Social Health and Behavior

ORIGINAL ARTICLE
Year
: 2019  |  Volume : 2  |  Issue : 2  |  Page : 58--63

Mental Health and Its Sociodemographic Determinants among High School Students: A Cross-Sectional Survey in Qazvin City of Iran


Mehran Alijanzadeh 
 Department of Health Services Management, School of Health, Qazvin University of Medical Sciences, Qazvin, Iran

Correspondence Address:
Dr. Mehran Alijanzadeh
Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin
Iran

Abstract

Introduction: Adolescence is one of the most important stages of human life, and there is a lot of evidence in the literature that psychiatric disorders can be transmitted through adolescence social interactions in high school. The present study aimed to assess mental health and its sociodemographic determinants among high school students in Iran. Methods: In this cross-sectional study, 600 female high school students from Qazvin were selected using cluster sampling. The 28-item General Health Questionnaire was administrated to collect data. t-tests, analysis of variance, and Pearson's correlation analysis were applied to analyze the data. Results: Mental disorders were found in 60% of the students with 3.3% suffered from severe disorders. The participants' mean score of mental health was 29.31 ± 14.63. Somatic symptoms, anxiety, social dysfunction, and depression were presented in 36%, 49.7%, 50%, and 41.3% of the students, respectively. Students' mental health was significantly related with their father's education and household income. However, students' season of birth, school grade, body mass index, grade point average, mother's education, and father's occupation were not significantly related with their mental health. Conclusion: Poor mental health was found to be highly frequent among female students. Low income and father's low education level were identified as the risk factors of poor mental health among female students in Qazvin.



How to cite this article:
Alijanzadeh M. Mental Health and Its Sociodemographic Determinants among High School Students: A Cross-Sectional Survey in Qazvin City of Iran.Soc Health Behav 2019;2:58-63


How to cite this URL:
Alijanzadeh M. Mental Health and Its Sociodemographic Determinants among High School Students: A Cross-Sectional Survey in Qazvin City of Iran. Soc Health Behav [serial online] 2019 [cited 2020 Jan 22 ];2:58-63
Available from: http://www.shbonweb.com/text.asp?2019/2/2/58/257176


Full Text



 Introduction



Mental health is a critical component of people's health and well-being. Since all physical, mental, and social states are incorporated into the definition of this concept, a mere absence of diseases does not necessarily indicate one's good mental health. In other words, mental health, defined as one's ability to adjust to others, adapt to environmental changes, and resolve personal conflicts, comprises two major aspects: the absence of diseases and the presence of well-being.[1] Like other dimensions of health, mental health can be affected by a range of socioeconomic factors.[2] Considering the high levels of disability and mortality among people with mental disorders, mental health seems to have undeniable effects on other conditions such as cardiovascular and gastrointestinal diseases. Increasing attention has thus been paid to mental health during 1994–2012.[3]

Previous studies have highlighted the high prevalence of mental health issues among students. Ranasinghe et al. reported the high risk of mental health disorders in students across different countries and emphasized the need for relevant measures to prevent such disorders in students.[4] In addition to rapid technological, cultural, and social changes in the world nowadays, a variety of other problems including parental divorce, financial difficulties of the family, limited relationships, marriage, and changes in values and beliefs may affect adolescents' mental health.[5] A warm and friendly family environment along with intimate relationships between family members can positively affect adolescents' mental health. Indeed, family plays a major role in the promotion of adolescents' health.[6] Moreover, the effects of health promotion programs and attention to mental health-promoting factors should not be neglected.[7] During the past decades, mental disorders have caused increasing burden and significant destructive effects on the health and economy of different societies. Health policymakers need to pay particular attention to adolescents' mental health because the psychological characteristics of students is a very sensitive stage of life.[8]

Depression is the most common mental disorder and a major cause of disability worldwide. Depressive disorders are present in almost 400 million people of different ages and tend to affect females more than males. According to the available statistics, 76%–85% of mental disorders remain untreated.[9] The main symptoms of mental disorders include headaches, early fatigue, loss of appetite, sadness, insomnia, and nightmares.[10]

A previous study on students indicated that mental disorders were more frequent at the beginning of the school year than at the end of it. Therefore, although exposure to a new environment had negative effects on students' mental health, they learned to adapt to the new conditions over time.[11] A study in Hamedan (Iran) suggested the risk of social dysfunction, anxiety, depression, and hypochondriasis among the majority of the evaluated students and underscored the need for appropriate planning in this regard.[12] Likewise, Rückert documented the high prevalence of mental disorders in students and reported psychological counseling as an effective strategy to resolve students' problems.[13] Mental health is very crucial health issue whose better understanding will help identify the existing shortcomings and eliminate the present barriers. Due to the significance of adolescence, particularly in girls, attention to adolescents' mental health is essential. Therefore, the current study aimed to assess social factors affecting students' mental health in the city of Qazvin (Iran).

 Methods



This descriptive-analytical study was conducted in Qazvin. The study population included all female students in Qazvin, Iran. The sample size was determined based on related research[12] and considering P = 0.6, accuracy = 5%, and design effect = 1.5. Multistage cluster sampling was used to select 600 participants. Six schools were examined, according to population areas, two schools in the East, two schools in the North, one school in the South, and one school in the West of Qazvin. With about 33 female students were randomly selected from each grade, each school had 100 students invited to participate in this study. The exclusion criteria were (1) the presence of any acute diseases, (2) experiencing the loss of a family member or friends in the past 3 months, and (3) unwilling to participate in the study.

Instruments

The 28-item General Health Questionnaire (GHQ-28) was administered to collect data. It assessed mental health of high school students in four domains of somatic symptoms (items 1–7), anxiety (items 8–14), social dysfunction (items 15–21), and depression (items 22–28). Questionnaires were completed within schools by interviews with students. The interview was conducted by trained interviewers and completed questionnaire at break time.

The validity of the GHQ-28 has been investigated in earlier studies.[12],[14] Each subscale of the GHQ-28 consists of seven items which are scored on a 4-point Likert scale from 0 to 3 (0 = absence of problem and 3 = existence of severe problem in each item). In each subscale, 0–7 indicates the absence of health problems; 7–12 indicates mild problems; 12–17 indicates moderate problems; and 17–21 indicates severe problems. Consequently, while the total score is between 0 and 23, it confirms the stable mental health of the participants; score higher than 23 denotes some level of symptoms associated with mental disorders, i.e., 23–41, 41–61, and 61–84 indicate the presence of mild, moderate, and severe problems, respectively. The questionnaire also contained demographic characteristics including the students' age, season of birth, school grade, body mass index (BMI), grade point average (GPA), household income, parents' education, and father's occupation.

Statistical analysis

The students were ensured of confidentiality replies, and the GHQ-28 was assessed by female interviewers who were skilled and trained experts because the trust can be built up. This process enhanced the accuracy of the obtained results. The Kolmogorov–Smirnov and Levene's tests demonstrated normal distribution of the collected data (P = 0.750 and 0.430). Cronbach's alpha for the GHQ-28 was satisfactory (0.86). The collected data were analyzed using t-tests, analysis of variance, and Pearson's correlation by SPSS (SPSS Inc., Chicago, IL, USA).

Ethical consideration

The Ethics Committee of Qazvin University of Medical Sciences approved this study. The importance of the study was explained to the students by interviewers, and the participants were assured that the information they provided would be confidential. A consent form was completed by each student.

 Results



The mean age of the studied high school girls was 16.3 ± 1.08 years. Almost all the participants (98%) were single, and 31.3% of them were born in summer. The mean GPA and BMI of the students were 17.29 ± 2.42 and 20.90 ± 3.62 kg/m2, respectively. Mean and standard deviation scores of the 28-item General Health Questionnaire is mentioned [Table 1]. Their parents mainly had a junior high school degree, and their mean household income was 15,590,000 ± 7,903,200 Rials. Moreover, 53% of the fathers were self-employed [Table 2].{Table 1}{Table 2}

Among the four subscales of the GHQ-28, the students scored the highest in social dysfunction (7.81 ± 3.39) and the lowest in somatic symptoms (6.70 ± 4.10). The mean total mental health score of the enrolled female students was 29.31 ± 14.63. While 60% of the students were found to have mental disorders, only 3.3% suffered from severe disorders. Moreover, somatic symptoms, anxiety, social dysfunction, and depression were present in 36.0%, 49.7%, 50.0%, and 41.3% of the students [Table 3].{Table 3}

No significant relations were detected between mental disorders and either GPA or BMI [Table 4]. However, students with good mental health had significantly higher household income compared to those with poor mental health (P = 0.028). The most significant correlation was observed between anxiety and mental health (r = 0.855). The least significant correlation, on the other hand, was that between somatic symptoms and social dysfunction (r = 0.383) [Table 5].{Table 4}{Table 5}

 Discussion



In this study, 60% of the evaluated students scored higher than 23 on the GHQ-28 and were thus suspected to have a mental disorder. Likewise, Sadeghian et al. reported the presence of mental disorders among 60.2% of female students in Hamedan, Iran.[12] Specifically, hypochondriasis, anxiety, social dysfunction, and depression were detected in 36.7%, 46.5%, 49%, and 45.8% of the students, respectively.[12] Similar cultural and economic conditions in the two cities along with the same gender of the participants can justify the agreement between the findings of the two studies. Habibzadeh found 67% of the students in Qom (Iran) to have depressive disorders.[14] This highlights the critical mental health status of students in the mentioned city.

Poorghaz and Raghibi[15] calculated the frequency of depression among the high school students of Zahedan, Iran, as 47.5%, which is slightly higher than the results of the present study. Meanwhile, the frequency of hypochondriasis in their study (23.1%) was lower than that in the current research (36.0%). Dissimilar cultural and living conditions in the two areas might have been responsible for the differences observed between the two studies.[15] While the presence of mental disorders, for example, stress, anxiety, and depression among the students is undeniable, failure to identify and resolve such problems will negatively affect people's lives and students' health.[16]

Yarmohammadi and Rahayi reported mental disorders in 38% of students in Shahrekord (Iran). Furthermore, the most common disorder was social dysfunction (49%). Consistent with our findings, they found a significant relationship between father's education and mental health.[17] In Japan, Ohtsu et al. detected mental disorders in 36.6% of male students and 48.8% of female students. They introduced mental health-care provision to students as a major factor in public health promotion.[18] Chen and Ying underlined the significant effects of socioeconomic factors on individuals' mental health and confirmed the education and welfare status of the family as major determinants of children's health.[19] These findings are in line with the results of the present study.

Sorkhkalaee et al. detected mental disorders in 47.7% of the evaluated students. They reported depression in 53.7% of these cases.[20] While schools are responsible for improving students' knowledge and skills, they will not succeed in fulfilling their duties in the absence of adequate attention to basic issues such as mental health.[21] Due to the increasing prevalence of mental disorders in different communities, appropriate planning and policymaking are required to promote students' mental health.[22]

According to Tomsa et al., freshmen experience higher levels of mental disorders in high school students compared to other students.[23] Fathi et al. identified depression as a major problem in students.[24] Sakinepoor et al. reported athletes to have better mental health than the general population.[25] The findings of Shakiba and Ziai highlighted higher levels of mental health in students living with their parents than in those under the custody of the State Welfare Organization of Iran.[26] These two studies revealed the positive effects of exercise and family support on improving students' mental health. Likewise, Soltanian et al. confirmed the beneficial role of physical activity in reducing stress and anxiety.[27] Koutra et al. underscored the critical role of psychological counseling in mental health promotion among university students.[28] Conley et al. suggested the necessity of self-management in decreasing anxiety and stress.[29] Manjunath and Kulkarni found depression to be highly frequent among medical students, i.e., the participants did not enjoy good mental health. In addition, similar to our findings, a significant relationship was observed between father's education and the main research variable (students' mental health).[30]

Due to the significance of mental health, the deteriorating effects of mental disorders on students need to be prevented by the planning and implementation of appropriate interventions. Such efforts will ultimately promote public health by helping the students develop their talents to the full and establish better interactions.[31] Soltanian et al. found that 48.9% of girls in Bushehr (Iran) had suspected mental disorders. Consistent with our findings, they detected positive relationships between mental health and both parents' education and household income.[32] On the other hand, while we found mental disorders in 60% of our participants, lower rates, i.e., 55.5% and 44%, were reported by Rael et al.[33] and Zivin et al.[22] Differences in research tools to assess mental health, along with sociocultural and economic variations in different countries, can justify the dissimilar rates. Masoodzadeh et al. administered two different tools to evaluate mental health in the same city (Sari, Iran) and reported mental disorders to be present in 39%–58% of the participants.[34] In the area of mental health of students, extensive research has been conducted in Qazvin Province.[35],[36]

Based on the findings of the current research, female high school students in Qazvin (Iran) do not have good mental health. Therefore, the relevant authorities need to design and implement appropriate interventions to improve students' mental health. Rajaei et al. emphasized the need for creating a healthy environment and good atmosphere in schools to promote students' mental health.[37] Dalir and Mazloum stressed the benefits and efficacy of educational–psychological counseling in training centers.[38]

Limitation

A limitation of this study was the complicated bureaucratic processes to receive the introduction letter and reassure the security officials of the department of education about the importance of the study, and the standard nature of the administered questionnaire and the generalizability of the sample are limited in the age group of 15–18 years. In addition, with the cross-sectional design, we do not know the causal relationship between the mental health and the studied sociodemographic factors. All the enrolled students were willing to participate in the study, and the questionnaires were distributed in schools with the approval of the Security and Research Management of the Department of Education of Qazvin Province.

 Conclusion



Attention to students' social function in Qazvin and reducing their anxiety are essential to improving their mental health. Schools are thus recommended to hold celebrations and happy morning routines, supply appropriate welfare and sports facilities, encourage the students to exercise, organize sports competitions and recreational camps, provide counseling services, promote parents' awareness and knowledge, and ultimately identify the students who need social or economic support.

Acknowledgment

The authors of this study appreciate the Head of Social Determinants of Health Research Center and the Research and Health Deputy at the Qazvin University of Medical Sciences.

Financial support and sponsorship

Qazvin Social Determinants of Health Research Center funded this research.

Conflicts of interest

There are no conflicts of interest.

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