Referral Patterns, Pathways to Care, Symptom Profile, and Diagnoses of Children Attending a Child Psychiatry Unit in South India: A Retrospective Chart Review

Background: Childhood mental disorders are a major global concern, particularly in India. Despite efforts to establish child psychiatry services, the treatment gap persists. This study investigates referral patterns, pathways to care, and diagnostic trends among children attending a child psychiatry unit (CPU). Methods: A retrospective chart review (2017–2022) was conducted at the CPU of Kasturba Medical College, Manipal. Two investigators analyzed 1,046 files, extracting data on demographics, pathways to care, reasons for referral, and diagnoses. Inter-rater reliability was confirmed, and associations between pathways to care, diagnosis, and demographics were examined. Results: This study included children with a mean age of 11.2 years, predominantly male (63.2%). Most children (97.5%) first sought care from a healthcare provider, with 29.3% consulting mental health professionals (MHPs) and 59.6% visiting medical specialists. Primary reasons for referral included behavioral disturbances, emotional disturbances, and academic decline. Common primary diagnoses were attention deficit hyperactivity disorder (16.5%), mental retardation (14.7%), and pervasive developmental disorder (12.6%). Significant associations were found between pathways to care and diagnosis (P =.001), as well as between gender and both referral reasons (P <.001) and diagnoses (P <.001). Conclusions: The study provides insights into the demographic and clinical characteristics of children with mental health problems in India. The medical model of care pathways is a positive shift, and these findings can guide gender- and culture-sensitive service planning, optimize resource allocation, and inform future research in child psychiatry.