DIAGNOSTIC AND BIOPSYCHOSOCIAL PROFILES OF CHILDREN AND ADOLESCENTS AT THE CHILD AND ADOLESCENT MENTAL HEALTH CLINIC OF THE UNIVERSITY COLLEGE HOSPITAL, IBADAN

Abstract

Recently, a couple of facilities for child and adolescent mental health services have been established across the country, however, little or no attention is being given to documentation of the biological, psychological, and social factors that are associated with the occurrence of mental disorders in this vulnerable population, despite the fact that it is well established that biological, psychological and social factors are involved in the development of mental disorders, especially in childhood and adolescence. Currently, there is a dearth of data on the pattern of mental, neurological, and substance use (MNS) disorders presenting at the child and adolescent mental health services in Nigeria. A previous study in this facility examined the prevalence and pattern of psychosocial problems and life events among patients attending the child and adolescent clinic. However, biological factors were not explored. Another study focused specifically on determining the obstetric risk factors in the same child and adolescent population. In the latter study, other forms of biological risk factors were not examined. It is, however, important to document important biological factors such as the family history of mental illness, comorbid medical conditions, neonatal complications, early childhood illnesses, and head injury, because of their various roles in the presentation, management, and outcome of mental health problems in children and adolescents. Methodology Using a retrospective cross-sectional design, a retrospective audit was carried out on the medical records of new referrals at the Child and Adolescent Mental Health outpatient facility of the University College Hospital, Ibadan who was 19 years old and younger from 1 January 2016 to 31 December 2019. New referrals who underwent detailed assessment, including the consultant’s review of final diagnosis, were included. A total of 267 case notes fulfilled the eligibility criteria and were reviewed in this study. A semi-structured proforma was used to extract data from the case notes of the patients on various aspects of sociodemographic characteristics, biological and psychosocial factors, diagnoses, management, and other clinical variables. Data was designed and analyzed using the statistical package for social sciences (SPSS version 25.0) and the significance level was set at 0.05 or less. Results The ages of the study patients ranged from 1 to 19 years with a mean age of 11.21 (SD 5.06) years, the majority (62.5%) of whom were adolescents (10-19 years). There were 149 (58.9%) boys and 104 (41.1%) girls. The duration of illness without hospital treatment was greater than 12 months in 77.9% of cases and 37.6% of the patients had received nonorthodox methods of care before the presentation. The most common diagnoses during the four years were intellectual disability (34.4%) and autism spectrum disorder (ASD) (14.2%). Psychiatric disorders were comorbid in 43.1% of cases and co-existing chronic medical conditions in 15.8% of cases. The prevalence of biological and psychosocial factors was 68.0% and 75.9% respectively, which were mainly delivery/birth complications (45.5%) and educational problems (78.6%) respectively. There was a significant association between diagnostic categories and age group (p<0.001), gender (p=0.014), and educational status of the patients (p<0.001). ASD and ADHD were significantly more likely to be diagnosed among the children (1-9 years); whereas, psychotic disorders and mood disorders occurred more commonly among the adolescents (10-19 years). Similarly, boys were more likely to present with ASD compared to girls; whereas, mood disorders were more common among girls. Children and adolescents with intellectual disability, ASD, psychotic disorders, mood disorders, and ‘other’ mental disorders were more likely to have a history of a biological risk factor (x2=44.537; p<0.001). A vast majority (80.2%) of the patients with a diagnosis of intellectual disability had biological risk factors. Patients with ASD (56.3%) and intellectual disability (46.9%) were more likely to have suffered delivery complications (p<0.05), while those with mood disorders (41.7%) were more likely to have a family history of mental illness (p<0.05). Conclusion The findings from the current study illustrate that the pattern of psychopathology at the CAMHC is similar to previous findings. Comorbidity is common and several psychosocial factors and biological risk factors such as obstetric complications are usually associated with mental health disorders in children and adolescents. Delayed presentation and prior nonorthodox interventions continue to be common findings in Nigerian CAMH clinics. These findings underscore the importance of using the biopsychosocial model of case formulation in the management of mental health problems in children and adolescents; the necessity of providing quality maternal and child health services in promoting mental health and preventing mental health problems; and the necessity of educational interventions for children with neurodevelopmental disorders and all children with mental health problems such as special school placement