|
OJHAS Vol. 10, Issue 3:
(Jul-Sep 2011) |
|
|
| Factors Contributing to Psycho-Social
Ill-Health in Male Adolescents |
|
Gurpreet Singh Chhabra, Assistant Professor,
Manmeet Kaur Sodhi, Associate Professor,
Department of Paediatrics, Sri Guru Ram Das Institute of Medical
Sciences and Research, Amritsar, Punjab |
|
|
| |
|
|
|
|
|
|
Address for Correspondence |
114-A, Guru Amar Das
Avenue,
Block A, Ajnala Road,
Amritsar, Punjab.
E-mail:
doctor.manmeet@yahoo.com |
|
|
|
|
|
Chhabra
GS, Sodhi MK. Factors Contributing to Psycho-Social
Ill-Health in Male Adolescents. Online J Health Allied Scs.
2011;10(3):2 |
|
|
|
|
Submitted: Sep 30,
2011; Accepted: Oct 20, 2011; Published: Nov 15, 2011 |
|
|
|
|
|
|
|
| |
|
| Abstract: |
|
Objective: To study the prevalence
of psychosocial problems in male adolescents and find out various factors
contributing to psycho-social ill health. Methods: 500 adolescents were interviewed
using a pre-tested structured questionnaire to elicit the information
about the psychosocial problems including depression, suicidal thoughts
and suicidal attempts. Association of academic performance, family problems,
psychological problems and substance abuse was also included. Results: More than one third (39.6%)
adolescents were having psychological problems. These problems were
significantly higher in middle adolescence (14-16 years), large extended
families (> 8 members) and lower socioeconomic status. Residence
had no significant relation to psychological problems in the adolescents.
On correlation, these adolescents with psychological problems were having
significantly more academic problems, family disputes, domestic violence,
lesser number of close friends and greater substance abuse. Conclusion: Considering that male adolescents
from large families with lesser education and lower income had higher
prevalence of psychosocial problems, it is essential for health care
planners to design comprehensive family and health education programs
for the adolescents. The family support, teacher student rapport and
peer group communication should be strengthened to counteract unsafe behaviours in the adolescents.
Key Words:
Adolescents; Psychological; Substance Abuse; Family
|
|
Adolescents suffer from psychosocial
problems at one time or the other during their development. Many of
these problems are of transient nature and are often not noticed. Further
children may exhibit these problems in one setting and not in other
(e.g. home, school). Several key transitional periods (moving from early
elementary to middle school, moving from middle school to high school
or moving from high school to college) can present new challenges for
these adolescents and symptoms of dysfunction may occur. Just 40 years
ago, many physicians doubted the existence of significant depressive
disorders in children. However, a growing body of evidence has confirmed
that children and adolescents not only experience the whole spectrum
of mood disorders but also suffer from the significant morbidity and
mortality associated with them.
Ahmad et al1 (2002) reported
that the most common psychosocial problem among school going male adolescents
problem was educational difficulties found in 17.4% of the study population,
followed by substance abuse with a prevalence of 13.3% ,adding to an
overall prevalence rate of 17.9% ,but with insignificant urban and rural
differences. The prevalence was higher in lower social class IV (30.8%)
as compared to social class I (13.8%), II (12.4%) and III (18.7%).
Arun and Chavan2 (2009)
in a study on 2400 students in Chandigarh, found that 45.8% had
psychological problems, 45% reported academic decline, 24.4% students
found relationship with parents stressful while 15.4% students
found peer relationship stressful. About 8.82% of students felt life
as a burden, 6% reported suicidal ideas and 0.39% of students reported
of having attempted suicide. There was significant correlation between
student's perception of life as a burden and class they were studying
, mother's working status, psychological problems and problems students
experienced in relation to study, peers, future planning and with parents.
Adolescent depression may affect the
teen's socialization, family relations and performance at school often
with potentially serious long-term consequences. Studies have found
that 3-9% of teenagers meet criteria for depression at any one time
and at the end of adolescence, as many as 20% of teenagers report a
lifetime prevalence of depression (Zuckerbrot et al. 2006)3.
Fergusson et al4 (1977) found that 35.1% of adolescents
had major depression on at least one occasion during the age period
of 16–21 years and 3.9% reported ten or more episodes in Christchurch
(New Zealand). An increasing number of depressive episodes years were
significantly associated with higher rates of adverse mental health
outcomes including major depression, anxiety disorder, suicidal ideation
and suicide attempt.
Glied
and
Pine5(1996) found the prevalence of depression in boys was
5% whereas that in girls was 9%. Children and adolescents with high
degrees of depressive symptoms missed about 1 day more of school in
the month preceding the survey and had higher rate of smoking, bingeing
and suicidal ideation.
Maharaj et al6(2008) did
a study on secondary school students aged 13-19 years in Trinidad and
found prevalence of depression as 25.3% ± 2.37% and revealed statistically
significant associations between depression and the categories of age,
gender, living arrangements and school type. Similar findings were observed
for respondents who admitted to cigarette and alcohol use or being injured
by their parent (p<0.05). He saw that females were 1.7 times as
likely to be depressed when compared with males; respondents not living
with both parents were 1.5 times as likely to be depressed as those
who were living with their parents . Adolescents reporting that they
were afraid of parents or of being injured by parents were three times
as likely to be depressed as who had not had those experiences.
Malhotra and Das7
(2005) found that depression in adolescents is a severe disorder
and adolescents appear to be a special group in terms of
consequences of poor psychosocial and academic outcome, increased risk
of substance abuse and suicide.
Suicidal behaviour amongst adolescent
students is a matter of great concern due to the tragic loss of prime
years of life it entails. The true magnitude of suicide as a public
health problem is not clear in India. In the last two decades, official
figures of suicide rate have increased from 7.9 to 10.3 per 100,000
in India as reported by Vijaykumar et al(2007).8 The actual number of suicides is understandably more than the reported
official figures as non-reporting, under-reporting and misclassification
are prevalent due to various socio-cultural stigmas, religious sanctions,
legal issues and insufficient registration systems.
Kar9 (1996) studied 149
suicide attempters and found that male to female ratio was around 1:3
in adolescents and most of the attempters were from rural areas. The
attempters reported childhood trauma, had addiction, wrote suicide notes
and took alcohol before the attempt. Most attempters belonged to extended
families, and most of them had expressed suicidal ideas before the actual
act. Most of the attempters had a middle socioeconomic status
(SES) amongst which the majority (86.8%) were of lower-middle socio-
economic status.
Sharma et al10 (2008) found
15.8% adolescents having thought of attempting suicide while 5.1% had
actually attempted suicide, both being more in females than in males.
Statistically significant associations were observed with the age of
the student, living status of parents, working status of mother and
whether the student was working part-time.
A cross-sectional study was conducted
in schools and colleges located in rural and urban field practice areas
of Department of Paediatrics, Sri Guru Ram Das Hospital, Amritsar. A
total of 500 male adolescent students from age 12-18 years were selected
by systemic random sampling so that 250 males were from rural areas
and 250 were from urban areas.
The families of adolescents were divided into 3 groups based on total
number of family members (< 4 family members, 4-8 family members
and >8 family members). Socio-economic status was evaluated on the basis of Kuppuswamy’s socioeconomic index
which is an important tool in hospital and community based research
in India. The study tool consisted of self developed, semi structured
proforma containing questions regarding adolescents’ socio demographic
background and adolescents’ school, family, psychosocial and personality
problems and history of substance abuse. The data was collected and
analyzed using SPSS-17. Multivariate analysis of association was also
done between school, family, psychosocial, substance abuse and sexual
activity among themselves using chi square test. For all statistical
tests, a p-value of >0.05 was considered non significant, a p-value
of <0.05 was considered significant and a p-value of <0.001 was
considered highly significant.
Table 1 shows that about 39.6% adolescents
experienced loneliness and depression. Out of them, majority (66.7%)
had occasional depression but 33.3% were persistently depressed. Family
was the most common contributory factor (59.6%) cited by adolescents
with depression. 20.4% adolescents had suicidal thoughts but out of
them, only 13.8% had actually attempted it in comparison to 86.2% males
who made no suicidal attempts.
|
Table 1:
Distribution of Psychological Problems of Male Adolescents in Study Group |
|
Variable |
Subgroup |
Number of adolescents |
Percentage |
|
Loneliness/depression (n=500) |
Yes |
198 |
39.6 |
|
No |
302 |
60.4 |
|
If
yes, whether (n=198) |
Persistent |
66 |
33.3 |
|
occasional
|
132 |
66.7 |
|
Cause
of depression (n=198) |
Family |
118 |
59.6 |
|
Teachers |
32 |
16.1 |
|
Friends |
39 |
19.7 |
|
Unknown |
9 |
4.6 |
|
Suicidal
thoughts (n=500) |
Yes |
102 |
20.4 |
|
No |
398 |
79.6 |
|
Suicidal
attempts (n=102) |
Yes |
14 |
13.8 |
|
No |
88 |
86.2 |
Table 2 shows that more than one third
(39.6%) adolescents were having psychological problems. These problems
were significantly higher in middle adolescence (14-16 years), large
extended families (> 8 members) and lower socioeconomic status. Residence
had no significant relation to psychological problems in the adolescents.
Maximum (62%) number of psychological problems were in adolescents in
age group 14-16 years in comparison to 16-18 years (18.0%) and this
was statistically highly significant (p<0.001).Psychological
problems were found in 39.2% urban adolescents and 40% rural adolescents
and this was not significant statistically (p>0.05). Maximum psychological
problems were in adolescents with family size >8 members (60.0%)
as compared to family size <4 members (12.6%) which was statistically
highly significant (p<0.001).Maximum psychological problems were
in lower socioeconomic status (68.4%) as compared to upper (23.7%) and
middle (22.3%) socioeconomic status. p value was highly significant
(p<0.001).
|
Table 2:
Socio Demographic Profile of Male Adolescents with Psychological Problems |
|
Variable |
Subgroup |
Number of adolescents with psychosocial
problem |
Percentage |
Statistical analysis |
|
Age group |
12-14 years (n=145) |
46 |
31.7 |
HS |
|
14-16
years (n=200) |
124 |
62 |
|
16-18
years (n=155) |
28 |
18.0 |
|
Residence |
Urban(n=250) |
98 |
39.2 |
NS |
|
Rural
(n=250) |
100 |
40 |
|
Total
family members |
<4 (n=103) |
13 |
12.6 |
HS |
|
4-8 (n=257) |
101 |
39.2 |
|
>8
(n=140) |
84 |
60.0 |
|
Socioeconomic
status |
Upper SES (n=101) |
24 |
23.7 |
HS |
|
Middle
SES (n=215) |
48 |
22.3 |
|
Lower
SES (n=184) |
126 |
68.4 |
Psychological problems were higher in adolescents with academic stress
(p<0.05), Family dispute (p<0.001), domestic violence (p<0.001) and having no
close friends (p<0.001). Substance abuse was also related to psychological
problems (p<0.05).
|
Table 3:
Association of Psychological Problems with Other Adolescent Problems |
|
Variable |
Sub group |
Number of adolescents with psychosocial
problems (n=198) |
Percentage |
Statistical analysis |
|
Academic problems |
Yes (n=319) |
140 |
43.8 |
S |
|
No (n=181) |
58 |
32.0 |
|
Family
dispute |
Yes (n=165) |
95 |
57.5 |
HS |
|
No (n=335) |
103 |
30.7 |
|
Domestic
violence |
Yes (n=145) |
98 |
67.5 |
HS |
|
No (n=355) |
100 |
28.1 |
|
Close
friends |
Yes (n=309) |
83 |
26.8 |
HS |
|
No (n=191) |
115 |
60.2 |
|
Substance
abuse |
Yes (n=94) |
50 |
53.1 |
S |
|
No (n=406) |
148 |
36.4 |
Table 1 shows that in our study of
500 male adolescents, 198 (39.6%) male adolescents had experienced loneliness
and depression and out of these depressed males, 66 (33.3%) had persistent
depression and 132 (66.7%) had occasional depression. The most important
contributor to adolescent depression was family seen in 118(59.6%) males
followed by friends (19.7%) and teachers (16.1%). Depression may have
an etiological role in a range of adverse mental health outcomes in
future and our study supports the results found in another survey conducted
by Maharaj et al6(2008) and Fergusson et al4
(1977) in Trinidad and New Zealand respectively establishing the importance
of developing effective methods for identifying, managing
and treating depressive
episodes in adolescence.
Table 1 also shows that a total of
398 (79.6%) adolescents reported no suicidal ideation whereas 102 (20.4%)
expressed suicidal ideation but out of them, only 14 males had actually
attempted suicide in our study. The same finding was also seen in the
Indian studies by Sharma et al10
(2008), Logaraj et al11
(2005) and Lalwani et al12
(2004) who observed a similar range for the prevalence of suicidal ideations.
In western literature, Bearman et al13 (2004) mentions that
it is expected that suicidal ideation is about three times more prevalent
compared to actual suicide attempts.
This was confirmed by the findings from the present study. It has been
mentioned that suicide is rare before puberty but the rate begins to
rise sharply after the age of 14 years. Teenagers in the late stage
of adolescence are likely to be experiencing more stress and emotional
turmoil as they face the threshold of adulthood. In this period, rising
expectations and responsibilities may create pressures for many of them
leading to suicidal ideation in the adolescents.
Table 2 shows the socio demographic
risk factors of adolescents with psychological problems. In our study,
62% of male adolescents were having psychological problems in middle
age group of 14-16 years in comparison to early (31.7%) and late (18%)
age groups. Ahmad et al1 (2002) also found the rising trend
of psychological problems with age. The 14-16 years age group faces
the transition stress of moving from junior high school to college leading
to adjustment problems. Both rural (40%) and urban (39.6%) adolescents
were having psychological problems in almost equal numbers and no significant
difference was observed. Maximum psychological problems were in adolescents
with extended families (60%) of size more than 8 members as compared
to nuclear families (12.6%) having less than 4 members as also found
by Kar9 (1996) in Cuttack. About 68.4% of male adolescents
of low socioeconomic status were having psychological problems in comparison
to 23.7% of adolescents belonging to upper socioeconomic status. Ahmad
et al1 (2002) also had a similar observation in his study
in Aligarh showing 30.8% adolescents of lower social class IV having
psychological problems as compared to 13.8% adolescents in upper social
class I. This could be because of the fact that negative factors like
malnutrition, illiteracy, ignorance and negligence which may exaggerate
psychological problems are more prevalent in lower socioeconomic status.
Table 3 shows the association of psychological
problems with other adolescent problems. On multivariate analysis, psychological
problems were higher in adolescents with academic problems (43.8% v
32%), family dispute (57.5% v 30.7%), domestic violence (67.5% v 28.1%)
and in teenagers with substance abuse (53.1% v 36.4%) and no close friends
(60.2% v 26.8%). Adolescents in schools who have academic decline loose
confidence, become discouraged and decrease their effort to study further.
Grade failure cause children to be older than their same grade peers
which will eventually affect their self confidence negatively leading
to serious consequences if left untreated and similar findings were
shared by Havas et al14 (2009) in Netherland. Children
need a stable environment to assist them in learning and circumstances
like family dispute, domestic violence, single parent and divorce affect
adolescents performance at school as reported by Kernic et al15(2002)
in USA. Arguments between parents and children increase considerably
during adolescence and it is the peer group that provides emotional
support to the adolescents. Having few or no close friends make adolescents
feel anxious and depressed thus causing increased number of psychological
problems. These adolescents are more likely to get engaged in health
impairing behaviours like smoking, drinking and substance abuse as was
also found by Ahmad et al1 (2002) in Aligarh.
Accepting
and supportive family relationships during adolescence may have long-term
associations with psychosocial functioning into adulthood .Considering
that male adolescents from large families with lesser education and
lower income had higher prevalence of psychosocial problems, it is essential
for health care planners to design comprehensive family and health education
programs for the adolescents.
- Ahmad A, Khalique
N, Khan Z, Amir A. Prevalence of psychosocial problems among school
going male adolescents. Indian J Community Med 2007;32(3):219-221
- Arun P, Chavan BS. Stress and suicidal
ideas in adolescent students in Chandigarh. Indian J Med Sci. 2009;63(7):281-287.
- Zuckerbrot RA, Jensen
PS. Improving recognition of adolescent depression in primary care.
Arch Pediatr Adolesc Med. 2006;160(7):694-704.
- Fergusson
DM, Boden JM, Horwood LJ.
Recurrence of major depression in adolescence and early adulthood, and
later mental health, educational and economic outcomes.
Br J Psychiatry
2007;191:335-342.
- Glied S, Pine DS.
Consequences
and Correlates of Adolescent Depression. Arch Pediatr Adolesc Med 2002;156:1009-1014.
- Maharaj RG, Alli F, Cumberbatch K,
Laloo P, Mohammed S, Ramesar A, Rampersad
N, Roopnarinesingh
N, Ramtahal
I. Depression among adolescents,
aged 13-19 years, attending secondary schools in Trinidad: prevalence
and associated factors. West Indian Med J. 2008;57(4):352-359.
- Malhotra S, Das PP. Understanding
childhood depression. Indian J Med Res. 2007 Feb;125(2):115-128
- Vijayakumar L. Suicide and
its prevention: The urgent need in India. Indian J Psychiatry 2007;49:81-84.
- Kar N. Profile of risk factors associated
with suicide attempts: A study from Orissa, India. Indian J Psychiatry
2010;52(1):48-56.
- Sharma R, Grover VL, Chaturvedi
S. Suicidal behavior amongst adolescent students in south Delhi. Indian
J Psychiatry 2008;50(1):30-33.
- Logaraj M, Felix JW, Vedapriya DR.
Attempted suicide in adolescents reported at a medical college hospital
in Tamilnadu-some observations. Indian J Prev Soc Med 2005;36:68-72.
- Lalwani S, Sharma GS, Kabra SK,
Girdhar S, Dogra TD. Suicide among children and adolescents in South
Delhi (1991-2000). Indian J Pediatr 2004;71:701-703
- Bearman PS, Moody J.
Suicide and friendships among American adolescents. Am J Public Health 2004;94:8
- Havas J, Bosma H, Spreeuwenberg C, Feron FJ. Mental health problems of Dutch adolescents:
the association with adolescents’ and their parents’ educational
level. European Journal
of Public Health 2010;20(3):258-264.
- Kernic MA, Holt VL, Wolf ME, McKnight B, Huebner CE, Rivara FP. Academic and School Health Issues Among Children
Exposed to Maternal Intimate Partner Abuse. Arch Pediatr Adolesc Med. 2002;156(6):549-555.
|
