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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 3  |  Issue : 1  |  Page : 19-22

A study of psychiatric morbidity and substance use pattern among the adolescents attending department of psychiatry of a tertiary hospital in Northeastern India


Department of Psychiatry, Regional Institute of Medical Sciences, Imphal, Manipur, India

Date of Web Publication24-May-2019

Correspondence Address:
Dr. Udayan Majumder
N.K. Datta Lane, Near Ramesh Boarding, R.K. Pur, Udaipur, Gomati - 799 120, Tripura
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aip.aip_36_18

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  Abstract 


Context: This hospital-based study attempts to explore the morbidity load of categorized mental disorders along with the pattern of substance use in the adolescent group of people presenting to a tertiary hospital of Manipur, India. Aims: This study aims to document sociodemographic profiles, psychiatric morbidity, and substance use pattern among the adolescents attending the Department of Psychiatry of a tertiary hospital of Manipur, India. Settings and Design: This study was a cross-sectional, hospital-based study. Subjects and Methods: This cross-sectional study included 474 consecutive adolescent patients (10–19 years) attending both outpatient department and inpatient department of the Department of Psychiatry of a Tertiary Hospital of Manipur, India, were enrolled during the study. Diagnoses were made according to the ICD-10. Statistical Analysis: The statistical software, namely SPSS 22.0 and R environment ver. 3.2.2 were used for the analysis of the data. Results: Almost 68.4% were within 16–19 years, 51.3% lived with their families, 56.1% were male, 62% of them were Hindus, and majority of them were from urban background (54.4%). Neurotic, stress-related, and somatoform disorders were the highest (41.4%), followed by psychotropic substance use in 21.3%, mood disorders in 14.8%, schizophrenia and delusional disorder in 12.2%, behavioral and emotional disorder in 9.3%, and disorders of adult personality and behavior (F60-69) in 0.4%. The most common categorical psychiatric diagnosis in males due to psychotropic substance use (37.2%) while neurotic, stress-related, and somatoform disorders (61.1%) were the most common categorical diagnosis in females. Conclusions: Very few studies have been conducted to reflect the scenario and pattern of psychiatric morbidities in the state of Manipur. We hope this study will be helpful in reflecting the psychiatric morbidity load in the adolescent group for helping them with early diagnosis and intervention.

Keywords: Adolescents, ICD-10, psychiatric morbidity, substance abuse, tertiary hospital


How to cite this article:
Majumder U, Gojendra S, Heramani N, Singh RL. A study of psychiatric morbidity and substance use pattern among the adolescents attending department of psychiatry of a tertiary hospital in Northeastern India. Ann Indian Psychiatry 2019;3:19-22

How to cite this URL:
Majumder U, Gojendra S, Heramani N, Singh RL. A study of psychiatric morbidity and substance use pattern among the adolescents attending department of psychiatry of a tertiary hospital in Northeastern India. Ann Indian Psychiatry [serial online] 2019 [cited 2019 Nov 17];3:19-22. Available from: http://www.anip.co.in/text.asp?2019/3/1/19/259087




  Introduction Top


Adolescence, marked by the physiological signs and surging sexual hormones of puberty, has three expected developmental stages such as increased risk-taking, increased sexual behavior, and a move toward peer affiliation rather than primary family attachments. Psychological maladjustment, self-loathing, disturbance of conduct, substance abuse, affective disorders, and other impairing psychiatric disorders emerge in approximately 20% of adolescent population.[1]

The WHO defines adolescents as young people aged 10–19 years and estimates of 1.2 billion adolescents, a fifth of world population with four out of five living in the developing countries. According to 2011 census, 20.9% of the Indian population is in adolescent age group, approximately 253 million (one-fourth of Indian population). The National Mental Health Survey of India, 2015–2016, pointed out that the prevalence of mental disorders in the age group of 13–17 years was 7.3% and nearly equal in both genders. Nearly 9.8 million adolescents are in need of active interventions.[2],[3]

There are several challenges in meeting the mental health needs of adolescents. One major challenge is that adolescent mental health needs often go undetected. There is a natural reluctance to diagnose mental disorder in adolescents from fears of adverse effects of being labeled and stigmatizing young people by identifying them as psychiatric patients. In addition to that, substance abuse among adolescents is also a major concern, especially in the northeastern state of Manipur, leading to comorbid psychiatric illnesses in majority of them. The present study attempts to explore the morbidity load of categorized mental disorders in the adolescents of this region and aims to document sociodemographic profiles, psychiatric morbidity, and substance use pattern among the adolescents attending the Department of Psychiatry of a tertiary hospital of Manipur, India.


  Subjects and Methods Top


This study has been conducted at the Department of Psychiatry of a tertiary hospital of Manipur, India, from September 2015 to August 2017, after being approved by the Research Ethics Board of the Institute. After considering exclusion criteria, a total number of 474 adolescent patients in the age group of 10–19 years who attended the psychiatric outpatient department (OPD) and/or admitted to the psychiatric ward were taken for the study. Valid written consent was taken from patients themselves (aged above 18 years and above) and from parents/legal guardians of them (aged 10–17 years). Prestructured and pretested pro forma comprising sociodemographic questionnaire and psychiatric case history was used for the study. Youth self-report version of Pediatric Symptom Checklist (PSC-Y) and Brief Psychiatric Rating Scale for children were used for initial psychological assessment.[4] ICD-10 was used for categorizing the final diagnosis.

Descriptive and inferential statistical analysis has been carried out in the present study. Results on continuous measurements are presented on mean ± standard deviation (Min-Max) and categorical measurements in number (%). Chi-square test has been used to find the significance of study parameters on categorical scale between two or more groups, wherever suitable. P < 0.05 is considered statistically significant. IBM SPSS Statistics for Windows, Version 22.0. (IBM Corp., Armonk, NY, USA) and R environment version 3.2.2 were used for the analysis of the data, and Microsoft Word and Excel have been used to generate graphs and tables.


  Results Top


Data of 474 adolescents was analyzed. About 68.4% were within 16–19 years and 31.6% were within 10–15 years of age group with mean age being 16.27 years. Nearly 56.1% were males, while 43.9% were females, respectively. About 62% of them were Hindus, 21.9% were Muslims, and 16% were Christians.

39.7%of the adolescents were from Imphal West, 22.4% from Thoubal, 14.1% from Imphal East, 8.2% from Bishnupur, 5.1% from Senapati, and least 1.7% from Tamenglong district. Majority were from urban background (54.4%), followed by semi-urban (34.2%) and 11.4% from rural areas.

51.3% lived with their families, 34% resided in hostels, and 14.8% lived with their relatives and others. Nearly 17.1% were from nuclear families while 82.9% belonged to joint families.

Majority sought self referral or were brought by family (58.4%), 9.9% were referred from Medicine OPD, 9.7% by general practitioners, 6.3% from emergency services, 5.9% from Pediatric OPD, and 0.5% from Neurology OPD [Table 1].
Table 1: Sources of referral (in % of total)

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As per ICD-10 classification, neurotic, stress-related, and somatoform disorders (F40-48) were the highest (41.4), followed by psychotropic substance use (F10-19) in 21.3%, mood disorders (F30-39) in 14.8%, schizophrenia and delusional disorder (F20-29) in 12.2%, behavioral and emotional disorder of childhood and adolescents (F90-98) in 9.3%, disturbances due to psychological and physical factors (F50-59) in 0.6%, and disorders of adult personality and behavior (F60-69) in 0.4%.

The most common categorical psychiatric diagnosis in males was psychotropic substance use (37.2%), while neurotic, stress-related and somatoform disorders (61.1%) were the most common categorical diagnoses in females [Table 2].
Table 2: Distribution of various psychiatric diagnosis according to ICD-10

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Among the 21.3% of the adolescents with substance use, opioid dependence (14.1%) was the highest followed by cannabis-induced psychosis (3.6%), alcohol dependence (1.7%), inhalant abuse (1.1%), amphetamine abuse (0.6%), and benzodiazepine dependence in 0.2% [Table 3].
Table 3: Substance use pattern among adolescents

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Neurotic, stress-related, and somatoform disorders (F40-48) were found to be more prevalent among adolescents from all the location settings, and highest (83.3%)among those in higher secondary school. Substance abuse was more common among secondary school students (27.9%). Schizophrenia and other delusional disorders, as well as behavioral and emotional disorders, were found mostly in the primary education group, frequencies being 16.4% and 14.7%, respectively (P = 0.009**). In regards to distribution according to location, mood disorders were more prevalent in those who resided in the urban areas (16.7%), while schizophrenia and delusional disorders were more prevalent in the rural areas (16.7%) (P = 0.045*).


  Discussion Top


Male preponderance in our study was consistent with findings of Anita et al.[5] in her study. Choudhary et al.[6] also found more male patients attending psychiatric clinics. This is unexpected as most studies worldwide showed female predominance in psychiatric clinics (higher female vulnerability due to biological factors, stress, and social pressure). Male:female ratio (1.3:1) was similar to that found by Sidhu[2] of 1.6:1. Malhotra and Chaturvedi[7] reported 3:2 ratio between males and females which reflects more attention and care given to male children as also concern for the well-being of a male child.

Better information and better access led to majority (54.4%) of the study population belonging to the urban background which is consistent with studies of Sidhu[2] and National Mental Health Survey (13.5% urban and 6.9% rural).

Majority of the study population were in secondary schooling (55.9%) followed by primary level schooling, which is consistent with Vaibhav et al.[8] in his study (54.2%). Almost 90.3% of the adolescents were unmarried in our study, which also goes consistently with study of Sidhu[2] (91.2% unmarried).

Shakya[9] in his study reported that the highest referrals made were from family medicine and emergency services, while patients reported by self and family were relatively higher (58.4%) in our study. It is probably due to more awareness about mental illness in the state, better family support due to joint family type, etc.

The most common diagnosis was found to be dissociative conversion disorder (16.5%), followed by other major psychiatric diagnoses such as opioid dependence syndrome (14.1%), generalized anxiety disorder (GAD) (8.4%), depression (8%), bipolar affective disorder (6.1%), schizophrenia (5.1%), attention deficit hyperactivity disorder (ADHD) (4%), cannabis-induced psychosis (3.6%), and conduct disorder (3.2%). Other diagnoses such as somatization disorder in 3%, adjustment disorder (1.9%), agoraphobia in (0.6%), and 0.2% in nocturnal enuresis, oppositional defiant disorder (ODD), phobic anxiety disorder, social phobia, and somnambulism, respectively.

The most common diagnosis in males was opioid dependence syndrome in 24.8%, followed by schizophrenia in 7.5% and 6.4% in both GAD and cannabis-induced psychosis. In females, the most common diagnosis was dissociative conversion disorder in 32.7%, followed by depression in 12.5% and GAD in 11.1%, respectively.

Khairkar et al.[10] reported that the most common psychiatric disorders were depressive disorders (3.73%), followed by nonorganic enuresis (2.18%) and ADHD (1.7%). In our study, the frequency of depressive disorders, nonorganic enuresis, and ADHD was 8%, 0.2%, and 4%, respectively. Dodangi et al.[11] in his study reported prevalence as follows: ADHD (11.9%), major depressive disorder MDD (4.6%), GAD (11.3%), ODD (2.4%), adjustment disorder (0.3%), obsessive-compulsive disorder (2.4%), separation anxiety disorder (1.6%), and social phobia (6.2%). Similarly in our study, frequency of the above psychiatric morbidities was found to be 4%, 8%, 8.4%, 3.2%, 0.8%, and 0.2%, respectively.

Sidhu[2] in his study found 6% of the adolescents having substance use disorders with more predominance in males (5.2%) as compared to females (0.8%). Vaibhav et al.[8] reported 5.2% of the study population abusing at least one type of substances. Shakya[9] reported 4% of the adolescents abused psychoactive substances. In our study, compared to the previous three studies referred to, the prevalence was found relatively higher (21.3%), opioid dependence remaining the highest (14.1%). Such a high percentage is due to continuous drug infiltration in Manipur from Myanmar and Thailand which is leading to drug hub prevailing here. Easy accessibility, lack of proper law, and order situation, insurgency problems disturbing the state, may synergistically lead to this high proportion of substance use disorders among the adolescents here.

Limitations

  1. Limited sample size, so generalizing the result to a state level will have limitations
  2. Selection was OPD based mainly, so selection bias could be an issue leading to difficulty in generalizing majority of the findings
  3. A patient was evaluated only cross sectionally, so any change in behavior or the morbidity could not be followed up, keeping in mind the dynamic pattern of psychiatric diagnosis.



  Conclusions Top


In this state of Manipur, more than 19% of the population is in the adolescent age group comprising a population of little more than 4.9 lakhs. A significant proportion, apart from the medical concerns, suffers a lot from psychosocial problems and psychiatric illnesses in one way or other leading to a major hindrance in their smooth academic and social upbringing. Very few studies have been conducted to reflect the scenario and pattern of psychiatric morbidities in the state of Manipur. The present study aims to provide comprehensive data on the pattern of psychiatric morbidities in adolescents presenting in the department of psychiatry of this tertiary hospital of Manipur, India. Despite its limitations, we hope this study will be helpful in reflecting the psychiatric morbidity load in the adolescent group for helping them with early diagnosis and intervention.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sadock BJ, Sadock VA, Ruiz P, editors. Kaplan and Sadock's Synopsis of Psychiatry Behavioural Sciences/Clinical Psychiatry. 11th ed. New Delhi: Wolters Kluwer; 2015.  Back to cited text no. 1
    
2.
Sidhu TK. Evaluation of psychiatric morbidity in adolescents in Patiala District, Punjab. Indian J Community Health 2012;24:63-6.  Back to cited text no. 2
    
3.
Murthy RS. National mental health survey of India 2015-2016. Indian J Psychiatry 2017;59:21-6.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Verhulst FC, Ende JV, editors. Assessment Scales in Child and Adolescent Psychiatry. 2nd ed. United Kingdom: Taylor & Francis; 2006.  Back to cited text no. 4
    
5.
Anita S, Gaur DR, Vohra AK, Subhas S, Hitesh K. Prevalence of psychiatric morbidity among 6 to 14 years old children. Indian J Community Health 2003;28:133-7.  Back to cited text no. 5
    
6.
Choudhary S, Mishra CP, Shukla KP. A study on psychosocial behaviour of adolescent girls in rural area of Varanasi. Indian J Prev Soc Med 2010;41:88-96.  Back to cited text no. 6
    
7.
Malhotra S, Chaturvedi SK. Patterns of childhood psychiatric disorders in India. Indian J Pediatr 1984;51:235-40.  Back to cited text no. 7
    
8.
Vaibhav J, Mayank S, Muzammil K, Jaivir S. Prevalence of psychosocial problems among adolescents in rural areas of District Muzaffarnagar, Uttar Pradesh. Indian J Community Health 2014;26:243-8.  Back to cited text no. 8
    
9.
Shakya DR. Psychiatric morbidity profiles of child and adolescent psychiatry out-patients in a tertiary-care hospital. J Nepal Paediatr Soc 2010;30:79-84.  Back to cited text no. 9
    
10.
Khairkar P, Pathak C, Lakhkar B, Sarode R, Vagha J, Jagzape T, et al. A5-year hospital prevalence of child and adolescent psychiatric disorders from central India. Indian J Pediatr 2013;80:826-31.  Back to cited text no. 10
    
11.
Dodangi N, Habibi Ashtiani N, Valadbeigi B. Prevalence of DSM-IV TR psychiatric disorders in children and adolescents of Paveh, a Western city of Iran. Iran Red Crescent Med J 2014;16:e16743.  Back to cited text no. 11
    



 
 
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  [Table 1], [Table 2], [Table 3]



 

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