Janapriya Journal of Interdisciplinary Studies, Vol.
6 (December 2017)
Research Article
Psychosocial Problem among School-going Adolescents in
Pokhara, Western Nepal
Ratna Shila Banstola
Instructor, T U, IOM, Pokhara Campus, Ramghat, Pokhara-12
Email: bastolaratna@gmail.com
Abstract
Adolescence the second decade of life is the crucial period demanding
significant adjustment to the physical and social changes. During this
transitional period, if adequate care and attention is not given adolescents
are prone to develop various psychosocial problems with long standing
impact. This descriptive cross-sectional study was conducted to assess the
prevalence of psychosocial problem and its associated factors among 360
adolescents studying in public schools of Pokhara Lekhnath Metropolitan
City. Data was collected by using self-administered questionnaire. The data
was analyzed in SPSS version 16 applying both descriptive and inferential
statistics. Findings of the study revealed that 21.7 percent of adolescents
had psychosocial problem. Adolescents who are facing physical/verbal
abuse (p=0.000, OR: 13.54),who do not feel good about home environment
(p=0.000, OR: 5.01), have high academic/school relates stress (p=0.000,
OR:5.304), who do not stay with their parents (p=0.000, OR: 4.49),
belonged to hardly sufficient family income (p=0.000, OR: 3.29), those
from joint family (p=0.004, OR: 2.12), whose mothers are illiterate
(p=0.027, OR: 1.96) and having disrupted marital status of parents
(p=0.040, OR: 1.78) were more likely to have psychosocial problem.
Hence, the combined effort of family and school team is essential to protect
adolescents from developing psychosocial problem
Keywords: Adolescent, Abuse, Family, Psychosocial problem, School
Introduction
Adolescence is the transitional period in the life span that occurs after
childhood and before adulthood. In this period of rapid growth and
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development adolescents experience physical and sexual maturation, along
with movement toward socio-economic independence and development of
identity (Shrestha, 2013). During this transition between childhood to
adulthood, adolescents often face a number of crises and dilemmas; lack of
adequate care and attention poses the risk of developing various
psychosocial problems with long standing impact (Sharma, Gupta, Luthra
& Mishra, 2014) and major impact on their psychosocial adjustment and
academic performance in school (Haynes, 2002). So that early
identification of mental health problems may lead to decreases in long-term
disability rates (Hacker, et. al., 2006). Lack in prompt identification and
proper management of these problems may have detrimental effect in their
potential adult life (Rimal & Pokharel, 2013).
Adolescents currently account for 1.2 billion of the world’s population.
Eighty-eight percent of them live in developing countries (UNICEF, 2011).
Adolescents in Nepal cover 23.62 percent of the total population i.e. nearly
a quarter of the population (Ministry of Health and Population, 2011).
Mental and behavioural disorders are estimated to account for 12% of the
global burden of disease and these disorders of childhood and adolescence
are very costly to society in both human and financial terms (WHO, 2001).
Various Studies conducted in different parts of the world shows that
prevalence of psychosocial problems among adolescents ranges from
13% to 45% (Ahmad, Khalique, Khan, & Amir, 2007; Syed, Hussein, &
Haidry, 2009; Suhail, Anees, Najam, Zulfia & Ali, 2012; Pathak, Sharma,
Parvan, Gupta, Ojha, & Goel, 2011; Saleem & Mahmood, 2013; and
Sharma, et. al., 2014). In the context of Nepal, studies conducted by Bista,
Thapa, Sapkota, Singh and Pokhrel, (2016) reported 17% prevalence of
psychosocial problem among school children in Hetauda and Sharma,
(2014) had found it as 30% in Pokhara. The environment in which some
adolescents live, learn and grow can undermine their physical, psychosocial
and emotional development, for example, where adolescents lack parental
guidance and support, face food shortages, or are surrounded by violence,
exploitation and abuse (WHO, 2017). In this backdrop the study was
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Janapriya Journal of Interdisciplinary Studies, Vol. 6 (December 2017)
executed to assess the prevalence and associated factors of psychosocial
problems among school-going adolescents in Pokhara.
Data and Methods
Descriptive cross-sectional study design and non-probability purposive
sampling technique was adopted for the study. The study was conducted in
public schools of Pokhara Leknath Metropolitan city. Four public schools
were selected purposively because they represent adolescents from low
socio-economic group among whom psychosocial problem is common
(Rao & Raju, 2012) and keeping in mind to find out the factors which are
more likely to cause the problem among these adolescents. From the
selected schools, students of class 7, 8 and 9 with the age range of 11-16
years were included in the study. Sample size was calculated considering
the prevalence of Psychosocial Problem as 30% (Sharma, 2014; Banstola,
2015) with allowable error 5% and Z value 1.96, using the formula n = (z2
p q)/e2 (kothari, 2011). The calculated sample size was 323 and after
adding the non-response rate of 10%, the final sample size was 355 but due
to the practical problem 5 extra students who were present in the class
during data collection time were also included, so that finally data was
collected among 360 respondents.
The instrument for data collection was self-administered questionnaire
which was divided in three parts. Part I related to socio-demographic
information, part II consisted of questions regarding family and school
related factors and part III was the standard tool to measure psychosocial
problem (Paediatric Symptom Checklist – Youth Report). The tool was
pretested among 35 respondents who met the similar characteristics of
study samples and they were not included in the main study. The Pediatric
Symptom Checklist (Y-PSC) is a brief screening questionnaire that can be
administered to adolescents ages 11 and up by health professionals
(doctors, registered nurses). The PSC 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
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each of the 35 items. For children and adolescents ages 6 through 16, a
cutoff score of 28 or higher indicates psychological impairment. This scale
showed high internal reliability (Cronbach’s alpha-0.89 and 0.75) when
used with Nepalese adolescents studying in various school and non-school
settings (Banstola, 2015; Bista, et. al., 2016). The PSC could be used
without explicit permission for educational and professional research.
Data was collected after getting approval from the Institutional research
committee, department of sociology, Prithvi Narayan Campus, Pokhara.
Formal permission was obtained from the selected schools. The purpose of
the study was explained to the respondents. Informed written consent was
taken from each respondent prior to data collection. Precautions were taken
throughout the study in every step to safeguard the right and welfare of all
respondents. The respondents were given full authority to withdraw their
participation without any fear or clarification at any time during the
investigation. Confidentiality had maintained throughout the study.
Obtained data was used for research purpose only. Time taken for data
collection was 25-30 minutes from each respondents. The questions were
clearly read out and explained by the researcher to make it clear and easy
for the respondents as well as for the completeness.
Collected data was checked, reviewed, organized daily for completeness
and accuracy. Data was analyzed in Statistical Package for Social Science
(SPSS) version 16. Descriptive statistics (i.e frequency, percentage, mean
and standard deviation) was used to describe the findings and inferential
statistics (chi-square test and odds ratio) were computed to see the
association between variables. The result was considered significant at 95%
confidence interval with p value ≤ 0.05.
Results and Discussion
Among 360 respondents, majority (65.4%) of the respondents were in the
age group 14-16 years with mean age 14.2. Proportion of females (56.1%)
was slightly higher than males (43.9%). Most (81.7%) of the respondents
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were Hindus. Almost equal representation found among Brahmin/Chhetri
(40.3%) and Mongolian (41.1%) ethnic groups. Seventy percent of the
respondents were staying with their parents and rests were not. The rest
were staying with their relatives, friends and brother/sister etc. Regarding
family dynamics, 78 percent of them had both parents live and staying
together but rest were not together i.e. separated or divorced or widow or
widower. Sixty eight percent of the respondents were from nuclear family,
more than four members in their family (61.7%) and (21.1%) had hardly
sufficient economic status of the family. (Table 1)
The overall prevalence of psychosocial problem was 21.7 percent. Taking
into account of subscales 23 percent of the adolescents had internalizing
problem, which was more than the externalizing and attention problem.
This finding is supported by Pathak, et al. (2011) that also found overall
prevalence of 30.0 percent and Internalizing syndrome was the most
common (28.6%) psychiatric problem. The other studies also corroborates
with this finding (Sojan & Baby, 2015; Sharma, 2014; Rimal & Pokhrel
2013; Syed, et. al., 2009; Ahmad, et. al., 2007; Al-Gamal, et. al., 2013;
Joshi, et. al., 2012; Hamdan-Mansour, et. al., 2013; & Uddin, et. al., 2009).
(Table 2)
The study has found the significant association between adolescents’
religion with the occurrence of psychosocial problem. Similar to this
Ahmad, et. al. (2007) also found the prevalence of psychosocial problem
higher in Hindus than others; it might be due to the higher percentage of the
respondents belonged to Hinduism in this study. There was significant
association between with whom the adolescent stay and psychosocial
problem. Adolescent who do not stay with their parents are 4 times more
likely to suffer from psychosocial problem. Findings of Sojan and Baby
(2015) also supports this finding which reported that family issues as
important factor for their distress, 78.94% distressed children complained
of inadequate time spent with parents whereas only 29.03% non-distressed
group complained about the same. Shiferaw, Fantahun, and Bekele (2006)
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Psychosocial Problem among …
also reported living with both biological parents and good parent-teen
connectedness are related to better psychosocial health (table 3).
Table 1
Socio-demographic Background Characteristics of the Respondents
(n=360)
Characteristics Frequency Percentage
Age
11-13 years 90 25.0
14-16 years 270 75.0
Sex
Female 202 56.1
Male 158 43.9
Ethnicity
Brahmin/ Chhetri 145 40.3
Janajati 148 41.1
Dalit 67 18.6
Religion
Hindu 294 81.7
Buddhist 40 11.1
Muslim 24 6.7
Christian 2 6.0
Staying With
Parents 253 70.3
Others 107 29.7
Type of Family
Single 243 67.5
Joint 117 32.5
Family Size
Up to five member 222 61.7
More than five member 138 38.3
Family Dynamic
Both parent live and staying 276 76.7
together
Separated/divorced, widow, 84 24.3
widower, both not live
Economic status
Hardly Sufficient 76 21.1
Sufficient 200 55.6
Surplus 84 23.3
Source: Field Survey, 2017
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Table 2
Prevalence of Psychosocial Problem (n=360)
Psychosocial Problem Frequency Percentage
Problem not present 282 78.3
Problem present 78 21.7
Subscales
Internalizing Problem 83 23.1
Externalizing Problem 30 8.3
Attention Problem 10 2.8
Source: Field Survey, 2017
Table 3
Association of Socio-demographic Characteristics with Psychosocial
Problem (n=360)
#
Characteristics Psychosocial Problem p OR(95% CI)
value
No (%) Yes (%)
Age
11-13 years 70(76.7) 22(23.3) 0.564 0.845
14-16 years 212(79.4) 56(20.55) (0.477-1.498)
Sex
Male 125(79.1) 33(20.9) 0.751 1.086
Female 157(77.7) 45(22.3) (0.654-1.802)
Religion
Non-Hindu 45(68.2) 21(31.8) 0.027* 0.515
Hindu 237(80.6) 57(19.4) (0.285-0.933)
Ethnicity
Brahmin/Chhetri 112(77.2) 33(22.8)
Mongolian 120(81.1) 28(18.9) 0.521
Dalit 50(74.6) 17(25.4)
Staying with
Parents 219(86.6) 34(13.4) 0.000* 4.499
Others(relatives, 63(58.9) 44(41.1) (2.653-7.628)
employer)
Source: Field Survey, 2017#: Pearson’s Chi square test,);*p –value
significant at ≤ 0.05, OR: Odds Ratio, CI: Confidence Interval
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The statistically significant association found between family type,
mother’s education, family income, parental marital status, verbal/physical
abuse at home, home environment and school/academic related stress with
psychosocial problem. Adolescents living in joint family were twice more
likely to have psychosocial problem. There might be the less parental
attention, time, focus and guidance towards the adolescents in the joint
family system. Adolescents whose mothers are illiterate (1.9 times), whose
family income is hardly sufficient (3.2 times) and adolescents whose
parents are not together i.e. either separated or divorced or widow/widower
are (1.7 times), those facing verbal/physical abuse at home (13.5 times),
who do not feel the home environment is good (5 times) and having high
stress at school (5.3 times) more likely to have psychosocial problem.
However, there was no statistically significant association found with
family size and number of siblings with psychosocial problem. (Table, 4)
In affirm to these findings, Rahi, Kumavat, Garg and Singh (2005), has
observed that prevalence of psychopathological disorders was highest in
children of low socio-economic status, living in overcrowded dwellings and
children of illiterate mothers (P <0.05). Chhabra and Sodhi, (2012) reported
psychosocial problems were significantly higher in adolescents of large
extended families (>8members) and in lower socioeconomic status.
Ahmed, et al. (2007) also reported the higher prevalence of psychosocial
problems in lower social class. According to Apollo Hospital Report
(2016),poor economic condition is a risk factor for the problem.
Pathak, et al. (2011) had also found family environment and parental
marital discord were statistically significant with psychosocial problem of
adolescents in India. Similarly, Kouros, Merrilees and Cummings, (2008)
found the association between parental marital conflict and emotional
problem among children. Childhood abuse is a contributor for psychosocial
problem (Apollo Hospital, 2016). There is also a higher rate of antisocial
and violent behavior among adolescents who have experienced neglect
(Moran, 2015). Moreover, Owoaje, et al (2011) found significant
association of child physical punishment and family trauma with adolescent
mental health problem. The exposure to conditions of abuse and neglect
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during childhood has been associated with an increased risk of
psychological, social and behavioral impairment (Pacheco, Irigaray, Nunes,
& Argimon, 2014).
Table 4
Association of Family, Home and School Related Characteristics with
Psychosocial Problem (n=360)
#
Characteristics Psychosocial Problem p OR(95% CI)
value
No(%) Yes (%)
Family type
Nuclear 201(82.7) 42(17.3) 0.004* 2.127
Joint 81(69.2) 36(30.8) (1.272-3.558)
Family size
Up to 4 94(81.0) 22(19.0) 0.391 1.273
More than 4 188(77.0) 56(23.0) (0.733-2.210)
Number of sibling
No sibling 5(83.3) 1(16.7) 0.764 1.390
277(78.2) 77(21.8) (0.160-12.07)
Father’s education
Literate 255(80.0) 64(20.0) 0.081 2.109
Illiterate 17(65.4) 9(34.6) (0.899-4.951)
Mother’s education
Literate 229(81.2) 53(18.8) 0.027* 1.964
Illiterate 44(68.8) 20(31.2) (1.070-3.604)
Family Income
Sufficient/Surplus 237(83.2) 48(16.8) 0.000* 3.292
Hardly Sufficient 45(60.0) 30(40.0) (1.887-5.742)
Parental marital status
Staying together 223(80.8) 53(19.2) 0.040* 1.783
Separated/Widow/Widower 59(70.2) 25(29.8) (1.023-3.107)
Abuse at home
Not present 275(82.6) 58(17.4) 0.000* 13.54
Present 7(25.9) 20(74.1) (5.474-33.52)
Home environment
Feel good 246(84.5) 45(15.5) 0.000* 5.011
Feel not good 36(52.2) 33(47.8) (2.836-8.855)
School/Academic Stress
Low 198(89.2) 24(10.8) 0.000* 5.304
High 84(60.9) 54(39.1) (3.077-9.141)
Source: Field Survey, 2017 #: Pearson’s Chi square test,);*p –value
significant at ≤ 0.05, OR: Odds Ratio, CI: Confidence Interval
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Conclusion
On basis of findings it is concluded that, a sizeable population (about one
fourth of the school going adolescents) were suffered from psychosocial
problem and the internalizing problem was most commonly found.
Furthermore, adolescents who were facing abuse at home, followed by do
not feel good about their home environment, have high academic/school
stress, not staying with their parents, hardly sufficient family income, who
are from joint family, adolescents whose mothers are illiterate and having
disrupted marital status of parents were more likely to develop
psychosocial problem. Thus these factors sought for the special concern
and need to be addressed. School based mental health services can handle
the problem in most effective way by screening and providing help to the
sufferers at earliest. It also seems imperative to have a post of psychosocial
counsellor in schools. These results have policy implications in respect of
the creation of a cordial school environment as well as encouraging a
healthy interpersonal relationship between adolescents and their family and
friends with the aim of reducing these risk factors.
Acknowledgment
The researcher is indebted to the public schools of Pokhara (Shree
Amarsingh HSS, Shree Mahendra HSS, Shree Shiva Shakti HSS and Shree
Kalika HSS) and all the participants.
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