Introduction:
Every child has all the rights to a safe childhood and a life free from violence. The experience of child abuse and neglect infringe upon that right. Adolescence is a crucial period for developing and maintaining social and emotional habits, important for mental well-being. These include adopting healthy sleep patterns; taking regular exercise; developing coping, problem-solving, and interpersonal skills; and learning to manage emotions. Supportive environments in the family, at school and in the wider community are also important.[1] An estimated 10–20% of adolescents globally experience mental health conditions, yet these remain underdiagnosed and undertreated. According to WHO reports,
multiple factors determine mental health outcomes. The more risk factors adolescents are exposed to, the greater the potential impact on their mental health. Other important determinants include the quality of their home life and relationships with peers. Violence (including harsh parenting and bullying) and socioeconomic problems are recognized risks to mental health.[1]
The WHO defines physical abuse as intentional use of physical force against the child that results in – or has a high likelihood of resulting in – harm for the child's health, survival, development or dignity. This includes hitting, beating, kicking, shaking, biting, strangling, scalding, burning, poisoning and suffocating. Much physical violence against children in the home is inflicted with the object of punishing.[2] The ministry of women and child department, Government of India, explored
through a study in 2007 across the 13 states in India, and the study stipulated that a critically high percentage of children in state run schools i.e., 53.8%,
faced corporal punishment.[3] In a study by Daral S etal, [4], of 1060
adolescents, majority were in mid-adolescence and approximately 70% study subjects were victims of at least one form of maltreatment and 42.6% of adolescents exposed to physical abuse.[4]
According to WHO report, one in six people aged 10–19 years show
mental disease and injury. Of all mental health conditions, 50% trigger by 14 years of age but most cases are unexplored and not treated.[1] Globally, illness and disability and also death rates due to depression among adolescents (15-19 year olds) is very high. The mental health conditions not treated in time will lead to severe mental health conditions in adulthood.[1] According to WHO report globally 10-20% of adolescents suffer with mental health conditions, unipolar depressive disorder
being more common among adolescents. Childhood ill-treatment will cause severe mental health disorders in adolescents. Suicide is a major risk
from depression and it is the second main cause for the death. Depression also causes severe social and educational disability.
Victims of physical, sexual, psychological abuse in children are highly associated with adolescent depression around the world,
as also in India.[1]
The present study examined physical abuse in primary and secondary school going adolescents and its relation with depression in Belagavi, in
Karnataka state and attempted to understand the correlation between physical abuse and depression among school going adolescents (10 -16 years age) in Belagavi.
Objectives of the study:
- To estimate the prevalence of physical abuse among school going adolescents (10 to 16 years age) in Belagavi.
- To estimate the prevalence of depression due to physical abuse among school going adolescents (10 to 16 years age) in Belagavi.
- To find out the correlation between physical abuse and depression among school going adolescents in Belagavi.
Materials and Methods
Design and setting:
The study was conducted in eight schools in Belagavi city using descriptive cross sectional research design. It included
primary and secondary schools of Belagavi.
Sample:
This comprised school children of primary and secondary grades selected by stratified cluster random sampling. Belagavi city was divided into four strata, North, East, South, and
West, 2 schools were randomly selected from each of the four strata. Eight schools having the maximum enrolment in each zone were selected and adolescents from these schools in the age group of 10-16 years were included in the study. The sample size was calculated to estimate a prevalence rate of physical abuse of 42.6% [4], and the required sample size was 785 students.
Tools for data collection:
Tool I: Sociodemographic questionnaire was used to collect
data about socio-demographic characteristics of the study participants such as age, sex, type of family, mother and father education and occupation, income etc.
Tool II: Physical abuse interview tool, to find out prevalence of physical abuse at home with the methods of physical abuse such as hitting beating, with the hand and also with objects, chocking, burning, locking in small place, etc. It contained 10 questions to be answered, with criteria 0 (never), 1(sometimes), 2(most of the times).
Tool III: Modified Kutcher Adolescent Depression Scale was used to find out levels of depression, 5 questions were included with criteria 0 (never), 1 (sometimes), 2 (most of the times). Total scores at above and 5 suggested for possible depression.
The reliability of the tool was assessed by test-retest method, the reliability value was 0.82. There was very high correlation coefficient and it was a good tool for identifying the physical abuse and levels of depression among adolescents.
Pilot study: The pilot study was carried out on sample of adolescents from other schools to test the clarity and reliability of the tool and feasibility of the tool. The tool was tested and necessary changes were done in the form of re-phrasing of some items. The pilot study participants were not included in the main study sample frame.
Field work: Institutional ethical clearance was obtained from Institutional Ethical Committee before the start of the study, also permission was obtained from office of the Directorate of Education (DDPI) of Belagavi District. Permission letter was also obtained by the all school headmasters, and consent from parents and assent from the study participants were obtained. The investigator met with students in the class room and explained the purpose of the study, and distributed the questionnaire forms to be completed.
Inclusion criteria
- Primary and secondary school going adolescents of aged 10-16 Years.
- Adolescent students who are willing to participate in the study.
- Adolescent students present at time of data collection.
Exclusion criteria
- Those Students whose parents declined to provide the informed consent.
- Students with cognitive, neurological, psychological and endocrinal disorder
Data analysis: The data were analyzed by using Karl Pearson’s Correlation Coefficient to find out the correlation between physical abuse and depression among school going adolescents. The software used was Statistical Package for the Social Sciences Version 20.
Duration of the study: The time duration of the present study was two years, December 2017 to December 2019.
Results:
The socio-demographic characteristics of the study population are presented in Table 1. It shows that participants in this study belong to the age group of 10-16 years, the maximum students 359(45.73%) were in the age group of 15-16 years, followed by 273(34.78%) in the 13-14 years age group and 153(19.49%) students were 10-12 years old. The male to female ratio was 84.08:15.92 among the 785 study participants. In the present study, 653(83.18%) were from nuclear family and 132(16.82%) were from joint family. Out of 785 participants, most were 662(84.33%) Hindu, 90(11.20%) were of other religion, and 33(4.25%) were of Muslim religion. Out of 785 adolescents, 320(40.76%) fathers had completed higher secondary education, 220(28.03%) had completed secondary education, 107(13.63%) had completed primary education, and 78 of them had completed degree and 60 of them were illiterates. Out of 785 adolescents, 378 (48.15%) mothers had completed secondary education, 213(27.13%) completed higher secondary, 117(14.90%) completed primary education, and 29 had completed degree and 48 were illiterates. Out of 785 adolescents, 316(40.25%) fathers were self-employed, 258(32.87%) private employees, 186(23.69%) were farmers, and 13 (1.66%) government employees, 12 fathers (1.53%) were professionals. Out of 785 adolescents, 344(43.82%) mothers were self-employed, 250(31.85%) private employees, 143(18.22%) were farmers, and 27 (3.47%) professionals, 21 mothers (1.53%) were housewives. Total of 492 (62.68%) participant families were having 6001-8000 rupees income per month, 144(18.34%) participants had more than Rs. 8000 income, 121(15.41%) participants had Rs. 4000-6000 and 28(3.57%) participants had Rs. 2000-4000 income, and none of them had above 8000 rupees income per month. Out of 785 adolescents, 546(69.55%) of adolescents were having 2 siblings, 228(29.04%) had three or more siblings, 11 (1.40%) had only one sibling.
| Table 1: Socio-demographic characteristics of school going adolescents (N=785) |
| Socio demographic characteristics |
No of respondents |
% of respondents |
Age groups |
10-12yrs |
153 |
19.49 |
13-14yrs |
273 |
34.78 |
15-16yrs |
359 |
45.73 |
Gender |
Male |
660 |
84.08 |
Female |
125 |
15.92 |
Types of family |
Nuclear |
653 |
83.18 |
Joint |
132 |
16.82 |
Religions |
Hindu |
662 |
84.33 |
Muslims |
33 |
4.20 |
Others |
90 |
11.46 |
Residence |
Rural |
469 |
59.75 |
Urban |
316 |
40.25 |
Fathers education |
Illiterates |
60 |
7.64 |
Primary |
107 |
13.63 |
Secondary |
220 |
28.03 |
Higher secondary |
320 |
40.76 |
Degree |
78 |
9.94 |
Mothers education |
Illiterates |
48 |
6.11 |
Primary |
117 |
14.90 |
Secondary |
378 |
48.15 |
Higher secondary |
213 |
27.13 |
Degree |
29 |
3.69 |
Fathers occupation |
Farmer |
186 |
23.69 |
Government employee |
13 |
1.66 |
Self Employed |
316 |
40.25 |
Private Employee |
258 |
32.87 |
Professional |
12 |
1.53 |
Mothers occupation |
Farmer |
143 |
18.22 |
Self Employed |
344 |
43.82 |
Private Employee |
250 |
31.85 |
Professional |
27 |
3.44 |
Housewife |
21 |
2.68 |
Monthly family income |
Rs.2001-4000 |
28 |
3.57 |
Rs.4001-6000 |
121 |
15.41 |
Rs.6001-8000 |
492 |
62.68 |
More than Rs.8000 |
144 |
18.34 |
No of siblings |
One |
11 |
1.40 |
Two |
546 |
69.55 |
Three and plus |
228 |
29.04 |
Total |
785 |
100.00 |
Table 2 shows that out of total 785 study subjects, 444(56.56%) had got exposed to moderate physical abuse, 196 (24.97%) had got exposed to low physical abuse, and 145(18.47%) had got exposed high level of physical abuse at home.
| Table 2: Overall Distribution of adolescent students with respect to Prevalence of physical (N=785) |
| Levels of physical abuse |
No of respondents |
% of respondents |
Mild physical abuse |
196 |
24.97 |
Moderate physical abuse |
444 |
56.56 |
Severe physical abuse |
145 |
18.47 |
Total |
785 |
100% |
Table 3 shows that out of 785 study subjects, 768 (97.83%) reported that they had experienced hitting, and being beaten, and spanked with hand by guardian/family member; 716 (91.21%) reported that they had been pushed and being grabbed and kicked by family member/guardian; 626 (79.75%) reported as being shouted and screamed by family member, 289(36.82%) reported hitting and being beaten and spanked by object by guardian /family member; 206 (26.24%) reported that their ear having been pulled and twisted/ pinched by family member/guardian; 99(12.61%) reported hair being pulled by family member/guardian; 76(9.68%) being locked in small place. Only 10(1.27%) reported that they had been burned/scalded by family member/guardian.
| Table 3: Patterns of Physical abuse at home as perceived by school going adolescents perpetrated by family member/guardian. |
| Characteristics’ of physical abuse |
Present |
% |
Absent |
% |
Shouting/screaming |
626 |
79.75 |
159 |
20.25 |
Pushed, grabbed or kicked |
716 |
91.21 |
69 |
8.79 |
Hitting, beating, and spanked with hand |
768 |
97.83 |
17 |
2.17 |
Hitting, beating, and spanked with object |
289 |
36.82 |
496 |
63.18 |
Choking |
73 |
9.30 |
712 |
90.70 |
Burned or scald |
10 |
1.27 |
775 |
98.73 |
Locked in small place |
76 |
9.68 |
709 |
90.32 |
Hair been pulled |
99 |
12.61 |
686 |
87.39 |
Ear been pulled, twisted or pinched |
206 |
26.24 |
579 |
73.76 |
Table 4 represents different symptoms/characteristics of depression among school going adolescents with different probe areas such as feeling low mood, sad, just can't be bothered, feeling worthlessness, hopelessness, not being a good person, feeling hard to get motivated, and wanting to rest or lie down a lot, feeling worried, nervous, panicky. Almost half of the adolescents, 341(43.44%), expressed about worthlessness, hopelessness, not being a as good person. A few adolescents 11(1.40%) expressed about hard to get motivated and feel to take rest.
| Table 4: Overall distribution of students with respect to characteristics of depression |
| Depression characteristics |
Never |
% |
Sometimes |
% |
Always |
% |
I feel low mood, sad, just can't be bothered. |
531 |
67.64 |
232 |
29.55 |
22 |
2.80 |
I feel as i am worthlessness, hopelessness, not being a good person |
438 |
55.80 |
341 |
43.44 |
6 |
0.76 |
I feel hard to get motivated, & want to rest or lie down a lot. |
523 |
66.62 |
262 |
33.38 |
11 |
1.40 |
I feel worried, nervous, panicky&, tensed |
529 |
67.39 |
256 |
32.61 |
4 |
0.51 |
Table 5 shows that among 10-12 years age group school going adolescents, 24.18% had experienced mild physical abuse, 58.82% of them had experienced moderate physical abuse, 16.99% reported severe physical abuse. Among the 13-14 years age group of school going adolescents, 26.01% had experienced mild physical abuse, 54.21% reported moderate physical abuse and 19.78% reported severe physical abuse. Among the 15-16 years age group of school going adolescents, 24.51% experienced mild physical abuse and 56.56% reported moderate physical abuse and 18.18% reported severe physical abuse. The level of depression was also assessed in study participants. Among the 10-12 years age group of school going adolescents, 33.3% were in mild depression levels, 62.1% were in moderate level of depression, 4.6% were found to have severe level of depression. Among the 13-14 years age group of school going adolescents, 26.4% were in mild depression levels, 69.2% were in moderate level of depression, 4.4% were found to have severe level of depression. Among the 15-16 years age group of school going adolescents, 24.2% were in mild depression levels, 68.5% were in moderate level of depression, 7.2% were found with severe level of depression.
| Table 5: Physical abuse and Adolescent students Depression levels |
Age Groups |
Levels of Physical abuse - Frequencies and Percentage (%) |
Levels of Depression - Frequencies and Percentage (%) |
|
Mild Physical abuse |
Moderate Physical abuse |
Severe Physical abuse |
Mild Depression Levels |
Moderate Depression Levels |
Severe depression Levels |
10-12yrs |
37 (24.18%) |
90 (58.82%) |
26(16.99%) |
51(33.3%) |
95(62.1%) |
7(4.6%) |
13-14yrs |
71 (26.01%) |
148(54.21%) |
54(19.78%) |
72(26.4%) |
189(69.2%) |
12(4.4%) |
15-16yrs |
88 (24.51%) |
206 (56.56%) |
65(18.11%) |
87(24.2%) |
246(68.5%) |
26(7.2%) |
Table 6 reveals that there is significant relationship between physical abuse and depression among adolescents, with r-value =0.1256, p-value=0.0326. This indicates there is linear relationship between physical abuse and depression among school going adolescents; as physical abuse increases there is tendency of depression among school going adolescents.
| Table 6: Correlation between physical abuse scores and depression scores in adolescents by Karl Pearson’s correlation coefficient method. |
Variables |
Physical abuse Perpetrated by Family member/Guardian among adolescents |
Levels of depression |
r-value |
t-value |
p-value |
0.1256 |
3.5620 |
0.0326 |
*significant (p<0.05) |
Discussion:
The current findings of our study improve our knowledge of the relationship between physical abuse and levels of depression among school going adolescents. In this study, we found that 10 to 16 years aged school going adolescents were the victims of physical abuse, and study participants have also expressed their different levels of depression due to physical abuse which was perpetrated by the family member/guardian. Other similar study has also reported that victims of physical abuse have high levels of depression traits, and that depression among adolescents will effect brain functions related psychological ability of reasoning and alter the behavior among the adolescents, leading to maladjustment to their present environment, and more negative behaviors in their day today life. In our study among adolescents, hitting, being beaten and being spanked with hand was being most common form of physical abuse.[5] Study reported by Ministry of women and child welfare (MWCD, GOI), Government of India had reported higher prevalence of child maltreatment.[3]
In our study we found significant relationship between physical abuse and depression among adolescents, with r-value =0.1256, p-value=0.0326. Similar study also conducted by Chang-Fang Yen et al in Taiwan indicated that among 1684 adolescents, 374 (22.2%) reported being victims of physical abuse in childhood, and the study also suggested that childhood physical abuse among adolescents will increase the risk of depression.[6] Carla Kmett Danielson et al also suggested in their study that young adolescents who are abused (physically, sexually) are at higher risk for depression.[7]
Strengths of the study:
The present study is the first to examine physical abuse in primary and secondary school going adolescents and its relation with depression level in Belagavi and also in Karnataka state. We included a variety of primary and secondary schools in Belagavi. Other strengths of the study are the use of a descriptive design and the fact that our measure of depression level and physical abuse were based on self-report rather than parental or teacher reports.
Limitations of the study:
In regard to sample characteristics, generalization from primary and secondary school students to other adolescents in the different schools may be limited. The other fact of concern is that depression levels may be influenced by genetic and environmental factors.
Conclusions of the study: Based on the findings of the study following conclusions were drawn. Out of total 785 study subjects, 444(56.56%) were exposed to moderate physical abuse, 196 (24.97%) were exposed to mild physical abuse, and 145(18.47%) were the victims of severe physical abuse. A total of 768 (97.83%) reported that they experienced hitting, and being beaten, and spanked with hand by guardian/family member. The study also found significant positive relationship between physical abuse and depression among adolescents, with r-value =0.1256, p-value=0.0326.
Acknowledgments: The authors are grateful for the administration, parents, and students of primary and secondary schools of Belagavi, for their support and participation.
Financial support and sponsorship: Nil.
Conflicts of interest: There are no conflicts of interest.
References:
- WHO. Adolescent mental health. Available from URL https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health. Accessed on [2020 April 6th].
- Wikipedia. Child abuse or child maltreatment. Available from URL https://en.wikipedia.org/wiki/Child_abuse. Accessed on [2020 April 6th].
- Ministry of Women and Child Development, Government of India. Study on Child Abuse India 2007. Available from URL: http://wcd.nic.in/childabuse. Accessed on [2020 April 6th].
- Daral S, Khokhar A, Pradhan S. Prevalence and determinants of child maltreatment among school-going adolescent girls in a semi-urban area of Delhi, India. Journal of Tropical Pediatrics. 2016 Jun 1;62(3):227-40.
- Negele A, Kaufhold J, Kallenbach L, Leuzinger-Bohleber M. Childhood Trauma and Its Relation to Chronic Depression in Adulthood. Depression Research and Treatment. 2015;650804.
- Yen CF, Yang MS, Chen CC et al. Effects of childhood physical abuse on depression, problem drinking and perceived poor health status in adolescents living in rural Taiwan. Psychiatry and Clinical Neurosciences. 2008;62: 575-583
- Danielson CK, de Arellano MA, Kilpatrick DG, Saunders BE, Resnick HS. Child maltreatment in depressed adolescents: Differences in symptomatology based on history of abuse. Child Maltreatment. 2005;10(1):37-48.
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