Pathways to Child Mental Health Services Among Patients in an Urban Clinical Setting in Egypt

Abstract

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. 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. 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%). 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.