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

Abstract

Back-ground Primary care physicians (PCP) are accessible health care provider for most patients and are gatekeepers to specialist care. The extent to which they can identify children with mental health problems need to be explored.

Objective: To explore the extent to which primary care physicians can identify children with mental health problems. Study setting The study was carried out at the Paediatric Clinic of the department of Family Medicine, University of Ilorin teaching Hospital, Ilorin, Nigeria.

Method: A 2 staged study in which 350 children aged 7-14 years were screened with child behaviour questionnaire (Rutter Scale A2). A stratified sub-sample of 157 (all high scorers and about 30% of low scorers) were further interviewed with children version of Schedule for Affective Disorders and Schizophrenia (K-SADS) by the psychiatrists. They were also evaluated by primary care physicians for the presence of mental health problems.

Results: Out of the 157 children interviewed in the second stage, primary care doctors identified 12 children as having mental health problems. K-SADS identified 40 as cases, this includes 8 of the 12 identified by primary care doctors; that is, they identified 8 cases. They were poor in discriminating between cases and non- cases (P=0.012). Poor school attendance (P=0.001), frequent hospital visit (P=0.009) and long standing illness (P=0.039) were associated with case-ness.

Conclusion: This study suggests that primary care physicians had difficulties in identifying mental health problems in the children. Interventions such as guideline protocols, primary care physician education and educational programmes to increase mental health literacy, may be effective in improving detection by primary care physicians.