Psychiatric morbidity among patients attending a primary health care centre in a deprived community in Nairobi

Abstract

Studies done in recent years have shown that previous estimates of the prevalence of psychological disorders have had to be revised upwards, the majority of this evidence emanating from the West (Reeler, 1987). Research conducted in developing countries has shown that the prevalence of psychiatric disorders is high contrary to earlier reports during colonial era (Carothers, 1947).

Gillis et al (1968) reported more psychiatric disturbance amongst people living in overcrowded conditions and those with least education. With this in mind, the author commenced this study with the aim of finding out whether the prevalence of psychiatric morbidity in a deprived community was high. The follOwing hypotheses were tested: (i) The prevalence of psychiatric morbidity in patients from a deprived community is substantial. (ii) Majority of patients with psychiatric morbidity present predominantly with physical symptoms rather than psychological symptoms. The study was set out to: (i) Find out the prevalence of psychiatric morbidity among patients from a deprived community. (ii) Attempt to identify any factors that may be associated with psychiatric morbidity. (iii) To make recommendations towards integration of mental health care into existing primary health care service in the area. (iv) To gather any other useful information about .. psychiatric morbidity. The study was carried out in a city health centre (Kariobangi) in Nairobi. A sample was selected using systematic random sample method. A two-stage procedure was used to detect and confirm patients with psychiatric disorders. A locally validated version of the Self- Rating Questionnare (SRQ) was used for screening and standardised psychiatric interview (SPI) for confirmation of the "Cases". ICD-9 was used for basing the psychiatric diagnosis. 201 patients above 15 years of age were selected randomly and interviewed. They were all physically examined, managed and disposed of appropriately. For all cases,

infonnation on oocio-derrographic data, health, drug use and abuse and mental state assessment data were collected. Confirmed psychiatric cases were termed as PM (Psychiatric Morbidity). The non-psychiatric cases were designated as NPM (Non-Psychiatric Morbidity). Using the "SIM' corputer analysis the data was analysed. The significant findings were as follows: (i) Of the 201 patients interviewed, 90 met the preestablished criteria for.. psychiatric cases (PM = 44.8 per cent). (ii) Psychoneuroses were the commonest group of disorders (41.8 per cent of total sample) and consisted of neurotic depression and anxiety neurosis. (iii) 6 patients (3%) of the total sample had psychosis, 4 of whan had Manic-depressive psychosis (depressed) and 2 had SChizophrenia. (iv) 61.1% of the PM cases did not have any discernible organic illness. The implications of these findings are discussed.