Diagnosis and symptoms of mental disorder in a rural area of Senegal.

A study was carried out in a rural area of Senegal to ascertain the pattern of mental disorders among patients presenting at primary health facilities. Among 545 children aged 5-15 years, attending health centres and posts, 17% were found to be suffering from some form of emotional problem, behaviour disturbance or neuro-psychiatric disorders. Using a 10-item screening questionnaire, it was shown that the symptoms "never plays with others' and "speech disturbance' were the strongest predictors of mental disorder among children. Among 933 adults, it was found that 16% reported more than seven symptoms commonly associated with psychiatric illness on a 24-item self-reporting questionnaire. The order in adults does not allow a precise estimate of morbidity to be made. Health workers diagnosed 9% of the patients as suffering from a mental health problem, usually in association with a physical problem. It was found that psychotic and suicidal symptoms (e.g. hallucinations, delusions) were more likely to be recognized by health workers as diagnostic of mental disorder, whereas psychophysiological symptoms (e.g. anorexia, insomnia, headache) and psychological symptoms (e.g. anxiety, depression) were less frequently recognized. The study supports the view that psychological symptoms and mental disorders occur relatively frequently among adults and children attending primary health facilities. Data allowing insight into the diagnostic sensitivity of primary health workers can provide a rational basis for planning training programmes in mental health.