Academic journal article East Asian Archives of Psychiatry

Prevalence and Correlates of Psychological Distress in Adolescent Students from India

Academic journal article East Asian Archives of Psychiatry

Prevalence and Correlates of Psychological Distress in Adolescent Students from India

Article excerpt

Introduction

Adolescence is a period of transition associated with many challenges, both physical and psychological. Although the majority of adolescents overcome these challenges, there is a significant proportion who exhibit depression, anxiety, suicidality, and self-destructive behaviours.1 Mental health problems in adolescence have a significant impact on academic and social achievements, with negative consequences extending into adulthood. There is also evidence that a substantial proportion of mental health problems in adolescence persist into adulthood.2,3

Regional surveys in the US have shown that about 1 in every 3 to 4 children experience mental health problems and about 1 in 10 children have a serious emotional disturbance.4,5 The National Comorbidity survey-Adolescence from the US reported a 31.9% prevalence of anxiety disorders and 14.3% prevalence of mood disorders.6 In a review of mental health in young people aged 12 to 24 years across high-income countries, the prevalence of mental disorders assessed using structured instruments ranged from 8% in the Netherlands to 57% in California.7 Epidemiological studies of the prevalence of mental health problems among children and adolescents in low-middle-income countries (LMIC) have shown a prevalence of 10% to 20%.8

Depression and anxiety are the most common mental health problems among adolescents. Between 20% and 50% of adolescents self-report depressive symptoms with significant and regular co-occurrence of anxiety symptoms.9 This co-occurrence is often described as psychological distress and is associated with poor mental health that negatively impacts level of functioning.10 Previous Indian studies of non-specific psychological distress have reported prevalence rates between 13% and 45%.11 Despite the high prevalence rates, only about 1 in every 4 to 5 youths with psychological distress fulfil the criteria for a lifetime mental disorder that is associated with severe role impairment and / or distress.6

Various risk factors for psychological distress have been identified across studies. Increasing age and female gender are associated with higher rates of psychological distress.9,11,12 Poverty, family dysfunction, and social disadvantage have been strongly associated with psychological distress among adolescents.13-15 Violence, abuse, and academic stress have also been reported to increase the risk.11,12'16-18 Substance use including alcohol and tobacco is higher in adolescents who experience psychological distress.19,20 One of the distressing outcomes of psychological distress is suicide. Depression and dysthymia were associated with a 12-fold risk of suicidal attempts.21 In a large Indian study that evaluated the cause of death among those aged 10 to 19 years, suicide accounted for about a quarter of all deaths in males and between 50% and 75% in females,22 with another study from India reporting psychological distress to be independently associated with suicidal behaviour.17

India has the largest national population of adolescents (243 million) who comprise 21.4% of the total population.23 Previous studies of psychological distress and its correlates in India have been conducted among limited subjects. Structured assessments were used only for assessing stress, not its correlates.11 It is in this context that we examined the prevalence of psychological distress in a large sample of school-going adolescents along with key clinical correlates in the socio-demographic and psychological domains. Data for the study were collected as part of a larger study by the National Rural Health Mission, a government initiative to study psychological issues including substance use among school-going adolescents in the State of Kerala, India. Kerala, a state in southern India, is well known for its egalitarian policies in terms of health care, redistributive actions and social reforms, with its health and literacy indicators close to those of high-resource countries despite a poor per capita income. …

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