Prevalence of Mental Health Problems among School-going Adolescents in Melmaruvathur: An Observational Study

Introduction

Around 2.2 billion of the world's population are children and adolescents. Ninety percentage live in low-and middle-income countries, where they make up 30%–50% of the population.^[1] Neuropsychiatric diseases are a major health burden for youth. These illnesses account for 15%–30% of a person's first three decades' disability-adjusted life-years.^[2] Despite the general recognition of the importance of mental health promotion and prevention in children and adolescents, the resources available to meet their needs are inadequate.^[3] Failure to treat mental health issues in low-resource children and adolescents, including developmental and intellectual difficulties, is a major public health issue. Failure to accomplish fundamental development goals in low-and middle-income countries also hinders this.^[4]

There is also evidence that many adult mental health difficulties stem from childhood. Its effects last into maturity. The global health agenda prioritizes early mental health intervention in low-and middle-income countries because mental diseases are long-term conditions that afflict young people and a disproportionate percentage of them live there. In addition to the ethical commitment to the most vulnerable young people, who may have their full developmental potential impeded by early intervention, early intervention may reduce society's costs. In low-to-middle-income countries, children who are victims of human trafficking, violent warfare, natural disasters, compulsory labor, or street life need prompt international assistance.^[5]

Mental health difficulties are increasing among children and adolescents worldwide. A meta-analysis of 41 studies from 1985 to 2012 in 27 countries found that 13% of children and adolescents had mental problems.^[6] It affects 7% of Indians and 23% of schoolchildren. Twenty percentage of youth live in India.^[4] Thus, mental health evaluation in India will impact global health. Adolescents attend school most of the time. Teachers can help teens identify mental health concerns. However, they lack the training and orientation to recognize early danger signs. Primary health-care providers may not have the time or patience to identify and address these concerns. Screening tools can help in this circumstance. A simple behavioral screening tool is the Strengths and Difficulties Questionnaire (SDQ). Child mental health research in India, especially in Uttar Pradesh, is lacking. If untreated, these illnesses harm children's development and capacity to lead satisfying and productive lives. This study examines mental health issues and their association with gender in Melmaruvathur, teenage school children.

Materials and Methods

After receiving approval from the Ethics Committee, a descriptive cross-sectional questionnaire-based study was carried out on adolescents who were attending schools in Melmaruvathur. The participants in the study filled out the questionnaires. The power of the study was set at 80%, and the significance level was set at 0.05. The estimated size of the sample was 500. The duration of the study was approximately 1½ years, beginning on June 1, 2021, and ending on December 30, 2022. The age range was anywhere between 11 and 17 years, participants had to be adolescents who attended school. Those who had participated in mental health training programs in the past were not allowed to participate.

Results

There were about 43.4% of females and 56.6% of males among the study participants. About 3.0% had very high conduct problems, 5.80% had high conduct problems, and 10% had slightly raised conduct problems. In this study, 1.4% had very high hyperactivity, 3.80% had high hyperactivity, 11.80% slightly raised hyperactivity, and 83% had hyperactivity. When we studied emotional problems, around 1.80% had very high emotional problems, 3.20% had high emotional problems, 6.60% slightly raised emotional problems, and 88.40% had emotional problems close to average. Around 7.40% had very high peer problems, 14.60% had high peer problems, 26.00% had slightly raised peer problems, and 52% had peer problems close to average. Around 6.80% had very low prosocial, 4.60% had low prosocial, 6.20% lowered prosocial, and 82.40% prosocial close to average. It was shown females had slightly raised emotional problems than males. On the other hand, males had a higher average score when it came to problems with their peers than girls did. There was no statistically significant difference between the genders regarding conduct problems, hyperactivity problems, emotional problems, peer problems, and prosocial [Table 1].

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Table 1

Distribution of mental health problems among school-going adolescents (n=500)

In the case of females, 77.52% had a total difficulty score that was quite close to the average, 15.13% had a slightly higher total difficulty score, 3.21% had a high total difficulty score, and 4.12% had a very high total difficulty score. In males, 81.53% received a total difficulty score that was quite close to the average, 13.24% received a difficulty score that was somewhat higher, 2.43% received a high difficulty score, and 2.78% received a very high total difficulty score [Figure 1].

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Distribution of total difficulty score among the study participants (n = 500)

Discussion

The primary objective of this research was to ascertain the frequency of mental health issues experienced by adolescents who were actively enrolled in educational institutions. Children and adolescents are reporting higher rates of depression and anxiety^[7] and children with typically developing children have a higher risk of having mental health disorders.^[8],[9] In our research, 3.16% of participants had very high conduct difficulties, whereas 1.58% had very high hyperactivity/inattention problems, 1.98% had very high emotional problems, 7.52% had very high peer problems, and 6.93% had very low prosocial behaviors. There has been an uptick in the number of cases of depression and anxiety reported in children and adolescents. The research gives a glimpse of vulnerability among adolescent school-going youngsters in Melmaruvathur, with 20.98% of the sample being at risk. The research offers a snapshot of the precarious situation faced by adolescents and school-aged children in and around Melmaruvathur. When compared to the results of other Indian studies (^[10] 8.7% had an abnormal SDQ score;^[11] 10.1% of adolescents had total difficulty levels; and^[12] 16% had an abnormal SDQ score), these rates consistently come out much higher than their counterparts. This could be attributed, in whole or in part, to the fact that the original cutoffs were employed in these specific pieces of study. This could be the case either completely or partially.

In their study, Goodman et al.^[13] expressed concern that the SDQ had a propensity to overestimate the prevalence of the disease in low-and middle-income countries like India. When screening instruments such as the SDQ are used as an indicator for further investigation and follow-up, the findings provide support to the appeal for local and contextual information as well as norms that are unique to a population. This is the case because the findings provide evidence that local and contextual information is important. According to the findings of this particular study, males and girls experience psychopathology in distinct ways, particularly when they are teens. It was shown females had slightly raised emotional problems than males. On the other hand, males had a higher average score when it came to problems with their peers than girls did. Both of these associations did not any statistical significance.

Bhola et al.^[11] observed that girls were more likely to experience emotional symptoms, whilst boys were more likely to face problems with their peers. This finding is in keeping with earlier research that made use of the SDQ and theoretical frameworks. The current statistics, which are highly fascinating, offer credence to the theory that males tend to have higher levels of both peer and behavior problems. This hypothesis is supported by the fact that the hypothesis is supported by the current data. The research that was done by Bhola et al.^[11] lends support to the concept that boys are more prone to display conduct problems and hyperactivity than girls are.

However, it is also plausible that this is a reflection of the reduction of the gender gap when it comes to conduct disorder in teenagers. Although it is likely that the subjective interpretations of the SDQ questions in these categories are to blame, it is also plausible that this is a reflection of the blame. The early identification and treatment of mental health problems among college students should be done from the standpoint of gender awareness. This is something that should not come as a surprise to anyone.^{[12],[13],[14],[15],[16]}

There are certain limitations in the study including having a sample that is not representative of the entire population and using a method of sampling that is restricted to only one location. It is possible that the number of young people who are at risk will be overestimated if a screening approach with only one stage is used, in addition to the fact that the impact supplement of the SDQ will not be used. The SDQ impact supplement is a second stage that makes use of standardized diagnostic interviews as well as the study of sensitivity and specificity. It could be used in future research that focuses on determining “caseness” and planning service delivery. This might end up being useful information for the investigation. Activities relating to the mental health of young people that take place in educational settings need to encompass a spectrum of vulnerability. Sensitive tools such as the SDQ, which taps into difficulties in the borderline and abnormal range, could assist in the detection of various teenage mental health needs.^{[17],[18],[19],[20],[21],[22],[23],[24]}

This research highlights the need to evaluate the psychometric properties of the SDQ in a larger community sample of adolescents in India who are representative of the nation as a whole.

Conclusion

The major goal of the research was to identify prospective mental health needs in an age group for which there is a dearth of literature in India. In addition, the research found some problems with the assessment procedures that were being used. The findings are significant for several reasons, including the understanding of gender-specific vulnerabilities, the creation of youth mental health interventions that are more specifically focused on youth, and the peculiarities of the home setting.