Child Mental Health Problems in the Gaza Strip
Thabet, Abdel Aziz Mousa, Vostanis, Panos, The Israel Journal of Psychiatry and Related Sciences
Abstract: This study describes the mental health characteristics of 150 children of 6-13 years of age, who had been referred to different types of services in the Gaza Strip: a community mental health center, five primary health centers and a pediatric hospital. There was a high rate of somatising disorders among children referred to the mental health center (42%). Parent-reported rates of significant mental health problems were high for all groups, i.e., 70% in the mental health center group, 30% in the pediatric group, and 18% among children referred to primary health centers.
Children with mental health problems and disorders are seen by a variety of health services and health care professionals, often in an uncoordinated way. A substantial proportion of cases are seen by community and hospital pediatricians, health visitors and school nurses (1, 2).
Garralda and Bailey found that 23% of children of 7-12 years of age attending general practice had psychiatric disorders, which were associated with family breakdown and parental stress. The same authors found a psychiatric prevalence of 28% among the same age group of referrals to general pediatrics, which was mainly accounted for by emotional disorders (two thirds of psychiatric disorders). The rate rose to 47% for reported psychological factors associated with somatic presentations (3-5).
Less is known about the rate and nature of child mental health problems seen in different health care settings in developing countries. In a two-stage study in Nigeria, Gureje et al. (6) found that 20% of children treated in pediatric primary care had a psychiatric disorder (6% depressive disorders, 4.7% anxiety-related disorders and 6.1% conduct disorders).
The aims of this study were (1) to identify the mental health characteristics of children referred to three types of health care services in the Gaza Strip, and (2) to compare the type of mental health problems among referrals to these services.
The study was completed in the Gaza Strip, the midyear 2001 total population in Gaza Strip is 1,196,591, out of them 603,615 are males and 592,976 are females as was estimated by the Palestinian Central Bureau of Statistics (7). The population is a young population, with 50.4% under 15 years, indicating a high dependency ratio. Gaza Strip has one of the highest birth rates in the world. The Palestinian Bureau of Statistics estimates in its reports a visible decline in the crude birth rate in the last five years. The crude birth rate of the population in Gaza Strip was 40 per 1,000 and 34.5 per 1,000 in 1996 and 1998, and 38 per 1,000 in 2002 respectively (7).
There are three types of residential localities in Gaza Strip: rural (villages), camps, and towns. In total, there are 8 refugee camps, 14 villages, and 4 towns; 9% of the general population lives in rural areas (villages), 3% live in semi urban areas, 53% live in urban areas (towns), and 35% live in refugee camps, where Palestinian families immigrated after the 1948 catastrophe. The refugee camps are very crowded urban settlements (7). In 1995, the annual infant birth rate was 49.4 per 1000 population, the infant mortality rate was between 26-50 per 1,000 infants, and the general population death rate was 8 per 1000. The annual increase of population growth in the Gaza strip is 4.5%.
Referrals were selected from the following health care settings:
a) A community child mental health service in Gaza. The mental health center was established in 1994, together with a community mental health center in the Khan Younis area. Referrals are made by other clinicians, schools and parents. There are two community clinics for both children and adults, as well as an outpatient clinic at the Gaza psychiatric hospital. These services are managed and clinically supervised by the first author.
b) Five Primary Health Centers in Gaza and Rafah city. …