Volume 22, Issue 6 (Feb - Mar 2019)                   J Qazvin Univ Med Sci 2019, 22(6): 164-177 | Back to browse issues page


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Sarraf N, Mohammadi M R, Ahmadi N, Khaleghi A, Gharibi S, Atapour H, et al . Epidemiology of Children and Adolescents Psychiatric Disorders in Qazvin Central Areas 2016-2017 (A National Project). J Qazvin Univ Med Sci. 2019; 22 (6) :164-177
URL: http://journal.qums.ac.ir/article-1-2730-en.html
1- Department of Psychiatry, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran. , dr.n.sarraf@gmail.com
2- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.
3- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran.
4- Department of Psychiatry, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.
5- Dr. Sarraf Child and Adolescent Psychiatric Clinic, Qazvin, Iran.
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Extended Abstract
1. Introduction

The diagnosis of mental health disorders in children and adolescents requires investigating their prevalence. Evidence suggests that approximately 15-32% of children and adolescents suffer from mental health disorders [2, 3]. The increased population of children and adolescents has enhanced the importance of planning for their treatment [8-5]. 
Alavi et al. conducted a study in the urban areas of Tehran Province, Iran, on 799 children aged 6-11 year. They applied the Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime version (K-SADS-PL). They concluded that 17.9% of children suffered from psychological disorders. The most prevalent condition was Attention-Deficit/Hyperactivity Disorder (ADHD) (8.6%); there were no significant differences between boys and girls [10]. 
Guilherme et al. demonstrated a meta-analysis on 41 studies conducted in 27 countries. They reported that the worldwide prevalence of mental health disorders was 13.4%. The prevalence of anxiety and depression were 6.5% and 2.6%, respectively [1]. Elberling et al. in a cohort study on 1585 children reported that the prevalence of mental health disorders was 5.7% [16]. Moreover, emotional disorders were the most prevalent ones (2.9%). The current study investigated the prevalence of mental health disorders and their comorbid disorders in children aged 6-18 years living in Qazvin Province, Iran.
2. Materials and Methods
This was a national project with a cross-sectional design implemented in 2017 on 1025 children and adolescents. The study participants aged 6-18 years and lived in the central areas of Qazvin, Iran. They were selected using cluster sampling method. For sampling, the first 170 clusters were randomly selected, including 30 central rural clusters and 140 urban clusters. The age groups were divided into the three groups of 6-9, 9-12 and 12-18 year olds. Each cluster included both genders from all three age groups. Only those who were the citizens of Qazvin Province (living there for at least one year) and aged 6-18 years were included in the study. Those who had severe physical illnesses were excluded from the study. The study participants and their parents were surveyed through a structured interview by trained clinical psychology experts, using the Persian version of K-SADS-PL. Informed consent forms were obtained after explaining the project to the study participants and their parents.
3. Results
The Mean±SD age of study participants was 11.8±3.83 years. The Odds Ratio (OR) for mental health disorders with a 95% CI was 0.72 for girls (P<0.01). The prevalence of mental health disorders was 28.19% (95% CI); this rate was 31.5% among the boys and 25% in the girls. The prevalence of mental health disorders significantly differed between the subjects in terms of gender (P<0.02). The overall prevalence of mental health disorders in the subjects with mothers having high school diploma was 34.7% (OR=0.88, 95% CI, P=0.83). Moreover, the overall prevalence of mental health disorders in those with fathers having a high school diploma was 34.7% (OR=1.43, 95% CI). The prevalence of mental health disorders was not significantly different between the subjects in terms of parents’ educational level. Regarding the occupation of parents, the overall prevalence of mental health disorders in the subjects whose mothers were self-employed was 52.8% (OR=2.89, 95% CI, P=0.006). 
Anxiety was the most prevalent mental health disorder in the samples (13.2%). Of this, specific phobia (4.7%) and separation anxiety (4.4%) were more prevalent. Among comorbid mental health disorders, psychosis disorder, conduct disorder, and alcohol abuse had the highest comorbidity rate and tic disorder had the lowest rate of comorbidity with mental health disorders. In terms of the comorbid mental health disorders in the subjects, behavioral disorders had the highest comorbidity with anxiety disorders. The comorbidity rates of mood disorders, neurodevelopmental disorders, substance use disorders, and psychosis disorders with anxiety disorders were 9.6%, 4.4%, 13.2% and 1.5%, respectively (Table 1).

4. Conclusion
This study suggested that mental health disorders significantly vary in terms of gender. A significant difference in the prevalence of mental health disorders was observed between the studied boys and girls. This data is consistent with the results of other studies [23]. According to the present study, the overall prevalence of mental health disorders in children aged 6-18 years was 28.2%. This is in agreement with the results of a prospective cohort study conducted in Brazil using the K-SADS-PL questionnaire. The prevalence rate of mental health disorders was reported equal to 10-20% [21]. Some studies reported a relationship between the mother’s job and the prevalence of mental health disorders in adolescents [34]. 
In our study, the occupation of mother (self-employed mothers) indicated a significant difference in relation to mental health disorders in children and adolescents. Factors such as parents’ occupation and education have long been considered as probable factors affecting mental health disorders in children and adolescents. In addition, low maternal education has been reported as an important risk factor [32, 33]. In our study, no significant difference was reported in the prevalence of mental health disorders in the samples with respect to parental education. This study strongly highlights the prevalence of anxiety and behavioral disorders in children and adolescents. 
We also demonstrated the increased prevalence of anxiety disorders comorbid with behavioral disorders, which is consistent with the findings of Dilsaver et al. [27]. Moreover, the present study indicated the association of behavioral disorders with anxiety and substance use disorders. Psychosis disorder, conduct disorder, and alcohol abuse had the highest comorbidity rates with mental health disorders; however, tic was often recognized as an individual disorder in the present research. Among anxiety disorders, generalized anxiety, agoraphobia, and separation anxiety had two or more comorbid disorders, which is in agreement with previous studies [2]. Consistent with other studies, conduct disorder, alcohol abuse, and anxiety disorders had the highest rate of comorbidity with hyperactivity disorder [28, 29].
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of  National Institute for Medical Research Development (code: IR.NIMAD.REC.1395.001).

Funding
This study has been financially supported by the Psychiatry and Psychology Research Center in Tehran University of Medical Sciences and National Institute for Medical Research Development (Grant No.: 940906).
Authors contributions
Supervision, management, writing, research, eEditing: Nasrin Sarraf; Monitoring, project management, financing: Mohammad Reza Mohammadi, Nastaran Ahmadi, Ali Khaleghi; Analysis, research, statistical survey: Soudabe Gharibi, Navid Pouri Tahvildari; and Questioning: Hafez Atapour, Hamideh Lashgari.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The authors would like to thank the interviewers, Psychiatry and Psychology Research Center of Tehran University of Medical Sciences, Roozbeh Hospital staff, National Institute for Medical Research Development, the Research Deputy of Qazvin University of Medical Sciences, and all counsellors in Mental Health Department for their valuable support and cooperation.
Type of Study: Research | Subject: Psychiatry

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