Detecting child psychiatric disorders during routine clinic work: A pre-interventional study of primary care physicians in Ilorin, Nigeria

Abstract

Background. Primary care physicians (PCPs) are accessible to most patients and are gatekeepers to specialist care. In our hospital the primary care department is potentially the main source of referral to our recently established child and adolescent psychiatric clinic, which is experiencing low attendance or under-utilisation. We suspected that child mental health problems were being under-detected at the primary level of care and that we needed to intervene. Objective. To explore the existing level of ability of PCPs in our primary care unit to identify children with mental health problems. Study setting. The study was carried out in the Paediatric Clinic of the Department of Family Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria. Method. A cross-sectional two-stage study in which 350 children aged 7 - 14 years, seen by PCPs in the course of their routine work, were subsequently screened with the parents’ version of the Child Behaviour Questionnaire or Rutter Scale A2. Of these, a stratified sub-sample of 157 children, consisting of all the 36 high scorers (score ≥7) and 121 low scorers (i.e. about 1 in every 3 low scorers), were selected and interviewed jointly with their mothers using the children’s version of the Schedule for Affective Disorders and Schizophrenia (K-SADS) to establish Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnoses.. Results. The PCPs identified 12 of the 157 children (7.6%) as having mental health problems of some sort. The K-SADS identified 40 of the 157 children (22.5%) as having a psychiatric disorder. A comparison of diagnoses by PCPs and the K-SADS shows that 8 of the 12 children diagnosed as having mental health problems were among the 40 identified by the K-SADS, suggesting that PCP had a low diagnostic ability rating of 8/157 (5.1%). The PCPs performed poorly in discriminating between cases and noncases (p=0.002). Poor school attendance (p=0.001), frequent hospital visits (p=0.009) and longstanding illness (p=0.039) were significantly associated with a child being identified as having a psychiatric disorder. Conclusion. Because of the apparent poor ability of the PCPs in this study to detect child psychiatric cases, some form of intervention is vitally needed to improve attendance at our child and adolescent psychiatric unit. Use of a guideline or protocol and interactive educational programmes to improve the child mental health literacy of our PCPs are being considered.