion Disorder (17.6%), Nocturnal enuresis (15.7%), Mild Mental Retardation (10.5%) and Seizure Disorder with Behavioral Problems (10.5%).

Conclusions: A significant number of children attending the Paediatric OPD of general hospitals have psychiatric disorders. The emotional and behavioral problems in children often present with physical symptoms. An effective liaison of services will help to identify and treat children with psychiatric morbidity.


Behavioral problems, Child guidance clinic, Psychiatric morbidity, Pediatric out patient

Full Text:



World Health Organization. The World Health Report 2001: Mental health: new understanding, new hope. World Health Organization; 2001.

McKelvey RS, Sang DL, Baldassar L, Davies L, Roberts L, Cutler N. The prevalence of psychiatric disorders among Vietnamese children and adolescents. Medi J Austr. 2002 Oct;177(8):410-7.

Sawyer MG, Arney FM, Baghurst PA, Clark JJ, Graetz BW, Kosky RJ, et al. The mental health of young people in Australia: key findings from the child and adolescent component of the national survey of mental health and well‐being. Australian and New Zealand J Psychiat. 2001 Dec;35(6):806-14.

Banerjee T. Psychiatric morbidity among rural primary school children in West Bengal. Ind J Psychiat. 1997 Apr;39(2):130.

Malhotra S, Kohli A, Arun P. Prevalence of psychiatric disorders in school children in Chandigarh, India. Indian J Medi Res. 2002 Jul 1;116:21.

Pahwa MG, Sidhu BS, Balgir RS. A study of psychiatric morbidity among school going adolescents. Ind J Psychiatr. 2019 Mar;61(2):198-203.

Surya NC, Datta SP, Krishna GR, Sundaram D, Kutty J. Mental morbidity in Pondicherry. Transaction-4, Bangalore: All India Inst Ment Health. 1964:50-61.

Nandi DN, Ajmany S, Ganguli H, Banerjee G, Boral GC, Ghosh A, et al. Psychiatric disorders in a rural community in West Bengal An epidemiological study. Indian J Psychiatr. 1975 Apr 1;17(2):87.

Srinath S, Girimaji SC, Gururaj G, Seshadri S, Subbakrishna DK, Bhola P, et al. Epidemiological study of child & adolescent psychiatric disorders in urban & rural areas of Bangalore, India. Indian J Medi Res. 2005 Jul 1;122(1):67-79.

Chadda RK. Pattern of psychiatric morbidity in children attending a general psychiatric unit. The Indian J Pediatr. 1994 May 1;61(3):281-5.

Mishra A, Sharma AK. A clinico-social study of psychiatric morbidity in 12 to 18 years school going girls in urban Delhi. Indian J Comm Med. 2001 Apr 1;26(2):71-82.

Sinha UK, Kapur M. Psychotherapy with emotionally disturbed adolescent boys: Outcome and process study. Nimhans Journal. 1999 Apr;17:113-30

Bhola P, Kapur M. Prevalence of emotional disturbance in Indian adolescent girls. Indian J Clini Psychol. 2000;27(2):217-22.

Patel V, Flisher AJ, Hetrick S, McGorry P. Mental health of young people: a global public-health challenge. Lancet. 2007 Apr 14;369(9569):1302-13.

Kim-Cohen J, Caspi A, Moffitt TE, Harrington H, Milne BJ, Poulton R. Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort. Arch Gen Psychiatr. 2003 Jul 1;60(7):709-17.

World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. WHO. Geneva. 1992. Available at:

Malhotra S, Chaturvedi SK. Patterns of childhood psychiatric disorders in India. Indian J Pediatr. 1984 Mar 1;51(2):235-40.

Chadda RK. Psychiatric morbidity in preschool children-A clinic based study. Indian J Pediatr. 1995 Jan 1;62(1):77-81.

Bhat BA, Hussain A, Dar MA, Dar SA, Jabeen N, Rasool S, Shafi S. The pattern of psychiatric morbidity in an outpatient child psychiatry clinic: A cross-sectional, descriptive study from a tertiary care hospital in Kashmir, North India. Indian J Psycholog Medi. 2018 Jul;40(4):349-55.

Rahim DA, Ali SM, Rabbani MG, Rahman MA. Analysis of psychiatric morbidity of outpatient children in Mitford Hospital, Dhaka. Bangladesh Medi Res Council Bulletin. 1997 Aug;23(2):60-2.

Hussain J. Birth order and psychiatric morbidity. Eur Psychiat. 2017 Apr 1;41:S356.

Risal A, Tharoor H. Birth order and psychopathology. J Family Medi Primary Care. 2012 Jul;1(2):137.

Leary PM. Conversion Disorder in Childhood–-Diagnosed Too Late, Investigated Too Much?. J Royal Soc Medi. 2003 Sep;96(9):436-8.

Solanki AN, Desai SG. Prevalence and risk factors of nocturnal enuresis among school age children in rural areas. Int J Res Med Sci. 2014 Jan 1;2(1):202-5.

Reddy NM, Malve H, Nerli R, Venkatesh P, Agarwal I, Rege V. Nocturnal enuresis in india: Are we diagnosing and managing correctly?. Ind J Nephrol. 2017 Nov;27(6):417.

Chaudhury S, Prasad PL, Zacharias R, Madhusudan T, Saini R. Psychiatric morbidity pattern in a child guidance clinic. Medi J Armed Forces India. 2007 Apr 1;63(2):144-6.

Malhotra S, Biswas P, Sharan P, Grover S. Characteristics of Patients Visiting the Child & Adolescent Psychiatric Clinic: A 26-Year Study from North India. J Indian Assoc Child Adolescent Mental Health. 2007;3(3):53-60.

Nawarathna SC, Subba SH, Guha A. Clinico-epidemiological profile of psychiatric disorders among children in a tertiary care hospital of Southern India. J Clini Diagn Res. JCDR. 2016 Mar;10(3):VC05.

Vogel W, Holford L. Child psychiatry in Johannesburg, South Africa. A descriptive account of cases presenting at two clinics in 1997. Eur Child Adolescent Psychiatr. 1999 Oct 1;8(3):181-8.

Staller JA. Diagnostic profiles in outpatient child psychiatry. Am J Orthopsych. 2006 Jan;76(1):98-102.

Knight T, Steeves T, Day L, Lowerison M, Jette N, Pringsheim T. Prevalence of tic disorders: a systematic review and meta-analysis. Pediatric Neurol. 2012 Aug 1;47(2):77-90.

Cubo E, y Galán JM, Villaverde VA, Velasco SS, Benito VD, Macarrón JV, et al. Prevalence of tics in schoolchildren in central Spain: a population-based study. Pediatr Neurol. 2011 Aug 1;45(2):100-8.

Saha R, Srivastava MK, Anand KS. Psychiatric presentation of childhood epilepsy: Case series and review. J Pediatric Neurosci. 2016 Oct;11(4):367.

Jayaprakash R. Clinical Profile of Children and Adolescents Attending the Behavioural Paediatrics Unit OPD in a Tertiary Care Set up. Journal of Indian Assoc Child Adolescent Mental Health. 2012;8(3):51-66.

DeBar LL, Lynch F, Powell J, Gale J. Use of psychotropic agents in preschool children: associated symptoms, diagnoses, and health care services in a health maintenance organization. Arch Pediatr Adolescent Medi. 2003 Feb 1;157(2):150-7.

Sarwat A, Ali SI, Ejaz MS. Mental health morbidity in children: A hospital based study in child psychiatry clinic. Pak J Med Sci. 2009 Oct 1;25(6):982-5.

Chapagai M, Dangol KM, Tulachan P. A study of psychiatric morbidty amongst children attending a child guidance clinic at a tertiary level teaching hospital in Nepal. J Nobel Medi Coll. 2013 Mar 3;2(1):55-63.

Grover S, Raju VV, Sharma A, Shah R. Depression in children and adolescents: a review of Indian studies. Indian J Psychol Medi. 2019 May;41(3):216.