Psychiatric morbidity among children and adolescents aged less than 17 years with sickle cell disease at Moi Teaching and Referral Hospital, Eldoret-Kenya

Abstract

Background: There is growing interest in mental illnesses associated with chronic medical conditions. Several studies suggest higher rates of psychiatric disorders in medically ill than in non-medically ill. Sickle cell disease (SCD) is associated with significant psychological implications on both patients and their caregivers. This could be due to financial implications and frequent hospital visits that come with the disease. SCD is a group of inherited red blood cell disorders characterized by an abnormal protein in red blood cells. Little is known about the burden of mental illness among children and adolescents attending the SCD clinic at Moi Teaching and Referral Hospital (MTRH). Factors such as, family income, age and sex among others were explored for association with psychiatric morbidity in this group. Objective: To describe the psychiatric morbidity and the factors associated with psychiatric morbidities among children and adolescents with sickle cell disease attending MTRH Sickle cell clinic. Methods: This was cross-sectional study. The study was conducted at the MTRH Sickle Cell Clinic. 298 respondents were recruited into the study by random sampling from a sampling frame from the SCD clinic records. Data was collected over a year between August 2020 and August 2021. Investigator designed questionnaire was used to collect sociodemographic data while the Minikid (Mini-International Neuropsychiatric Interview for children and Adolescents) tool that has been used locally and validated against the WHO designed Composite international diagnostic interview was used to screen psychiatric illnesses. Pretesting was done in the pediatric oncology clinic. The dependent variable was a psychiatric diagnosis such as schizophrenia. The independent variables were the age, sex, net monthly income of caretakers, the living status (who the participant lives with), number of hospital admissions and whether patients have encountered a mental health expert. Descriptive bivariate analysis was used to establish the association between psychiatric morbidity and potential factors. Results: Of the participants, 129(43.3%) had one or more psychiatric diagnosis. The screened diagnoses were major depression (22%), panic disorders (18%), separation anxiety (16%), manic hypomanic episodes (15%), PTSD (10%), OCD (8%) and agoraphobia (6%). Bivariate analysis showed a statistically significant association between depression and the number of hospital admissions (P=0.015). Panic disorders significantly associated with sex (P=0.015), who the respondents lived with (P=0.005) and the number of hospital admissions (P=0.033). Conclusion: There is a high burden of mental illness in children and adolescents with SCD in MTRH SCD clinic especially depression and anxiety disorders. Association exists between number of previous hospital admissions, who the child lives with and gender with psychiatric morbidity. Recommendation: Screening of SCD patients for psychiatric conditions. Minimize hospital admissions through improved outpatient care of SCD patients. Improve on modifiable sociodemographic characteristics of SCD patients that are associated with psychiatric morbidities through government policies and programs.