Adolescence is a critical period for the emergence of a broad range of psychiatric disorders, which negatively impact psychosocial functioning and social cost. Global health projects primarily have addressed communicable disease—not mental health; moreover, limited research and resources are available to meet the needs of adolescents with mental health problems—particularly in low- and middle-income countries. The purpose of this study was to explore psychological distress and examine the relationship between distress and individual, family, and school factors among adolescents in Laos, Mongolia, Nepal, and Sri Lanka.
Methods:
A total of 4,098 adolescents in Laos, Mongolia, Nepal, and Sri Lanka were surveyed as part of the Healthy School Development Project. The project was designed to develop school capacity for improving health among all school members and the school environment through tailored school health programs in the four countries. A self-report questionnaire was used to assess psychological distress (i.e., stress, loneliness, anxiety, sadness, suicidal thoughts, suicidal plans, and suicidal attempts), family factors (i.e., parent understanding and monitoring, and parent smoking and alcohol use), and school factors (i.e., having close friends, not bullied, school attendance, health education) among the participants. Data were collected from September to November in 2012 and 2013. Descriptive statistics, chi-squared testing, and logistic regression were used to analyze data collected in 2012.
Results:
Over half of the participants were female (56.8%) and below 15 years of age (57.7%). Approximately 44% of the students reported good health status, and 33% reported the presence of psychosocial distress. Forty-four percent and 60% of the students reported that their parents understood them and monitor their activities, respectively. Most students (94%) had one or more close friends, and 20% were bullied. School attendance and providing health education were reported by 81% and 74% of respondents, respectively, as causing distress. Overall, older students were more vulnerable to psychosocial distress (OR=1.78; 95% CI 1.53-2.08), and factors associated with psychological distress comprised food insecurity (OR 1.51; 95% CI 1.05-2.17), family factors (i.e., parent understanding, parent monitoring, and parent smoking) (p < .05), and school factors (i.e., being bullied, school absence, and health education) (p < .001).
Conclusion:
Approximately one-third of the adolescents reported psychological distress. Parent involvement and school environments can function as either protective factors or risk factors of psychological distress among adolescents in Laos, Mongolia, Nepal, and Sri Lanka. Interventions that (1) empower the family to ameliorate psychological distress (2) reduce the likelihood of bullying by peers at school and (3) provide effective health education programs are recommended for these four countries. Additionally, subsequent inquiry into adolescent mental health research and resources in low- and middle-income countries would contribute to reducing psychological distress among adolescents in these contexts.