# Integrating mental health assessment and intervention into cleft care: a prospective cohort study from a tertiary clinic in India

## TL;DR

This study shows that integrating mental health care into cleft treatment in India improves patient engagement and reduces stigma.

## Contribution

The study demonstrates the feasibility and acceptability of integrating mental health services into cleft care in a low- and middle-income country setting.

## Key findings

- Psychiatric comorbidity was identified in 53.3% of participants.
- Integrated mental health services were associated with improved follow-up continuity and reduced perceived stigma.
- Younger age and higher socioeconomic status correlated with better follow-up rates.

## Abstract

CLP is a complex congenital anomaly with considerable psychosocial and medical implications. Despite recognised psychiatric co morbidity, mental health integration in cleft services remains uncommon in LMICs. This study prospectively evaluated a psychiatry-integrated multidisciplinary cleft clinic in a public tertiary hospital in India.

Consecutive patients aged ≤ 18 years attending a psychiatry-integrated multidisciplinary cleft clinic at Goa Medical College (January 2022–September 2024) were prospectively followed for 12 months. Psychiatric screening was conducted using the Strengths and Difficulties Questionnaire, followed by disorder-specific assessments where indicated, with diagnoses formulated according to ICD-10 criteria. Follow-up continuity was categorised as regular, irregular, or dropout (≥ 90-day lapse). Feasibility and acceptability of the integrated model were assessed using predefined service-delivery indicators and structured caregiver feedback.

Of 224 registered patients, 210 met the inclusion criteria (mean age 9.8 ± 4.3 years; 56.2% male). Regular, irregular, and dropout follow-up rates were 45.7%, 25.7%, and 28.6%, respectively. Psychiatric comorbidity was identified in 53.3% of participants and was significantly associated with follow-up status (p = 0.009), with a higher prevalence among irregular attendees and dropouts. Better follow-up continuity was significantly associated with younger age, higher maternal education, higher socioeconomic status, urban residence, and completion of planned surgical milestones. Speech therapy involvement differed significantly across follow-up groups (p = 0.002), with higher engagement among irregular attendees and dropouts, whereas hearing impairment showed no association with follow-up (p = 0.48).From a feasibility perspective, 93.8% of registered patients were enrolled, baseline psychiatric assessment was completed for all participants, and all children with identified psychiatric morbidity received at least one mental health intervention. Caregiver feedback (n = 150) indicated high satisfaction with integrated care and perceived stigma reduction; dissatisfaction was infrequent (11.3%) and primarily related to logistical barriers.

Embedding mental health services within multidisciplinary cleft care is feasible and acceptable in LMIC settings and is associated with improved engagement and continuity of care. Structured psychosocial assessment and coordinated interventions may help address psychiatric morbidity and support sustained participation in cleft care.

The online version contains supplementary material available at 10.1186/s13034-026-01040-5.