Prevalence and predictors of emotional and behavioral problems among institutionalized children in Kandy District, Sri Lanka.

BACKGROUND

Child care institutions (CCIs) in Sri Lanka (SL) provide residence to over 14,000 children. These children have a high risk of developing psychological problems. However, there has been no prior scientific inquiry into mental health issues of institutionalized children in SL.

OBJECTIVE

To investigate the emotional and behavioral problems of children living in CCIs in Kandy District, and to explore associated factors.

PARTICIPANTS AND

SETTING

Ten CCIs in Kandy District were selected and all children aged 6-18 years were recruited.

METHODS

Child Behavior Checklist (6-18) -Sinhala version (CBCL-S) was filled by the caregivers, and pertinent problem scores were derived. Relevant socio-demographic data were also collected.

RESULTS

A total of 259 children participated. Of them, 66.8 % were female. The mean age was 13.9 years. The average duration in care was 4.3 years. Clinical levels of behavioral problems were found in 14 % of children, whereas 7% were borderline. Externalizing problems like rule-breaking and aggression were more common (23.3 %) than internalizing problems (6.6 %). Male children exhibited more behavioral problems (p = 0.034). Present age, age on admission, duration in care, history of sexual abuse, institutional transfers and frequency of family contact were not associated with behavioral problems.

CONCLUSIONS

Institutionalized children showing high levels of externalizing problems may be a reflection of disturbed psychosocial development. However, internalizing problems may not be readily recognized, partly due to the shortage of trained caregivers in SL. Educating caregivers to detect and refer children with behavioral problems to psychiatric services is recommended.