Volume 1 (1) 2010

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Determinants Affecting Psychological Well-being of Urban and Rural Adolescents– A Comparative Study. Dr. Mudassir Azeez Khan*, Shreyas Gangadhara** ,Seetha Lakshmi***, Suhas Gangadhara***

* Dr. Mudassir Azeez Khan, MD is Professor and Head, Dept of community medicine, Mysore medical college and research institute, Mysore,email:[email protected] **Shreyas Gangadhara is Medical Student Mysore medical college and research institute, Mysore,email:[email protected] ***Seetha Lakshmi is Medical Student Mysore medical college and research institute, Mysore,email: [email protected] ****Suhas Gangadhara is Medical Student Mysore medical college and research institute, Mysore,email: [email protected]

ABSTRACT Aims and objectives: We have limited studies and data allowing us a bleak tunnel vision into the world of adolescent mental health. A comparative study was initiated to have a better understanding of the determinants affecting adolescent psychological wellbeing. Methodology: In Mysore District, India, 319 adolescents 16-18 yr, were from urban and rural 11th and 12th grades. A structured questionnaire based on the “General Psychological well being scale” was used. Results: - No significant difference in the scores of urban and rural adolescents [χ2=1.12, df=3, p>0.05] - economic backwardness positively correlates with the psychological stress in adolescents [χ2=9.15, df =3, p <0.05] - In grade 2, 64% reported difficulty in concentration compared to 10% in grade 5. [χ2=47.01, df=2, p<0.001] - There was no significant gender difference in the psychological score [χ2=1.44, df=1, p>0.05]

Conclusions: Our study shows that there is no significant influence of urban and rural residence or gender on the psychological health of the adolescents. We conclude that the economic constraints on the adolescents were associated with lower psychological health. Lower psychological health is associated with decreased concentrating ability and thereby scholastic performance. Recommendations The study also shows how a rapid screening technique can be incorporated into school health screening camps thereby enabling us to integrate mental health screening at an early stage into mainstream. The policies towards betterment of adolescent mental health should be directed towards their economic and academic needs than their areas of residence or gender. Keywords- Psychological health, adolescents, urban and rural. Introduction The World Health Organization (WHO) defines Adolescence as that period of life, which falls between the ages of 10 –19 years. In general terms, it is considered as a time of transition from childhood to adulthood, a

Khan MA et al

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Volume 1 (1) 2010

period of physical and psychological changes

It is also known that those with greater

associated with puberty, and a time of

psychological health in adolescence show

preparation for the roles, privileges and

more improvement in adult psychological

responsibilities of adulthood. In the modern

health (6). It is now recognized that many

competitive world this is the age which is

mental disorders seen in adulthood have their

subjected to maximum and multitude of

beginnings in childhood. The prevalence of

psychological and social demands. At the

many psychiatric problems such as depression

same time it is the period of life that these

and suicidal behavior increases markedly in

“growing adults” are most often marginated

adolescence (7, 8). Mental health problems in

by both physicians and pediatricians. The

adolescence

nature and experience of adolescence vary

aggression,

tremendously by sex, marital status, class,

Historically, suicide rates have tended to

region and cultural context. As a group,

increase with age, but some countries have

however,

generally

recently shown a secondary peak in the age

recognized to have sexual and psychological

group 15 to 24 years. Suicide, which is

health needs that differ from those of adults,

increasing among young men, is frequently

and which are still poorly understood in much

associated with depression. There are also

of the world.

gender differences; younger men are more

adolescents

are

are

often

violence

associated or

with

self-harm.

prone to suicide than women. (9) Many studies done in 1950s and 60s showed

that

the

children

and

young

Problem statement

adolescents did not have the psychological

World

structure (e.g. superego functions) to truly

The prevalence of many psychiatric problems

experience

other

such as depression and suicidal behavior

psychological disorders [1,2]. In addition, the

increases markedly in adolescence (7, 8).

classic characterization of adolescence as a

Worldwide, up to 20% of children and

time of "storm and stress" [3] led many

adolescents suffer from disabling mental

researchers

to

view

during

health problems (10). Four per cent of 12- to

adolescence

as

a

developmental

17-year-olds and 9% of 18-year-olds suffer

depression

or

any

depression

normal

stage.

from depression, making it one of the most But studies done recently have shown

prevalent

disorders

with

wide-ranging

that children and adolescents do indeed

consequences (11).The WHO Atlas project has

suffer from both depressive symptoms and

documented that 23% of countries have no

depressive disorders [4, 5].

programs for children. Only between 10% and 15% of young people with mental health

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Volume 1 (1) 2010

problems receive help from the existing child

Survey Report on the psychological well being

mental health services.

which shows •

that in their study

Nearly 5% of adolescents reported that

Western nations

they are not happy with their life and self..

A number of epidemiological studies have

•

reported that up to 2.5 percent of children

50%) mentioned staying aloof and not talking

and up to 8.3 percent of adolescents in the

when upset.

U.S. suffer from depression (12) An NIMH-

•

sponsored

study

girls

estimates

that

of the

9-

to

17-year-olds

prevalence

of

any

Majority of adolescents (more then

Nearly 9% to 15% boys and more among reported

experiencing

loneliness,

depression; sleep problem, stress, and worry.

depression is more than 6 percent in a 6-

•

month period, with 4.9 percent having major

adolescents as mentioned by them was for

depression(13) In addition, research indicates

study result or scholastic performance and

that depression onset is occurring earlier in

lack of job. Among girls in addition lack of

life today than in past decades(14) A recently

family support and lack of educational

published

reason

for

stress

among

prospective

study

opportunities were also mentioned as cause

depression

often

of concern.

continues

into

Prevalence rates of psychiatric morbidity in

adulthood, and indicates that depression in

0-16 yr old children in India were found to be

youth may also predict more severe illness in

lower than Western figures. Middle class

adult life(15) Depression in young people

urban areas had highest and urban slum areas

often co-occurs with other mental disorders,

had lowest prevalence rates (18).

found

longitudinal

Main

that

persists,

early-onset

recurs,

and

most commonly anxiety, disruptive behavior, or substance abuse disorders(16) and with physical illnesses, such as diabetes(17)

AIMS & OBJECTIVES There are limited data on child mental health

Indian scenario

needs

Early Indian studies reported prevalence

epidemiological

rates of psychiatric disorders among children

extent adolescent psychological health was

ranging from 2.6 to 35.6 per cent1-5. A

initiated. We aim to study the psychological

comparatively recent and methodologically

health of adolescents from Rural and urban

superior study reported a rate of 9.4 per cent

areas and the psychosocial correlates of their

in a sample of 1403 rural children aged 8 -12

mental well being

yr (18).An important study in this field is Adolescent Initiative Uttaranchal - Baseline

Khan MA et al

in

our

country. study

to

Therefore,

an

determine

the

Original Research

Volume 1 (1) 2010

Methodology & Techniques

communicate a more positive attitude about their future (25). In contrast, adolescents

A Sample size of 319 students including Boys

who report lack of social support and feelings

and girls of age group 16-18 was selected

of isolation may behave in self-harming ways

from rural and urban colleges in Mysore

such as suicidal ideation and suicide attempts

district, Karnataka, India. These include Govt

(26). In our study we found that there was no

PU

significant correlation between family size

college

H.D.kote,

Maharani`s

PreUniversity college, Mysore and Yuvaraja

and

Pre University college, Mysore.

adolescents.

psychological

wellbeing

of

the

Tools: A structured questionnaire based on

Longitudinal studies of children and

the General Psychological well being scale

adolescents who have experienced severe

was used and the results analyzed. The scale

adversity also indicate the importance of

assesses 22 items on anxiety, depression,

caregiver

vitality, positive well-being, self-discipline,

adaptation and psychological health. The

and general health, with the possible score

protective elements of family connectedness

for each item ranging from 0 to 110. Its

appear to derive from the connection to at

approach may be seen as more "positive" than

least one nurturing adult however single

other

parented children reported greater incidence

quality-of-life

scales

because

it

relationships

for

successful

measures well-being rather than disability.

of psychological problems (22)

Statistical

19 % of single parented adolescents scored

analysis

was

done

using

frequencies and percentages, and by applying

less than grade 2.

Chi-square tests. Grading was done based on the score. Grade 5 represents optimum psychological well-being.

A study conducted by Meltzer H et al shows

that

the

rates

of

psychological

Inclusion criteria- Age group between 16 and

disorders are higher in poorer areas and in

18.

unemployed

households

(19).

There

are

research findings showing that perceived RESULTS AND DISCUSSION

economic

Sociodemographic details:

adjustment

stress of

is

associated adolescent

with

the

children

experiencing economic disadvantage (20) Adolescents who report feeling supported by

Our findings suggest that economic

school staff, family, or peers display more

backwardness positively correlates with the

effective

coping

Khan MA et al

mechanisms

and

Volume 1 (1) 2010

Original Research

psychological stress in adolescents as shown

urban adolescent girls showed lower grades

by the above two studies

of mental wellbeing compared to their rural counterparts. Similar results were obtained by Shobha srinath et all at Bangalore(18).

There were no significant differences among prevalence rates in urban middle

In a study conducted in Bangalore by

class, slum and rural areas(18). Residence in

shobha shrinath et al a sizeable number of

rural communities have higher rates and are

children (9.4%) had scholastic problems. in

at a greater disadvantage

due to limited

our study. In our study group 26% complained

access to health care, a scarcity of resources,

of difficulty in concentration and out of them

and traditional cultural belief systems(21).

33% were under grade 2 and 76% under grade

But our study confirms with the study

3. In grade 2, 64% reported difficulty in

conducted by Shobha Srinath et al that there

scholastic performance compared to 10% in

are no significant difference between the

grade 5.

urban and rural adolescents, in terms of psychological well being. Discussion & Conclusions In terms of gender, adolescent girls are

more

internalized

The prevalence rates of psychiatric

symptoms of psychological stress, and boys

disorders in India in a study conducted among

are more likely to engage in externalizing

the 4 - 16 yr age group was 12 per cent

types

women

overall (18). Our study group comprised of

after

16-18 yr adolescents and 9% of them showed

pubertal

very low scores (Grade 1 & 2) on the

development, personal control, and parent-

psychological wellbeing scale. It is of concern

teen relationship quality (24). Young girls are

that 26% reported a decrease in scholastic

now diagnosed more frequently than in the

performance and concentration. Also we

past with mental disorders and particularly

found that low scores were associated with

with depressive symptoms (22). In contrast to

difficulty in concentration. This is in line with

above literature, there were no significant

an earlier school-based epidemiological study

gender differences in total prevalence rates

from north India (23)

of

likely

to

behavior

experience

greater

accounting

for

have

(27).

Young

distress

body

even

image,

in a study conducted in Bangalore (18).

Our study revealed that there is no

In our study we found that there is no

gender difference in the psychological well

significant gender difference in perception

being among the adolescents. We found that

and expression of psychological distress. The

even though there was no demonstrable

Khan MA et al

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Volume 1 (1) 2010

difference between the Urban and rural

was a strong correlation of the lower scores

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Khan MA et al

Convention,

Toronto,

Ontario,

Volume 1 (1) 2010

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TABLES

Table:1- Gender distribution gender

Urban

Rural

total

Boys

58

59

117

Girls

174

28

202

Table:2 Religion Grade (Score)

Hindu

Muslim

Christian

Others

Grade 1 (0-22)

0(0%)

0(0%)

0(0%)

0(0%)

Grade 2 (23-44)

17(5%)

0(0%)

0(%)

0(%)

Grade 3 (45-66)

120(39%)

3(33%)

0(%)

1(10%)

Grade 4 (67-88)

150(49%)

6(67%)

1(50%)

0(%)

Grade 5 (89-110)

20(7%)

0(%)

1(50%)

0(%)

TOTAL

307

9

2

1

Khan MA et al

Volume 1 (1) 2010

Original Research

Table:3 Family size

Grade 1

Grade

2 Grade

3 Grade

(0-22)

(23-44)

(45-66)

(67-88)

(89-110)

1

0

0

0

0

0

2

0

0

1(1%)

1(1%)

1(5%)

3

0

2(12%)

1(1%)

7(5%)

1(5%)

4

0

5(29%)

35(28%)

43(27%)

6(27%)

5

0

6(35%)

48(39%)

61(39%)

10(45%)

6

0

3(18%)

28(23%)

25(16%)

3(14%)

7

0

0

5(4%)

7(5%)

0

8

0

1(6%)

3(2%)

9(6%)

1(5%)

9

0

0

0

2(1%)

0

10

0

0

2(2%)

1(1%)

0

>10

0

0

0

0

0

Total

0

17

123

156

22

Family size

4 Grade

Chi-Square = 1,DF=3, P=0. 0.7722 Table:4 Single parent

Grade (Score)

No parent

Single parent

Both parents

Mother

father

total

Grade 1 (0-22)

0

0

0

0(0%)

0

Grade 2 (23-44)

0

2

1

3(19%)

13

Grade 3 (45-66)

1(1%)

9

0

9(7%)

117

Grade 4 (67-88)

0

7

0

7(5%)

144

Grade 5 (89-110)

0

1

0

1(5%)

19

Chi-Square = 1.27, D.F.=1

p = 0.2598

Khan MA et al

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Volume 1 (1) 2010

Table:5 Monthly income Grade (Score)

Grade 1 (0- Grade

2 Grade

3 Grade

4 Grade

22)

(23-44)

(45-66)

(67-88)

(89-110)

0-2500 Rs

0(0%)

9(69%)

53(48%)

53(38%)

4(20%)

2501-5000 Rs

0(0%)

0(0%)

20(18%)

41(29%)

6(30%)

5001-7500 Rs

0(0%)

1(8%)

11(10%)

14(10%)

1(5%)

7501-10000 Rs

0(0%)

1(8%)

25(22%)

25(18%)

1(5%)

>10000 Rs

0(0%)

2(16%)

2(2%)

7(5%)

8(40%)

Total

0

13

111

140

20

Chi-Square 9.15 with 3 D.F.

p 0.0274

Table:6 Comparison between urban and rural students

Grade (Score)

Urban

Rural

Grade 1 (0-22)

0 (0%)

0 (0%)

Grade 2 (23-44)

15 (7%)

2 (2%)

Grade 3 (45-66)

86 (37%)

38 (44%)

Grade 4 (67-88)

113 (48%)

43 (50%)

Grade 5 (89-110)

18 (8%)

4 (4%)

TOTAL

232

87

Chi-Square = 0.07with 1 D.F.

p = 0. 7913

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Table:7 Comparison between total boys and girls

Grade (Score)

Boys

Girls

Grade 1 (0-22)

0 (0%)

0 (0%)

Grade 2 (23-44)

3 (3%)

14 (7%)

Grade 3 (45-66)

52 (45%)

71 (35%)

Grade 4 (67-88)

56 (47%)

100 (50%)

Grade 5 (89-110)

5 (5%)

17 (8%)

TOTAL

117

202

Chi-Square = 0.65with 1 D.F.

Khan MA et al

p = 0. 4201

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Table:8 Gender Differences in Psychological Health

Urban Grade (Score)

Rural

boys

girls

boys

Girls

Grade 1 (0-22)

0 (0%)

0

0

0

Grade 2 (23-44)

2 (3%)

13 (7%)

1 (2%)

1 (3%)

Grade 3 (45-66)

25 (43%)

61 (35%)

28 (47%)

10 (36%)

Grade 4 (67-88)

28 (49%)

85 (49%)

28 (47%)

15 (55%)

Grade 5 (89-110)

3 (5%)

15 (9%)

2 (4%)

2 (6%)

TOTAL

58

174

59

28

Table:10 Difficulty in concentration Grade (Score)

No

Little

yes

total

Grade 1 (0-22)

0

0

0

0

Grade 2 (23-44)

0

5(36%)

9(64%)

14

Grade 3 (45-66)

21(17%)

51(40%)

55(43%)

127

Grade 4 (67-88)

78(49%)

60(38%)

20(13%)

158

Grade 5 (89-110)

18(90%)

2(10%)

0

20

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Volume 1 (1) 2010

Chi-Square = 68.05with 2 D.F. p <.0001

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