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STUDY OF PSYCHIATRIC MORBIDITY OF PATIENTS ATTENDING FREE MENTAL HEALTH CHECK UP CAMPS IN FAR WESTERN RURAL NEPAL Dr C P Sedain Department of psychiatry Chitwan Medical College, Bharatpur,Chitwan,Nepal
STUDY
OF PSYCHIATRIC MORBIDITY OF PATIENTS ATTENDING FREE
MENTAL HEALTH CHECK UP CAMPS IN FAR WESTERN RURAL NEPAL
Dr C P Sedain
Department
of psychiatry Chitwan
Medical College, Bharatpur,Chitwan,Nepal
Abstract
Introduction:
The hilly area of far western development region is the most
remote area of Nepal. This is the region of less health facility. The aim of the study
was to find out psychiatric
morbidity of patients attending free check up clinic of far western
development region Nepal.
Methods:
A
prospective cross-sectional study comprised of all consecutive patients
attending free check up psychiatric clinic of
far western development region Nepal. All the patients attending
the free clinics for four days were
taken as case. The study was performed in the
month of June, 2013. Demographic data
and disease profile of 287 patients attending the clinic were analyzed. The ratios and
proportions were used for statistical analysis.
Conclusions
Most of Patients attended of far western development
region free mental health clinic are farmer of
age group 20-29 .
The commonest incidence of psychiatric illness attending the
free clinic is depressive disorder and
(tension/migraine) headache.
Key
words: diagnosis
profile, socio-demographic characteristics, BPAD
Correspondence
Prof Dr.C P Sedain
Department of
Psychiatry
Chitwan Medical College
Bharatpur ,Chitwan,Nepal
Email-drcpsedai@yahoo.com
Phone:9779855056666
Introduction
The hilly area of far western
development region is the most remote area of Nepal. This is the region of less
health facility. The majority of people of this region are poor. The
psychiatric problems in the far western development region are high as compare
to other part of the country. HIV
positive cases are found in Acham, Doti and Bajura districts. These
people still believes traditional healers. The status of mental health is low in far western development region.
The free mental health check up was done in Daduldhara, Doti, Acham and Bajura districts. Many patients came from
neighboring districts for free check up.
Most of the patients are poor, low educational status. No single psychiatrist posted
in these areas. Most of the people go to India for treatment of mentally ill
patients.
The Far Western Region covers 19,539 km2 and comprises two zones, the
Seti and Mahakali. It has nine districts with the regional headquarters at
Dipayal, Doti district. The Far Western Region is remote and developmentally
challenged. Forty four percent of people
in the Far West Hills and 49% in the Himalayan districts live beneath the
poverty line. The region has limited access to basic services and increasing
services is challenging due to the difficult topography.
The region has complex
socio-economic structures and there is both widespread gender and caste based
discrimination. Traditional systems associated with religion, culture and
customs also have a great impact on overall development. Major Challenges are prevalence of gender and caste based discrimination; lack
of employment and high seasonal migration to India; High prevalence of HIV/AIDs
among migrants; a legacy of
socio-economic exploitation, such as bonded labour and the Kamaiya/Haliya systems;
Widespread child labour.1
Studies regarding psychiatric morbidity are scare in Nepal.
The pattern of psychiatric illness has been described to similar across the
country. Regmi et al. found that majority of cases were
neurotic stress related and
somatoform disorder (42.46%) followed by
mood disorder(37.23%). Still that the culture plays an important role on
morbidity pattern in the community is known as an acknowledged fact. Thus the
studies in this aspect becomes important, mainly to formulate any plan
regarding mental illness 2. There
are few studies on mental illness e.g. by Nepal et al , Wright , Shrestha and Sharma . About half of the patients in
all studies were of the age group 20-40 years and more than half were males.
However the diagnostic distribution differed among the studies. Nepal et al found that the patients mainly suffered from
neurotic and related disorders. Majority of the patients in Wright’s study were
epileptic (32℅), Shrestha found most of the patients suffering from psychosis
(63℅), while Sharma described as many as 41℅ suffered from depression. The
inconsistencies may be because of the difference in the setup, population
studied and the criteria used. Shrestha had studied the patients attending a Mental
Hospital valley; Sharma conducted the
study in private clinic setup in Pokhara, whereas Wright studied the patients
attending the health posts in a rural community. Thus despite the
inconsistencies in the diagnostic distribution, the findings in the different
setup have their own importance 3. The
Quality Adjusted Life Year(QALY) losses
in primary care is highest
is in pain related physical condition followed by mood disorder4.
Major depression
is the most common psychiatric problem seen in primary care. Prevalence figures
for major depression vary substantially between surveys 5. The reasons for increased rates among women are uncertain.
Depression is more common among the unemployed; divorced, all medical illness
and their treatment can act as non-specific stress, which may lead to mood
disorder in predisposed subject. The present study
was conducted to find out psychiatric morbidity
of patients attending
far western development region
of Nepal. The free mental health check up camp was
performed four places Dadeldhura, doti
,acham and bajura district one day each continuously.
Methods
A prospective cross-sectional study
comprised of all consecutive psychiatric patients attending far
western development region of Nepal. All
the patients attending the psychiatric
free check up clinics were taken as case. The study was performed month of June 2013. A brief explanation about the
study was offered to the subjects and written or verbal consent was obtained
either from them or guardians. A continuous sequential number was given
to each subject and available necessary information was kept confidential in a
separate file. The socio demographic profile which contains name, age, sex,
caste, address, marital status, occupation, and other information also filled.
The diagnosis was done on the basis of I.C.D. - 10 diagnostic research criteria
6. Data were entered in to a computer and analyzed using Statistical
Package for Social Studies (SPSS) software. The free psychiatric patients check
up camp was completed in four days.
Results
A total of 287 patients were included in the study. Out of them male were 151(52.61%) and female were 136 (47.39%). Data shows highest numbers of patients were age group 20-29 (N-68, 23.69%) followed by age group 30-39 (N-63, 21.95%). Data shows highest numbers of patient were married (N-191, 66.55%) and most of cases were farmer (N-162, 56.44 %). Distribution on the basis of ICD 10 diagnosis, highest number of cases were depressive disorder (N-98,33.45 %) followed by tension/migraine headache (N-44, 15.33%) , epilepsy (N-25, 8.01 %) and alcohol use disorder (N-24, 7.67 %). Similarly Schizophrenia (N-19, 5.92 %) , anxiety disorder (N-18, 5.57 %), somatoform disorder (N-16, 5.57 %), mania/BPAD (N-15, 4.52 %) and conversion disorder (N-7, 2.44 %) .
Table 1
DISTRIBUTION ON THE BASIS OF AGE GROUP |
|
AGE
|
N
|
|
|
|
|
%
|
|
10-19
|
43
|
14.98
|
|
20-29
|
68
|
23.69
|
|
30-39
|
63
|
21.95
|
|
40-49
|
53
|
18.47
|
|
50-59
|
36
|
12.54
|
|
60-69
|
20
|
6.97
|
|
70-79
|
4
|
1.39
|
|
TOTAL
|
287
|
100
|
Table 2
DISTRIBUTION ON THE BASIS OF SEX
|
SEX
|
CASE
|
|
|
|
NO
|
%
|
|
MALE
|
151
|
52.61
|
|
FEMALE
|
136
|
47.39
|
|
TOTAL
|
287
|
100
|
Table –3
DISTRIBUTION ON THE BASIS OF MARIETAL STATUS
|
||||||||||||||||||||||||||||
Table-4
DISTURIBUTION ON THE BASIS OF
OCCUPATION
|
OCCUPATION
|
N
|
%
|
|
|
||
|
FARMER
|
162
|
56.44
|
|
BUSINESSMAN
|
13
|
4.53
|
|
SERVICE
HOLDER
|
24
|
8.36
|
|
HOUSEWIFE
|
27
|
9.41
|
|
LABOUR
|
28
|
9.76
|
|
UNEMPLOYED
|
17
|
5.92
|
|
STUDENT
|
16
|
5.57
|
|
TOTAL
|
287
|
100
|
Table-5
DISTURIBUTION ON THE BASIS OF DIAGNOSIS
(ICD-10 DCR)
|
DIAGNODIS-ICD,10
|
MALE
|
FEMALE
|
TOTAL
|
%
|
|
DEPRESSIVE
DISORDER(F32)
|
36
|
62
|
98
|
33.45
|
|
SCHIZOPHRENIA
(F20)
|
11
|
8
|
19
|
5.92
|
|
EPILRPSY
(G40)
|
12
|
13
|
25
|
8.01
|
|
MANIA/BPAD
(F30-31)
|
10
|
5
|
15
|
4.52
|
|
ANXIETY
DISORDER (F4O-41)
|
6
|
12
|
18
|
5.57
|
|
ALCOHAL
USE DISORDER (F10)
|
21
|
3
|
24
|
7.67
|
|
SUBSTANCE
USE DISORDER (F11-19)
|
1
|
1
|
2
|
0.69
|
|
CONVERSION
DISORDER (F44)
|
2
|
5
|
7
|
2.44
|
|
ADHD
|
1
|
1
|
2
|
0.69
|
|
PTSD
(F43)
|
3
|
0
|
3
|
1.04
|
|
SOMATOFORM
DISORDER (F45)
|
9
|
7
|
16
|
5.57
|
|
ORGANIC
PSY DISORDER
|
2
|
4
|
6
|
2.09
|
|
MENTAL
RETARDATION (F70-79)
|
2
|
2
|
4
|
1.39
|
|
(TENSION/MIGRAINE)
HEADACHE (G43-44)
|
33
|
11
|
44
|
15.33
|
|
OTHER
|
2
|
2
|
4
|
1.39
|
|
TOTAL
|
151
|
136
|
287
|
100
|
Discussion:
Far western region are prevalent of high infant and maternal mortality rates due
to a lack of basic health services and high malnutrition; low literacy rate,
insufficient school facilities and limited access to quality education. There
are lack of medical facility and different health problems including acute respiratory tract infection,
headache, gastritis (APD), pyrexia, diarrhoea, intestinal worms and amoebic
dysentery are among the most common diseases. The Far West also has high maternal
and child mortality rates and a high prevalence of HIV/AIDS. Hygiene
and sanitation in the region are poor , more than 70% of people living in the
region do not have access to toilets but use ‘open defecation areas’. There is
also a strong preference, particularly among those living in rural areas, to
visit religious healers (Dhami, Jhakri) when they are sick, rather than
visit formal health institutions.
The life style is becoming complex day
by day, thus the patients consulting the psychiatrist is increasing than previous
decade. Depressive disorder is the commonest psychiatric disorders worldwide. A review of anxiety disorder
surveys in different countries found that average lifetime prevalence estimates of
16.6%, with women having higher rates on average7.A review of mood disorder surveys in different countries found
that lifetime rates of 6.7% for major
depressive disorder (higher in some studies, and in women) and 0.8% for Bipolar
I disorder In the United States the frequency of disorder
is: anxiety disorder (28.8%), mood disorder (20.8%), impulse-control disorder
(24.8%) or substance use disorder (14.6%)8.A
2004 cross-Europe study found that approximately one in four people reported
meeting criteria at some point in their life for at least one of the DSM-V psychiatric disorders assessed, which included
mood disorders (13.9%), anxiety disorders (13.6%) or alcohol disorder (5.2%).
Approximately one in ten met criteria within a 12-month period. Women and younger
people of either gender showed more cases of disorder. A 2005 review of surveys
in 16 European countries found that 27% of adult Europeans are affected by at
least one mental disorder in a 12 month period 9. Psychiatric disorder like schizophrenia, BPAD, alcohol &
drug addiction problems are also equally challenging to us. A ten-year
perspective study in Zurich, estimated
the life time prevalence of major depression is about 16 percent. The rates of
depressive disorder seems to be higher in industrialized countries10. They are consistently
increased in woman across different cultures. Nepal et al Regmi et al reported
that patients attending to psychiatric OPD of TUTH were commonly neurotic and stress
related disorder. Similarly Sharma’s study shows 41℅ patients were depressive
disorder only.
Pokhrel et al reported that mood disorder
(35℅) followed by schizophrenia and related disorder (28℅) and neurotic and
stress related disorder (17 ℅) respectively. The percentage distribution of
depressive illness reported by Sharma is similar to our finding. Major
depression is the commonest psychiatric problem seen in primary care center.
Depression is more common among the unemployed and divorced people. If we look
at our finding the depressive illness was observed among the patient of SLC and
intermediate education level. All medical illnesses and their treatment can act
as non-specific stress factor which may lead to mood disorder in predisposed
subject. Prevalence of psychiatric disorders among general hospital population
is higher than in community. Sedain found
Maryknoll free mental health check up clinic Simara, Bara,Nepal shows depressive disorder is the commonest
psychiatric disorder (18.93%).11
Data on current study shows that total of 287 patients were included in the study. Out of them male were 151(52.61%) and female were 136 (47.39%). Data shows highest numbers of patients were age group 20-29(N-68, 23.69%) followed by age group 30-39 (N-63, 21.95%). Data shows highest numbers of patient were married (N-191, 66.55%) and most of cases were farmer (N-162, 56.44 %).Distribution on the basis of ICD 10 diagnosis, highest number of cases were depressive disorder (N-98,33.45 %) followed by tension/migraine headache (N-44, 15.33%) , epilepsy (N-25, 8.01 %) and alcohol use disorder (N-24, 7.67 %). Similarly Schizophrenia (N-19, 5.92 %) , anxiety disorder (N-18, 5.57 %), somatoform disorder (N-16, 5.57 %), mania/BPAD (N-15, 4.52 %) and conversion disorder (N-7, 2.44 %) .
Conclusions
The hilly area of far western development region is the most
remote area of Nepal. This is the region of less health facility. Data shows
depressive disorder ( F-32 ) is the commonest psychiatric disorder. Similarly
other disorders include tension/migraine headache( G-43 ,G-44) , epilepsy (G
-40), alcohol use disorder (F- 10 ), schizophrenia ( F-20), mania/BPAD(F-30), anxiety disorder(F-40,F-41), somatoform disorder
(F-45) and conversion disorder (F-44).
Most of the patients were farmer
of age group 20-29 .
REFERENCES
1
Far-western regional health directorate Dipyal
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