Social Psychiatry and Psychiatric Epidemiology

, Volume 46, Issue 8, pp 787–796

Behavioral problems among children living in orphanage facilities of Karachi, Pakistan: comparison of children in an SOS Village with those in conventional orphanages

  • Zohra S. Lassi
  • Sadia Mahmud
  • Ehsan U. Syed
  • Naveed Z. Janjua
Original Paper



This study compared the behavioral problems of children living in an SOS Village, which attempts to provide a family setup for its children, with those living in conventional orphanages.


We conducted a cross-sectional survey of 330 children, aged 4–16 years, living either in an SOS or other conventional orphanages of Karachi, and assessed their behavioral problems using strengths and difficulty questionnaire (SDQ). Behavioral problems on composite SDQ and subscales, rated by foster mothers, were compared between children in the two groups using χ2 test of independence. Multivariable models were built, using generalized estimating equations (GEE) regression approach, to identify factors independently associated with behavioral problems.


The overall prevalence of behavioral problems was 33%. On univariate comparison, we found that groups did not differ in their overall behavioral problems, while they were significantly different on the peer problem scale (P = 0.026). The model for composite SDQ behavioral problems identified five factors: wasting, <5 years length of stay in the facility and foster mother’s depression, while facility type and sex of the child were part of a significant interaction. Foster mother depression, child’s malnourishment and fewer years of stay at the facility were associated with conduct problems, while the child’s sex, facility type and child’s parental living status were part of two interactions.


We found a high burden of behavioral problems among children living in orphanages of Karachi, Pakistan. Foster mothers’ depression and child’s nutritional status, which are associated with behavioral problems, can be target of interventions to reduce behavioral problems of children living in orphanages.


Mental health Orphaned children Orphanages in Karachi Behavioral problem Conduct problem 


  1. 1.
    National Institute for Health Care Management (2005) Children’s mental health: an overview and key considerations for health system stakeholders. A report by National Institute for Health Care ManagementGoogle Scholar
  2. 2.
    Wattie B (2003) The importance of mental health of children, Canadian Mental Health AssociationGoogle Scholar
  3. 3.
    Nikapota AD (1991) Child psychiatry in developing countries. Br J Psychiatry 158:743–751PubMedCrossRefGoogle Scholar
  4. 4.
    Syed EU, Hussein SA, Mahmud S (2007) Screening for emotional and behavioral problems amongst 5–11 years old school children in Karachi, Pakistan. Soc Psychiatry Psychiatr Epidemiol 42(5):421–427PubMedCrossRefGoogle Scholar
  5. 5.
    Mullick M, Goodman R (2005) The prevalence of psychiatric disorders among 5–10 years old in rural, urban and slums areas of Bangladesh: an exploratory study. Soc Psychiatry Psychiatr Epidemiol 40:663–671PubMedCrossRefGoogle Scholar
  6. 6.
    Srinath S, Sirimaji S, Ruraj G, Seshadri S, Subbakrishna D, Bhola P (2005) Epidemiological study of child and adolescent psychiatric disorders in urban and rural areas of Bangalore, India. Indian J Med Res 162:67–79Google Scholar
  7. 7.
    Rutter M (1989) Pathways from childhood to adult life. J Child Psychol Psychiatry 30:23–51PubMedCrossRefGoogle Scholar
  8. 8.
    Fleitlich B, Goodman R (2001) Social factors associated with child mental health problems in Brazil: a cross-sectional survey. BMJ 323:599–600PubMedCrossRefGoogle Scholar
  9. 9.
    Goodman R, Slobodskaya H, Knyazev G (2005) Russian child mental health: a cross-sectional study of prevalence and risk factors. Eur Child Adolesc Psychiatry 14:28–33PubMedCrossRefGoogle Scholar
  10. 10.
    Hackett R, Hackett L, Bakta P, Gowers S (1999) The prevalence and association of psychiatric disorders in children in Kerala, South India. J Child Psychol Psychiatry 40:801–807PubMedCrossRefGoogle Scholar
  11. 11.
    Javed MA, Kundi MZM, Khan PA (1992) Emotional and behavioral problems among school children in Pakistan. J Pak Med Assoc 42(2):181–183PubMedGoogle Scholar
  12. 12.
    Durkin MS, Hasan ZM, Hasan KZ (1998) Prevalence and correlates of mental retardation among children in Karachi, Pakistan. Am J Epidemiol 147:281–288PubMedGoogle Scholar
  13. 13.
    Mirza I (2001) Common mental disorders in urban vs. rural Pakistan. Br J Psychiatry 178:475–476PubMedCrossRefGoogle Scholar
  14. 14.
    Chisholm D, Sekar K, Kumar K, Saeed K, James S, Mubbahar M et al (2000) Integration of mental health care into primary care. Br J Psychiatry 174:581–588CrossRefGoogle Scholar
  15. 15.
    Mubbashar MH (2001) Mental health literacy in developing countries. Br J Psychiatry 179:75PubMedCrossRefGoogle Scholar
  16. 16.
    Naqvi HA, Khan MM (2006) Pathway to psychiatric care in Karachi. JCPSP 16(6):438–439PubMedGoogle Scholar
  17. 17.
    Goodman R, Renfrew D, Mullick M (2000) Predicting type of psychiatric disorder from strengths and difficulties questionnaire (SDQ) scores in child mental health clinics in London and Dhaka. Eur Child Adolesc Psychiatry 9(2):125–134CrossRefGoogle Scholar
  18. 18.
    Durkin MS, Khan NZ, Davidson LL, Huq S, Munir S, Rasul E et al (2000) Prenatal and postnatal risk factors for mental retardation among children in Bangladesh. Am J Epidemiol 152:1024–1033PubMedCrossRefGoogle Scholar
  19. 19.
    Rahman A, Mubbashar MH, Gater R, Goldberg D (1998) Randomized trial of impact of school mental health programme in rural Rawalpindi, Pakistan. Lancet 352:1022–1025PubMedCrossRefGoogle Scholar
  20. 20.
    Mumford DB, Mihhas FA, Akhtar I, Akhter S, Mubbashar MH (2000) Stress and psychiatric disorder in urban Rawalpindi. Br J Psychiatry 177:557–562PubMedCrossRefGoogle Scholar
  21. 21.
    Hughes DA (1999) Building the bonds of attachment: awakening love in deeply troubled children. Jason Aronson, LondonGoogle Scholar
  22. 22.
    Halfron N, Zepeda A, Inkelas M (2002) Mental health services for children in foster care. UCLA Center for Healthier Children, Families and Communities, Los AngelesGoogle Scholar
  23. 23.
    DosReis S, Zito JM, Safer DJ, Soeken KL (2001) Mental health services for youths in foster care and disables youth. Am J Public Health 91(7):1094–1099PubMedCrossRefGoogle Scholar
  24. 24.
    Simms MD, Dubowitz H, Szilagyi MA (2000) Health care needs for children in the foster care system. Pediatrics 106(4):909–918PubMedGoogle Scholar
  25. 25.
    Wolff PH, Fesseha G (1998) The orphans of eritrea: are orphanages part of the problem or part of the solution. Am J of Psychiatry 155(10):1319–1324Google Scholar
  26. 26.
    SOS children village Pakistan.
  27. 27.
    Epi Info 6 (2001) A word processing, database and statistics program for public health. In: 6.04d ed. Center for Disease Control, World Health Organization, Geneva, SwitzerlandGoogle Scholar
  28. 28.
    Badar S, Hashim R, Murad M, Imtiaz J (1998) Development of an indigenous screening instrument in Pakistan: the Aga Khan University Anxiety and Depression Scale. J Pak Med Assoc 48:261–265Google Scholar
  29. 29.
    Goodman R (1997) The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry 38(5):581–586PubMedCrossRefGoogle Scholar
  30. 30.
    Goodman R, Ford T, Simmons H, Gatward R, Meltzer H (2000) Using the strengths and difficulties questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. Br J Psychiatry 177:534–539PubMedCrossRefGoogle Scholar
  31. 31.
    Samad L, Hollis C, Prince M, Goodman R (2005) Child and adolescent psychopathology in a developing country: testing the validity of the strengths and difficulties questionnaire (Urdu version). Int J Methods Psychiatr Res 14(3):158–166PubMedCrossRefGoogle Scholar
  32. 32.
    Cogill B (2003) Anthropometric indicators measurement guide. Food and Nutrition Technical Assistance Project, Academy for Educational Development,Washington, DCGoogle Scholar
  33. 33.
    Inc S. SAS for windows. In. SAS 9.1.3 edGoogle Scholar
  34. 34.
    Allison PD (1999) Logistic regression using the SAS system: theory and application. SAS Institute Inc, North CarolinaGoogle Scholar
  35. 35.
    Hosmer DW, Lameshow S (2000) Applied logistic regression, 2nd edn edn. Wiley, New YorkCrossRefGoogle Scholar
  36. 36.
    Rothman KJ, Greenland S (1998) Modern epidemiology, 2nd edn edn. Lippincott-Raven, PhiladelphiaGoogle Scholar
  37. 37.
    Roberts RE, Atkinson CC, Rosenblatt A (1998) Prevalence of psychopathology among children and adolescents. Am J Psychiatry 155:715–725PubMedGoogle Scholar
  38. 38.
    Brown JD, Wissow LS, Gadomski A et al (2006) Parent and teacher mental health ratings of children using primary-care services: inter-rater agreement and implications for mental health screening. Amb Pediatr 6:347–351CrossRefGoogle Scholar
  39. 39.
    Dix KL, Askell-William H, Lawson MJ (2008) Different measures, different informants, same outcomes? Investigating multiple perspectives of primary school students’ mental health. Paper presented at Australian Association for Research in Education conference, Brisbane 2008Google Scholar
  40. 40.
    Ferris M, Holm-Hansen C (2007) Mahnomen county rural mental health outreach project: evaluation report. Wilder Research, MinnesotaGoogle Scholar
  41. 41.
    Liu J, Raine A, Venable PH, Mednick SA (2004) Malnutrition at age 3 and externalizing behavioral problems at ages 8, 11 and 17 years. Am J Psychiatry 161(11):2005–2013PubMedCrossRefGoogle Scholar
  42. 42.
    Williams A (2005) Depression research in nursing: global perspective. Springer, New YorkGoogle Scholar
  43. 43.
    Last CG, Hersen M, Kazdin A (1991) Anxiety disorders in children and their families. Arch Gen Psychiatry 48:928–934PubMedGoogle Scholar
  44. 44.
    Lieb R, Isensee B, Hofler M (2002) Parental major depression and other mental disorders in offspring. Arch Gen Psychiatry 59:365–374PubMedCrossRefGoogle Scholar
  45. 45.
    Hammen C, Brennan PA (2003) Severity, chronicity and timing of maternal depression and risk for adolescent offspring diagnosis in a community sample. Arch Gen Psychiatry 60:253–258PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Zohra S. Lassi
    • 1
  • Sadia Mahmud
    • 1
  • Ehsan U. Syed
    • 1
  • Naveed Z. Janjua
    • 1
  1. 1.Aga Khan UniversityKarachiPakistan

Personalised recommendations