Study: Integrate psychiatric assessment into cleft-care protocols
Abdul Wahab Khan
Panaji : A study has found that more than half of the children with cleft lip and/or palate assessed at Goa Medical College (GMC) had at least one psychiatric condition, with anxiety, adjustment disorders and depression among the problems identified, highlighting the need to integrate mental-health support into treatment for congenital facial conditions.
A cleft is a birth defect in which the upper lip, the roof of the mouth (palate), or both do not fuse completely during early development before birth.
Besides affecting feeding, speech, hearing and dental development, the condition can expose children to bullying, social stigma and emotional difficulties. The study, published in 2026 in Child and Adolescent Psychiatry and Mental Health, was conducted by Ajay Aditya Aadhi Mani and Aksha Gaunekar of the Department of Psychiatry, Institute of Psychiatry and Human Behaviour, Goa Medical College, Bambolim.
The researchers followed children and adolescents aged up to 18 years attending a multidisciplinary cleft clinic between January 2022 and September 2024.
Of the 224 patients registered, 210 met the study’s inclusion criteria. Psychiatric comorbidities were identified in 112 children, accounting for 53.3 per cent of the study group. Anxiety disorders were the most common, affecting 17.1 per cent of participants, followed by adjustment disorders at 11.4 per cent, specific learning disorders at 9.5 per cent and depressive disorders at 8.6 per cent. Attention-deficit/hyperactivity disorder was identified in 6.7 per cent.
The study also found an association between psychiatric morbidity and discontinuity in treatment. Psychiatric conditions were identified in 65 per cent of children who dropped out of follow-up, compared with 42.7 per cent of those who attended regularly. Overall, 45.7 per cent maintained regular follow-up, 25.7 per cent attended irregularly and 28.6 per cent dropped out.
The researchers cautioned that these findings establish an association rather than proving that mental-health conditions directly caused children to discontinue care.
Socioeconomic circumstances also appeared to influence attendance. Children from lower-income households, those whose mothers had less formal education and those from rural areas were more likely to experience irregular follow-up or disengage from treatment.
The integrated service at GMC combined psychiatric screening, counselling, parent guidance and treatment for identified conditions with multidisciplinary cleft care. The researchers reported that “all children with identified psychiatric morbidity received at least one mental health intervention”. Psychoeducation and parent guidance were among the most frequently provided interventions.
The integrated model demonstrated strong service-delivery outcomes. All 210 enrolled children completed baseline psychiatric screening, and all 112 children diagnosed with psychiatric morbidity received at least one mental health intervention.
Among 150 caregivers who provided feedback, 94.7 per cent expressed satisfaction with the integrated approach, while 11.3 per cent reported dissatisfaction or unmet expectations, mainly related to practical difficulties such as travel and time.
The researchers concluded that “Embedding mental health services within multidisciplinary cleft care is feasible and acceptable in LMIC settings”. They advocated integrating psychiatric assessment and intervention into routine cleft-care protocols to improve continuity and address children’s psychological needs alongside surgical and rehabilitative treatment.
The researchers said that integrating psychiatric assessment, counselling and coordinated interventions into routine cleft services could help address psychological difficulties, reduce stigma and improve continuity of care.
However, the study was conducted at a single centre, and the authors acknowledged that its findings may not be generalisable to every cleft-care setting.
