Screening of pcychiatric disorders in hearing-impaired children and adolescents 4-16 years old attending special education institution in Karachi : a cross sectional study
Date of Award
Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)
Community Health Sciences
Introduction: Hearing-impaired children constitute a mute population; therefore, they are vulnerable to variety of medical and social problems. Literature suggests association of hearingimpairment and consanguinity. In addition, it indicates that there is a correlation between hearing impairment and psychiatric problems among children and adolescents, but there is no established prevalence of psychiatric problems among hearing impaired children in Pakistan. Therefore, the main objective of this study was to estimate the prevalence of psychiatric problems and to identify associated factors among hearing-impaired children and adolescents (aged 4-16 years) attending special education institutions in Karachi (Pakistan). We hypothesized that prevalence of psychiatric problems among hearing impaired children would be greater than 34%, where the later represents an estimate of psychiatric problems among children attending main-stream schools in Karachi. Methodology: A cross-sectional study using stratified random sampling was conducted in Karachi from September 2010 to July 2011 on 272 hearing-impaired children aged 4-16 years, attending two special education institutions (Ida Rieu and Dewa Academy). Multi informant rating (responding parent and teacher) was used to assess prevalence on SDQ total difficulties score and its five subscales, and kappa statistic was applied to assess agreement between parents/teachers ratings. Moreover, parents' rating was used to build multivariable model for assessing factors independently associated with psychiatric problems of the children. Furthermore, factor analysis and internal consistencies of SDQ (parent-rated) were computed as SDQ has not been validated for hearing-impaired children in Pakistan. Results: This study estimated an overall parent-rated prevalence of psychiatric problems among hearing-impaired children as 18% and teacher-rated prevalence as 32.7%; poor inter-rater agreement was found between the two raters. Final model indicated protective effect of increase in child's age (in months) at the time of diagnosis [OR (adj) =0.49; 95% CI (0.25,0.96)], depression among responding parents was highly associated with psychiatric problems of the children [OR (adj) = 2.61; 95% CI (1.34, 5.11)]. Children with good performance [OR (adj) =3.09; 95% CI (1.04, 9.25)] and with fair/poor performance [OR=3.43; 95% CI (1.17, 10.04)] were more likely to have psychiatric problems as compared to children with outstanding/excellent performance. Moreover, children belonging to mothers without any formal education [OR(adj) =0.27; 95% CI (0.10, 0.76)] or mothers with 'primary to matric' education [OR(adj) =0.33; 95% CI (0.13, 0.82)] were less likely to have psychiatric problems as compared to children whose mothers had above matric qualification. On the contrary, children whose fathers did not have formal education [OR (adj) =4.05; 95% CI (1.36, 12.07)] and the children whose fathers had formal education 'primary-matric' [OR (adj) =2.63; 95% CI (1.06, 6.52)] were more likely to have psychiatric problems as compared to the children whose fathers had above matric qualification. On factor analysis we were able to reproduce three factors of SDQ excluding the hyperactivity and peer problems scale; internal consistency was also lower for these two subscales. Cronbach's alpha (0.71) on overall SDQ indicated an acceptable internal consistency. Conclusion: In our study, parent rated prevalence for overall psychiatric problems was 18% that did not support our hypothesis. Therefore, we recommend that researches should be conducted on prevalence of psychiatric problems among hearing-impaired children for further clarification of the estimate. Awareness programs should be held for parents and teachers for better dealing with hearing-impaired children, and children with poor performance in class should be screened regularly for psychiatric problems. Moreover parents should be screened regularly for depression and referred for treatment if found positive. In addition SDQ needs validation in population of hearing-impaired children.
Nazar, A. (2011). Screening of pcychiatric disorders in hearing-impaired children and adolescents 4-16 years old attending special education institution in Karachi : a cross sectional study (Unpublished doctoral thesis). Aga Khan University, Karachi, Pakistan.