Patel, Srividya J, Kumar D R, and Suresh V C: Assessment of mental health status among adolescent school children in Karnataka


Introduction

Adolescence a transition from childhood to adulthood, is the period of rapid physical, sexual, and psychological growth. Often addressed as teens, they are young people aged between the age of 10 and 19 years. Adolescents in India constitute a quarter of the country’s population which is approximately 243 million, which in turn constitutes 20% of the world’s 1.2 billion adolescents.1 About half of all lifetime mental disorders begin before the age of 14 years, although first detected later in life and account for 16% of global burden of disease and injury among adolescents2, 3 A meta-analysis of 41 studies conducted between 1985 and 2012 in 27 countries estimated a global prevalence of mental disorders in children and adolescents of 13%.4 The prevalence of childhood psychiatric disorders in India have been found to be 7% in the community and 23% in schools.5, 6 Nevertheless, most cases go undetected and untreated. Poor mental health is strongly related to other health and development concerns in young people - lower educational achievements, substance abuse, violence, poor reproductive and sexual health. According to present estimates by WHO, mental illnesses are the leading causes of DALYs worldwide, accounting for 37% of healthy years lost from non-communicable diseases. Worldwide, first main cause of YLD (Years Lived with Disability) for 10- to 24-year-olds was neuropsychiatric disorders (45%).7 Hence the present study was conducted with an intension to –

  1. To assess the mental health status of adolescents in Karnataka.

  2. To determine the prevalence of abnormal mental health status among adolescents in Karnataka,

-such that further interventions can be done in terms of detection/diagnosis, management, prevention and promotion of better mental health.

Materials and Methods

A cross-sectional study was conducted in a private co-educational institution in Chikkaballapura district, Karnataka, between March to September 2019 on 375 adolescent school children from class 5 to 9, aged between 10-15 years. Students were interviewed using a pretested, validated, semi structured questionnaire after obtaining informed assent from the school administrators and the primary care givers. Institutional ethical clearance was obtained.

The questionnaire consisted of socio-demographic details. Assessment of mental health status was done using a questionnaire which consisted of 41 questions, covering 4 different domains - Educational factors included questions on: scholastic performances, extracurricular activities; Physical health factors included questions on: physical appearance, sight or earing problems, appetite; Emotional factors included questions on: aggressive behaviour, substance abuse, mood swings, often feeling lonely, disinterested; Social factors included questions on: social interactions, conflicts with friends, family or neighbours. Students were asked to respond to the questions based on their experience in the last one month. Scores of negatively framed questions were reversed and counted. Overall, the scores ranged between 0 to 41. Further the scores were regrouped as normal (> 30), borderline (15-30) and abnormal (<15), overall and also under each domain. Results were interpreted as: Higher the scores better the mental health status of the student.

Statistical analysis

Data was analyzed using SPSS software version 24. Association between two proportions was accepted as significant when p value was less than 0.05, using chi square test.

Results

Out of 375 participants, 183 (48.8%) were girls and 192(51.2%) were boys with majority in the age group of 12-14 years. Overall, mean age of the study subjects was 12.7 yrs. Majority were Hindu by religion. Around 54% of the girls’ parents were well-educated (degree holders or post graduate and above) whereas around 34% of the boys’ parents were well-educated (degree holders or post graduate and above).

Overall, 12.5% of adolescents had abnormal mental health status, which was more among girls (15.4%) as compared to boys (9.9%). Around 70% of the adolescents had Borderline mental health status, which was more among boys (76%) as compared to girls (62.8%), (p <0.01) (Table 1). Overall, physical health domain was most affected (17.3%), followed by educational (15%) and emotional factors (13.6%) (Table 2). Educational factors were most affected among boys (17.7%-abnormal) as compared to girls (12%-abnormal) and this difference was found to be statistically significant. Similarly, physical health factors were most affected among girls (20.2%- abnormal) as compared to boys (14.6%- abnormal) p< 0.001 (Table 3). Both boys and girls were equally affected in emotional factors. Social factors were least affected among both the genders.

Table 1

Gender-wise distribution of mental health status among adolescents

Mental health status

Girls (N=183) n (%)

Boys (N=192) n (%)

Total n (%)

p value

Normal

40 (21.8)

27 (14.1)

67 (17.8)

0.021

Borderline

115 (62.8)

146 (76)

261 (69.6)

Abnormal

28 (15.4)

19 (9.9)

47 (12.5)

Total

183

192

375

Table 2

Domain-wise distribution of mental health status among adolescents

Domain

Frequency n (%), where N= 375

1. Educational factors:

Normal

115 (30.6)

Borderline

204 (54.4)

Abnormal

56 (15)

2. Physical health factors:

Normal

82 (21.8)

Borderline

228 (60.8)

Abnormal

65 (17.3)

3. Emotional health factors:

Normal

84 (22.4)

Borderline

240 (64)

Abnormal

51 (13.6)

4. Social factors:

Normal

107 (28.5)

Borderline

248 (66)

Abnormal

20 (5.3)

Table 3

Gender-wise distribution of mental health status under different domains

Domain

Girls (N=183)

Boys (N=192)

p value

1. Educational factors:

n (%)

n (%)

Normal

67 (36.6)

48 (25)

0.034

Borderline

94 (51.4)

110 (57.3)

Abnormal

22 (12)

34 (17.7)

2. Physical health factors:

Normal

26 (14.2)

56 (29.2)

0.0018

Borderline

120 (65.5)

108 (56.2)

Abnormal

37 (20.2)

28 (14.6)

3. Emotional factors:

Normal

38 (20.8)

46 (24)

0.746

Borderline

119 (65)

121(63)

Abnormal

26 (14.2)

25 (13)

4. Social factors:

Normal

51 (27.9)

56 (29.2)

0.96

Borderline

122 (66.7)

126 (65.6)

Abnormal

10 (5.5)

10 (5.2)

Discussion

Our study revealed that 12.5% students had abnormal mental health status, which is similar to a study conducted by Harikrishnan et al.8 and Nair et al.,9 wherein one tenth (10%) and 15% of the adolescents had some mental health issues, respectively. Furthermore, abnormal mental health status was more among adolescent girls i.e,15.4%, which is similar to a study conducted by Smitha et al., wherein prevalence of mental health disorders among adolescent girls was found to be 15.5%. This could be because, boys may have more difficulties in acknowledging their mental health problems and tend to mask their mental health problems by acting out their difficulties in the form of aggression, resulting in more externalising disorders that are problematic for others such as antisocial personality disorders and substance abuse or dependence.3 This also affects their scholastic performance, explaining why educational factors were most affected among boys (17.7%-abnormal) as compared to girls (12%-abnormal). Another study by Nair et al.9 also states that conduct disorders, peer problems and hyperactivity were more predominant in boys.

The lower self-esteem of adolescent girls when compared to boys in the same age group, and their anxiety over their body-image is known to result in a higher prevalence of internalizing disorders such as depression, anxiety and eating disorders. This explains why physical health factors were most affected among girls (20.2%-abnormal) as compared to boys (14.6%-abnormal).

Emotional factors were equally affected among both the genders, although the difference is not statistically significant. This is in contrast to a study by Nair et al.9 which states that emotional problems were more common in girls. Girls are expected to be more emotionally sensitive,10 suffer more from stressors which involve significant others such as the death of friends or relatives,11 experience more restricted gender roles and body dissatisfaction12, 13 ruminate more as a coping strategy, experience more family violence, abuse and school performance pressure.

Social factors like social interactions, family disputes were less compared to other studies. This could be because of the better socio-economic status of the families and better curriculum and exposure at the school campus (ICSE board affiliated).

Conclusion

Considering the prevalence of mental health problems among adolescents, it is evident that a policy for improving adolescent mental health is the need of the hour. Biological gender differences and the different societal expectations towards boys and girls which are related to mental health problems call for effective mental health promotion strategies that are adapted to the needs of boys and girls

Integration of childhood and adolescent mental health in primary health care is necessary. Adolescent Reproductive and Sexual Health (ARSH) clinics should also focus more on mental health conditions.

Also the problem needs to be addressed with well-defined school-based intervention programs life skill–based education (LSBE) in the regular curriculum, counseling services, mentorship program and health education along with Teachers’ orientation programs.

Source of Funding

None.

Conflict of Interest

The authors declare that there is no conflict of interest.

References

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T Haugen BT Johansen Y Ommundsen The role of gender in the relationship between physical activity, appearance evaluation and psychological distressChild Adolesc Ment Health2014192430

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Article History

Received : 15-06-2021

Accepted : 21-06-2021

Available online : 12-07-2021


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https://doi.org/10.18231/j.ijfcm.2021.013


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