Project
Project
PSYCHOSOCIAL, EMOTIONAL,
BEHAVIOURAL PROBLEMS AND
DRUG ABUSE IN SCHOOL AND
COLLEGE STUDENTS
CONTENTS
SI.NO TITLE PAGE NO
1 ABSTRACT 1
2 INTRODUCTION 3
5 REVIEW OF LITERATURE 11
6 METHODOLOGY 17
7 DATA COLLECTION 21
8 RESULT 24
9 DISCUSSION 35
10 CONCLUSION 51
11 BIBLIOGRAPHY 53
12 APPENDIX 57
GRAPH INDEX
SL.NO TITLE PAGE.NO
1 Comparison of anxiety between male and 26
female students
2 Comparison of anxiety between school and 27
college students
3 Comparison of depression between male 28
and female students
4 Comparison of depression between school 29
and college students
5 Comparison of eating disorder between 31
male and female students
6 Comparison of eating disorder between 32
school and college students
7 Comparison of alcohol abuse between male 33
and female students
8 Comparison of alcohol abuse between 34
school and college students
TABLE INDEX
SL.NO TITLE PG.NO
1 Frequency of anxiety in male students 22
2 Frequency of anxiety in female students 22
3 Frequency of depression in male students 22
4 Frequency of depression in female students 22
5 Frequency of eating disorder in male students 23
6 Frequency of eating disorder in female students 23
7 Frequency of alcohol abuse in male students 23
8 Frequency of alcohol abuse in female students 23
9 Mean and SD of anxiety in students 25
10 Frequency and percentage of anxiety in male and 25
female students
11 Frequency and percentage of anxiety in school and 26
college students
12 Mean and SD of depression in students 27
13 Frequency and percentage of depression in male and 28
female students
14 Frequency and percentage of depression in school and 29
college students
15 Mean and SD of eating disorder in students 30
16 Frequency and percentage of eating disorder in male 30
and female students
17 Frequency and percentage of eating disorder in school 31
and college students
18 Mean and SD of alcohol abuse in students 32
19 Frequency and percentage of alcohol abuse in male 33
and female students
20 Frequency and percentage of alcohol abuse in school 34
and college students
ABSTRACT
BACKGROUND; Adolescence is a unique and formative time. Multiple
physical, emotional and social changes, including exposure to poverty, abuse, or
violence, can make adolescents vulnerable to mental health problems. In the
modern world due to urbanization, industrialization, modernization children are
more vulnerable to psychosocial, emotional, behavioral problems. The aim of the
study was to assess the prevalence of psychosocial, emotional, behavioral
problems and drug abuse in school and college students.
METHOD; survey method of study was used. Taking 100 school students from
Our Lady Of Fatima High School Kumbalangi, Kochi and 100 College students
from Medical trust institute of medical sciences, Irumpanam, Kochi. A self-
administered questionnaire incorporating standardized instruments like
GENARALIZED ANXIETY DISORDER-7(GAD-7) for anxiety, PATIENT
HEALTH QUESTIONNAIRE 9 (PH-Q 9) for depression, SCOFF TEST for eating
disorder, (AUDIT) ALCOHOL USE DISORDER IDENTIFICATION TEST for
alcohol were given and collected after completion.
RESULT; in this study, the mean value of anxiety for boys is 5.6 (S.D=3.93) and
for girls it is 5.52(S.D=4.23). The mean value of anxiety for school students is
6.01(S.D=3.78) where as in college it is 5.08(S.D=4.41).
The mean value of eating disorder in boys is 0.507 (S.D=1.09) and for girls
1.185(S.D=1.19). The mean value for school is 0.84 (S.D=1.134) and for college is
1.09(S.D=1.256).
The mean value of alcohol abuse in boys is 6.97 (S.D=6.314) and in girls its 3.36
(S.D=4.320) and in school the mean value is 3.63(S.D=4.996) and in college it is
5.44 (S.D=5.494).
1
CONCLUSION; From this study we concluded that the prevalence of anxiety
was higher among school. The study shows that higher incidence of anxiety in
male students when compared to female students. In case of depression the
prevalence of depression was higher among college. Comparing with male and
female students, the male students have higher incidence of depression than female
students.
The prevalence of eating disorder was higher among college students. Comparing
with male and female students, the female students have higher incidence of eating
disorder than male students. From this study we concluded that the prevalence of
alcohol abuse was higher among college. Comparing with male and female
students, the male students have higher incidence of alcohol abuse than female
students.
2
INTRODUCTION
WHO defines 'Adolescents' as individuals in the 10-19 years age group and 'Youth'
as the 15-24 year age group. While 'Young People' covers the age range 10-24
years. Adolescence is divided into early, middle and late periods, which are
respectively the 10-14, 15-17 and 18-19-year age groups.(1) Adolescence is the
transitional stage of development between childhood and adulthood, representing
the period of time during which a person experiences a variety of biological and
emotional changes (2).The term 'storm and stress' was coined by G. Stanley Hall.
Hall used this term because he viewed adolescence as a period of inevitable
turmoil that takes place during the transition from childhood to adulthood. 'Storm'
refers to a decreased level of self-control, and 'stress' refers to an increased level of
sensitivity (3). This period denoted as “Storm and Stress” and states “conflict at this
developmental stage is normal” (2). During this period, adolescents suffer from
various forms of problems/dysfunctions and conflicts, which ultimately impair
normal psychosocial development aggravating psychosocial dysfunction.
Researchers have tried to define psychosocial problems in many ways, but
confusion remains. However, understanding regarding psychosocial problems
concludes that it is a state of emotional and behavior disorders synonymous with
internalizing and externalizing conditions, respectively. Most common disorders
include depression and anxiety (internalizing disorders), and delinquency,
aggression and educational difficulties (externalizing disorders). Adolescence is
mainly affected by home and school environments. Schools play a vital role in the
development of an adolescent, as they spend much time attending school, engaging
in extracurricular activities, and completing scholastic work at home. School
represents an institution that contributes to the overall educational and socialization
processes, critical in personality development of an adolescent (2).
Globally, 1 out of 10 (20%) adolescents encounter at least one behavioral problem.
Half of lifetime mental disorders begin before the age of 14 years, and 75% begin
by the age of 24 years. Studies completed in Canada and USA had shown that
mental health among the adolescent population is a public health issue. In the
Indian context, 14–40% of adolescent students are assumed to have mental health
problems (4).
3
The young people in the age group of 10-24 years in India constitutes one of the
precious resources of India characterized by growth and development and is a
phase of vulnerability often influenced by several intrinsic and extrinsic factors
that affect their health and safety .Nutritional disorders (both malnutrition and
over-nutrition), tobacco use, harmful alcohol use, other substance use, high risk
sexual behaviors, stress, common mental disorders, and injuries (road traffic
injuries, suicides, violence of different types) specifically affect this population and
have long lasting impact. Multiple behaviors and conditions often coexist in the
same individual adding a cumulative risk for their poor health. Many of these
being precursors and determinants of Non communicable diseases (NCDs)
including mental and neurological disorders and injuries place a heavy burden on
Indian society in terms of mortality, morbidity, disability and socio-economic
losses.(5)
Most young people are presumed to be healthy but, as per WHO, an estimated 2.6
million young people aged 10 to 24 year die each year and a much greater number
of young people suffer from illnesses ‘behaviors’ which hinder their ability to
grow and develop to their full potential. Nearly two-thirds of premature deaths and
one-third of the total disease burden in adults are associated with conditions or
behaviours initiated in their youth (e.g. tobacco use, physical inactivity, high risk
sexual behaviours, injury and violence and others). (6)
Anxiety, fearfulness, and worrying are regularly experienced as a part of normal
development. When they become disabling to the point that they negatively affect
social interactions and development, they are pathologic and warrant intervention.
Substance abuse and alcohol are increasing in students these days. Twenty percent
of students start experimenting with alcohol and drugs by age of 11. Other factors
that lead to use of drugs are change in lifestyle, low frustration toleration and peer
pressure. The clinical manifestation of substance use in children is – change in
behavior, irritability, lying and stealing, decline in academic performance, and
changes in eating and sleeping behavior.
4
a low body weight; bulimia nervosa, where people eat a lot and then try to rid
themselves of the food; pica, where people eat non-food items; rumination
syndrome, where people regurgitate food; avoidant/restrictive food intake
disorder (ARFID), where people have a lack of interest in food; and a group of
other specified feeding or eating disorders. Anxiety disorders,
depression and substance abuse are common among people with eating disorders.
These disorders do not include obesity. The causes of eating disorders are not
clear. Both biological and environmental factors appear to play a role. Cultural
idealization of thinness is believed to contribute to some eating disorders.
Treatment can be effective for many eating disorders. Typically, this
involves counseling, a proper diet, a normal amount of exercise and the reduction
of efforts to eliminate food.
Depression is a common illness worldwide, with more than 264 million people
affected. Depression is different from usual mood fluctuations and short-lived
emotional responses to challenges in everyday life. Especially when long-lasting
and with moderate or severe intensity, depression may become a serious health
condition. It can cause the affected person to suffer greatly and function poorly at
work, at school and in the family. At its worst, depression can lead to suicide.
Depression results from a complex interaction of social, psychological and
biological factors. People who have gone through adverse life events
(unemployment, bereavement, psychological trauma) are more likely to develop
depression. Depression can, in turn, lead to more stress and dysfunction and
worsen the affected person’s life situation. Effective community approaches to
prevent depression include school-based programs to enhance a pattern of positive
thinking in children and adolescents. Interventions for parents of children with
behavioral problems may reduce parental depressive symptoms and improve
outcomes for their children (7).
5
NEED OF THE STUDY
6
NEED OF THE STUDY
Adolescence is a stage of changes in body and behavior that may affect mental
health. Lack of attention to the mental wellbeing of adolescents and youth, in a key
phase of socialization, may lead to mental health consequences that may remain
throughout life and reduces the capacity of societies’ socioeconomic productivity.
More precisely, it can be claimed that proper psychosocial development of
adolescent is reflected with sound academic performance, physical health and
adequate social, emotional, and psychological health. This ultimately contributes in
reducing the risk of psychosocial and behavioral problems, violence, crime,
teenage pregnancy, and misuse of drugs and alcohol. Detection of psychosocial
dysfunction in the early adolescence can be fruitful for the quality of life of the
individual.
This study has conducted to determine the prevalence of the psychological and
behavioral problems among school and college children. This study assesses the
psychological problems among male and female students. The standardized
questionnaire we used in this survey is GENARALIZED ANXIETY DISORDER-
7(GAD-7) for anxiety, PATIENT HEALTH QUESTIONNAIRE 9 (PH-Q 9) for
depression, SCOFF TEST for eating disorder, AUDIT (Alcohol Use Disorders
Identification Test) to screen for hazardous alcohol intake. This survey helps to
assess the severity of the psychological problems and behavioral problems among
school and college students.
7
8
AIMS AND OBJECTIVES
9
AIMS AND OBJECTIVES
10
REVIEW OF LITERATURE
11
REVIEW OF LITERATURE
ARTICLE 1
Psychosocial Problems among Adolescent Students: An Exploratory Study in
the Central Region of Nepal
ARTICLE 2
Study for adolescent problem and psychology
12
age group submit to peer pressure. In drug abuse alcohol intake was 12% and 19%
in school and college group while prevalence of smoking was 4% and 12%
respectively. Total number of students who were active in sexual activity was
found to be 7.5% in schools and 14.6% in colleges (8).
ARTICLE 3
Eating Disorder Symptoms among College Students: Prevalence, Persistence,
Correlates, and Treatment-Seeking
Dr. Daniel Eisenberg et al (2007)
A random sample of students at a large university were recruited for an Internet
survey in Fall 2005 and a follow-up survey in Fall 2007.Eating Disorder symptoms
were measured using the SCOFF screen. 2,822 (56%) students completed the
baseline survey. Among undergraduates the prevalence of positive screens was
13.5% for women and 3.6% for men. Among students with positive screens, 20%
had received past-year mental health treatment. In the follow-up sample (N = 753),
Eating Disorder symptoms at baseline significantly predicted symptoms 2 years
later. Symptoms of Eating Disorders were prevalent and persistent among college
students in this study. These findings suggest that brief screens can identify a large
number of students with untreated Eating Disorders. (9)
ARTICLE 4
13
2000–2002 (n = 1,210). They examined exposure to violence at ages 12–15 and
14–17, and depression, conduct disorder and drug use at ages 14–17 and 17–20.
Multivariate transition models revealed an association between prior conduct
disorder and drug use, as well as a relationship between prior depression and
conduct disorder. Adolescent exposure to violence was associated with higher odds
of conduct disorder and drug use but not depression. Comorbid relations between
conduct disorder and drug use were independent of prior exposure to violence.
Although preventing adolescent exposure to violence may reduce the risk of
conduct disorder and drug use by young adulthood (10).
ARTICLE 5
Depression and anxiety among high school students at Qassim Region
ARTICLE 6
14
Patterns of Alcohol Consumption and Drinking Motives Among Korean
Medical Students
Hyo Hyun Yoo, Sung Wook Cha, and Sang Yeoup Lee (2016)
A questionnaire-based, multicenter, cross-sectional study was carried out in 323
students from 5 medical colleges in Korea between July and October 2016. They
used the Korean version of the Alcohol Use Disorders Identification Test (AUDIT)
and an anonymous, self-administered questionnaire that included demographic
characteristics, smoking status, consumption of alcohol, and drinking motives. The
mean AUDIT score was 9.8±7.5 for males and 6.3±5.4 for females. Heavy
drinking (75.9%) and binge drinking (56.0%) were very high among Korean
medical students. Female medical students drank as much as male students, and
much more than other women. The probability that a student would be a binge
drinker was 2.72 times higher for a smoker than a non-smoker. The scores for
drinking frequency, alcohol intake at one time, heavy drinking, binge drinking, and
alcohol dependence symptoms were highest in the group who had “enhancement
drinking motives”.(12)
ARTICLE 7
Evaluation of the psychometric performance of the SCOFF questionnaire in a
Mexican young adult sample
ARTICLE 8
15
Gender-specific differences in depression and anxiety symptoms and
help-seeking behavior among gastroenterology patients in Riyadh,
Saudi Arabia
Fahad D. Alosaimi, MD, Omar A. Al-Sultan, and Sulaiman I. Alqannas,
16
METHODOLOGY
17
STUDY DESIGN
STUDY SETTING
This study was carried out in both school and college students in the area of
Ernakulam district, Kerala. Taking 100 school students from Our Lady Of Fatima
High School Kumbalangi, Kochi and taking 100 College students from Medical
trust institute of medical sciences, Irumpanam, Kochi.
100 students were selected in school in the range of 10-16yrs. Equal number of
students selected in college in the range of 17-24 yrs according to the following
criteria.
INCLUSION CRITERIA
EXCLUSION CRITERIA
STUDY DURATION
Survey conducted was conducted over the first week of February 2019.
18
STUDY INSTRUMENT
The PHQ-9 is the nine item depression scale of the patient health questionnaire. It
is one of the most validated tools in mental health and can be a powerful tool to
assist clinicians with diagnosing depression and monitoring treatment response.
The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria
as “0” (not at all) to “3” (nearly every day). Depression Severity: 0-4 none, 5-9
mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe.
SCOFF TEST
The SCOFF questionnaire is a simple five question test devised for use by non-
professionals to assess the possible presence of an eating disorder. One point is
assigned for every "yes"; a score greater than two (≥2) indicates a possible case of
anorexia nervosa or bulimia nervosa.
19
4, with the first response for each question (never) scoring 0, the second ( less than
monthly) scoring 1, the third (monthly) scoring 2, the fourth (weekly) scoring 3,
and the last response (. daily or almost daily) scoring 4. For questions 9 and 10,
which only have three responses, the scoring is 0, 2 and 4. Low Risk (0-7 points),
medium Risk (8-15 points), high Risk (16-19 points), addiction Likely (20+
points).
ETHICS ASPECT
Administrative approvals were received from the school and college authorities
prior to the survey.
METHOD
The study was conducted at the first week of February. We explained the purpose
of the study to the approached under graduate students and school students. The
time consumed for questionnaire ranges from 30-45 minutes with each students
using previously mentioned tools. The questions were asked in their preferred
language but prepared in English. The questionnaire included the general
identification data (bio data). Once the questionnaire was completed, the collected
data analyzed using Microsoft Excel and result was obtained. A descriptive
statistical analysis was done and graphs plotted based on the same. Analyzing the
complete data, conclusion was done.
20
DATA COLLECTION
21
DATA COLLECTION
ANXIETY IN BOYS
ANXIETY IN GIRLS
SCHOOL 19 34 6 1 60
COLLEGE 46 20 7 2 75
Table 2; FREQUENCY OF ANXIETY IN FEMALE STUDENTS
DEPRESSION IN BOYS
MINIMAL MILD MODERATE MODERATELY SEVERE TOTAL
SEVERE
SCHOOL 5 24 7 2 2 40
COLLEGE 6 16 1 1 1 25
DEPRESSION IN GIRLS
MINIMAL MILD MODERAT MODERATELY SEVERE TOTAL
E SEVERE
SCHOOL 19 31 7 2 1 60
COLLEGE 13 41 9 8 4 75
22
EATING DISORDER IN MALES
EATING NOT HAVING TOTAL
DISORDER EATING
DISORDER
SCHOOL 6 34 40
COLLEGE 4 21 25
Table 5; FREQUENCY OF EATING DISORDER IN MALE STUDENTS
SCHOOL 25 12 2 1 40
COLLEG
E 5 15 4 1 25
Table7; FREQUENCY OF ALCOHOL ABUSE IN MALE STUDENTS
SCHOOL 53 7 0 0 60
COLLEGE 59 16 0 0 75
Table 8; FREQUENCY OF ALCOHOL ABUSE IN FEMALE STUDENTS
23
RESULT
a)
24
RESULT
The table 9 represents the mean value of anxiety for boys are 5.6 and for girls it is
5.52, it indicates that boys had more anxiety than girls. The S.D value of boys 3.93
and girls it is 4.23. The mean value of school is 6.01 where as in college it is 5.08.
Thus it is concluded that school had higher incidence of anxiety compared to
college. The S.D value of school is 3.78 and college it is 4.41.
GENDER BASED DIFFERENCE OF THE PREVALENCE OF THE GAD IN THE
MALE AND FEMALE:
The table 10 represents the comparison between the GAD level among male and
female students. The percentage of GAD in female students is found as normal-
48%, mild -40%, moderate-10%, severe -2% whereas in male student’s normal -
40%, mild-51%, moderate-6%, severe-3%. Thus it concluded that males show a
higher incidence of GAD symptoms compared to female students.
25
ANXIETY IN BOYS AND GIRLS
BOYS GIRLS
48% 51%
40% 40%
10%
6%
3% 2%
NORMAL MILD MODERATE SEVERE
26
ANXIETY IN SCHOOL AND COLLEGE
SCHOOL COLLEGE
56% 55%
35%
32%
8% 9%
2% 3%
DEPRESSION
The table 12 represents mean depression scores for boys is 7.71 and for girls its
7.62. In school the mean value is 7.2 and in college it is 8.1. Thus it concluded that
boys have higher incidence of depression than girls. Comparing with school and
college, the college have higher incidence of depression than school. The S.D
value of boys and girls are 4.860 and 5.177 respectively. The S.D value of school
is 4.716 and college is 5.376.
27
Gender based difference of the prevalence of the Depression in the male and
female students;
The table 13 represents the comparison between the depression level among male
and female students. The percentage of Depression in female students is found
minimal-24%, mild-53%, moderate 12%, moderately severe -7%, severe -4%
where as in male students minimal-17%,mild-62%, moderate-12%, moderately
severe 5%, severe-5%. Thus it is concluded that males show a higher incidence of
depression compared to female students.
DEPRESSION MALE FEMALE
FREQUENCY PERCENTAG FREQUENCY PERCENTAGE
E
MINIMAL 11 17% 32 24%
MILD 40 62% 72 53%
MODERATE 8 12% 16 12%
MODERATELY
SEVERE 3 5% 10 7%
SEVERE 3 5% 5 4%
TOTAL 65 100% 135 100%
28
DEPRESSION IN BOYS AND GIRLS
BOYS GIRLS
62%
53%
24%
17%
12% 12%
5% 7% 5% 4%
The table 14 represents the comparison between the depression level among school
and college students. The percentage of Depression in school students is found as
minimal-24%, mild -55%, moderate-14%, moderately severe-4%, severe -3%
where as in college students minimal-19%, mild- 57%, moderate-10%, moderately
severe-9%,severe-5%. Thus it concluded that college students show a higher
incidence of depression compared to school students.
DEPRESSION SCHOOL COLLEGE
FREQUENCY PERCENTAG FREQUENCY PERCENTAGE
E
MINIMAL 24 24% 19 19%
MILD 55 55% 57 57%
MODERATE 14 14% 10 10%
MODERATELY
SEVERE 4 4% 9 9%
SEVERE 3 3% 5 5%
TOTAL 100 100% 100 100%
24%
19%
14%
10% 9%
4% 3% 5%
EATING DISORDER
30
Table 15; MEAN AND SD OF EATING DISORDER IN STUDENTS
The table 15 represents mean value for boys is 0.507 and for girls 1.185. It shows
that girls have higher incidence of eating disorder. The mean value for school is
0.84 and for college is 1.09. The college shows higher incidence of eating disorder.
The S.D value of boys is 1.0 and girls it is 1.19. The SD value of school and
college is 1.134 and 1.256 respectively.
Table16; FREQUENCY AND PERCENTAGE OF EATING DISORDER IN MALE AND FEMALE STUDENTS
31
EATING DISORDER IN BOYS AND GIRLS
EATING DISORDER NOT HAVING EATING DISORDER
85%
75%
25%
15%
BOYS GIRLS
SCHOOL COLLEGE
FREQUENCY PERCENTAGE FREQUENCY PERCENTAGE
STUDENTS
HAVING
EATING 19 19% 25 25%
DISORDER
STUDENTS
NOT HAVING
EATING 81 81% 75 75%
DISORDER
TOTAL 100 100% 100 100%
Table17; FREQUENCY AND PERCENTAGE OF EATING DISORDER IN SCHOOL AND COLLEGE STUDENTS
32
EATING DISORDER IN SCHOOL AND
COLLEGE
EATING DISORDER NOT HAVING EATING DISORDER
81%
75%
25%
19%
SCHOOL COLLEGE
ALCOHOL ABUSE
The table 18 represents mean value of alcohol abuse in boys is 6.97 and in girls its
3.36.in school the mean value is 3.63 and in college it is 5.44. Thus it concluded
that the boys have higher incidence of alcohol abuse than girls. Comparing with
school and college, the college have higher incidence of alcohol abuse than school.
The SD value for boys is 6.314and for girls its 4.320. The SD value for school is
4.996 and for college it is 5.494.
33
The table 19 represents the comparison between the alcohol abuse among male
and female students. The percentage of alcohol in female students is found as low
risk-83%, medium risk -17%, high risk-0%,addiction-0% where as in male
students low risk-46%, medium risk-42%, high risk-9%,addiction-3%. Thus it is
concluded that the males show a higher incidence of alcohol abuse compared to
female students.
ALCOHOL MALE FEMALE
ABUSE FREQUENCY PERCENTAGE FREQUENCY PERCENTAGE
LOW RISK 30 46% 112 83%
MEDIUM RISK 27 42% 23 17%
HIGH RISK 6 9% 0 0%
ADDICTION 2 3% 0 0%
TOTAL 65 100% 135 100%
Table19; FREQUENCY AND PERCENTAGE OF ALCOHOL ABUSE IN MALE AND FEMALE STUDENTS
34
ALCOHOL ABUSE IN MALE AND FEMALE
MALE FEMALE
83%
46%
42%
17%
9%
0% 3% 0%
LOW RISK MEDIUM RISK HIGH RISK ADDICTION
The table 20 represents the comparison between the alcohol abuse among school
and college students. The percentage of alcohol abuse in college students is found
as low risk-64%, medium risk-31%, high risk-4%, addiction-1%, where as in
school students low risk78%, medium risk-19%, high risk-2%, addiction-1%. Thus
it is concluded that college show a higher incidence alcohol abuse compared to
school students.
Table20; FREQUENCY AND PERCENTAGE OF ALCOHOL ABUSE IN SCHOOL AND COLLEGE STUDENTS
35
GRAPH 8; COMPARISON OF ALCOHOL ABUSE IN SCHOOL AND COLLEGE STUDENTS
DISCUSSION
36
DISCUSSION
WHO defines adolescents as individual in 10-19 years of age and youth as 15-24
years of age. Adolescent is the transitional stage of development between
childhood and adulthood representing the period of time during which a person
experience variety of changes in them. Young people in the age of 10-24 years in
India, constitutes one of the precious resources of India. Most young people are
presumed to be healthy but as per WHO an estimated 2.6 million young people
aged 10-24 years die each year. Lack of attention to the mental health of youth
may lead to mental health consequences that may remain throughout life and
reduces society’s socioeconomic productivity.
According to the survey conducted among 200 students, equal participation was
there from school and college students. A community based survey study was
conducted to identify whether they are suffering from these problems. We found
that modern lifestyle and the pressure the students face has led to development of
different behavioral and psychosocial problems. Common problems that are found
among students are anxiety, depression, eating disorder, alcohol abuse. A survey
was conducted among 200 school and college students to find the psychosocial,
behavioral problems in students.
The study shown that by using GAD7 questionnaire among 200 students 109
student’s (55%) had anxiety. The study was conducted in 135 female and 65 male
students. The result of the study showed that out of 135 females, 70 females (52%)
had anxiety and out of 65 males, 39 males (60%) had anxiety. The percentage of
GAD in female students is found as normal-48%, mild -40%, moderate-10%,
severe -2% whereas in male student’s normal -40%, mild-51%, moderate-6%,
severe-3%. The study shows that boys had more anxiety than girls. Anxiety was
found to be prevalent among the students i.e. 109 in 200 (55%) students are
affected with anxiety. In school out of 100 students, 65 students (33%) are affected
with anxiety and in college out of 100 students, 44 (22%) students are affected
with anxiety. The study shows that anxiety was more in school students. Anxiety
can lead to social and behavioral problems, poor performance in learning,
neglected hygiene, poor self-care practices and low self-esteem. Interventions like
yoga, therapeutic massage, teaching Jacobson’s relaxation technique, aerobic
37
exercise etc. can be helpful for students to reduce stress. It helps to improve sleep
and also improves mental clarity and concentration. (15)
In our study depression was highly prevalent among the students i.e. 157(79%) in
200 students. The study was conducted in 135 females and 65 males. The result of
the study showed that out of 135 females, 103 females (76%) had anxiety and out
of 65 males, 54 males (83%) had anxiety. The percentage of Depression in female
students is found minimal-24%, mild-53%, moderate 12%, moderately severe -7%,
severe -4% where as in male students minimal-17%,mild-62%, moderate-12%,
moderately severe 5%, severe-5%. Thus it is concluded that males show a higher
incidence of depression compared to female students. The result of the study shows
that out of 100 school students, 76 students had depression and out of 100 college
students, 81 students had depression. The total number of depression in school and
college is 157(79%), in which college students (41%) are more affected than
school students (38%).
A study conducted by Sibnath Deb et.al (2016) about “Depression among Indian
university students and its association with perceived university academic
environment, living arrangements and personal issues”. The study is to ascertain
the level of depression among university students across gender, academic stream,
semesters, perception of family environment and relationship with parents,
academic performance, and family income. In addition, the study examines the
association between students' perceived university academic environment, living
arrangements, personal issues, and depression. Findings disclosed that 37.7%,
13.1%, and 2.4% of the students were suffering from moderate, severe, and
extremely severe depression. The study further disclosed that the students who
reported positive views about the university academic environment and living
arrangements had lower level of depression compared to their counterparts.
Personal resilience's such as being able to sharing personal problems with others
and doing regular exercise were found to be associated with positive mental health.
(16)
A study by the government of India shows that one out of every five Indians is
suffering from depression. An alarming increase rates of depression by five percent
of the population. It shows in spite of the suicides, stress related shootings, and
students hanging themselves being the norm of the day. Depression is caused due
38
to a variety of reasons. It depends on an individual. It can be due to life events such
as neglect, physical abuse, financial difficulties, job problems, a medical related
issue, loss of loved ones, relationship troubles and social rejection . (17)Depression is
a major problem faced by many college students today. Students with depression
can have significant impairments in many areas of functioning, including social,
academic, and occupational. Depression among college students is extremely
prevalent and widespread problem across the country. College students are a
special group of people that are enduring a critical transitory period in which they
are going from adolescence to adulthood and can be one of the most stressful times
in a person’s life.
A study conducted by Tapas Karmakar and Santosh Kumar Behera (2017) about
Depression among the College Students: An Empirical Study. They found that
most common psychological problems of college students are depression. Research
survey on college student’s reports there will be 10 to 20 % of student population
suffering from psychological problems (Stress, Anxiety & Depression). So those
kinds of problems are creating a barrier on the way of all round development.
Depression is a serious illness among the students and longtime depression has the
causes of mental disorder. The results presented that level of depression among
college students and found that out of 160, 16.88 % students are Minimal
Depression, 35.62% students are Mild Depression, 41.25% students are Moderate
Depression and the percentage of High level of Depression is 6.25. It is found that
there is significant difference exists between Rural and Urban College students
with regard to depression. The study revealed that there is no significant difference
exists between gender (Male & Female), religion (Hindu & Muslim) and Stream
(Science & Arts) students with regards to depression. The study also revealed that
there is no significant difference on the basis of social class, academic years and
job satisfaction with regards to depression. (18)
In our study Eating disorder was found to be prevalent among the students i.e. in
44 in 200 (22%) students are affected with eating disorder, in which out of 135
girls 34 female students (17%) was more affected as compared to the 10 male
students (5%) out of 65 boys. A variety of researches have shown that the eating
disorders are more prevalent among female. The study conducted by Omar
Sánchez-Armass et al (2012) , about Evaluation of the psychometric performance
of the SCOFF questionnaire in a Mexican young adult sample, which showed that
39
eating disorder are more prevalent among female than male. The study showed that
more females (24.2%) presented risk for ED (SCOFF > 2) than males (11.2%).
Nomological validity indicated that risk for ED in young women was associated
with demographic (e.g., parental education), psychological (e.g., depression,
weight management efficacy), physical (e.g., BMI), and social (e.g., family
conflict) indicators in conceptually coherent ways. Fewer variables were
significant for males. (13). Eating disorder was found among the students i.e. 44 in
200 (22%) students are affected with eating disorder. In school out of 100 students,
19 students (10%) are affected with anxiety and in college out of 100 students, 25
(12%) students are affected with eating disorder.
An article by Rae Jacobson about Eating Disorders and College; “Why the first
years away from home are a perfect storm for anorexia and bulimia” has found that
eating disorders can and do occur in teenagers, and even in young children. But it’s
during the college years that young people, especially young women, are most at
risk for developing them. The challenges of college life, adding pressure to
underlying mental health issues, create a “perfect storm” for these disorders, the
most common of which are anorexia and bulimia. The storm occurs when the
realities of college life—increased workload, less structure, and more focus on
peers—collide with anxieties, learning issues, or poor self-esteem. A young
woman who was able to manage stress and stay afloat during high school with a lot
of hard work and support from her parents might find herself drowning in the
confusing, complicated world of college. Eating disorders develop when the need
to feel control over a stressful environment is channeled through food restriction,
over-exercise, and an unhealthy focus on body weight. “College can be a time of a
lot of excitement and stimulation and also a lot of stress,” explains Dr. Baker, a
child and adolescent psychopharmacologist. “It asks young people who are not yet
adults to act in a very adult way, especially if they’re contending with mental
illness and suddenly have to begin managing it on their own.” (19)
“The stress of a college schedule, managing a new social context, and dealing with
independent living can trigger re-emergent anxiety or, in some cases a new mental
illness,” explains Dr. Douglas Bunnell, clinical director of the Monte Nido
treatment center in New York. “If you have a heavy dose of anxiety and you’re in a
social environment, and you’re constantly exposed to the thin body ideal, that’s a
perfect storm convergence of factors that can drive a vulnerable individual into an
40
eating disorder.” Full-blown eating disorders typically begin between 18 and 21
years of age, according to the National Eating Disorders Association (NEDA). The
association estimates that between 10 and 20% of women and 4 to 10% of men in
college suffer from an eating disorder and rates are on the rise. (19)
Alcohol abuses were measured using AUDIT questionnaire. Alcohol abuse was
found to be prevalent among the students i.e. in 58 in 200 (29%) students are
affected with alcohol abuse, in which out of 65 males students 35 students (17.5%)
was more affected as compared to the 23 female students (11.5%) out of 135.
Researches have shown that alcohol abuse is more prevalent among male students.
A study conducted by Emilene Reisdorfer et al (2012), about Prevalence and
associated factors with alcohol use disorders among adults: a population-based
study in southern Brazil, which showed that drug abuse are more prevalent among
male than female. The study showed that the prevalence of alcohol use disorders in
the population was 18.4%, higher among men (29.9%) than in women (9.3%). (20).
Alcohol abuse was found among the students i.e. 58 in 200 (29%) students are
affected with drug abuse. In school out of 100 students, 22 students (11%) are
affected with anxiety and in college out of 100 students, 36 (18%) students are
affected with eating disorder.
An article by Carol Galbicsek (2020) about College Alcoholism has found that
many young adults admit to drinking alcohol even before they enter college. After
graduating high school and moving out on their own, college students want to
experience their newfound freedom and independence. The availability of alcohol
at sporting events and social activities is often tempting to students. What may start
out as one drink can quickly turn into two, three or more. Drinking week after
week causes the body to start building a tolerance to alcohol. This means it will
require to drink more in order to get the same high. Frequent heavy drinking
greatly increases the chance of developing an alcohol use disorder (AUD), which
can cause serious physical and emotional damage. A large percentage of college
students consume alcohol by binge drinking. Binge drinking is defined as when a
person consumes an excessive amount of alcohol in a short timeframe. For men,
binge drinking involves drinking five or more alcoholic beverages in two hours.
On the other hand, binge drinking for women is considered four or more drinks
within a two-hour time period.
41
The high-risk period of binge drinking for college students is during the first six
weeks of their freshman year. Many of these students fall into peer pressure and
begin drinking soon after the first day of classes. Alcohol use is commonly viewed
as the “college experience” that students desire. They want to fit in and make new
friends, so they keep drinking without thinking about the potential consequences
involved. Within the last couple of decades, college students have started
consuming more hard liquor than beer. Rather than drinking to socialize, an
increasing number of young adults are drinking to get drunk. Since liquor has one
of the highest alcohol percentages by volume, it takes fewer drinks to feel its
effects. The end goal for some is to drink as much as possible or black out. These
outcomes are extremely dangerous and can possibly lead to life-threatening effects,
such as alcohol poisoning. Excessive alcohol consumption can take a toll on a
student’s academics. Drinking may even become a priority over attending classes,
completing homework and studying for exams. An estimated one in every four
college students admit to having poor grades or other academic problems because
of their drinking behavior. A lack of effort in school can make a difference in
whether a student passes or fails a class. It can cost thousands of dollars to retake a
course or change majors due to bad grades. In addition, failing classes will push
back a student’s graduation, taking more time and money to complete the degree
program. (21)
42
PHYSICAL THERAPY INTERVENTIONS
ANXIETY
Physical therapy had a major role in relieving anxiety disorder. It helps to improve
the mental health of a person suffering from anxiety. In which some of the
techniques include:
BENEFITS INCLUDE:
-Reduce anxiety
-reducing work related stress
-lowering your blood pressure
-improving your sleep (22)
43
Yoga allows us to breathe and move, activating the parasympathetic
nervous system to relax the body and mind. During yoga, the body releases
tension and allows the muscle to relax. Practicing yoga asanas or
pranayama breathing can help to relieve stress and anxiety. It helps to
reducing heart rate, lowering blood pressure, and easing respiration. (24)
Deep breathing exercise also plays an important role in relieving stress
and anxiety. When people are anxious they tend to take rapid, shallow
breaths that come directly from the chest. This type of breathing is called
thoracic or chest breathing. When you’re feeling anxious, you may not
even be aware you’re breathing this way. Chest breathing causes an upset
in the oxygen and carbon dioxide levels in the body resulting in increased
heart rate, dizziness, muscle tension, and other physical sensations. Your
blood is not being properly oxygenated and this may signal a stress
response that contributes to anxiety and panic attacks.
Several breathing techniques include:
- Diaphragmatic breathing
- Pursed lip breathing
- Segmental breathing (25)
44
It requires the use of equipment, including elastic bands, free weights,
dumbbells, medicine balls or resistive machines. The exercise involves a
combination concentric (i.e. shortening) or eccentric (i.e. lengthening)
muscle movement with single or multiple joint action. RET also improve
sleep quality and reduce other anxiety symptoms. (26)
DEPRESSION
Yoga
Breathing exercises;
- Equal Breathing; inhale through your nose for the count of 4 and exhale
through your nose for the count of 4.
45
- Abdominal Breathing; Put on hand on your stomach and one hand on your
chest. Breath in deep through you nose and feel your stomach and chest rise.
Then breathe out fully through your nose and feel your chest and stomach
fall.
- Alternate Nostril Breathing; Place your thumb on your right nostril and
breathe in deep through the left nostril. Once you have breathed in place
your ring finger on the left nostril and open the right nostril and breathe out.
Repeat this breathing in and out while alternating thumb and ring finger on
each nostril.
Biofeedback.
Aerobic exercise
When performing aerobic exercise your body releases endorphins from the
pituitary gland which are responsible for relieving pain and improving
mood. These endorphins can also lower cortisol levels which have been
shown to be elevated in patients with depression. Additionally, exercise
increases the sensitivity of serotonin in the same way antidepressants work,
46
allowing for more serotonin to remain in the nerve synapse. Exercise can be
aerobic or resistive in nature, as both have been shown to be beneficial in a
variety of patient types. Depression symptoms can be decreased
significantly after just one session but the effects are temporary. An exercise
program must be continued on a daily basis to see continued effects. As a
person continues to exercise they may experiences changes in their body
type which can help to improve self-esteem and body image issues they may
have been having. Some other benefits of regular physical exercise include:
EATING DISORDER
Postural exercises
A correct posture reduces physical symptoms, but also increases self-esteem.
Patients with a long history of Anorexia Nervosa can experience postural
abnormality due to weakened muscles, which results in poor posture
compensations (scoliosis, (hyper-) kyphosis, lumbar (hyper-) lordosis, scapula
alata) and low back pain. In these cases, specific postural and general
47
strengthening exercises can be included to recover the balance between hypo-
and hypertonic muscles. In some cases, postural stability training is indicated.
Relaxation exercises
Relaxation reduces perceived stress and anxiety and the level of salivary
cortisol. There are a number of available relaxation techniques. In eating
disorder units, applying the Bernstein and Borkovec’s method derived from
Jacobson’s progressive relaxation. This method seems to be most suitable for
patients with Anorexia Nervosa because it is quite active and the patient
maintains a level of control. For some patients, the therapist might consider
autogenic training, yoga, mindfulness or biofeedback. Relaxation can be an
important component of the treatment of night eating syndrome
Massage
In the treatment of patients with Eating disorder, the following forms of
massage are used: relaxing and/or activating massage of the back and legs with
or without instruments and passive mobilization of the limbs. The most
commonly used techniques are patting, subtle touching, and kneading. The
passive mobilization consists of letting limbs and the head move passively,
while the therapist mobilizes the joints; it aims at relaxation and awareness of
the body. Anorexia Nervosa reported lower stress and anxiety levels and had
lower cortisol (stress) hormone levels following massage.
Exercises targeting self-perception
Exercises targeting self-perception aim to amplify awareness of one’s own
body in its external appearance. In addition to mirror exercises, estimation
techniques are used in which patients are instructed to estimate their own size.
Examples include video distortion methods, techniques involving video or
photographs, and exercises using ropes to estimate the size of various body
parts such as the waist. These exercises are based on exteroception, which is the
opposite of sensory awareness and based on interoception.
Mirror exercises
Recently, both clinical and research attention has increased regarding the use of
mirror exercises during therapies addressing body concerns. Three behaviors
are generally considered, including normal mirror behavior, mirror avoidance,
and mirror checking. The term ‘mirror avoidance’ implies a refusal to look at
oneself in mirrors. Mirror checking is defined as constantly examining or
judging specific body parts, or changes in body shape and weight. Patients with
48
Eating disorder often avoid mirrors and this mirror avoidance is important to
address during treatment. Patients are taught to handle a mirror correctly, to
look at their reflection alone or with others. The mirror can be used to help form
a more stable integrated mental representation of the body and increases ability
to estimate one’s own body size. Mirrors can be used effectively to help
minimize denial of low weight, provoke an intense reality testing, reduces
negative cognitions and feelings of fear, uncertainty, and sadness. In addition,
mirrors can affect the activation of the autonomic and endocrine system in the
hypothalamus. Mirror exercises represent forms of habituation training in which
the patient becomes more familiar with her own body and with associated
changes following weight gain during treatment.
Sensory awareness training
Sensory awareness training aims to discover the body through the senses in a
non-threatening manner. Improving awareness and consciousness of internal
sensations has a direct effect on the ability to recognize feelings. It is also an
important step toward achieving a mutual relationship between bodily
sensations and feelings. Peripheral concentration exercises focus attention on
relatively neutral objects through auditory and visual observation. This way, the
attention is on the stimuli without being affectively immersed. Body boundary
exploration concentrates on tactile awareness of the difference between one’s
body and the outside world. Body scanning (‘trip around the body’) is a key
tactile exercise to explore the external manifestations of the body through
touching and feeling of the body boundaries. Internal sensory exploration
focused on breathing, heartbeat, and feelings of hunger and fatigue.
Other physiotherapeutic approaches
In the Scandinavian countries, basic body awareness therapy (BBAT) and the
Norwegian psychomotor physiotherapy (NPMP) are physiotherapeutic
modalities used in patients with Eating disorder. (31)
49
traditional substance abuse treatment methods. Yoga is increasingly being
used in substance abuse treatment programs and throughout recovery to help
prevent relapse, reduce withdrawal symptoms and drug cravings, and
provide a healthy outlet to cope with potential triggers and daily life
stressors. Yoga poses used in addiction recovery:
- Spinal breathing pranayama
- Fish pose
- Yogi Bicycles
- Downward facing dog
- Low lunge
- Sage twist
- Pigeon pose (32)
Aerobic exercise
In mental health research, both aerobic exercise and strength training are
effective in the treatment of mood disorders, with effect sizes comparable to
medication and psychological therapy. Some aerobic exercise is used for the
drug abuse is the;
- Walking
- Jogging
- Swimming
- Cycling
- Dancing
50
STRENGTH OF THE STUDY
We conducted the survey involving 200 students only who are in inclusion
criteria due to lack of time availability.
The number of male students who participated for our study is
comparatively less than the female students.
FUTURE RESEARCH
In future, we would like to conduct the same study in more number of school
and undergraduate students.
We would like to include exercise interventions in the study in order to
prove its effect in improving the quality of life in school and undergraduate
students.
51
CONCLUSION
52
CONCLUSION
The psychosocial problems and behavioral problems among school and
undergraduate students is also a major public health concern. From this study we
concluded that the prevalence of anxiety was higher among school. Comparing
with male and female students, male students had higher incidence of anxiety. In
case of depression the prevalence of depression was higher among college.
Comparing with male and female students, it is found that male students are
comparatively more depressed then male students.
The prevalence of eating disorder was higher among college students. Comparing
with male and female students, the female students have higher incidence of eating
disorder than male students. From this study we concluded that the prevalence of
alcohol abuse was higher among college. Comparing with male and female
students, the male students have higher incidence of alcohol abuse than female
students.
53
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32.YOGA https://americanaddictioncenters.org/therapy-treatment/yoga yoga poses
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57
APPENDIX
QUESTIONNAIRE
Socio-demographic data;
Name;
Age;
Gender;
(Not at all, Several days, More than half the days, Nearly every day)
(Not at all, Several days, More than half the days, Nearly every day)
(Not at all, Several days, More than half the days, Nearly every day)
4. Trouble relaxing?
(Not at all, Several days, More than half the days, Nearly every day)
(Not at all, Several days, More than half the days, Nearly every day)
(Not at all, Several days, More than half the days, Nearly every day)
(Not at all, Several days, More than half the days, Nearly every day)
58
PATIENT HEALTH QUESTIONNAIRE- 9
(Not at all, Several days, More than half the days, Nearly every day)
(Not at all, Several days, More than half the days, Nearly every day)
(Not at all, Several days, More than half the days, Nearly every day)
(Not at all, Several days, More than half the days, Nearly every day)
(Not at all, Several days, More than half the days, Nearly every day)
6. Feeling bad about yourself - or that you are a failure or have let yourself or your
family down?
(Not at all, Several days, More than half the days, Nearly every day)
(Not at all, Several days, More than half the days, Nearly every day)
8. Moving or speaking so slowly that other people could have noticed? Or the
opposite - being so fidgety or restless that you have been moving around a lot more
than usual?
(Not at all, Several days, More than half the days, Nearly every day)
9. Thoughts that you would be better off dead, or of hurting yourself in some way?
(Not at all, Several days, More than half the days, Nearly every day)
59
SCOFF TEST
60
5. During the past year, how often have you failed to do what was normally
expected of you because of drinking?
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
6. During the past year, how often have you needed a drink in the morning to
get yourself going after a heavy drinking session?
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
7. During the past year, how often have you had a feeling of guilt or remorse
after drinking?
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
8. During the past year, have you been unable to remember what happened
the night before because you had been drinking?
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
No
61
Yes, but not in the past year
Yes, during the past year
10. Has a relative or friend, doctor or other health worker been concerned
about your drinking or suggested you cut down?
No
Yes, but not in the past year
Yes, during the past year
62