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Indian Journal of Community Medicine

Prevalence of psychosocial problems among school going male adolescents

Author(s): Ahmad Anees, Khalique Najam, Khan Zulfia, Amir Ali

Vol. 32, No. 3 (2007-07 - 2007-09)

SHORT ARTICLE

Year : 2007 | Volume : 32 | Issue : 3 | Page : 219-221

Prevalence of psychosocial problems among school going male adolescents

Ahmad Anees, Khalique Najam, Khan Zulfia, Amir Ali
Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
Date of Submission 23-May-2006

Correspondence Address:
Ahmad Anees
Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh - 202 002
India

Source of Support: None, Conflict of Interest: None
How to cite this article:
Ahmad A, Khalique N, Khan Z, Amir A. Prevalence of psychosocial problems among school going male adolescents. Indian J Community Med 2007;32:219-21
How to cite this URL:
Ahmad A, Khalique N, Khan Z, Amir A. Prevalence of psychosocial problems among school going male adolescents. Indian J Community Med [serial online] 2007 [cited 2007 Nov 30];32:219-21. Available from: http://www.ijcm.org.in/text.asp?2007/32/3/219/36836

Adolescence is defined by WHO[1] as the age group of 10-19 years. In India, adolescents (10-19 years) constitute 21.4 percent of the population, comprising one fifth of the total population.

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.

The term psychosocial reflects both the undercontrolled, externalizing or behavioral problems such as conduct disorders, educational difficulties, substance abuse, hyperactivity etc and the overcontrolled, internalizing or emotional problems like anxiety, depression etc. The emotional problems have been relatively neglected compared with behavioral problems because these are not easy to be detected by the parents or teachers.

Nowadays, because of rapid industrialization and urbanization majority of young couple are employed and live in unitary setup, so unavoidably they get less time to look after their children. Under these circumstances, psychosocial (emotional and behavioral) problems and psychiatric problems are on the rise.

It is surprising to note that there are only few studies about male adolescent psychosocial problems from India. Most of the epidemiological survey on school going children and adolescents have reported a wide variation (20-33%) in the prevalence of psychosocial problems.[2] Individual studies illustrated the prevalence of psychosocial problems ranging between 10-40%. [3],[4],[5]

Materials and Methods

The study was undertaken during 2002-2003, in the schools under rural and urban field practice areas of the Department of Community Medicine, JNMC, Aligarh. The total population of the male adolescents (10-19 yrs) for all schools was 2347, out of which a sample of 410 students (205 from the rural schools and 205 from the urban schools) were selected using Proportionate Probability Sampling (P.P.S) but only 390 students cooperated in the study.

The study was carried out in 2 phases. In phase 1, a detailed psychosocial history was obtained from all selected adolescents and a screening tool - the youth report of Pediatric Symptom Checklist (Y-PSC) [3] was used to screen the psychosocial impairment. The Y-PSC can be administered to the adolescents and youths. It consists of 35 items that are rated as "Never," "Sometimes," or "Often" present and scored 0, 1 and 2, respectively. The total score is calculated by adding together the score for each of the 35 items. The cutoff score for the Y-PSC is 30 or higher. Items that are left unanswered are simply ignored (i.e, score equals 0). If four or more items are left blank/unanswered, the questionnaire is considered invalid. The sensitivity is 95% in middle socioeconomic class samples compared with 80% in lower class samples and specificity ranges from 100% in the lower class compared with 68% in middle class samples and has been found to be valid and reliable tool for screening psychosocial problems in children and adolescents.

In the 2 nd phase, all those adolescents with suspected psychosocial problems were referred to the psychiatrist for specific diagnosis. The diagnosis was generated as per criteria laid down in ICD-10. Statistical Analysis was done by using SPSS 10 pack for windows. Chi square test (c2 -test) was used for comparing groups.

Results

Major proportion of the population belonged to early (10-13 yrs) and mid teens (14-15 yrs) of predominantly Hindu religion and lower to middle socioeconomic status. 82 students (38 from rural and 44 from urban) were found positive by screening test (Y-PSC). After psychiatric assessment by ICD-10 criteria, 70 (33 rural and 37 urban students) fulfilled one or more ICD-10 criteria for the psychosocial problems giving an overall prevalence of 17.9%.

It was found that 82.1% of the study population was free from the psychosocial problems studied. Thus the prevalence of the overall psychosocial problems was 17.9% among male adolescents with insignificant urban and rural difference. The most common problem was educational difficulties found in 17.4% of the study population, followed by substance abuse with a prevalence of 13.3% and conduct disorders 9.2% [Table - 1].

The prevalence of the psychosocial problems was maximum 25.2% in 14-15 yrs age group and minimum (10.3%) in the 10-13 yrs age group. The difference of overall psychosocial problems was found significant. Conduct disorders were also maximum (12.9%) in the 14-15 yrs age group. Substance abuse was minimum (4.8%) in the 10-13 yrs age group, followed by 18.7% in the 14-15 yrs age group and maximum (20.9%)in the 16-19 yrs age group. The rising trend of substance abuse with age is highly significant.

The percentage of children with no problem show a declining trend as the socioeconomic status decreases i.e. the prevalence of psychosocial problems are higher in lower social class IV (30.8%) as compared to social class I (13.8%), II (12.4%) and III (18.7%). [Table - 2] further depicts that, all the types of psychosocial problems studied are having a higher prevalence in social class IV as compared to other social classes and the least prevalence was in social class I. The difference in psychosocial problems with SES was found to be significant.

Discussion

The study found that the overall prevalence of psychosocial problems was 17.9% (82.1% of the population was free of the problems). No significant urban and rural difference was observed as also studied by Anita et al. using ICD-10 criteria for the diagnosis of the diseases and Rao using Goldberg's General Health Questionnaire (GHQ) for the screening of the problems. The reason for no urban / rural difference might be because the schools from both the area were mostly private and the economic status of the population registered in both the areas was more or less similar. High prevalence of 63.7% using GHQ were also shown in the studies and the reason was the selection of the students of schools run by Agra Corporation where the students were from poor families.

So several caveats should be borne in mind when comparing the estimates of such disorders across studies. These include variation in sample characteristics, screening tool used, source of information and case definition included in the study.

The reason for the greater prevalence of overall psychosocial problems in the later age group (14-19 yrs) may be the greater prevalence of substance abuse in them. Also the later age group understand themselves better and can answer more openly during the interview. The 14-15 yrs age group also faces the transition stress of moving from Junior High School to High School syllabus. The rising trend of psychosocial problems with age is also shown by others.[1],[4]

Adolescents belonging to Muslim religion have higher prevalence of psychosocial problems esp. educational difficulties due to illiteracy and lower SES of the parents who may be ignorant of the problems that their children are facing in the schools.

Higher prevalence of the problems in lower SES families observed in this study comparable with other researches.[2],[5] The increased risk is because the factors like malnutrition, illiteracy, ignorance and negligence in the childcare are associated with socio-economic status.

Conclusions

Poor mental health awareness, limited school and other community-based services combine to make male adolescents an underserved population in our country. The combination of ignored psychosocial problems and the lack of mental health services in our country amplify the risk of precipitating academic underachievement and rising delinquent behavior in male adolescents. There is need to raise public awareness about the prevalence of these often "hidden" emotional disorders in Indian adolescents.

References

1. Gupta I, Verma M, Singh T, Gupta V. Prevalence of behavioral problems in school going children. Indian J Pediatr 2001;68:323-6. [PUBMED] [FULLTEXT]
2. Anita, Gaur DR, Vohra AK, Subash S, Khurana H. Prevalence of Psychiatric morbidity among 6 to 14 yrs old children. Indian J Commun Med 2003;28:133-7.
3. Jellinek MS, Murphy JM, Robinson J, Feins A, Lamb S, Fenton T. Pediatric symptom checklist: Screening school-age children for psychosocial dysfunction. J Pediatr 1988;112:201-9. [PUBMED]
4. Gupta SC, Dabral SB, Nandan D, Mehrotra AK, Maheshwari BB. Psychosocial behavioural problems in urban primary school children. Indian J Commun Health 1997;9:18-21.
5. Sood N, Misra G. Home environment and problem behaviour in children. J Personality Clin Studies 1995;11:23-32.

Tables

Table 1: Distribution of the psychosocial problems according to the age groups of the adolescents

Table 1: Distribution of the psychosocial problems according to the age groups of the adolescents

Table 2: Distribution of the psychosocial problems according to the SES of the adolescents.

Table 2: Distribution of the psychosocial problems according to the SES of the adolescents.

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