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Mental health problems among adolescents a chief cause of poor school behaviour: Local survey

05 Jul 2022

  • Somatic symptoms (headaches, fatigue, body aches) mainly attributed to physical problems
BY Ruwan Laknath Jayakody Since poor school performance, aggression, and violence were mainly attributed to mental health problems and somatic symptoms such as headaches, fatigue, and body aches were mainly attributed to physical problems, educating adolescents on the possibility that such somatic symptoms can be indicators of possible mental health problems, and conversely that other factors may contribute to aggression and violence need to be considered. These findings and recommendations were made in a research article on “The ability of adolescents to recognise common indicators of mental health problems, and their sources of mental health knowledge” which was authored by U.R. Attygalle (attached to the Colombo South Teaching Hospital, Kalubowila), H. Perera (attached to the Colombo University’s Medical Faculty), and B.D.W. Jayamanne (attached to the same Faculty of the Kelaniya University) and published in Sri Lanka Journal of Social Sciences 44 (2) in December, 2021. Mental health problems among adolescents are a major public health concern. According to E.J. Costello, S. Mustillo, A. Erkanli, G. Keeler, and A. Angold’s “Prevalence and development of psychiatric disorders in childhood and adolescence”, one out of every four youths will meet the lifetime criteria for a mental health-related disorder. L.H.R. Hackett’s “Child psychiatry across cultures” indicated the possibility of mental health problems in children and adolescents being more prevalent in developing countries. H. Perera’s “Mental health of adolescent school children in Sri Lanka – A national survey” conducted in 2004, indicated that close to one fifth of adolescents aged 13–18 years showed features of emotional and behavioural problems.  Attygalle et al.’s study sought to describe the ability of an adolescent population to recognise and attribute poor school performance, headache, fatigue, body ache, aggression, and violence (all these are indicators of mental health problems and are commonly seen in clinical presentations to adolescent health services) to a mental health problem. While poor school performance is known to be associated with mental health problems in a bidirectional manner (S. Agnafors, M. Barmark and G. Sydsjö’s “Mental health and academic performance: A study on the selection and causation effects from childhood to early adulthood”), somatisation is commonly seen in South Asian populations (S. Grover and A. Ghosh’s “Somatic symptoms and related disorders in Asians and Asian Americans”). Per an Italian study, aggression and violence can also be a part of mental health problems, although this can be due to many other factors. Attygalle et al. conducted a community-based, cross-sectional study in the Sri Jayewardenepura educational zone in the Colombo District and those in Grades Nine and 10 were chosen, with the adolescents being between 13-16 years of age. The data collection tool was a self-administered questionnaire. The respondents were simply asked to self-report whether they recognised and attributed poor school performance, headache, fatigue, body ache, aggression, and violence as a mental health, physical, spiritual. or other problem. Spiritual problems were included in the list as, according to T.V. Pham, R. Koirala, M.L. Wainberg, and B.A. Kohrt’s “Reassessing the mental health treatment gap: What happens if we include the impact of traditional healing on mental illness?”, there is a tendency in Asian populations to attribute features of mental health problems to spiritual factors and to seek traditional healing methods. In total, data was collected from 1,002 adolescent respondents. There were 590 (58%) males in the sample with a mean age of 14 years. The results were as follows: With regard to poor school performance, 56% (majority) attributed it to a mental health problem, 34.6% to a physical problem, and 32.4% to a spiritual problem; with regard to headache, 72.8% attributed it to a physical problem (a relatively high proportion), 42.3% to a mental health problem; with regard to fatigue, 75% attributed it to a physical problem (a relatively high proportion), 32.7% to a mental health problem; with regard to body ache, 81.8% attributed it to a physical problem (a relatively high proportion), 26.5% to a mental health problem; with regard to aggression, 64% attributed it to a mental health problem (predominantly), 32.4% to a physical problem (a relatively small number), and 29.1% to a spiritual problem (a relatively small number); with regard to violence, nearly 67% attributed it to a mental health problem (predominantly), 39.2% to a physical problem (a relatively small number), and 22.2% to a spiritual problem (a relatively small number); with regard to the sources of acquiring mental health-related knowledge, 71.7% had through a subject or programme at school (almost half), 50.9% through television (TV) (almost half), 50.6% through elders (almost half), 46.7% through newspapers (almost half), 30% through the internet, and 13% through a friend. Perera noted that the impact of emotional and behavioural parameters in adolescents was felt mostly in the domain of educational functioning (15.5%) which may be explained by this population having to face two major exams, the General Certificate of Education (G.C.E.) Ordinary Level (O/L) and Advanced Level (A/L), that have major consequences for their future. On the other hand, the Family Health Bureau’s “National Youth Health Survey 2012/2013” indicated that nearly 40% of adolescents found it stressful to cope with academic pressures due to the expectations of parents and teachers. Thus, difficulties with academic work at school may also be an indicator of psychological distress in vulnerable adolescents. “As such, it is encouraging that many adolescents in this study consider it as a possible sign of a mental health problem.” Daily fatigue (substantial and frequent), headache, stomach ache, backache, and sleepiness in the mornings are relatively common in adolescent populations.
  1. Satharasinghe’s “Census Department measures information and communications technology penetration into households” shows that as of 2007, 76% of households had access to a TV. With considerable penetration into households, this media appears to be an important source of gaining mental health knowledge.
According to World Bank data on Sri Lanka, internet use is rapidly increasing with an estimated 34% of the population in 2019. As such, it is likely to be an important source of mental health knowledge in the future. It is commonly acknowledged that adolescents are influenced to a great degree by their peers. Per C. Herrera, J.B. Grossman, T.J. Kauh, and J. McMaken’s “Mentoring in schools: An impact study of big brothers, big sisters school-based mentoring", successful peer mentoring programmes for young people indicate that friends and peers can be a valuable source of mental health knowledge in addition to being a source of support. In Sri Lanka too, these types of formalised programmes are likely to be useful in the future. It is likely that programmes that aim to improve mental health knowledge could gain the best results if they utilise various media and sources, both in and outside of school. Both traditional and newer forms of media can be utilised to increase their mental health knowledge, Attygalle et al. added.  


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