Child Mental Health in Nepal. An epidemiological study of emotional and behavioral problems (EBP) among Nepali schoolchildren reported by parents and teachers

• Main Author: Ma, Jasmine
• Format: Dissertation
• Language: English
• Subjects: child; mental health

Background - There is a substantial gap in our knowledge about the prevalence, magnitude, and correlates of child emotional and behavioral problems (EBPs) in Nepal. Little is known about the agreement between parent and teacher reports on EBP among Nepali children. Therefore, a large-scale survey in the general population was undertaken to fill this gap. Methods - This is a cross-sectional, observational study among schoolchildren aged 6-18 years from 64 schools 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 completed by parents and the Teacher Report Form (TRF)/6-18 as screening instruments. We used questionnaire to collect background information and assess possible family correlates, including parental education, family structure, migrant worker parents, parental mental and physical illness, family conflicts, and child-rearing reported by parents. The prevalences of child EBPs were computed based on American norms. Comparisons of parent-reported EBPs between genders and across the seven largest castes and ethnic groups were carried out by analysis of variance. The associations between family variables and child internalizing and externalizing problems were analyzed using bivariate correlations and multiple regression. Linear mixed model analysis was used for group comparisons of TRF scale scores and for computing intraclass correlations of teacher reported EBPs. Correlations between the CBCL and TRF scale scores were analyzed using Pearson’s correlation test. Results - The prevalence of parent and teacher reports of Total Problems found in this study were 19.1% and 15.4%, respectively. In both the parent and teacher reports, the prevalence of internalizing problems was higher than that of externalizing problems. The mean CBCL scale scores for Total, Externalizing, and Internalizing problems were 29.7 (standard deviation, SD 25.6), 7.7 (SD 8.0), and 9.1 (SD 8.1). Corresponding mean TRF scale scores were 26.9 (SD 24.5), 6.1 (SD 7.2), and 7.9 (SD 7.3) respectively. For both parent and teacher reports, mean scores for Total Problems and Externalizing Problems were higher among boys than girls. The lowest Hindu caste scored the highest and the indigenous Tharu group scored the lowest on all problem scales. CBCL scores of EBP were higher in the rural areas of the Mountains and Middle Hills regions, whereas in the Ta