|Year : 2013 | Volume
| Issue : 1 | Page : 86-88
Psychiatric morbidity at secondary level health facility in Ballabgarh, Haryana
Harshal Salve, Pradip Kharya, Puneet Misra, Sanjay K Rai, Shashi Kant
Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
|Date of Web Publication||24-Dec-2013|
Centre for Community Medicine, Old OT Block, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: There is dearth of information about psychiatric morbidity at secondary level health facility in India. Aim: To study psychiatric morbidity amongst patients attending psychiatry clinic in secondary level health facility. Settings and Design: Present study is based on hospital record review of psychiatry clinic at secondary care hospital in Ballabgarh, Haryana. Materials and Methods: Service record of psychiatry clinic at civil hospital Ballabgarh was reviewed. Diagnosis of psychiatric morbidity was done according to DSM IV and ICD 10 classification. Statistical Analysis: Descriptive analysis of data was carried out. Results: A total of 724 (0.7%) new OPD patients consulted psychiatry clinic. Common Mental Disorders comprising of mood disorders, neurotic stress -related and somatoform disorders were the most commonly diagnosed disorders (60.5%) amongst reported psychiatric morbidity in the hospital. Conclusion: Substantial burden of psychiatry morbidity highlights necessity of psychiatry clinic at secondary care hospital in India.
Keywords: India, psychiatry morbidity, secondary level health facility
|How to cite this article:|
Salve H, Kharya P, Misra P, Rai SK, Kant S. Psychiatric morbidity at secondary level health facility in Ballabgarh, Haryana. Ind Psychiatry J 2013;22:86-8
Mental health is an important component of health without which holistic health could not be achieved.  A review of epidemiological studies on psychiatric disorders documented that nearly 10% of the total population suffer from mental and neurological problems requiring professional help at any point of time. 
Several studies from India have reported that psychiatric disorders contribute to substantial amount of morbidity at primary care facility and thus there is a need to treat these disorders at primary care level. ,, Assessment of extent and pattern of such disorders is important because of its potential of identifying individual with disorder and providing needed care at this level. Most often the psychiatric disorders at primary care level remain undiagnosed because patients present with physical disorders or somatic complaints. , There is a dearth of studies at secondary level facility about psychiatry morbidity in India. Present study deals with the profiling of the patients attending psychiatry clinic at secondary level hospital in Ballabgarh block of Haryana.
| Materials and Methods|| |
Presents study was carried out in psychiatry clinic at civil hospital, Comprehensive Rural Health Services Project, Ballabgarh of All India Institute of Medical Sciences, New Delhi. The study facility was 60 bedded secondary level health care facility located in a peri-urban area around 34 kilometers from national capital, Delhi. The facility catered to the middle and low income population and also served as first referral hospital for nearby Primary Health Centres. Daily attendance in the general adult OPD was 200-250 patients. Psychiatry clinic was one among other speciality clinics running at the study facility. During study period psychiatry clinic was operating once a week in the hospital. In this clinic, diagnosis and counselling for psychiatric disorders was done by the psychiatrist. In the present study, service delivery hospital records were used for demographic profiling of patients attending psychiatry clinic during one and half year (January 2011 to August 2012).
Diagnosis of psychiatric disorders was made by using both International Classification of Disease 10 th version (ICD 10)  and Diagnostic and Statistical Manual of Mental Disorders IV version (DSM IV) criteria.  Demographic data on age and sex of the patients were analysed. Data was entered into Microsoft excel and analysis was done in Statistical Package for Social Sciences (SPSS) version 13 for windows. Results were expressed as absolute numbers, proportions, and means with standard deviations.
| Results|| |
During study period, 100,029 new adult patients attended the general OPD at the study facility. A total of 724 (0.7%) new patients attended psychiatry clinic during the study period. Most (52.2%) of the patients were females. Mean age of the patient was 35.5 years (SD: 14.4). Out of total patients, most (43.5%) of the patients belonged to 25-44 years of age group [Table 1].
|Table 1: Distribution of patients attending psychiatry clinic at secondary level hospital by age and sex|
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According to ICD 10 classification, most common diagnosed psychiatric disorders were Neurotic, stress-related and somatoform disorders (34.3%) followed by mood disorders (26.2%). Other commonly diagnosed psychiatric disorders were schizophrenia, schizotypal and delusional disorders (12%). Common Mental Disorders (CMD) were the most common diagnosed psychiatric morbidities (60.5%) amongst patients attending psychiatric OPD. CMD included mood disorders, neurotic stress -related and somatoform disorders. Most of the patients with CMD belonged to 25-60 years age (41.9%) and were females (55.1%).
According to DSM IV classification, most of the patients (23%) were diagnosed with depression. Almost equal proportion of patients was diagnosed with psychotic disorders (14%) and anxiety disorders (14%). Other psychiatric disorders are shown in [Figure 1]. Patients with non psychiatric illness like migraine (3%) and headache syndromes (7%) also consulted the psychiatrist.
|Figure 1: Pattern of Psychiatric disorders by DSM (IV) classification of patient attending psychiatry clinic at secondary level health facility *Other psychiatric disorders include adjustment disorders, alcohol abuse disorders, hypomania disorders, sexual disorders, dissociative disorders|
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| Discussion|| |
Present study reported burden and pattern of psychiatric morbidity in psychiatry clinic at secondary level health facility in north India. Study revealed that significant proportion of adult OPD attendees reported at once a week psychiatry clinic. CMD was the most common disorders amongst reported psychiatric morbidity in the present study. This was comparable with profile of psychiatric disorders at primary care level as reported in various studies in India. ,, Barua et al. in their study reported similar pattern of psychiatric disorders by using Patient Health Questionnaire at secondary level hospital in Karnataka. 
National mental Health Programme envisages integration of mental health with primary care by making available mental health care services at district level.  Indian Public Health Standards (IPHS) for sub-district hospitals doesn't envisage desirability of psychiatrist in 30-51 bedded hospital.  Present study highlights the need of one day psychiatry clinic at sub-district hospitals. This will ensure decentralize mental health care below district level in the country. With given paucity of psychiatrist in the country  general physician at Community Health Centre and sub-district hospital level may be trained in screening and management of common psychiatric disorders.
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