Pathways to child mental health services among patients in an urban clinical setting in Egypt.
OBJECTIVE
Of the 82.6 million people living in Egypt, 31% are children under age 15. Until recently, identification and treatment of child mental health problems have not been a high priority in Middle East countries. This study examined referral patterns of children who visited a government- operated, urban, outpatient mental health clinic in Cairo and the duration of illness before psychiatric consultation was obtained.


METHODS
A total of 123 patients were recruited from a child psychiatry outpatient clinic at the Institute of Psychiatry of Ain Shams University hospitals. Diagnoses were made with the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version, the Gilliam Autism Rating Scale, and the Stanford-Binet Intelligence Scale.


RESULTS
For 63% of children, the most distressing symptom reported was behavioral problems. The mean ± SD duration of illness before psychiatric consultation was 3.4 ± 3.1 years. Autism, mental retardation, and nocturnal enuresis were significantly associated with delays in obtaining psychiatric consultation, as was belonging to the middle or low social class. For most patients (67%), the first contact was with either a pediatrician or a psychiatrist. For a smaller proportion (5%), the first contact was a traditional healer. Most patients were referred to the clinic by relatives (30%), followed by pediatricians (21%), school teachers (12%), and traditional healers (5%).


CONCLUSIONS
Most parents first sought the advice of pediatricians for their child's mental health problem, and a substantial number consulted traditional healers. Awareness programs targeting pediatricians and elementary school teachers are urgently needed in Egypt to shorten the duration of undiagnosed illness among children.
Department of Neuropsychiatry, Faculty of Medicine, Ain Shams University, PO Box 11657 Dair Al-Malak, Abbassia, Cairo, Egypt. hosman70@gmail.com
Hanan
H
Hussein
Nermin
N
Shaker
Mona
M
El-Sheikh
Hisham A
HA
Ramy
D002648:Child; D002662:Child Health Services / Q000600:supply & distribution*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004534:Egypt; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000628:therapy; D008605:Mental Health Services / Q000600:supply & distribution*; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D013997:Time Factors; D019037:Urban Health Services / Q000600:supply & distribution*