Research

Psychopathology and functional impairment among patients attending an adolescent health clinic: Implications for healthcare model reform

Sushila Russell¹ , Balakrishnan Subramanian² and Paul Swamidhas Sudhakar Russell¹

¹  Child and Adolescent Psychiatry Unit, Department of Psychiatry, Christian Medical College, Vellore 632 002, India

²  Department of Clinical Psychology, Sri Ramachandra Medical College and Research Institute, Chennai 600 116, India

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Osteopathic Medicine and Primary Care 2008, 2:3doi:10.1186/1750-4732-2-3

Published:	8 February 2008

Abstract

Background

In developing countries, primary health care facilities, such as adolescent health clinics, are frequently the first contact for an adolescent with a health professional for a myriad of health problems including mental health issues. Psychopathology is prevalent among adolescents, and causes significant educational, occupational and social impairment. The presence of psychopathology with impairment requires the development of treatment models to address both of these components. We studied the psychopathology and associated impairment in patients at an adolescent health clinic as an indicator for healthcare model reform.

Methods

Psychopathology and functional impairment were assessed in 100 patients at an adolescent health clinic in the city of Chennai, Southern India. The patients had initially visited the clinic for various medical disorders. Adolescents were diagnostically classified for psychopathology using the Child Behaviour Checklist (CBCL) and the International Classification of Disease: 10^th Edition (ICD-10). Functional impairment was assessed with the Child Global Assessment Scale (CGAS). Data were analysed using bivariate and multivariate methods.

Results

Eight percent had a diagnosable psychopathology, and they also satisfied at least one ICD-10 diagnosis. Adolescents screened had significant impairment as indicated by low CGAS scores, whether or not they presented with psychopathology. Adolescents with psychopathology were more functionally impaired both in the bivariate (Z = -3.1; P = 0.002) and multivariate analyses (β(SE) = 1.09(0.3), t = 3.9, 95% confidence interval = 0.5, 1.6; P = 0.001). Impairment in adolescents without psychopathology is primarily attributed to the medical disorders they presented with.

Conclusion

Patients attending adolescent health clinics should be screened for psychopathology and functional impairment. Documented psychopathology and impairment necessitates the use of a combined treatment model to address the short and long-term problems these adolescents face.