|Year : 2019 | Volume
| Issue : 1 | Page : 39-42
Prevalence of mental health status in adolescent school children of Kohima District, Nagaland
Kelhouletuo Keyho, Nilesh Maruti Gujar, Arif Ali
Department of Psychiatric Social Work, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India
|Date of Web Publication||24-May-2019|
Dr. Arif Ali
Department of Psychiatric Social Work, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur - 784 001, Assam
Source of Support: None, Conflict of Interest: None
Background: Adolescents suffer from psychosocial problems at one time or the other during their development phase and they are highly vulnerable to develop psychiatric disorders. The aim of the study was to see the mental health status of school-going adolescents in Kohima district, Nagaland. Methods: The researcher used a cross-sectional study as the design. In the present study, field setting was private and government schools of Kohima district, Nagaland. The population sample consisted of school-going adolescents' age between 13 and 19 years from private and government schools in Kohima. Random sampling technique was used for the selection of schools. On the basis of which three schools were selected, the selected schools were taken consent from the school authority. Total enumeration method was used for data collection. A total of 702 students were recruited for the study. Adolescents, as well as parental consent, were undertaken. The study was undertaken with the approval of the Scientific Committee and the Ethical Committee of Lokopriya Gopinath Bordoloi Regional Institute of Mental Health. Socio-demographic data sheet and the Strengths and Difficulties Questionnaire were used. Results: The prevalence of mental health status on the basis of the total difficulties score was found to be 17.2% at the abnormal level whereas 28.8% was at the borderline level. The study results also revealed that in adolescent population, emotional problem was present in 17.1%, hyperactivity in 16.1%, conduct problem in 15.2%, peer problem in 5.6%, and prosocial behavior in 5.1%. Conclusions: Mental health problems are highly prevalent among the adolescent population in India. Early identification, treatment, and promotion of mental health services are required.
Keywords: Adolescents, conduct problems, emotional, hyperactivity, prosocial behaviors, relationship, strengths and difficulties
|How to cite this article:|
Keyho K, Gujar NM, Ali A. Prevalence of mental health status in adolescent school children of Kohima District, Nagaland. Ann Indian Psychiatry 2019;3:39-42
|How to cite this URL:|
Keyho K, Gujar NM, Ali A. Prevalence of mental health status in adolescent school children of Kohima District, Nagaland. Ann Indian Psychiatry [serial online] 2019 [cited 2020 Jan 22];3:39-42. Available from: http://www.anip.co.in/text.asp?2019/3/1/39/259094
| Introduction|| |
In India, the National Mental Health Survey (2016) examined mental morbidity among adolescents (13–17 years); the overall prevalence of any mental morbidity was 7.3%. The World Health Organization reports that worldwide, 20% of children and adolescents suffer from a disabling mental illness; the Global and National Burden of Diseases and Injuries Among Children and Adolescents reports that mental health problems represent the greatest burden of disease among children and adolescents. In India, Malhotra and Patra reported the prevalence rate of child and adolescent psychiatric disorders in the community to be 6.46%, and in the school, it has been found to be 23.33%. In a survey conducted on school-going adolescents in Gujarat India, Nair et al. found that 5% had a high Strengths and Difficulties Questionnaire (SDQ) score and stated that at least one in eight adolescents is at risk of mental health problems. Similarly, in an Indian study, the prevalence of psychological morbidity on the basis of total difficulties score was found to be 9.75%. The prevalence of emotional, conduct problem, hyperactivity, peer problem, and prosocial behavior was 5.42%, 5.56%, 3.78%, 4.40%, and 4.26%, respectively, in schoolchildren.
There is little information about mental health issues among adolescents in Nagaland. No systematic studies have carried on the mental health status of children in Nagaland. Nagaland is a small state and is predominantly inhabited of Nagas, a tribal group in the North Eastern region of India. Nagaland is, of course, going through the transition and social change, a young state influenced by Western lifestyle and modernization. There are numerous behavioral and psychosocial risks besetting the adolescents in Nagaland. Nuken and Singh highlighted that stressful life experiences, including major events and common hassles, threaten the well-being of adolescents. There are issues of alcohol and drug use, divorce families, drugs, increased peer pressures, values, and risk-taking behaviors.,,, Thus, the present study aimed to assess the mental health status (emotional problems, conduct problems, hyperactivity problems, peer problems, and prosocial behavior) in the school-going adolescents of Kohima district, Nagaland.
| Methods|| |
It was a cross-sectional study done among school-going adolescents from private and government schools of Kohima district, Nagaland, India. There are private 22 higher secondary schools with a secondary section, 22 recognized private high schools, and 25 permitted schools in the Kohima, 7 government higher secondary schools with a secondary section, and 24 government high schools. Random sampling technique was used for the selection of schools. Three schools were selected (Christ King Higher Secondary School, St. Mary's Cathedral Higher Secondary School, and Ruzhukhrie Government Higher Secondary School, Kohima, Nagaland) through the lottery method. Permission was taken from the school authority, and adolescent and parental consent were taken for conducting the research. The population sample consisted of school-going adolescents' age between 13 and 19 years (from Class 8th to Class 12th) from private and government schools in Kohima, Nagaland. Total enumeration method was used for data collection. A total of 723 students participated in the study. In the study, three participants who did not fulfill the criteria of adolescents' age 13-19 years were excluded and 18 participants were excluded due to missing score in the scale. Hence, a total of 702 participants were included for analysis of data. The study was undertaken with the approval of the Scientific Committee and Ethical Committee of Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur.
Tools of data collection
Sociodemographic pro forma
Socio-demographic data sheet was constructed for the purpose of these domains such as age, sex, class, family details, and other details.
Strengths and Difficulties Questionnaire (SDQ) was administered for measuring emotional and behavioral disorder in children and adolescents. The SDQ is a structured questionnaire that is used for screening the child and adolescent psychiatric problems and contains 25 questions that consist 5 subscales including emotional problem, hyperactivity, peer problem, conduct problems, and prosocial behaviors with 5 items in each. The sum of the first four subscales consists of the total difficulty score. The questionnaire has three forms: parent report, teacher report, and self-report. For the present study, the self-report questionnaire was used.
The researcher used the Statistical Package for the Social Sciences (SPSS) software version 19 (South Asia Pvt. Ltd., Kacharakanahalli, Bangalore, India) to analyze and measure the data. Descriptive statistics were used to calculate frequencies, percentage and mean of the socio-demoghraphic variables, and prevalence of mental health status in school-going adolescents.
| Results|| |
In the present study, 702 students participated in the study. The mean age of participants was 16.4 years (standard deviation: 1.32). Female participants were greater in proportion (55.27%). Majority of the participants were Christian (97.2%), from nuclear family (74.8%), and from a tribal community (97%). Majority of participant belonged to upper lower socio-economic status (43.45%).
The SDQ was used to assess mental health status [Table 1]. The findings showed that 13.5% participants had borderline and 17.1% abnormal scores for emotional problems. 19.2% adolescents had borderline and 15.2% abnormal scores for conduct problems. Similarly, 17.9% had borderline and 16.1% abnormal scores for hyperactivity. 5.6% of the adolescents had peer problems as compared to 28.9% who had borderline scores. In prosocial behavior, 16.1% of the participants were in the borderline range and 5.1% were at the abnormal range. The prevalence of mental health status on the basis of total difficulties score was found to be 17.2% at the abnormal level, whereas 28.8% were borderline.
| Discussion|| |
Nowadays, adolescents are dealing with the challenges of growth. They are going through puberty, meeting the changing expectations of others, and coping with feelings they might not have experienced before. The most common sources of day-to-day stress for adolescents are school-related problems or pressures; problems with peers, family issues, or parents; and their own thoughts, feelings, or behaviors, for instance feeling depressed or lonely, getting into trouble because of their behavior. These problems are routine for most adolescents. In the present study, the prevalence of mental health problems among school-going adolescents was 28.8% in the borderline range and 17.2% in the abnormal range. In a study conducted in Tezpur, Assam, it was found that the prevalence of mental health problems among school-going adolescents was 31.6% (borderline range - 23.8%; abnormal range - 7.8%). Dhoundiyal and Venkatesh stated that two-thirds of the adolescents had abnormal and borderline scores as per the SDQ. Bharath Kumar Reddy et al. stated that mental health problems are widespread among Indian adolescents. They found that 8.7% had an abnormal SDQ score and 15.3% had a borderline SDQ score. The prevalence of mental health issues therefore seems higher in the North East states (Assam and Nagaland) as compared to previous Indian studies. Long et al. pointed out that in India, mental health disorders are a serious issue among adolescents, and there is a need for an understanding of the factors related to poor mental health, and effective and targeted interventions for Indian adolescents required. On the various subscales of SDQ our findings are keeping with those of Harikrishnan et al. In the survey study conducted by Ali and Eqbal on the school-going tribal adolescents of Eastern part of India, it was found that emotional symptoms were present in 5.12% of the tribal students, conduct problems in 9.61%, hyperactivity in 4.23% of the students, and 1.41% of the tribal students had significant peer problems. Faizi et al. reported that the prevalence of mental health status (psychiatric morbidity) on the basis of total difficulties score was found to be 9.75% (95% confidence interval [8.33–11.39]). The prevalence of emotional problems was 5.42%, conduct problems 5.56%, hyperactivity 3.78%, peer problems 4.40%, and prosocial behavior 4.26% in school-going adolescents of Aligarh, India. When comparing with other studies, the prevalence of psychiatric morbidity is high among school-going adolescents of Kohima, Nagaland [Table 1]. There have been ongoing conflicts in the North East. The conflict, violence, and insecurity can have an impact on young people's mind. There have been changing family values and structure in the Naga society. Adolescents in Nagaland are influenced by Western lifestyle and modernization. The prevalence of drug abuse and alcoholism has become a serious social problem and has affected individuals, family, and community. They are more inclined towards seeking fun, mix easily with their peers, are more dependent on their family and relatives for long, with unemployment being more predominant. It makes the youngsters more vulnerable to engage in risk behaviors and can therefore affect their well-being.
| Conclusions|| |
Mental health problems are highly prevalent among the adolescent population in India. A significant proportion of school-going adolescents had mental health problems, in Kohima, Nagaland. Prevention, early identification, and treatment of these disorders is urgently needed. School and community mental health awareness programs need to be organized to sensitize the teachers, parents, and other stakeholders. The current study had some limitations; the data was cross-sectional; only self-reported assessment was done and parent or teacher version was not done; mental health was measured using only SDQ and other clinical assessments were not conducted. The study results are helpful in understanding the emergence of psychiatric disorders which need to work on the mental health of school-going adolescents. The study suggests addressing the mental health issues among adolescents, and strengthening the school mental health program. There is a need for school mental health program which can help the adolescent in the assessment, referrals, and management of the affected adolescents by teaching life skill to cope with day-to-day problem and stress.
The authors would like to acknowledge the support of all principals for permission to conduct the study and all students for their participation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gururaj G, Varghese M, Benegal V, Rao GN, Pathak K; NMHS Collaborators Group. National Mental Health Survey of India, 2015-16: Prevalence, Patterns and Outcomes. NIMHANS Publication No. 129. Bengaluru: National Institute of Mental Health and Neuro Sciences; 2016.
World Health Organization. Department of Mental Health, Substance Abuse, World Psychiatric Association, International Association for Child, Adolescent Psychiatry, & Allied Professions. Atlas: Child and Adolescent Mental Health Resources: Global Concerns, Implications for the Future. Atlas: World Health Organization; 2005.
Global Burden of Disease Pediatrics Collaboration, Kyu HH, Pinho C, Wagner JA, Brown JC, Bertozzi-Villa A, et al.
Global and National Burden of Diseases and injuries among children and adolescents between 1990 and 2013: Findings from the global burden of disease 2013 study. JAMA Pediatr 2016;170:267-87.
Malhotra S, Patra BN. Prevalence of child and adolescent psychiatric disorders in India: A systematic review and meta-analysis. Child Adolesc Psychiatry Ment Health 2014;8:22.
Nair S, Ganjiwale J, Kharod N, Varma J, Nimbalkar SM. Epidemiological survey of mental health in adolescent school children of Gujarat, India. BMJ Paediatr Open 2017;1:e000139.
Faizi N, Azmi SA, Ahmad A, Shah MS. Assessment of psychological problems in schoolgoing adolescents of Aligarh. Ind Psychiatry J 2016;25:184-8.
] [Full text]
Nuken A, Singh LL. Risk-taking behaviors among youth in Dimapur, Nagaland. Int J Sci Res Publ 2013;3:643.
Hickie I, Groom G, Davenport T. Investing in Australia's Future: The Personal, Social and Economic Benefits of Good Mental Health. Canberra: Mental Health Council of Australia; 2004.
Bricker D, Davis MS, Squires J. Mental health screening in young children. Infants Young Children 2004;17:129-44.
Lynne Lane K, Parks RJ, Robertson Kalberg J, Carter EW. Systematic screening at the middle school level: Score reliability and validity of the student risk screening scale. J Emot Behav Disord 2007;15:209-22.
Patel V, Flisher AJ, Hetrick S, McGorry P. Mental health of young people: A global public-health challenge. Lancet 2007;369:1302-13.
Goodman R, Ford T, Simmons H, Gatward R, Meltzer H. Using the strengths and difficulties questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. Br J Psychiatry 2000;177:534-9.
Harikrishnan U, Arif A, Sobhana H. Assessment of mental health status among school going adolescents in North East India: A cross sectional school based survey. Asian J Psychiatr 2017;30:114-7.
Dhoundiyal M, Venkatesh R. The psychological world of adolescence: A comparative evaluation between rural and urban girls. Indian J Psychol Med 2009;31:35-8.
] [Full text]
Bharath Kumar Reddy KR, Biswas A, Rao H. Assessment of mental health of Indian adolescents studying in urban schools. Malays J Paediatr Child Health 2011;17:35-40.
Long KN, Gren LH, Long PM, Jaggi R, Banik S, Mihalopoulos NL, et al.
Apicture of Indian adolescent mental health: An analysis from three urban secondary schools. Int J Adolesc Med Health 2017. pii:/j/ijamh.ahead-of-print/ijamh-2017-0035/ijamh-2017-0035.xml.
Ali A, Eqbal S. Mental health status of tribal school going adolescents: A study from rural community of Ranchi, Jharkhand. Age 2016;17:1.