Evaluation of Psychiatric Morbidity in The Community Through Application of Schedule For Clinical Assessment in Neuropsychiatry (Scan)
Evaluation of Psychiatric Morbidity in The Community Through Application of Schedule For Clinical Assessment in Neuropsychiatry (Scan)
Evaluation of Psychiatric Morbidity in The Community Through Application of Schedule For Clinical Assessment in Neuropsychiatry (Scan)
ABSTRACT
Background: Hospital based reports do not reflect prevalence of psychiatric morbidity in the community. Even the lack of knowl-
edge and stigma associated with mental disorders cause hindrance to avail hospital services. Community based survey in a well
defined sample is the right and appropriate approach for proper estimation of prevalence of such illnesses.
Aims: To estimate the prevalence of psychiatric illnesses in the community and to study the socio demographic co-relates of
the positive cases.
Methods: 10% of participants from the pool of three thousand (3,000) respondents recruited for World Mental Health (WMH)
Survey were selected, by using systemic random sampling method and psychopathology was tested by using the translated
Assamese version of Schedule for Clinical Assessment in Neuropsychiatry (SCAN).
Results: The prevalence of psychiatric morbidity in the community was found to be 13.18%, with Alcohol Use Disorder being
the most common psychiatric morbidity.
Conclusion: Alcohol Use Disorders are the commonest psychiatric morbidity (4.39%) in the study population followed by De-
pression (3.38%), Anxiety (1.69%) and Psychosis (1.69%). The figures reflect only the point prevalence of the diseases.
Key Words: Psychiatric morbidity, Clinical assessment, Composite international diagnostic interview
Corresponding Author:
Corresponding
Dr. DhrubajyotiAuthor:
Bhuyan, Assistant Professor Department of Psychiatry, Assam Medical College, Dibrugarh, Assam, India
Anil Pawar, Assistant Professor, Department of Zoology, D.A.V. College for Girls, Yamunanagar (Haryana); Mobile:919467604205;
Pin 786002; Mob: 9435030212; E-mail: dr.dhrubajyoti@gmail.com
Email: sumanil27@yahoo.co.in
Received: 15.05.2015 Revised: 09.06.2015 Accepted: 28.06.2015
Received: 16.6.2014 Revised: 11.7.2014 Accepted: 29.7.2014
AIMS AND OBJECTIVES and problems associated with basic bodily functions and
use of Alcohol and other Substance use, while Part II con-
The aims and objectives of the study are tains Psychotic and Cognitive disorders and observed ab-
normalities of speech, affect and behaviour. The instru-
1. To estimate the prevalence of mental disorders in
ment was translated into Assamese and adopted after
the community.
testing the inter-rater reliability which was found to be
2. To study the socio-demographic correlates of the
of higher order.
positive cases.
Place of Study:
METHODOLOGY The study was conducted in the rural and urban areas of
Dibrugarh District having a total population of 2,08,548
Sample Selection: households according to the 2001 census.
The samples for the study were drawn from a prede-
termined sample for another study – The World Men- Procedure:
tal Health (WMH) Survey, conducted by the WHO. The The Study was undertaken after receiving ethical clear-
WMH study was completed in the Department of Psy- ance of Institutional ethical committee of Assam Medical
chiatry, Assam Medical College and Hospital, Dibrugarh College and Hospital, Dibrugarh
in the month of October 2004. This study has the ad-
vantage of having a meticulously worked out sample of For the purpose of the study, a SCAN trainer who had
3000 households, which was made on the basis of sam- been trained in New Delhi trained five PG students from
ple proportion to size. From this pool of 3000 households the Department of Psychiatry, Assam Medical College
the sample for our study was drawn by using systematic and Hospital Dibrugarh.
random sampling method (every 10th sample). The in-
Informed consent was obtained from each respondent
vestigators were blind about the diagnostic status of the
before evaluation. Those respondents suffering from de-
sample, which has already been evaluated by the WMH
bilitating systemic illness were excluded from the study.
– CIDI in the study mentioned above.
The diagnosis was obtained by using the diagnostic algo-
Size of the Sample: rithm of SCAN.
We have selected a sample of Three hundred respond-
ents by using the method mentioned above.
RESULTS
Inclusion Criteria: Though our original sample size was 300, 4 respondents
1. Age: 18 years and above were excluded from the study due to their debilitating
2. Sex: Both sexes. physical illnesses as per the criteria. Therefore effective
Exclusion Criteria: sample size reduced to (300 – 4) = 296.
1. Age: Below 18 years. 181 male & 115 female respondents participated in the
2. Respondents with chronic debilitating illness. study and their age wise distribution is shown in table 1:
Instruments Used: Table 1: Distribution of samples according to age
Schedule for Clinical Assessment in Neuropsychiatry and sex.
(SCAN): It is an instrument for assessing, measuring and
Age group Male Female
classifying major psychiatric illnesses, It was developed
in the framework of the World Health Organization and < 20 1 4
the National Institute of Health joint project on Diagnosis
and Classification of Mental Disorders, Alcohol and Drug 20 - <30 37 28
related problems. It consists of four parts: 30 - <40 45 36
1. The Tenth Edition of Present State Examination 40 - <50 36 26
(PSE10)
2. The Glossary of Differential Definitions. 50 - <60 34 11
3. The Item Group Checklist (IGC)
60 and above 28 10
4. Clinical History Schedule (CHS)
PSE 10 itself has two parts, Part I covers Somatoform, Total 181 115
Dissociative, Anxiety, Depressive and bipolar disorders
The study was conducted in both urban & rural areas of Table 5: Prevalence of Psychiatric illness in the com-
Dibrugarh District. As many as 255 ( 86.15%) respond- munity.
ents hailed from rural areas and only 41 (13.85%) were No of
from urban area. This is depicted in table 2: Total posi-
Variable %
Sample tive
Table 2: Distribution of study group according to cases
locality.
Overall 296 39 13.18
Locality Male Female Total
Male 181 24 13.26
Gender
Urban 25 16 41 Female 115 15 13.04
Schizophrenia 03 00 03
04 00 05
Distributions of positive cases are shown according to various sociodemographic variables in table 8 to table 11:
RURAL 08 03 03 11 05 02 01
Married 06 03 03 10 04 02 Nil
Data analysis:
I. Analysis based on age wise distribution
According to the statistical analysis based on age wise distribution of the positive cases the following results
were obtained –
According to the statistical analysis co- relation between common in early adult ages. However, statistical analysis
age and depression was found to be 0.230, which indi- shows no linear co-relation between Age and Obsession.
cates that as the age increases the occurrence of Depres-
sion also increases and it its percentage of increment is Positive co-relation was found between Years of Formal
23%. Such type of positive co-relations were also found Education and Anxiety, the co-relation coefficient being
with Mixed Anxiety Depression, Alcohol Use Disorder, 0.700. A negative co-relation of –0.705 was found be-
Psychosis and Dementia: tween Years of Formal Education and Dementia. Obses-
sion, Psychosis, Mixed Anxiety Depression and Alcohol
o Co-relation between Age and Mixed Anxiety De- Use Disorder also show a positive co-relation with lit-
pression = 0.064 eracy.
o Co-relation between Age and Alcohol Use Disor-
der = 0.633 o Co-relation between Years of Formal Education
o Co-relation between Age and Psychosis and Obsession = 0.363
= 0.193 o Co-relation between Years of Formal Education
o Co-relation between Age and Dementia and Mixed Anxiety Depression = 0.293
= 0.655 o Co-relation between Years of Formal Education
This indicates these disorders are related to age and they and
increase as the age progresses. Alcohol Use Disorder = 0.277
o Co-relation between Years of Formal Education
However, a negative co-relation (-0.442) was found and Psychosis = 0.195
between Age and Anxiety indicating that as the Age in- However, no co-relation was shown to occur between
creases prevalence of Anxiety decreases and its percent- Years of Formal Education and Depression.
age of decrease is 44.2%, in other words Anxiety is more
DISCUSSION ACKNOWLEDGEMENT
Our study shows point prevalence of 13.18% psychiat- Authors acknowledge the immense help received from
ric illnesses including Alcohol Use Disorders, which is in the scholars whose articles are cited and included in ref-
keeping with the study- NIMH – Epidemiological Catch- erences of this manuscript. The authors are also grateful
ment Area (ECA) Programme (1984) conducted in USA, to authors / editors / publishers of all those articles, jour-
which showed 1-month prevalence of psychiatric illness- nals and books from where the literature for this article
es being 15.14%4. has been reviewed and discussed.
Conclusion
Epidemiological studies involving this type of sophisti-
cated instrument are quite a few in the world and ours
is one of its kinds in this part of the country. Although
the sample size was small the case detection with the
help of SCAN was very meticulous and the results were
in accordance with the standard literature. The trans-
lated Assamese version of SCAN was found to be very
useful and no technical problems during its application
was met with. This study is expected to be a guide in the
field of Community Based Study and inspire the future
generation for a more comprehensive study in the field
of Mental Health Disorders.