PREVALENCE OF DEPRESSION

AND ANXIETY AMONGST

CHILDREN ADMITTED WITH
PSYCHO SOMATIC SYMPTOMS,
CONVERSION SYMPTOMS AND
SUICIDAL BEHAVIOUR.
INTRODUCTION
Around 2 billion children and adolescents make up almost a third of the world's
population, and nearly 90% of them reside in low- and middle-income
countries. There is a huge disparity between demands and resources despite the
growing acknowledgement of the significance of mental health promotion and
prevention in children and adolescents. (Christian et al., 2011).
The worldwide prevalence of mental health disorders in children was 13.4%.
Polanczyk et al., (2015)
According to study, having stressful experiences raises a child's risk of having
stressful and psychological issues. ( Raija -Leena ,2015) Children of school
age undergo quick physical and psychological changes, which increases their
risk of developing internalized behavioural issues such stress, disorientation,
and anxiety [8]. Children's mental health is influenced by a variety of elements,
including the qualities of their homes, their interactions with their parents and
classmates, their schooling, and their living environment. (Sunyeob choi ,
2023)
Disruptive (oppositional defiance disorder (ODD), conduct disorder (CD),
attention deficit hyperactivity disorder (ADHD), pervasive (autistic spectrum
disorders), emotional-obsessive-compulsive disorder (OCD), anxiety, and
depression are some of the common mental health disorders in children.
( Michael 2018)
With about 1 in 12 children and 1 in 4 adolescents affected, anxiety disorders
are the most prevalent mental illnesses in children and adolescents. Specific
phobias, social anxiety disorder, separation anxiety disorder, agoraphobia, panic
disorder, and generalized anxiety disorder are examples of anxiety disorders.
(Alicia et al.,2022). A systematic review of studies conducted in 27 countries
estimates that the worldwide prevalence of anxiety disorders in children is
6.5%.polanczyk et al., (2015)
Children and adolescents are frequently at risk for depressed symptoms and
clinically significant depressive disorders.(Costello et al., 2006)
Major depression is characterized by the presence of five or more symptoms
over a period of two weeks, according to the DSM-V (Diagnostic and Statistical
Manual of Mental Disorders) . Depressed or irritable mood, decreased interest
or pleasure, insomnia or hypersomnia, psychomotor agitation or retardation,
fatigue or loss of energy, feelings of worthlessness or unwarranted guilt,
decreased ability to concentrate, recurrent thoughts of death, suicidal ideation
with or without a specific plan, or a suicide attempt are symptoms. (Wegner et
al., 2020)
(DSM-5) includes in the category of depressive disorders the following:
disruptive mood dysregulation disorder, major depressive disorder, persistent
depressive disorder, premenstrual dysphoric disorder, substance/medication-
induced depressive disorder, depressive disorder due to another medical
condition, other specified depressive disorder, and unspecified depressive
disorder. (Kaplan and Sadock, 2015)
Anxiety is excessive fear, or worry that is out of proportion to the circumstance,
event, person, or object . Children and adolescents with anxiety disorders often
have autonomic nervous system symptoms such as diaphoresis, palpitations,
tightness in the chest, nausea, faintness, chills, and muscle tension. (Kowalchuk
et al., 2022). Generalized anxiety disorder (GAD), social phobia (SoP)/social
anxiety disorder, and separation anxiety disorder (SAD) are often referred to as
the "pediatric anxiety disorder triad" disorders. "Triad anxiety disorders" co-
occur often have very comparable histories have a common neurophysiology
and respond similarly to psychotherapeutic and psychopharmacologic therapies
(such as selective serotonin reuptake inhibitors [SSRIs] and cognitive
behavioral psychotherapy . (Wehry et al., 2015)
During the past decades the prevalence of eating disorders like anorexia
nervosa, bulimia nervosa and obesity has been on the rise. According to
estimates, 0.5% of adolescent girls in the United States have AN, 1% to 2% of
them match the diagnostic requirements for BN, and up to 5% to 10% of all
eating disorders affect males. (David .S Rosen 2010). Currently, no medications
are approved by the Food and Drug Administration (FDA) for the treatment of
AN. Contrary to AN, a number of drugs, including TCAs, SSRIs, serotonin
norepinephrine reuptake inhibitors, and other antidepressants, have been
demonstrated to be more effective than placebo in treating BN. Other
substances, such serotonin receptor antagonists and anticonvulsants, particularly
topiramate, have also been beneficial.

Childhood-onset schizophrenia (COS) is an extraordinarily rare illness, with an

incidence less than 0.04%. The evaluation of a child with suspected COS
includes collecting extensive collateral information, observing patients/families
over several visits, excluding underlying medical illnesses, and evaluating, with
a high index of suspicion, for speech/language/educational deficits and
comorbid mood or anxiety disorders. ( David i. Driver 2013). The term
"psychosis" refers to a major disruption in a person's "reality testing" as shown
by particular pathological symptoms, such as thought disturbance,
hallucinations, or delusions . children experience psychotic symptoms such as
believing in fantasy characters, having imaginary companions, and having
auditory hallucinations. In this age group, substance use psychosis also becomes
more prevalent. Teenagers with conduct issues and other ailments might
describe hallucinations but not delusions. They are more likely to develop
personality disorders but not psychosis. Volkmar, (1996).
Obsessive-compulsive disorder (OCD) is a psychiatric condition characterised
by persistent and unwanted intrusive thoughts, images and urges (obsessions)
and repetitive behaviours or mental acts (compulsions) . Once considered to be
rare in youth, epidemiological studies have found an estimated prevalence of
0.25%–4% among children and adolescents. There has been emerging clinical
evidence over the past 10–15 years of a subgroup of children who experience
sudden onset OCD and/or tics after streptococcal infection. This group of
children was originally given the acronym PANDAS (paediatric autoimmune
neuropsychiatric disorders associated with streptococcus),19 but more recently
the term PANS (paediatric acute-onset neuropsychiatric syndrome) has been
used in preference, as it is felt to capture both the sudden onset and the
uncertainty about aetiology.20 These children tend to have more widespread
neuropsychiatric difficulties than other children with OCD, including enuresis,
deterioration in handwriting and impulsivity. ( Krebs and Heyman, 2014)
Suicide is defined as death occurring as a result of direct or indirect impact of
self-destructive act done intentionally by the person being aware that it would
result in his / her death. Suicidal behavior, defined as non-fatal suicidal
thoughts and behaviors that include having suicide ideation, plan, and attempts,
is a leading cause of injury and death among adolescents globally. (Khan et al.,
2020) 
To date, the main risk factors, among others, known to be associated with
suicidal behaviour are depression, hopelessness, dysfunctional families,
substance abuse, school failure and harassment. (Actas Esp Psiquiatr, 2014).
It is estimated that for every completed youth suicide, as many as 200 suicide
attempts are made. Poisoning, suffocation, firearms are the most common
causes of suicide, whereas ingestion of medication is the most common method
of attempted suicide. The 15 to 19 yr old age group is the most likely to
intentionally harm themselves. (Nelson textbook of paediatrics 21st ed).
 Somatic symptom disorder is a common disorder encountered in paediatric
medicine. It involves the presentation of physical symptoms that are either
disproportionate or inconsistent with history, physical examination, laboratory,
and other investigative findings. SSDs result in significant impairment with
considerable increase in healthcare utilization, school absenteeism, and the
potential for unnecessary diagnostic evaluation and treatment intervention.
Patients and families often feel dismissed and may worry that a serious
condition has been missed. Primary care providers are frequently frustrated due
to a lack of a successful approach to patients and families impacted by
SSD. (Malas et al., 2017) .According to the fifth edition of the American
Psychiatric Association’s Diagnostic and Statistical Manual of Mental
Disorders (DSM-5), the key characteristic of somatic symptom disorders is the
presence of one or more persistent somatic symptoms that are associated with
excessive thoughts, feelings, and behaviours related to the symptoms. the
somatic symptom disorders’ group in DSM-5 includes the following disorders:
“somatic symptom disorder,” “illness anxiety disorder,” “conversion disorder”
(functional neurological symptom disorder), “psychological factors affecting
another medical condition” and “factitious disorder.” Somatic syndromes that
are below-threshold are classified under two residual categories, “other
specified” and “unspecified somatic symptom and related disorders.” (Kaplan
and Sadock’s synopsis of psychiatry 10th ed).

Conversion disorder is defined as a condition in which symptoms and deficits in

voluntary motor function suggest a neurological or other physical condition
which is in fact not present. Child psychiatrists have reported a prevalence of 1–
3% in the patients they see. During childhood, conversion disorder occurs most
commonly in the 10–15 year age bracket and the condition is roughly twice as
common in girls as it is in boys.
Symptoms are most commonly motor—paralysis, gait disturbance,
incoordination, tremor, loss of speech. Sensory manifestations include
paraesthesia, intractable pain, tunnel vision and blindness. Incapacitating
headache, unremitting fatigue and pseudoseizures are other common presenting
features. Allowance must be made for cultural variation in the mode of
presentation. A study in Pakistan showed 'unresponsiveness' as the commonest
presenting feature in conversion disorder, and in certain areas of Southern
Africa a state of apparent agitated dementia is well recognized. (P M Leary
2003)
Apart from these , trauma and stress related disorder, sleep wake disorders,
sexual dysfunctions, impulse control and conduct disorders are common among
children.
It is crucial to address the needs of children and adolescents with mental health
disorders. A number of children report to paediatrics emergency with neuro-
psychiatric emergencies , unexplained somatic complaints, suicidal behaviour
and other mental disorders. There is a paucity of data from our centre in this
field and hence this study will further help us strengthen the existing body of
knowledge and guide interventions and policies related to child mental health.
Therefore this study is being conducted in the department of paediatrics, Shri
Maharaja Gulab Singh Hospital, Government Medical College, Jammu.

REVIEW OF LITERATURE
Raija – Leena (2015), studied the mental health of Palestinian children
exposed to political violence. The study suggested that mental health of parents
especially the mother, acts as a buffer between stressful experiences and their
effect on mental health.

Sunyeob choi (2023), studied the various factors which influence the
mental health of children in multicultural south Korean families. The mental
health of children from multicultural homes was impacted by stress (odds ratio
[OR]=0.53, p.001), life satisfaction (OR=2.09, p=.004), self-esteem (OR=1.73,
p=.032), and peer support (OR=1.46, p=.019). In the final model, the
socioeconomic, cultural, and environmental variables generally did not have a
substantial impact on the mental health status of children from mixed
households.

Michael (2018) , studied the impact of behavioural and emotional disorders

on childhood. Childhood behaviour and emotional problems with their related
disorders have significant negative impacts on the individual, the family and the
society. They are commonly associated with poor academic, occupational, and
psychosocial functioning. It is important for all healthcare professionals,
especially the Paediatricians to be aware of the range of presentation, prevention
and management of the common mental health problems in children and
adolescents.

Kowalchuk et al., (2022) studied the anxiety disorders in children and

adolescents. Similar to adult symptoms, those of anxiety disorders in children
and adolescents might include physical and behavioural manifestations such
diaphoresis, palpitations, and tantrums. A clinical interview with the child or
teenager and their primary caregivers serves as the foundation for the diagnosis.
SCARED ( the screen for child anxiety related emotional disorders) and SCAS (
spence child anxiety scale) are the scales used for assessment of anxiety. Both
psychological therapies and pharmacological therapies are used for the
management. Combined treatment has been shown to be the most effective
treatment for treatment of childhood anxiety. Some childhood anxiety disorders
linger until adulthood despite appropriate therapies. Researchers discovered that
after four years, just 22% of study participants were in stable symptom
remission, 48% had relapsed, and 30% were chronically ill in a longitudinal
study looking at the remission rates of anxiety among 319 young people.

Guilherme et al.,(2015) studied the worldwide prevalence of mental

disorders in children by conducting a metaanalysis study. They included 41
studies conducted in 27 countries from every region in the world. 13.4% (CI
95% 11.3-15.9) of children globally reported having a mental illness. Any
anxiety disorder had a prevalence of 6.5% (CI 95% 4.7-9.1), depressive
disorder 2.6% (CI 95% 1.7-3.9), attention-deficit hyperactivity disorder 3.4%
(CI 95% 2.6-4.5), and disruptive disorder 5.7% (CI 95% 4.0-8.1) worldwide.

Costello el at (2006), conducted a meta – analysis of all the studies that

used structured diagnostic interviews to make diagnosis of depression in
children and adolescents. Nearly 60,000 observations on kids born between
1965 and 1996 who had at least one structured psychiatric interview that could
have resulted in a formal diagnosis of depression were gathered from 26 studies,
which were found. The year of birth has no impact on depression rates.
Taxonomy, measuring method, and interview duration had no impact. Under 13:
2.8% (standard error (SE).5%); 13-18: 5.6% (SE.3%); 13-18 girls: 5.9%
(SE.3%); 13-18 boys: 4.6% (SE.3%). These estimates represent the overall
prevalence.

Wegner et al., (2020) studied the effect of exercise on depression in

children and adolescents. 2,110 participants (aged 5 to 20 years) from 30
separate research, most of which included gender-mixed samples, made up the
overall sample. The interventions lasted an average of 11.5 weeks. Exercise's
overall mean impact on depression was moderate (d = 0.50). Additional
research on samples of people who had clinical depression revealed a slight to
medium mean effect (d = 0.48) in favor of the intervention.
Wehry et al., (2015) in their study described the assessment and
treatment of childhood anxiety disorders. They described the current
neurobiology, epidemiology, and longitudinal trajectory of anxiety disorders in
childhood. There has been a significant uptick in the evidence supporting the
use of exposure-based CBT, SSRIs/SSNRIs, and psychopharmacological
treatments to treat pediatric anxiety disorders. Psychopharmacologic trials
results specifically indicate that SSRIs and SSNRIs are effective and well-
tolerated in pediatric patients with non-OCD anxiety disorders. The
effectiveness of benzodiazepines or buspirone in the treatment of young people
with anxiety disorders, however, is not supported by placebo-controlled
research.

David S Rosen (2010) published a clinical report on identification and

management of eating disorders in children and adolescents. The initial
assessment of the patient with disordered eating is included in the clinical
report, along with a discussion of the diagnostic criteria. They described that
neuroendocrine abnormalities have been implicated in the etiology of eating
disorders. The Bright Futures recommendations give examples of how to
approach this topic with teenagers of various ages. Although only validated in
adults, the SCOFF questionnaire can serve as a framework for screening. The
US Food and Drug Administration has not authorized any drugs to treat AN.
The most popular medications are selective serotonin-reuptake inhibitors
(SSRIs), although they might not work in patients who are extremely
undernourished.

Driver et al., (2013) studied childhood onset schizophrenia and early

onset schizophrenia disorders. Schizophrenia is a devastating illness,
particularly when presenting in childhood or adolescence. Despite the presence
of premorbid characteristics, a reliable premorbid phenotype has not been
defined and research into the pathophysiology of the syndrome remains ongoing
without a substantial target demonstrated in a systematic way. The frequency
and duration of psychotic episodes have deleterious neuropsychological,
neurophysiological, and neurostructural effects,96–100 making prompt,
aggressive treatment an important component of care. Once the diagnosis is
established and other comorbid conditions are adequately assessed, clinicians
should treat this illness aggressively. Treatment planning should encompass
psychopharmacologic, psychotherapeutic, and early psychosocial intervention,
such as support and education of the family about the disorder, particularly
during the first years of the evolution of the disease, as these can actually
improve the course of illness.101 In addition, clinicians should not avoid using
Clozapine, as evidenced by the epidemiologic studies demonstrating that its use
occurs even much later than that recommended by the clinical guidelines.

Fred R. Volkmar (1996), conducted a review study over the past 10

years on childhood and adolescent psychosis. The review of the recent literature
focuses on developmental aspects of psychotic phenomena, i.e., hallucinations,
delusions, and thought disorder. While the applicability of much early work on
this topic is limited, more recent work suggests that psychotic conditions are
observed in childhood and increase in frequency during adolescence.
Developmental factors in the expression of psychosis are relevant to the
diagnosis and treatment of such conditions.

Krebs and Heyman, (2014) studied obsessive compulsive disorders in

children and adolescents. This review considers current knowledge of causes
and mechanisms underlying OCD, as well as assessment and treatment. Issues
relating to differential diagnosis are summarised, including the challenges of
distinguishing OCD from autism spectrum disorders and tic disorders in youth.
The recommended treatments, namely cognitive behaviour therapy and
serotonin reuptake inhibiting/ selective serotonin reuptake inhibitor
medications, are outlined along with the existing evidence-based and factors
associated with treatment resistance. Finally, novel clinical developments that
are emerging in the field and future directions for research are discussed.

Khan et al., (2020) studied the suicidal behaviour among school going
adolescents in Bangladesh. This study aimed to explore the prevalence of and
the factors associated with suicidal behavior among school-going adolescents in
Bangladesh. This study utilized data from the 2014 Global School-based
Student Health Survey (GSHS), Bangladesh. A sample of (n = 2989) school-going
adolescents aged 11–18 years was selected for this study. Risk factors of
suicidal behavior were identified using a generalized estimating equation-
modified Poison regression approach. The age-adjusted prevalence of suicidal
behavior among adolescents in Bangladesh was 11.7%. Health-risk behaviors
such as ever having sexual intercourse, alcohol and drug abuse, and social–
environmental factors, such as rare parental homework check, and lack of peer
support were found to be positively associated with adolescents’ suicidal
behavior. Additionally, a dose–response relationship is observed between the
experience of multiple adverse psychosocial factors and suicidal behavior.

Actas Esp Psiquiatr (2014), studied suicide among children and

adolescents. This review emphasizes how the phenomenology of child suicidal
conduct is influenced by the sociological traits of postmodernity. This paper
reviews suicide rates, the most common methods used and the conceptual
delimitation of suicide. . It also includes an analysis of the reasons for the
increase in suicide among children and adolescents, according to the
characteristics of the society in which we have to live.

Malas et al., 2017 studied the pediatrics somatic symptoms disorder. This
review provides insight into the examination and treatment of pediatric SSD
based on empirical research as well as clinical experience. Somatic symptoms
involve physical symptoms that are either disproportionate or inconsistent with
history, physical examination, laboratory, and other investigative findings

Naomi et al. (2009), conducted a study in which all the discharged

patients between 3 to 20 years were studied in the nationally representative kids’
database and in the pediatrics health information system. They found out that
nearly 10% of pediatrics hospitalizations nationally were for a primary mental
health diagnosis. Nationally, the most frequent and costly primary mental health
diagnoses were depression , bipolar disorders and psychosis.

Alen et al. (1985) examined the relation of direct observations of overt

behaviour to depression among 62 child psychiatric inpatients aged 8 to 13
years among 62 child psychiatric inpatients aged 8 to 13 years. Assessment was
done by self-report and interview measures administered separately to children
and their mothers. The study found out that depressed children engaged in
significantly less affect related expression than their non depressed peers. This
study suggests that depressive symptoms are reflected in diverse behaviours in
everyday life.

Holly et al. (2014) studied the prevalence of depressive disorders among

parents of children brought for evaluation in child speciality mental health
clinics This report describes implementation of caregiver depression screening
and treatment referral in a child mental health clinic that serves youth aged 4 to
18. Caregivers were screened with PHQ9 . Of 581 caregivers screened, 233
(40%) scored > 8 . of those , 45% accepted referrals for mental health services;
12% declined , 16% were deemed by the child clinician not to require referrals,
<1% requested more information.

Campo et al. (2004), examined the prevalence of depression and anxiety

in children aged 8 to 15 years with recurrent abdominal pain(RAP) N =42 or for
routine care in absence of pain N= 38. Found that 43% of children with RAP
had elevated depressive symptoms, 79% had elevated anxiety symptoms.
Anxiety disorders ( mean age of onset : 6.25 ) were significantly more likely to
precede RAP in patients with associated anxiety.

Dirk et al conducted a study on the outcome of self reported functional

somatic symptoms in a community sample of adolescents. Measures of the
functional somatic complaints in adolescents were derived from youth self-
report. This a questionnaire of 103 questions for 11 to 18 years covering
emotional and behavioural problems during the last 6 months. The longitudinal
association between functional somatic symptoms and psychiatric diagnosis was
assessed. Findings were that functional somatic symptoms were not only
common but also associated with psychiatric disturbances in 6 to 8 years follow
up.

Richard et al. conducted a study on multiple somatic complaints and

possible somatization disorder in prepubertal children. Five prepubertal
children reported enough somatic symptoms during a structured interview to
warrant consideration of a diagnosis of somatization disorder by DSM-III and
Feighner criteria. Compared to 13 children with anxiety or affective disorders
and 7 with conduct disorder, these 5 had significantly more somatic symptoms
from significantly more symptom groups than the others. They reported more
pseudoneurologic symptoms and subjectively were thought to present more
“hysterical” features clinically.

Robert et al. (1998) studied the incidence and predictors of suicidal

behaviour in young adolescents. Adolescents from a two-stage, community-
based longitudinal study were classified into suicidal behavior categories ( plan,
ideation, and none) for baseline and follow-up years. While there are a number
of predictors of suicidal behaviors, the false-positive rate is high. Focusing on
proximal risk factors, particularly stressors in adolescent development, may
overlook the fundamental role of underlying mental disorder and familial
factors—both biological and environmental.

Helen et al. (2014) studied the prevalence of DSM4 mental disorders and
suicidal behaviour in early adolescence. This study investigated the prevalence
of DSM-IV Axis 1 mental disorders, deliberate self-harm and suicidal ideation
in a sample of Irish adolescents aged 11–13 years. A total of 1131 students was
surveyed for general psychopathology using the Strengths and Difficulties
Questionnaire. Following this, a representative sample of 212 adolescents was
assessed for mental disorders, deliberate self- harm and suicidal ideation using
the Schedule for Affective Disorders and Schizophrenia for School-Aged
Children. Following clinical diagnostic interviews, 27.4% of participants
received a current diagnosis of an Axis 1 disorder and 36.8% received a lifetime
diagnosis, those rates falling to 15.4% and 31.2% respectively when specific
phobias were excluded. Findings from this study reveal that Irish adolescents
aged 11–13 years are experiencing high levels of mental ill-health.

Negreiros, J., & Miller, L. D. (2014) studied the role of parenting in

childhood anxiety. Theoretical models of anxiety disorders suggest that family
processes and parenting are important factors in the development, maintenance,
and transmission of childhood anxiety. The direction of effects between
parenting and childhood anxiety, however, remains unclear. This review article
integrates theoretical, empirical, and applied knowledge regarding the
association between parenting and childhood anxiety as a means to better
understand the implications of involving parents in the treatment of their
children's anxiety.

Barbara et al. (2019) studied the role of parenting styles on behaviour

problem profile of adolescents. The objectives of this work were: (i) to identify
adolescents profiles according to their behavior problems; (ii) to explore
individual, family, and social characteristics associated with these profiles; and
(iii) to analyze the potential role of parenting styles in belonging to adolescents’
profiles. A total of 449 Spanish adolescents (223 from families declared at-risk
and enrolled in Child Welfare Services and 226 from families from the general
population) participated in this study. The analyses revealed three profiles of
adolescents based on external and internal behavior problems (adjusted, external
maladjustment, and internal maladjustment). It shows that parenting styles were
homogeneously distributed, with the Neglectful style being the most frequently
reported and Indulgent being the least. On the other hand, adjustment problems
obtained a similar average with moderate variability in their scores. In addition,
the analyses focusing on the dimension of self-concept reflected that the
dimension referring to the family presented the highest average score, but also
the lowest academic score. To conclude the descriptive analyses, adolescents
had experienced an accumulation of four SLE over the previous five years.
Egger et al. (2006), investigated the association between somatic
symptoms and internalizing problems (including depression and anxiety) in
preschool aged children. the study found that children with somatic symptoms
were more likely to have depression and anxiety.

Renee et al. (2004) studied the association of panic attacks and panic
disorders in children with childhood abuse and familial violence. After
adjustment for childhood and related factors, exposure to childhood physical
abuse was associated with a significantly increased risk of later panic attack
(OR 2·3, 95% CI 1·1–4·9) and panic disorder (OR 3·0, 95% CI 1·1–7·9);
childhood sexual abuse was associated with a significantly increased risk of
panic attack (OR 4·1, 95% CI 2·3–7·2) and a marginally significant increase
risk of panic disorder (OR 2·2; 95% CI 0·98–5·0). Exposure to interparental
violence was unrelated to later panic attack or disorder after adjustment.
Exposure to childhood sexual and physical abuse was associated with increased
risks of later panic attack/disorder even after adjustment for prospectively
assessed confounding factors.

Fergusson et al. (2005) examined the association between

psychosomatic symptoms and emotional /behavioural problems, including
anxiety and depression, in adolescents aged 14 to 16 years. The study reported
that psychosomatic symptoms were associated with a higher prevalence of
emotional and behavioural problems.

Xinyin chen et al. (2000) The purpose of the study was to examine
contributions of depressed mood to social and school adjustment in Chinese
children. A sample of children in the People’s Republic of China, initially aged
12 years, participated in this two-year longitudinal study. Data concerning
depressed mood, and social and academic performance were obtained from
multiple sources including self-reports, peer assessments, teacher ratings, and
school records. It was found that depressed mood was stable over the two years.
Moreover, depression contributed negatively to later social and school
achievement and positively to the development of adjustment difficulties. These
results suggest that depressed mood is a significant phenomenon in social and
psychological development in Chinese children and thus deserves attention
from parents, teachers and professionals.

Xinyin et al. (1997) studied the role of authoritative and authoritarian

parenting practices on social and school performance in children. The purpose
of the study was to examine the relations between authoritative and
authoritarian parenting styles and social and school adjustment in Chinese
children. A sample of second grade children, aged eight years, and their parents
in Beijing, People’s Republic of China, participated in this study. The children
were group administered a peer assessment measure of social behaviour and a
sociometric nomination measure. Teachers completed a rating scale on school-
related social competence and problems for each child. Data concerning child-
rearing practices were obtained from parents. In addition, information on
children’s academic and social competence was obtained from school records. It
was found that authoritarian parenting was associated positively with aggression
and negatively with peer acceptance, sociability-competence, distinguished
studentship and school academic achievement. In contrast, parental authoritative
style was associated positively with indices of social and school adjustment and
negatively with adjustment problems. The results indicated that, inconsistent
with the argument in the literature (e.g. Steinberg, Dornbusch, & Brown, 1992),
authoritative and authoritarian parenting practices were relevant to social and
academic performance in Chinese children.

Mathew et al. (2012) Anxiety and depression are linked to lower

academic performance. It is proposed that academic performance is reduced in
young people with high levels of anxiety or depression as a function of
increased test-specific worry that impinges on working memory central
executive processes. Participants were typically developing children (12 to 13-
years-old) from two UK schools. The study investigated the relationship
between negative affect, worry, working memory, and academic performance
using self-report questionnaires, school administered academic test data, and a
battery of computerized working memory tasks. Higher levels of anxiety and
depression were associated with lower academic performance. There was
support for a mediation hypothesis, where worry and central executive
processes mediated the link between negative affect and academic performance.
Semetana et al. (2006), conducted a longitudinal study to examine the
relationship between parenting styles and depressive symptoms in adolescents
over a two year period. The study found that authoritative parenting ,
characterised by warmth, support , reasonable levels of control, was associated
with lower levels of depressive symptoms in adolescents. In contrast
authoritarian and permissive parenting styles were associated with higher
levels of depressive symptoms.

Deb and Chatterjee et al (2010) conducted a study on influence of

parent’s high expectations regarding children’s education , compulsion for
academic achievement are found to be important contributing factors for anxiety
in adolescents and school children.

Rice et al. (2018), this systematic review examined the familial

transmission and heritability of childhood depression . the study found strong
evidence for familial transmission, with children of parents with depression
being at higher risk of developing depression themselves.

AIMS AND OBJECTIVES

1. To assess the prevalence of depression and anxiety amongst children in
the age group of 7 to 17 years admitted in pediatrics ward with
unexplained somatic symptoms, conversion disorder and suicidal
behaviour.
2. To assess the role of family, parenting styles, school adjustments, school
on depression and anxiety in children.

MATERIALS AND METHODS

Study settings: The study is planned to be conducted in the

Department of Paediatrics, Shri Maharaja Gulab Singh (SMGS) hospital,
Government Medical College, Jammu which is a tertiary level care hospital
located in the centre of Jammu city. It caters to the population of whole Jammu
division of the union territory of Jammu and Kashmir. It a 200 bedded hospital
with an average daily admission rate of 60 /day.

Study design: cross sectional observational study (hospital based).

Study period: 1 year (August 2023 to july 2024).

Inclusion Criteria:
1. The children and adolescents who will be admitted in the wards of the Post
Graduate Department of Pediatrics with complaints of unexplained somatic
symptoms, conversion disorder and suicidal behaviour.
2. Age group 7 to 17 years.
3. Patients/ parents consenting to participate.

Exclusion Criteria:
1. Children admitted with other medical illnesses.
2. Children not falling in the category of 7 to 17 years.
3. Patients/ parents not consenting to participate.

Methodology: A hospital based cross sectional study will be

undertaken in the pediatrics wards of Postgraduate Department of
Pediatrics ,SMGS , GMC jammu over a period of one year after taking
approval from institutional ethical committee.
Assessment of patients will be done using clinical features, detailed history will
be taken , thorough examination will be performed after taking consent from
patients/parents.
 Semi structured performa, The Children’s Depression Inventory, SCARED
(Screen for Child Anxiety Related Disorders), The Social Adjustment Child
Questionaire, The Somatic Symptoms Scale-8 will be used for the evaluation of
children and adolescents and scoring will be done .
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