|Year : 2019 | Volume
| Issue : 1 | Page : 43-49
Prevalence of common psychological morbidities among youth and their association with tobacco and/or alcohol use: A cross-sectional study from a village in Central India
Shambhavi Chowdhary, Kshitija Palhade, Kartik Ingole, Shruti Atram, Eashwar Tupat, Sanghe Doma, Abhishek V Raut
Department of Community Medicine, MGIMS, Wardha, Maharashtra, India
|Date of Web Publication||24-May-2019|
Dr. Abhishek V Raut
Department of Community Medicine, MGIMS, Sewagram, Wardha - 442 102, Maharashtra
Source of Support: None, Conflict of Interest: None
Context: Youth is a period of major physical and psychological changes. During this vulnerable phase, many individuals develop an inclination toward addiction. Objectives: The objectives of this study are to assess the prevalence of common psychological morbidities among the youth and its association with addiction. Study Design: The community-based cross-sectional study was conducted among individuals in the age group of 15–24 years. Methodology: A sample size of 102 individuals was estimated assuming 50% prevalence, 95% confidence level, and a nonresponse rate of 10%. One hundred and five individuals were offered participation, of which 97 individuals gave consent and were included in the study. The Global Mental Health Assessment Tool–Primary Care version was used for determining the prevalence and severity of common psychological morbidities. Data regarding tobacco and/or alcohol use were collected using the World Health Organization-Alcohol, Smoking, and Substance Involvement Screening Test. Descriptive analysis was performed using frequency and percentage. Association was found out using the odds ratio with 95% confidence intervals. Results: One-third of respondents have consumed tobacco in their lifetime, whereas 13.4% of respondents are alcohol consumers. Among psychological morbidities, anxiety had the highest prevalence (42.3%). Tobacco consumers had greater odds of developing all the eight psychological morbidities, and significant association was found with depression. Alcohol consumers showed greater odds of developing seven common psychological morbidities. Combined tobacco and alcohol users have greater odds of developing six of the eight common psychological morbidities and had a significant association with depression. Conclusions: There is a wide prevalence of addiction and psychological morbidities among rural youth. The high prevalence of addiction and its significant association with depression compels us to consider paying greater attention to these two factors as a whole.
Keywords: Addiction, psychological morbidities, substance abuse, youth
|How to cite this article:|
Chowdhary S, Palhade K, Ingole K, Atram S, Tupat E, Doma S, Raut AV. Prevalence of common psychological morbidities among youth and their association with tobacco and/or alcohol use: A cross-sectional study from a village in Central India. Ann Indian Psychiatry 2019;3:43-9
|How to cite this URL:|
Chowdhary S, Palhade K, Ingole K, Atram S, Tupat E, Doma S, Raut AV. Prevalence of common psychological morbidities among youth and their association with tobacco and/or alcohol use: A cross-sectional study from a village in Central India. Ann Indian Psychiatry [serial online] 2019 [cited 2019 Jun 16];3:43-9. Available from: http://www.anip.co.in/text.asp?2019/3/1/43/259082
| Introduction|| |
The World Health Organization (WHO) defines youth as the population in the age group of 15–24 years. Youth constitute around 16% of the global population. In India, the youth constitute a fifth of our population with around 2/3rd of them living in rural areas.
Youth is a very critical and vulnerable phase of life as during this phase major physical, physiological, and social changes occur. It is at this turn of life, a number of psychological transformations occur. The main health needs of youth include mental health problems, reproductive health needs, violence, malnutrition, and substance abuse.
The cumulative effects of lack of proper guidance, peer pressure, and the pressure to stand up to everyone's expectations are definite stressors and contribute to impaired mental health among the youth. Stress, anxiety, and depression are the common psychological morbidities found among the youth. In the past few decades, awareness about mental health has improved. However, taboos and myths surrounding the concept of psychological morbidities are still prevalent, especially in rural areas.
The problem of psychological morbidities among youth gets further compounded by prevalent substance abuse among youth. The National Family Health Survey-4 (NFHS-4) reveals that tobacco and alcohol consumers of both genders form a larger proportion of the community in rural areas vis-à-vis urban areas. NFHS-3 revealed that 40% of males and 5% of females aged 15–24 year consumed tobacco nationwide. Excessive use of alcohol has been identified as a major contributor to the global burden of disease. It causes 5.9% of all deaths globally. In addition, it is responsible for 5.1% of the disability-adjusted life years. A national review on harmful effects of alcohol reported greater social acceptability of drinking, increasing consumption in rural and transitional areas, younger age of initiating drinking, and phenomenal socioeconomic and health impact, more so among young people.
As the problem of psychological morbidities and substance abuse coexist among youth, it is imperative to study them together and not look at these important public health issues in isolation. The recent systematic reviews on this topic indicate that there have been studies with an attempt to correlate psychological morbidities and substance abuse; however, such studies are done mostly in other countries and in urban areas. The studies on this topic from the Indian context are lacking., Moreover, these studies have focused primarily on the smoked form of tobacco and do not focus on nonsmoked form of tobacco use, thereby neglecting a large number of individuals who use smokeless tobacco.
This warrants a study to be conducted in rural Indian context quantifying the prevalence of addiction and psychological morbidities. Considering this, an analytical cross-sectional study in a selected village was carried out to study the common psychological morbidities, the prevalence of current tobacco and alcohol use and the association of tobacco and alcohol consumption with common psychological morbidities.
| Methodology|| |
The present community-based analytical cross-sectional study was conducted with youth in the age group of 15–24 years in a single village from Central India. The village, wherein the study was conducted was the adopted village for the group of students who conducted this study and was selected considering the feasibility of implementation. In our institute, under the village adoption scheme, a new village is adopted for every batch of undergraduate (UG) students for 3.5 years. Each student is allotted 3–4 families for longitudinal follow-up regarding various health issues.
The study was initiated after taking prior approval from the Institutional Ethics Committee. Individual written informed consent was obtained from the study participants. The estimated sample size was 102, considering 50% prevalence, 10% absolute precision, 95% confidence level, and a nonresponse rate of 10%. For this, universal sampling was attempted, and participation was offered to all those who were in the age group of 15–24 years in the village. Enumeration list of potential participants was obtained from the database of this village, and three attempts were made to contact each one of them. Ninety-seven individuals who were eligible and consented constituted the final sample size.
Data were collected by trained UG students during the monthly field visits to the village through individual interviews maintaining confidentiality and privacy. The responses were marked based on the self-reported symptoms by the study participants. The data collection process was supervised by the postgraduate students and faculty in Community Medicine. A structured questionnaire was used for collecting the background sociodemographic information. It included questions regarding age, sex, occupation, education, socioeconomic status, history of any chronic illness, type of family, and marital history. The validated GMHAT-Primary Care (GMHAT-PC) version was used for determining the prevalence and severity of common psychological morbidities., Data regarding tobacco and/or alcohol use were collected using the WHO-Alcohol, Smoking, and Substance Involvement Screening Test (WHO-ASSIST). Individuals who consumed either tobacco and/or alcohol in any form, frequency or quantity within the past 3 months were considered as current users.
Data entry was done in MS-Excel and analyzed using Epi Info™ 7 version 184.108.40.206 developed by Centers for Disease Control and Prevention (CDC), Atlanta. Descriptive analysis was performed using frequency and percentage. Association was found out using the odds ratio with 95% confidence intervals.
| Results|| |
[Table 1] shows sociodemographic profile of the study participants. Among the study participants, 62 (63.9%) were in the age group of 20–24 years, whereas 35 (36.1%) were between 15 and 19 years of age. Males outnumbered females by 11.2%. Only 2% of the study population was illiterate, with around 59.7% having received education up to higher secondary level or above. More than half (53.7%) of our respondents were students followed by homemakers (23.8%). About 70.1% of the study participants were married. Around 40% of the participants belonged to the below poverty line. Three-fourths of our study participants were from nuclear families. About 2% of the respondents had suffered from some chronic illness in the past.
[Table 2] shows pattern of tobacco usage and its associated aspects. One-third of the study participants had consumed tobacco in their lifetime, of which 93.7% were current users. Almost all the participants consumed the locally available smokeless form of tobacco – theKharra. Nearly 62.5% of tobacco users reported that they had a daily urge to consume tobacco. About 65.7% of the study participants suffered from health, social, legal, and financial problems in the past 3 months due to their tobacco intake. Around half of the participants felt that they did not fail to do what was expected of them in the past 3 months. Around 75% of the participants conceded that their friends and relatives had expressed concern about their tobacco use in the past 3 months. Around 62.5% of the participants had made attempts at some point of time to stop using tobacco indicating that they themselves perceived it as a problem.
[Table 3] gives the pattern of alcohol usage and its associated aspects. Of the population screened, 13.4% were ever users of alcohol. Around two-thirds of the ever users of alcohol had consumed alcohol either once in a month or once/twice in the past 3 months. Nearly 69.3% of the study population admitted to having experienced a strong urge for alcohol consumption in the past 3 months. In the past 3 months, more than half of alcohol users reported having faced some kind of health, social, legal, and financial problems, whereas one-fourth had not been able to do what was expected of them. For around 69.3% of the study participants, concern was expressed by their friends and family members regarding their habit. 61.6% of alcohol consumers had initiated some efforts to cut down or stop alcohol use as they felt it to be a problem.
[Table 4] gives the prevalence of psychological morbidities. The study population was screened for different psychological morbidities using the GMHAT-PC version. Anxiety was the most prevalent psychological morbidity found in 41 (42.3%) participants followed by depression in 36 (37.1%) participants. Obsession and eating disorder were seen in 27 (27.8%) and 23 (23.7%) participants, respectively. Around one-fifth of the participants reported to have stress and memory-related issues, whereas phobia and concentration-related issues were found in 21 (21.6%) and 18 (18.5%) participants, respectively.
[Table 5] gives the association of psychological morbidities with tobacco consumption. Tobacco users had increased odds for all the eight prevalent psychological morbidities. However, only the association between tobacco intake and depression was found to be statistically significant. The odds for tobacco consumption were 2.7 times higher among those who were depressed as compared to those who were not depressed.
|Table 5: Association of psychological morbidities with tobacco consumption|
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[Table 6] gives the association of psychological morbidities with alcohol consumption. Alcohol consumers had increased odds for seven of the eight prevalent psychological morbidities. However, none of these were found to be statistically significant within the study population.
|Table 6: Association of psychological morbidities with alcohol consumption|
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[Table 7] gives the association of psychological morbidities with tobacco and alcohol consumption. Those individuals who consumed both tobacco and alcohol had increased odds of developing six of the eight common psychological morbidities evaluated under this study. However, only the association with depression was found to be statistically significant. The participants who consumed both tobacco and alcohol had four times higher odds for being depressed as compared to those who consumed neither.
|Table 7: Association of psychological morbidities with tobacco and alcohol consumption|
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| Discussion|| |
This study was designed with the intention of estimating the prevalence of tobacco and/or alcohol use and evaluating the burden of psychological morbidities among youth in the selected village. Further, an attempt was made to assess any possible association between addiction and psychological morbidities. Although mental health is an essential component of an individual's well-being, psychological morbidities have been associated with lack of social acceptance and hence have continued to remain largely neglected. The parameters under study were evaluated on the basis of self-reported responses to the WHO-ASSIST and GMHAT-PC questionnaires, for addiction and mental health, respectively.
Of the population under study, 32.9% had ever consumed tobacco in their lifetime, of which 93.7% were current users. NFHS-4 indicates that 58.6% of the rural population >15 years of age in Maharashtra are consumers of tobacco. The marked difference in the observed prevalence of tobacco use could be because of two possibilities. First, since our study included the age group of 15–24 years, which is a subset of the population considered in NFHS-4, the estimate of tobacco consumers was found to be less. Second, about half of our respondents were students and therefore, did not have a definite source of income to support their habit, which could be one of the reasons why the prevalence of tobacco use was less in them.
Alcohol consumers formed 13.4% of our respondents as compared to 14.2% of the rural population of Maharashtra. As the data was recorded on the basis of self-reported responses, a certain degree of under reporting can be considered. was in a district, where the sale of alcohol was prohibited. Despite constraints in accessibility to alcohol at such a location, the figures obtained in this study are a cause of concern.
About 69.8% of tobacco consumers and 81.6% of alcohol consumers reported that they had attempted some kind of intervention in the past to cut down or stop their addiction. This is in concordance with the national figures as obtained by the Global Adult Tobacco Survey-2. The fact that a high proportion of tobacco and alcohol consumers have attempted reduction in addictive habits shows that people understand the detrimental effects of addiction: health-related, financial, or personal. In spite of this understanding, these individuals continue to consume tobacco and alcohol that reflects the knowledge-practice gap and the challenges involved in quitting tobacco and/or alcohol use.
Among the psychological parameters evaluated, anxiety was found to be most prevalent (42.3%), followed by depression (37.1%). About 53.6% of our respondents were students, who coped with difficulties in academics, peer pressure as well as physical and physiological changes on a day-to-day basis, which accounted for the higher prevalence of anxiety. Furthermore, anxiety may have an impact on substance abuse.
The association between tobacco consumption and depression was found to be statistically significant. About 65.7% of tobacco consumers reported that they suffered from problems due to their tobacco consumption. Since regular consumption of habit-forming substances needs adequate financial backing, its association with depressive symptoms cannot be ruled out.
Despite alcohol users having greater likelihood of developing seven of the eight common psychological morbidities, none were found to be statistically significant. The dual factors of lower prevalence of alcohol consumption and lesser frequency of intake might be a reason for its insignificant statistical association with psychological morbidities in spite of higher odds.
Those individuals who consumed both tobacco and alcohol were found to have significantly greater odds of developing depression. Since, tobacco and alcohol consumption have been independently found to be responsible for widespread health, social and financial problems, intake of both these substances together can lead to the superimposition of such issues. Synergistic effect of both tobacco and alcohol consumption may be responsible for statistically significant depression among individuals consuming both these products.
The young members of any population are considered to be free from major health issues. The significant presence of psychological morbidities in this age group, as indicated by our study is a major cause of concern. Such a finding forces us to speculate whether undiagnosed psychological conditions could be a major cause of morbidities in this age group. The high prevalence of addiction and its significant association with depression compels us to consider paying greater attention to these two factors together and not try and deal with them in isolation.
In spite of a comprehensive search, adequate studies and literature for this segment of the population could not be found in the Indian context. Although mental health has now been incorporated as one of the objectives under Rashtriya Kishore Swasthya Karyakram, paying greater attention in this regard is the need of the hour. Combined efforts to tackle addiction and mental health as a whole could be envisaged for holistic health development of the youth.
This study has been conducted in the community setup. Data has been collected by trained UG medical students in person by visiting every individual household. The individuals which have been included in this study belong to one of the most vulnerable segment of the population, i.e., youth. The parameters considered under this study have been evaluated using GMHAT-PC for psychological morbidities and WHO-ASSIST for substance abuse. Both these are standardized questionnaires prevalidated for the Indian population. This study was carried out on 97 individuals which is adequate to assess the desired parameters within the population of the village. However, these results cannot be generalized for larger populations and other geographical regions. Therefore, a larger study needs to be carried out for the validation of the results obtained.
| Conclusions|| |
This study reveals that substance abuse and psychological morbidities are common among youth in the rural setup. Higher odds of psychological morbidities have been found among tobacco and/or alcohol consumers, specifically for depression. This reveals strong association between substance abuse and mental ill-health. This makes it imperative that addictions and psychological morbidities can best be tackled, only if these are addressed together and not independently. Furthermore, mental health should be given due importance, especially among rural youth. More comprehensive studies focusing on the causal relationship between addictions and psychological morbidities are needed in future to understand and address these medico-social issues better.
- We deeply acknowledge all the study participants who spared their valuable time for answering the questions related to the present study
- We are grateful to Faculty and Staff of Department of Community Medicine, MGIMS, Sevagram who conducted the essential national health research workshop for undergraduate students that motivated us to undertake this project in our adopted village
- We are grateful to the management of MGIMS, Sevagram for initiating the Dr. Sushila Nayar Short Term Under-graduate Research Grant at MGIMS, Sevagram, and for providing the financial support to carry out this research work.
Financial support and sponsorship
This research work was conducted by undergraduate students as part of the Essential National Health Research project work supported through the Dr. Sushila Nayar Short Term Under-graduate Research Grant of MGIMS, Sevagram.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]