Psychiatric morbidity among adolescents attending a primary health care centre in a high population density urban community in Nairobi

Abstract

Introduction: Psychiatric disorders are on the increase and they are expected to increase further as time passes by. It is estimated that a quarter of patients visiting a health facility suffer from mental illness. Adolescents form a vital age group in the society and experience many changes; physiological, anatomical, psychological and social. Some of these changes in association with certain variables can predispose the adolescents to developing mental illness. Locally most studies on adolescent psychiatric morbidity have been done in learning institutions unlike in health facilities. This study was an attempt to fill that gap. Objectives: (a)To determine the prevalence and pattern of psychiatric morbidity among adolescents attending a primary health care facility in a socia-economically deprived, densely populated community in Nairobi-Kenya. (b)To identify significant sociodemographic factors contributing towards psychiatric morbidity among these adolescents. Design: The design of the study was a cross sectional descriptive study. Setting: Kariobangi orth Health Centre in Nairobi-Kenya. Method: Two hundred and fifty five adolescents aged 12-21 years (101 males and 154 females) were selected by consecutive sampling. A socia-demographic questionnaire was administered and DSM-IV TR guided interview and criteria were then used to reach diagnosis. Results: The adolescents were aged 12-21 years with a mean age of 17 years, standard deviation of 3, a mode of 21 years and a median of 18 years. Majority were single (79.6%) while the rest were married, widowed or separated. Most had primary school level of education (63.9%) while 32.5% had secondary school education but none had university education. The majority were protestants (56.1 %) while the rest were catholics (35.3%) or muslims (7.8%). Most of them were not employed (76.9%) due to various reasons while 23.1 % had some form of employment. Most of them were staying with their parents (54.5%) while the rest were living with relatives, spouses, alone, friends or with employer. Out of the 255 subjects interviewed, 115 (45.1 %) had psychiatric axis I disorders. Among these 115 with psychiatric morbidity, 41(35.7%) were males and 74 (64.3%) females. The psychiatry morbidity pattern was: anxiety disorders (40.32%), mood disorders (3l.14%), substance related disorders (20.96%), somatoform disorders (3.22%), schizophrenia and other psychotic disorders (2.41 %) and conduct disorder (l.61 %). There was a statistically significant association between psychiatric morbidity and 1) age 2) education 3) religion 4) unemployment 5) number of children 6) guardian 7) duration of physical illness 8) sexual partners had 9) substance use. Conclusion: The prevalence of PM among the adolescents was higher than that expected in the general population as well as in health and learning institutions locally and in other countries. The statistically significant correlates were identified as potential risk factors for developing mental illness in these adolescents. The findings can be generalized to other high density population communities in urban areas locally. Recommendation: It is necessary to develop early screening programs and management services for psychiatric conditions in adolescents so as to reduce eventual psychiatric morbidity in adulthood. More vigorous training of the health workers (nurses and clinical officers) on mental health is necessary.