Risk factors for spirit possession among school girls in southern Thailand.

In September 1993, at a school in the south of Thailand, an outbreak of spirit possession suddenly afflicted 32 girls aged 9-14 years. A case-control study was done to investigate factors that predispose a child to spirit possession. Psychiatric evaluation was done on 32 cases and 34 matched controls. Parents were interviewed regarding the child's psychosocial history. Results of the study were as follows. Children with spirit possession were first-born and came from small families with 1-3 children. Compared with the controls their family life was characterized by more psychosocial stressors and there were significantly higher rates of psychiatric disorders, anxious and fearful character traits, histrionic character traits and history of recurrent trance states. The history of traumatic experiences and exposure to spirit possession ceremonies were more frequent in spirit-possessed children than in the control group but the difference was not significant. This study showed that being first-born from a small family, individual vulnerability especially psychiatric disorders, problematic character traits and dissociative tendency were significant risk factors in the development of possession states in children.

The Children's Depression Inventory as a screen for depression in Thai children.

This study examines the utilization of the Children's Depression Inventory (CDI), Thai version, as a screen for depression in Thai children. Subjects which consisted of 139 children aged 10-15 years filled out the CDI and were evaluated with structured psychiatric interview by a child psychiatrist who was blind to the results of the CDI. Children with interview validated depression had significantly elevated CDI scores (mean = 18.5, SD = 6.1) compared with nondepressed children (mean = 9.3, SD = 4.1), P > 10(-6). Furthermore, the CDI scores increased as the severity of depression increased. Using the Receiver Operating Characteristic Curve, a cut-point of 15 produced the best overall screening characteristics (sensitivity = 79%, specificity = 91% and accuracy = 87%). The results of this study indicate that the CDI efficiently differentiated depressed from non-depressed children. Since the CDI is an economical, easy to adiminister and readily analyzable instrument, it should be used as a screen for depression and a supplant for clinical evaluation and follow-up in the treatment of depression in children.

Prevalence and risk factors for depression in children: an outpatient pediatric sample.

The purpose of this research was to study the prevalence, type, and psychosocial stressors associated with depression. The subjects were 81 children who came to the outpatient pediatric clinic, Chulalongkorn Hospital. There were 39 boys and 42 girls with the age range of 9.3-15.3 years. The results of the study were as follows. The prevalence of depression was 34.6 per cent. Types of depression were depressive symptoms only, 7.4 per cent; adjustment disorder with depressed mood, 17.3 per cent; dysthymia, 6.2 per cent; and major depression, 3.7 per cent. Females had more severe symptoms than males. Of the depressed group, 60.7 per cent had previous suicidal behavior compared with 20.6 per cent in the non-depressed group (p < 0.001). The rates of all psychosocial stressors were higher in the depressed group. Those with statistical significance were parental psychiatric illness, unstable living condition and history of abuse. Depressed children also experienced twice the number of psychosocial stressors compared with the non-depressed group (p < 0.01). This study shows that depression is prevalent in children with physical illnesses. It is imperative that physicians be aware of this problem especially in children who have many psychosocial stressors.