European Journal of Cardiovascular Medicine

Children from tribal communities often face unique socio-cultural and environmental challenges that can significantly impact their emotional and behavioral well-being (1). Studies indicate that tribal children are disproportionately exposed to adverse childhood experiences such as poverty, inadequate healthcare access, malnutrition, and educational deprivation, all of which contribute to increased psychological distress (2,3). Emotional and behavioral disorders in children are critical public health concerns, as they influence academic performance, social relationships, and long-term mental health outcomes (4). Despite this, mental health assessment and intervention strategies tailored for tribal populations remain limited, emphasizing the need for culturally sensitive screening tools.

The Paediatric Symptom Checklist-17 (PSC-17) is a widely used, validated instrument designed to identify psychosocial problems in children aged 4 to 17 years. It is a brief parent-reported screening tool that assesses emotional, attentional, and behavioral issues, helping in early detection and intervention (5,6). The PSC-17 has demonstrated strong reliability and validity in diverse  populations, but its applicability among tribal children has

been relatively unexplored (7). Given the distinct socio-cultural background of tribal children, it is crucial to assess its effectiveness in accurately capturing their mental health concerns.

This study aims to evaluate the prevalence of emotional and behavioral problems in tribal children using the PSC-17. By identifying the primary psychological challenges faced by these children, this research seeks to inform policymakers and healthcare professionals about necessary interventions and support systems. Understanding the psychological burden in tribal populations is essential for promoting holistic child development and ensuring equitable mental health care (8,9).

This study was a cross-sectional, observational study conducted in tribal communities of Chamarajanagar District between May 2023 to December 2024. The research aimed to assess the emotional and behavioral issues in tribal children using the Paediatric Symptom Checklist-17 (PSC-17), a validated screening tool for identifying psychosocial problems in children aged 4 to 17

years. A total of 146 tribal children aged 4 to 17 years were included in the study using a convenience sampling method. The inclusion and exclusion criteria were as follows:

Inclusion Criteria:

• Children belonging to tribal communities.
• Age between 4 and 17 years.
• Parental consent obtained for participation.

Exclusion Criteria:

• Children with known psychiatric disorders already under treatment.
• Parents/guardians unwilling to provide information.

Study Tool: Pediatric Symptom Checklist-17 (PSC-17)

The PSC-17 is a parent-reported screening instrument that assesses three domains of psychosocial functioning:

1. Emotional problems subscale (5 items)
2. Behavioral problems subscale (7 items)
3. Attention problems subscale (5 items)

Each item is rated on a 3-point Likert scale:

• 0 = Never
• 1 = Sometimes
• 2 = Often

A total score of ≥ 15 is considered positive for psychosocial impairment. The cut-off scores for individual subscales

were ≥ 5 for emotional problems, ≥ 7 for behavioral problems, and ≥ 7 for attention problems.

Data Collection Procedure:

Data collection was conducted through structured interviews with parents/guardians in their native language. Trained researchers administered the PSC-17 questionnaire, ensuring clarity and cultural appropriateness. Sociodemographic details such as age, gender, socioeconomic status, and parental education were also recorded.

Statistical Analysis:

Data were analyzed using SPSS version [mention version]. Descriptive statistics were used to summarize demographic characteristics. The prevalence of emotional, behavioral, and attentional issues was determined using frequency and percentage distributions. Chi-square tests and independent t-tests were employed to assess associations between psychosocial problems and sociodemographic variables. A p-value < 0.05 was considered statistically significant.

Ethical Considerations:

The study was approved by the Institutional Ethics Committee (IEC) of CIMS, Chamarajanagar. Written informed consent was obtained from parents/guardians, and verbal assent was taken from children above 7 years. Confidentiality and anonymity of participants were strictly maintained throughout the study.

Table 1: Socio demographic Profile of children in the study

The study included 146 children, with 63.0% older than 10 years and 37.0% younger than 10 years (mean age: 11.18 ± 2.79 years). The gender distribution was slightly higher for males (53.4%) than females (46.6%). A significant proportion of fathers (34.2%) and mothers (49.3%) were illiterate. Most families (76.0%) belonged to the lower-middle-class socioeconomic group. The majority of children (95.2%) had parents living together, and 53.4% were from nuclear families. Fathers' alcohol consumption was reported in 24.7% of cases, while substance abuse was seen in 6.8%. Psychiatric illness, emotional problems,

behavioral problems, and attention problems were observed in 0.7%, 2.7%, 2.1%, and 4.8% of children, respectively.

The mean age of fathers was 36.52 ± 5.21 years, with a median of 36 years and a range of 25 to 48 years. Mothers had a mean age of 30.74 ± 5.25 years, with a median of 32 years, ranging from 20 to 47 years. Majority of children were in the 8th and 9th grades, each comprising 17.1%. Majority of children were second-born (39.7%), followed by first-born (26.7%) and third-born (26.0%). Majority of father’s were daily wage workers (53.4%), followed by farmers (21.2%) and majority of mothers were daily wage workers (48.6%).

Table 2: Factors associated with Emotional Problems

Pearson Chi-Square Tests

Emotional problems were present in 2.7% of children, all of whom were older than 10 years, though the association was not statistically significant (p = 0.120). Gender and socioeconomic status showed no significant associations. However, emotional problems were significantly associated with paternal alcoholism (p < 0.001) and substance abuse (p < 0.001), as all affected children had fathers with alcohol dependency and a history of substance use.

Table 3: Factors associated with Behavioural problems

Pearson Chi-Square Tests

Behavioral problems were identified in 2.1% of children, all of whom were older than 10 years, but this association was not significant (p = 0.180). No significant gender or socioeconomic differences were found. However, behavioral problems were significantly associated with paternal alcoholism (p = 0.002) and substance abuse (p < 0.001), with all affected children having these risk factors.

Table 4: Factors associated with Attention Problems

Pearson Chi-Square Tests

Attention problems were reported in 4.8% of children. Unlike emotional and behavioral problems, attention issues were significantly associated with gender (p = 0.011), as all cases occurred in males. No significant associations were found with age, socioeconomic status, family structure, paternal alcoholism, or substance abuse.

The present study aimed to assess the emotional and behavioral issues among tribal children using the Pediatric Symptom Checklist 17 (PSC-17). The findings indicate a low prevalence of emotional (2.7%), behavioral (2.1%), and attention problems (4.8%). However, significant associations were identified between emotional and behavioral problems with paternal alcoholism and substance abuse, while attention problems were significantly associated with male gender.

The observed prevalence rates are relatively lower compared to other studies that utilized the PSC-17 in diverse populations. For instance, a study conducted in Indonesia found that early detection using the PSC-17 was crucial in identifying children at risk of emotional and behavioral disorders, emphasizing the importance of early screening in school settings (Dewi et al., 2024) [10]. Another study conducted in Germany explored the use of the Strengths and Difficulties Questionnaire (SDQ) as a screening tool and found a higher prevalence of emotional and behavioral problems, advocating for systematic early detection strategies in pediatric care (Hense et al., 2024) [11]. The discrepancy in prevalence rates might be attributed to differences in socio-cultural contexts, sample sizes, and assessment methods.

The strong association between paternal alcoholism and both emotional and behavioral problems in the present study aligns with prior findings highlighting the adverse effects of parental substance use on child mental health (Agustina et al., 2024) [12]. Furthermore, the association of

attention problems with male gender is consistent with existing literature, where boys tend to have a higher prevalence of attention-related difficulties (Shakya et al., 2024) [13]. The absence of a significant relationship between socioeconomic status and emotional or behavioral problems contradicts some studies suggesting lower socioeconomic status as a risk factor for childhood mental health issues. However, this may be due to the homogeneity of the sample, with most participants belonging to lower-middle-class backgrounds.

While the present study provides valuable insights, it has certain limitations, including a relatively small sample size and the lack of longitudinal follow-up. Future research should aim to incorporate larger, more diverse samples and longitudinal methodologies to better understand the trajectory of emotional and behavioral problems in tribal children. Additionally, interventions targeting parental substance use may be crucial in mitigating the risk of emotional and behavioral issues in children.

Emotional and behavioral problems were significantly linked to paternal alcoholism and substance abuse. Attention problems showed a significant association with gender, being more prevalent in males. Other socio-demographic factors did not show significant relationships with emotional, behavioral, or attention issues. The findings highlight the need for targeted mental health interventions, particularly for children exposed to parental substance abuse, and emphasize the importance of early screening and community-based support systems to mitigate emotional and behavioral difficulties in vulnerable populations.

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