Parent reports of children’s emotional and behavioral problems in a low- and middle- income country (LMIC): An epidemiological study of Nepali schoolchildren

Abstract

Background As epidemiological data on child mental health in low- and middle-income countries are limited, a large-scale survey was undertaken to estimate the prevalence and amount of child emotional and behavioral problems (EBP) in Nepal as reported by the parents. Methods 3820 schoolchildren aged 6–18 years were selected from 16 districts of the three geographical regions of Nepal, including rural, semi-urban and urban areas. We used the Nepali version of the Child Behavior Checklist (CBCL)/6-18 years as screening instrument. Comparisons of child problems between genders and between the seven largest castes and ethnic groups were carried out by analysis of variance. Prevalence was computed based on American norms. Results Adjusted prevalence of Total Problems was 18.3% (boys: 19.1%; girls:17.6%). The prevalence of internalizing problems was higher than externalizing problems. The mean scores of Total, Externalizing, and Internalizing problems were 29.7 (SD 25.6), 7.7 (SD 8.0), and 9.1 (SD 8.1), respectively. The Khas Kaami (Dalit) group scored the highest, and the indigenous Tharu group scored the lowest on all scales. In the Mountains and Middle Hills regions, problem scores were higher in the rural areas, whereas in the Tarai region, they were higher in the urban areas. Conclusion The prevalence and magnitude of emotional and behavioral problems in Nepali children were found to be high compared to findings in meta-analyses worldwide. Problem scores varied according to gender, castes /ethnic groups, and living areas. Our findings highlight the need for a stronger focus on child mental problems in a low-and middle-income country like Nepal.

Psychopathology in Children and Adolescents in Lebanon Study (PALS): a national household survey

“…Compared to similar national surveys that used screening tools, the general prevalence in our study remains higher [ 25 – 27 ]. Specifically, the percentage of Nepali children who scored in the clinical range on the child behavior checklist (CBCL) was 19% in a national survey [ 28 ], while in Germany, 14.5% of children and adolescents screened positive for psychiatric disorders in the national mental health and examination survey [ 27 ]. In a 2-stage epidemiological study using the SDQ in Saudi Arabia, however, the prevalence of any psychiatric disorder was 36% [ 26 ].…”

Family correlates of emotional and behavioral problems in Nepali school children

“…To assess the internal consistency of the Nepali version of CBCL/6-18 for the present study, we computed Cronbach’s alphas for the empirically based syndrome scales. The results are reported in a previous paper [ 4 ] and were: Withdrawn / Depressed: 0.71; Somatic Complaints: 0.79; Anxious / Depressed: 0.76; Rule-breaking Behavior: 0.76; Aggressive Behavior: 0.88; Social Problems: 0.73; Attention Problems: 0.80; Thought Problems: 0.75 [ 4 ].…”

“…This result contrasts with other studies where children of the lowest educated parents had more EBP [ 11 – 13 ]. One explanation may be the inclusion of illiterate parents from indigenous groups/ ethnic minorities in our sample [ 4 ]. International studies have reported that parents of ethnic minorities maybe less likely to perceive EBP in their children as compared to parents of ethnic majority groups due to less acknowledgement of such problems [ 45 ].…”

“…In a previous, recently published paper, we reported data from the same sample on the prevalence, magnitude and types of child EBP in different castes and ethnic groups in Nepal and in different geographical locations and types of living area. The level of problems was found to be rather high, demanding additional investigations into possible family risk factors [ 4 ].…”

“…In the present study, which is part of a large-scale epidemiological project [ 4 ], our specific aim was to assess the associations between selected family variables and internalizing and externalizing behavior problems in Nepali schoolchildren aged 6–18 years.…”