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Mental Status and Related Factors in High School Adolescent Students
Available online at www.sciencedirect.com
ScienceDirect Procedia - Social and Behavioral Sciences 114 (2014) 500 – 505
4th World Conference on Psychology, Counselling and Guidance- WCPCG-2013
Mental status and related factors in high school adolescent students Nihal BOSTANCI DAŞTAN a * a
Department of Nursing, Health High School, University of Kafkas, Kars and 36100, Turkey
Abstract The purpose of this study was to determine in high school population adolescents’ mental status and related factors. A descriptive and cross-sectional survey conducted among 558 ninth-grade Turkish adolescents aged between 13 and 17. Sociademographic data form, Strength and Difficulties Questionnaire (SDQ) was applied. The 25 self-report SDQ items are divided between 5 scales (hyperactivity scale, emotional symptoms scale, conduct problems scale, peer problems scale and prosocial scale) of 5 items each. In order to analyze the data; descriptive statistics, student’s t test, One-way Anova tests were used. 15.1 % of the students had 16-19 score (limit point), 9.1% had 20 and above score (abnormal) for SDQ and at risk. It was found that the SDQ scores are high in the students whom are older, in those who lives with relatives, in those who have divorced or separated family type, whose parents are irrevelant, whose family income is bad, in those whose relations are bad with the family or the people, in those who has problems in the continuation of human relations, in those who has a health problem , whose monthly income is not enough and in those who works somewhere else (p< 0.05). Mental problems are prevalent in high school students. The implementation of therapeutic, structured mental support program to adolescences with mental problems could be beneficial improving mental status of these individuals. © 2013 The Authors. Published by Elsevier Ltd. © 2013 The Authors. Published by Elsevier Ltd. Selection and and peer-review peer-review under and Research Selection under responsibility responsibilityof ofAcademic Prof. Dr. World Tülay Education Bozkurt, Istanbul KulturCenter. University, Turkey Keywords: Adolescence, mental status, psychopathology
1. Introduction Mental health is as important as physical health. According to a description which is accepted nowadays, “mental health is a state of individual being in peace with his/her environment, with the people around him/ her and with society, and the continuation of the necessary effort fort he continuous balance, neatness and the coherence” (Çağan & Pehlivan 2012).
* Corresponding author name. Nihal BOSTANCI DAŞTAN Tel.: +90-474-225-1265 E-mail address: [email protected]
1877-0428 © 2013 The Authors. Published by Elsevier Ltd.
Selection and peer-review under responsibility of Academic World Education and Research Center. doi:10.1016/j.sbspro.2013.12.736
Nihal Bostanci Daştan / Procedia - Social and Behavioral Sciences 114 (2014) 500 – 505
Adolescence is not a simple transitional period from childhood to adulthood, but a time of great maturational change during which important foundations of adult behaviours and emotions are formed (Öner et al., 2013; Eryılmaz 2009). The rapid changes in social, cultural and economical conditions at the present day causes individuals experiencing the adolescent period more harder because of its commonly accepted as a tumultuous period in a human development (Özmen et al., 2008; Eskin et al., 2008; http://www.who.int. 2013). Young person may experience some problems about her/his body image, identity and sexual identity, self-esteem, leaving parent dependency, individualisation, relationships with schoolmates and friends and future plans (Eryılmaz 2009; Yorukoğlu 1994). According to the population census which has been done in Turkey in 2012, of Turkey’s population 8.46 % (adolescent: 6.405.556; total population : 75.627.384) is the adolescent aged between 15-19 (http://www.tuik.gov.tr, 2013). It has been notified that approximately 10-25% of them show serious mental disorders and the psychiatric disorders in adolescent period start in this term (Küçük & Bayat, 2012; Öztop 2012). According to World Health Organization data in 2000, 20 % of the adolescents experience mental disorders and according to data in 2001 adolescents self destruction takes the 3rd place in the causes among adolescent death (http://www.who.int. 2013). Adolescent and children constitute a section of population where their mental health problems examined less and the health service serving in these kind of problems are not enough both in means of quantity and attribute. Revealing the prevalence of mental disorders by investigation is important in means of planning and serving the health services for the group that is mentioned (http://www.who.int. 2013). Although the mental symptoms in this century mostly have temporary and periodical character, they must be seriously take into consider because of arising in a period where an organization of both personal and mental form takes place and also their becoming of probability of permanent disorders in the future (Kırpınar, 1992). It has been shown in the epidemiologic studies that although the prevalence or the incidence of psychiatric disorders increases in the adolescent period, most of them couldn’t obtain the suitable mental help because of some barriers (lack of resources- financial, human resources; facilities, stigma and other barriers (http://www.who.int. 2013). Because of this, the mental health of the youth must be evaluated carefully. Aim The aim of this study was to determine in high school population adolescents’ mental status and related factors. 2. Method Design and participants: This research, which was planned as a descriptive and cross-sectional study, was conducted two high schools in Kars. All of the schools in the city centres were reached. Students, who presented to this school, between October 1- December 30 2010, were the student population, and 558 students. Measures: Two forms were used by the researchers for data collection: The Descriptive Characteristics Questionnaire for Students: This form was developed after a review of the literature (Çağan & Pehlivan 2012; Öner et all. 2013; Özmen et all. 2008; Eskin et all. 2008; Küçük & Bayat 2012; Kırpınar 1992; Bağcı et all. 2004; Goodman et all. 2000; Keskin & Çam 2008). This form had two sections. In the first section, questions were asked to obtain information about the patients' sociodemographic characteristics (age, gender, family type, his/her mother-father educational level, his/her mother-father employment status, his/her family income level and longest place of residence). In the second section, questions were directed at determining the students' mental status and related factors (school performance, mental problems, and his /her family members’ mental problems). Strengths and Difficulties Questionnaire (SDQ): This scale which has been developed by Goodman and its Turkish validity and reliability has been made by Güvenir and friends are used for determining the adolescents’ suffiency areas and their problem behaviours and are filled by the adolescent. The questionnaire has 25 items, divided between 5 scales of 5 items each: Hyperactivity Scale: “I am restless, I cannot stay still for long”, “I am constantly fidgeting or squirming”, “I am easily directed, I find it difficult to concentrate”, “I think before I do things”, and “I finish the work I’m doing. My attention is good”. Emotional Symptoms Scale: “I get a lot of headaches, stomach-aches or sickness”, “I worry a lot”, “I’m often unhappy, down-hearted or tearful”, “I’m nervous in new situations. I easily lose confidence”, and “I have many fear. I’m easily scared”. Conduct Problems Scale: “I get very angry and often lose my temper”, “I usually do as I am told”, “I fight a lot. I can make other people do what I want”, “I’m often accused of lying and cheating”, and “I take things that are not mine from home, school or elsewhere”. Peer Problems Scale: “I’m usually on my own. I generally play alone or keep to myself”, “I have one
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good friend or more”, “Other people my age generally like me”, “Other children or young people pick on me or bully me”, and “I get on better with adults than with people my own age”. Prosocial Scale: “I try to be nice to other people. I care about their feelings”, “I usually share with others (food, games, pens, etc.)”, “I’m helpful if someone is hurt, upset or feeling ill”, “I’m king to younger children”, and “I often volunteer to help others (parents, teachers, children)”(Goodman et all. 2000; Keskin & Çam 2008; Goodman et al., 1998; Goodman 2001; Ramos et all. 2003; Güvenir et al., 2004) . Each item can be answered as ‘Not True’, ‘Somewhat True’ and ‘Certainly True’ receiving punctuations from 0 to 2 for each answer, ‘not true’ being punctuated as 0 or 2 depending on the template. The punctuation for each of the subscales is obtained adding the punctuations of the five items which compose each subscale, thus generating a punctuation which ranges from 0 to 10. The punctuations in the subscales of hyperactivity, emotional problems, conduct and relationship are added generating a total punctuation of difficulties ranging from 0 to 40. The punctuation of the pro-social scale is not incorporated in the total punctuation of difficulties, as the absence of pro-social behaviours is conceptually different from the presence of psychological difficulties. SDQ score based on ranges of normal, borderline and abnormal evaluations are shown in Table 1 (Goodman et all. 2000; Keskin & Çam 2008; Goodman et all. 1998). Table 1. SDQ score based on ranges of normal, borderline and abnormal evaluations Normal Borderline Abnormal Total score 0-15 16-19 20-40 Emotional Symptoms Scale 0-3 6 7-10 Conduct Problems Scale 0-5 4 5-10 Hyperactivity Scale 0-3 6 7-10 Peer Problems Scale 0-4 4-5 6-10 Prosocial Scale 6-10 5 0-4 Data Collection: Written permission was obtained from the education department in which the research was conducted. The surveys were administered at classroom settings during regular class time. The researcher informed the students about the purpose and scope of the study prior to the study, both verbally and in written form. The students were free to refuse participation or withdraw from the study at any time. The obtained data from the students was used only for the study. The students were informed about the fact that all findings would be reported as group results and be submitted for publication. The students were given 15-20 minutes to complete the form and asked to do so by themselves so that they would not affect each other. They were informed that the information they provided would be kept confidential and were asked not to write their names on the form. Data Analysis: In analysing data, SPSS 20.0, descriptive statistics, student’s t test, One-way Anova were used. 3. Results Students' Sociodemographic Characteristics: The average age of the students was 15.69 ± 0.81. When demographic characteristics of students were investigated, it was determined that most of students were men (57.9%), were born is Eastern and Southeastern Anatolia (96.2%), mostly lived in a city (62.9%), living with family (79.6%), raised by family (98.9%), have nuclear family (56.5%), has protective mother (53.8%) and father (45.7%), whom mother (38.7%) and father (30.1%) graduated from primary school, his mother is a housewife (95.7%), his father is worker (72.6%), his family have medium economic status (43.0%), have good school performance (61.3%), don’t have a mental problems (87.1%) and don’t have a family member with mental problems (91.4). Students' Strengths and Difficulties: When we look to the students’ SDQ average point, the highest point can be seen in fellow problems sub-scale and the lowest average point can be seen in behaviour sub-scale. The students’ SDQ scale average points are given in Graphic1.
Nihal Bostanci Daştan / Procedia - Social and Behavioral Sciences 114 (2014) 500 – 505
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Graph 1. Students’ SDQ Average Score
The students’ assessment due to SDQ points in means of being normal , limited and abnormal can be seen in Table 2. 15.1 % of the students had 16-19 score (limit point), 9.1% had 20 and above score (abnormal) for SDQ and at risk. Table 2. SDQ score based on ranges of normal, borderline and abnormal (%) Normal Borderline Abnormal Total score 75.1 15.1 9.8 Emotional Symptoms Scale 74.2 6.5 19.3 Conduct Problems Scale 87.1 8.6 4.3 Hyperactivity Scale 89.0 7.6 3.4 Peer Problems Scale 33.3 56.5 10.2 Prosocial Scale 93.0 5.4 1.6 The factors that affected the students SDQ were investigated. It was found that the SDQ scores are high in the students whom are older, in those who lives with relatives, in those who have divorced or separated family type, whose parents are irrelevant, whose family income is bad, in those whose relations are bad with the family or the people, in those who has problems in the continuation of human relations, in those who has a health problem , whose monthly income is not enough and in those who works somewhere else (p< 0.05). 4. Discussion Because of effort for search of the identity, a change in the character of the family and friend relations, adolescents may frequently faced with mental problems and there may be seen changes or cycles in their emotional states. For this reason the adolescents must be carefully analyzed in terms of mental health. In this study, it is seen that the students got the highest point from the peer problems sub-scale from the SDQ (Graphic 1). One distinctive feature of the adolescent period is the increased importance of the peer group. In adolescent period a great importance is given to the peers because of giving an advice, being together, building up a behaviour model, supporting and serving a feedback, being a source because of personal character and about ability. Most of the adolescent conveyed that they don’t prefer their family, they prefer their peer synergy. Many of the adolescents aren’t peer group centred, but they are sensitive to peer specific affects in different periods under specific conditions. While the adolescent get bigger he or she expose identity social role and social state and they become lower addicted to their peer acceptance and support. The studies which have been made in Turkey showed that peer relations are very important in adolescents’ mental health (Eskin et al., 2008; Özcan et al., 2005). In spite of peer group become important with the adolescent period for the young people their family don’t lose their importance for them (Eskin et al., 2008). Family is still the basic confidence source for the child of this period. For this reason it is estimated that the adolescent relation with the family must or have an effect on the adolescent mental health. Our findings also certify this opinion. The results of the studies made before are parallel with our finding (Eskin et al., 2008; Maedows et al., 2006). While in this study the peer problems are the most important problem in this group, Ramos et al., (2003) found the most important problems as emotional symptoms and conduct problems, with the same
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scale which has been applied to the children aged 6-11, and for Keskin and Çam (2008), the hyperactivity and peer problems are the main problem that they found in their study which has been applied to the children aged 11 to 15. So we can say that while getting older the adolescent allow away from their conduct problems and the problems of peer problems and emotional symptoms are seen mostly. In this study, %24.9 of the students is risky in means of mentally and their mental problems levels are higher (Table 2). Whereas, in our country this rate has been found between % 60.2-69.4 with the help of the General Health Questionnarie 12 or 28 (GHQ 12 or 28) which has been made with the students (Çağan & Pehlivan 2012; Küçük & Bayat 2012; Bağcı et al., 2004; Eskin 2000). This may result from because of the different surveying equipment. In this study, it has been determined that the students who are older and their relations with their family or their friend relations are bad have higher SDQ points. The findings of the study are fit with Kucuk and Bayat’s (2012) findings. Even so, in Eskin’s study which has been made in 2000, it has been seen that the older adolescents face more mental problems. In the study of Bagcı et al., (2004) the adolescent who have relation problems with their friends and family have more mental problems, and it has been seen that in Cagan and Pehlivan study (2012) the family structure don’t affect the students mental health. In this study, it can be seen that the students whose family income are bad, whose Money isn’t enough and the one who has a health problem, have more mental problems than others. The findings of Ozmen et al., study (2008) also support these findings. Hatun et al., (2003) declared that, in a society the mostly affected group from the destitution are the children while the destitution affected their physical development and health negative causing psychosocial problems and affected the mental development negatively. Some findings have been obtained from the studies made in overseas. It has been also declared that destitution have a close relation with mental diseases, in most of the children who lives indigent areas have mental problems, the children whose family is poor and have a serious economic loos have greater depression, anxiety and antisocial behaviours (Patel et all. 1998; Xue et all. 2005). In this study, it is seen that the ones who have mental problems before, have higher mental points. Cagan and Pehlivan’s study [1] also support this finding. This study which has been made in a city in the east and which don’t get enough portion in means of social comfort and only limited with the adolescent who trains in first class of the high school, constitutes the limited horizon of this study. For the generalization of the findings to whole of the adolescent in our country, the similar study must be made in different places with different cultural or socioeconomic characters. In conclusion, mental problems are prevalent in high school students. The implementation of therapeutic, structured mental support program to adolescences with mental problems could be beneficial improving mental status of these individuals. I can recommend, in order to remove students’ depressive mood which increased with sense of worthlessness and inadequacy, to increase students’ self confidence and esteem, to increase and support their self expression opportunities. Students should be encouraged to professional help when needed.
References Çağan, Ö., & Pehlivan, E. (2012). Malatya il merkezindeki lise öğrencilerinin ruhsal durumlarının GSA-12 ile değerlendirilmesi (Evaluation of the Mental Status of Last-Grade High School Students with the General Health Questionnaire-12 in the Center of Malatya). İnönü Üniversitesi Tıp Fakültesi Dergisi, 19(2), 88-95. Öner, Ö., Ergüder, T., Çakır, B., Ergun, U., Erşahin, Y., Erol, N., et all. (2013). Ergenlerin bildirdiği dürtüsellik belirtileri ve ruhsal sorunlar: epidemiyolojik bir çalışma. Mental problems and impulsivity reported by adolescents: an epidemiological study. Turk Psikiyatri Derg, 24 (1), 35-43. Eryılmaz, A. (2009). Ergenlik döneminde stres ve başaçıkma (Stress and cope at adolescence). Yüzüncü Yıl Üniversitesi Eğitim Fakültesi Dergisi, VI (II), 20-37. Özmen, D., Erbay Dündar, P., Çetinkaya, A.C., Taşkın, O., & Özmen, M. (2008). Lise öğrencilerinde umutsuzluk ve umutsuzluk düzeyini etkileyen faktörler (Hopelessness and factors affecting hopelessness in high school students). Anatolian Journal of Psychiatry, 9, 8-15. Eskin, M., Ertekin, K., Harlak, H., & Dereboy, Ç. (2008). Lise öğrencisi ergenlerde depresyon yaygınlığı ve ilişkili olduğu etmenler (Prevalence of and factors related to depression in high school students). Türk Psikiyatri Dergisi, 19(4), 382-389. Caring for children and adolescents with mental disorders. (2003). World Health Organization, Geneva. http://www.who.int/mental_health/media/en/785.pdf (Accessed in 26 April 20013). Yorukoglu, A. (1994). Children mental health, Acar Pub. Inc. Istanbul. Nüfus Sayım Sonuçları. http://www.tuik.gov.tr/VeriTabanlari.do?vt_id=9&ust_id=5. (Accessed in 26 April 20013). Küçük, S., & Bayat, M. (2012). Ortaöğretim öğrencilerinin ruhsal durumlarının değerlendirilmesi (To determine mental statutes of secondary school students). Sağlık Bilimleri Dergisi (Journal of Health Sciences), 21(2), 103-111. Öztop, D.B. (2012). Adolesanlarda ruhsal sorunlar (Psychological problems in adolescent period). Turk Aile Hek Derg, 16,14-18.
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Kırpınar, İ. (1992). Erzurum yetiştirme yurdunda kalan gençlerde ruhsal belirtilerin dağılımı (The distribution of psychiatric symptoms in young people in orphanages in Erzurum). Turk Psikiyatri Derg, 3(5), 265-268. Bağcı T, Üner S, Velipaşaoğlu M. (2004). Ankara’da Dikmen’de bulunan iki meslek lisesinin lise 1 ve lise 2 öğrencilerinin GSA kullanılarak ruhsal durum ve bazı riskli davranışlar yönünden incelenmesi (The mental state and in some risky behaviors in terms of examination using GSA whose vocational high schools students in first and second class in Ankara, Dikmen), IX. Halk Sağlığı Günleri, Ankara. Goodman, R., Ford, T., Simmons, H., Gatward, R., & Meltzer, H. (2000). Using the Strengths and Diffuculties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. Br J Psychiatry,177, 534-539. Keskin, G., & Çam, O. (2008). Ergenlerin ruhsal durumları ve anne baba tutumları ile bağlanma stilleri arasındaki ilişkinin incelenmesi (Relationship between mental health, parental attitude and attachment style in adolescence). Anatolian Journal of Psychiatry, 9, 139-147. Goodman, R., Meltzer, H., & Bailey, V. (1998). The strengths and difficulties questionnaire: a pilot study on the validity of the self-report version. Eur Child Adolesc Psychiatry, 7(3), 125-130. Goodman, R. (2001). Psychometric properties of the Strengths and Difficulties Questionnaire. J Am Acad Child Adolesc Psychiatry, 40, 1337-1345. Ramos, C., Jose, C., & Golfeto, J.H. (2003). Strengths and difficulties questionnaire (SDQ): a study of school children in Ribeirão Preto. Rev Bras Psiquiatr, 25(3), 139-145. Güvenir, T., Özbek, A., Baykara, B., Arkar, H., Şentürk, B., & İncekaş, S. (2004). Güçler ve Güçlükler Anketi ergen formunun Türkçe çevirisinin geçerlik ve güvenilirlik çalışması (Strengths and Difficulties Questionnaire adolescents form Turkish validity and reliability study) . 15. Ulusal Çocuk ve Ergen Psikiyatrisi Kongresi, İstanbul. Özcan Demir. N., Görgün Baran. A., & Ulusoy. D. (2005). Türkiye’de Ergenlerin Arkadaş-Akran Grupları İle İlişkileri ve Sapmış Davranışlar: Ankara Örneklemi (With Friends-peer groups of adolescents in Turkey Relations and Strayed Behaviors: Ankara sample). Bilig, 32, 83-108. Meadows, S.O., Brown, J.S., & Elder, G.H. (2006). Depressive symptoms, stress, and support: Gendered trajectories from adolescence to young adulthood. J Youth Adolescence, 35, 93-103. Eskin, M. (2000). Ergen ruh sağlığı sorunları ve intihar davranışı ile ilişkileri (Mental health problems and suicidal behavior relationships in adolescent) . Klinik Psikiyatri, 3, 228-234. Hatun, Ş., Etiler, N., & Gönüllü, E. (2003). Yoksulluk ve çocuklar üzerine etkileri (The poverty and effects on children). Çocuk Sağlığı ve Hastalıkları Dergisi, 46, 251-260. Patel, V., Pereira, J., Coutinho, L., Fernandes, R., Fernandes, J., & Mann, A. (1998). Poverty, psychological disorder and disability in primary care attenders in Goa, India. Br J Psychiatry, 172, 533-536. Xue, Y., Leventhal, T., Brooks-Gunn, J., & Earls, F.J. (2005). Neighborhood residence and mental health problems of 5- to 11-year-olds. Arch Gen Psychiatry, 62, 554-563.
ScienceDirect Procedia - Social and Behavioral Sciences 114 (2014) 500 – 505
4th World Conference on Psychology, Counselling and Guidance- WCPCG-2013
Mental status and related factors in high school adolescent students Nihal BOSTANCI DAŞTAN a * a
Department of Nursing, Health High School, University of Kafkas, Kars and 36100, Turkey
Abstract The purpose of this study was to determine in high school population adolescents’ mental status and related factors. A descriptive and cross-sectional survey conducted among 558 ninth-grade Turkish adolescents aged between 13 and 17. Sociademographic data form, Strength and Difficulties Questionnaire (SDQ) was applied. The 25 self-report SDQ items are divided between 5 scales (hyperactivity scale, emotional symptoms scale, conduct problems scale, peer problems scale and prosocial scale) of 5 items each. In order to analyze the data; descriptive statistics, student’s t test, One-way Anova tests were used. 15.1 % of the students had 16-19 score (limit point), 9.1% had 20 and above score (abnormal) for SDQ and at risk. It was found that the SDQ scores are high in the students whom are older, in those who lives with relatives, in those who have divorced or separated family type, whose parents are irrevelant, whose family income is bad, in those whose relations are bad with the family or the people, in those who has problems in the continuation of human relations, in those who has a health problem , whose monthly income is not enough and in those who works somewhere else (p< 0.05). Mental problems are prevalent in high school students. The implementation of therapeutic, structured mental support program to adolescences with mental problems could be beneficial improving mental status of these individuals. © 2013 The Authors. Published by Elsevier Ltd. © 2013 The Authors. Published by Elsevier Ltd. Selection and and peer-review peer-review under and Research Selection under responsibility responsibilityof ofAcademic Prof. Dr. World Tülay Education Bozkurt, Istanbul KulturCenter. University, Turkey Keywords: Adolescence, mental status, psychopathology
1. Introduction Mental health is as important as physical health. According to a description which is accepted nowadays, “mental health is a state of individual being in peace with his/her environment, with the people around him/ her and with society, and the continuation of the necessary effort fort he continuous balance, neatness and the coherence” (Çağan & Pehlivan 2012).
* Corresponding author name. Nihal BOSTANCI DAŞTAN Tel.: +90-474-225-1265 E-mail address: [email protected]
1877-0428 © 2013 The Authors. Published by Elsevier Ltd.
Selection and peer-review under responsibility of Academic World Education and Research Center. doi:10.1016/j.sbspro.2013.12.736
Nihal Bostanci Daştan / Procedia - Social and Behavioral Sciences 114 (2014) 500 – 505
Adolescence is not a simple transitional period from childhood to adulthood, but a time of great maturational change during which important foundations of adult behaviours and emotions are formed (Öner et al., 2013; Eryılmaz 2009). The rapid changes in social, cultural and economical conditions at the present day causes individuals experiencing the adolescent period more harder because of its commonly accepted as a tumultuous period in a human development (Özmen et al., 2008; Eskin et al., 2008; http://www.who.int. 2013). Young person may experience some problems about her/his body image, identity and sexual identity, self-esteem, leaving parent dependency, individualisation, relationships with schoolmates and friends and future plans (Eryılmaz 2009; Yorukoğlu 1994). According to the population census which has been done in Turkey in 2012, of Turkey’s population 8.46 % (adolescent: 6.405.556; total population : 75.627.384) is the adolescent aged between 15-19 (http://www.tuik.gov.tr, 2013). It has been notified that approximately 10-25% of them show serious mental disorders and the psychiatric disorders in adolescent period start in this term (Küçük & Bayat, 2012; Öztop 2012). According to World Health Organization data in 2000, 20 % of the adolescents experience mental disorders and according to data in 2001 adolescents self destruction takes the 3rd place in the causes among adolescent death (http://www.who.int. 2013). Adolescent and children constitute a section of population where their mental health problems examined less and the health service serving in these kind of problems are not enough both in means of quantity and attribute. Revealing the prevalence of mental disorders by investigation is important in means of planning and serving the health services for the group that is mentioned (http://www.who.int. 2013). Although the mental symptoms in this century mostly have temporary and periodical character, they must be seriously take into consider because of arising in a period where an organization of both personal and mental form takes place and also their becoming of probability of permanent disorders in the future (Kırpınar, 1992). It has been shown in the epidemiologic studies that although the prevalence or the incidence of psychiatric disorders increases in the adolescent period, most of them couldn’t obtain the suitable mental help because of some barriers (lack of resources- financial, human resources; facilities, stigma and other barriers (http://www.who.int. 2013). Because of this, the mental health of the youth must be evaluated carefully. Aim The aim of this study was to determine in high school population adolescents’ mental status and related factors. 2. Method Design and participants: This research, which was planned as a descriptive and cross-sectional study, was conducted two high schools in Kars. All of the schools in the city centres were reached. Students, who presented to this school, between October 1- December 30 2010, were the student population, and 558 students. Measures: Two forms were used by the researchers for data collection: The Descriptive Characteristics Questionnaire for Students: This form was developed after a review of the literature (Çağan & Pehlivan 2012; Öner et all. 2013; Özmen et all. 2008; Eskin et all. 2008; Küçük & Bayat 2012; Kırpınar 1992; Bağcı et all. 2004; Goodman et all. 2000; Keskin & Çam 2008). This form had two sections. In the first section, questions were asked to obtain information about the patients' sociodemographic characteristics (age, gender, family type, his/her mother-father educational level, his/her mother-father employment status, his/her family income level and longest place of residence). In the second section, questions were directed at determining the students' mental status and related factors (school performance, mental problems, and his /her family members’ mental problems). Strengths and Difficulties Questionnaire (SDQ): This scale which has been developed by Goodman and its Turkish validity and reliability has been made by Güvenir and friends are used for determining the adolescents’ suffiency areas and their problem behaviours and are filled by the adolescent. The questionnaire has 25 items, divided between 5 scales of 5 items each: Hyperactivity Scale: “I am restless, I cannot stay still for long”, “I am constantly fidgeting or squirming”, “I am easily directed, I find it difficult to concentrate”, “I think before I do things”, and “I finish the work I’m doing. My attention is good”. Emotional Symptoms Scale: “I get a lot of headaches, stomach-aches or sickness”, “I worry a lot”, “I’m often unhappy, down-hearted or tearful”, “I’m nervous in new situations. I easily lose confidence”, and “I have many fear. I’m easily scared”. Conduct Problems Scale: “I get very angry and often lose my temper”, “I usually do as I am told”, “I fight a lot. I can make other people do what I want”, “I’m often accused of lying and cheating”, and “I take things that are not mine from home, school or elsewhere”. Peer Problems Scale: “I’m usually on my own. I generally play alone or keep to myself”, “I have one
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good friend or more”, “Other people my age generally like me”, “Other children or young people pick on me or bully me”, and “I get on better with adults than with people my own age”. Prosocial Scale: “I try to be nice to other people. I care about their feelings”, “I usually share with others (food, games, pens, etc.)”, “I’m helpful if someone is hurt, upset or feeling ill”, “I’m king to younger children”, and “I often volunteer to help others (parents, teachers, children)”(Goodman et all. 2000; Keskin & Çam 2008; Goodman et al., 1998; Goodman 2001; Ramos et all. 2003; Güvenir et al., 2004) . Each item can be answered as ‘Not True’, ‘Somewhat True’ and ‘Certainly True’ receiving punctuations from 0 to 2 for each answer, ‘not true’ being punctuated as 0 or 2 depending on the template. The punctuation for each of the subscales is obtained adding the punctuations of the five items which compose each subscale, thus generating a punctuation which ranges from 0 to 10. The punctuations in the subscales of hyperactivity, emotional problems, conduct and relationship are added generating a total punctuation of difficulties ranging from 0 to 40. The punctuation of the pro-social scale is not incorporated in the total punctuation of difficulties, as the absence of pro-social behaviours is conceptually different from the presence of psychological difficulties. SDQ score based on ranges of normal, borderline and abnormal evaluations are shown in Table 1 (Goodman et all. 2000; Keskin & Çam 2008; Goodman et all. 1998). Table 1. SDQ score based on ranges of normal, borderline and abnormal evaluations Normal Borderline Abnormal Total score 0-15 16-19 20-40 Emotional Symptoms Scale 0-3 6 7-10 Conduct Problems Scale 0-5 4 5-10 Hyperactivity Scale 0-3 6 7-10 Peer Problems Scale 0-4 4-5 6-10 Prosocial Scale 6-10 5 0-4 Data Collection: Written permission was obtained from the education department in which the research was conducted. The surveys were administered at classroom settings during regular class time. The researcher informed the students about the purpose and scope of the study prior to the study, both verbally and in written form. The students were free to refuse participation or withdraw from the study at any time. The obtained data from the students was used only for the study. The students were informed about the fact that all findings would be reported as group results and be submitted for publication. The students were given 15-20 minutes to complete the form and asked to do so by themselves so that they would not affect each other. They were informed that the information they provided would be kept confidential and were asked not to write their names on the form. Data Analysis: In analysing data, SPSS 20.0, descriptive statistics, student’s t test, One-way Anova were used. 3. Results Students' Sociodemographic Characteristics: The average age of the students was 15.69 ± 0.81. When demographic characteristics of students were investigated, it was determined that most of students were men (57.9%), were born is Eastern and Southeastern Anatolia (96.2%), mostly lived in a city (62.9%), living with family (79.6%), raised by family (98.9%), have nuclear family (56.5%), has protective mother (53.8%) and father (45.7%), whom mother (38.7%) and father (30.1%) graduated from primary school, his mother is a housewife (95.7%), his father is worker (72.6%), his family have medium economic status (43.0%), have good school performance (61.3%), don’t have a mental problems (87.1%) and don’t have a family member with mental problems (91.4). Students' Strengths and Difficulties: When we look to the students’ SDQ average point, the highest point can be seen in fellow problems sub-scale and the lowest average point can be seen in behaviour sub-scale. The students’ SDQ scale average points are given in Graphic1.
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Graph 1. Students’ SDQ Average Score
The students’ assessment due to SDQ points in means of being normal , limited and abnormal can be seen in Table 2. 15.1 % of the students had 16-19 score (limit point), 9.1% had 20 and above score (abnormal) for SDQ and at risk. Table 2. SDQ score based on ranges of normal, borderline and abnormal (%) Normal Borderline Abnormal Total score 75.1 15.1 9.8 Emotional Symptoms Scale 74.2 6.5 19.3 Conduct Problems Scale 87.1 8.6 4.3 Hyperactivity Scale 89.0 7.6 3.4 Peer Problems Scale 33.3 56.5 10.2 Prosocial Scale 93.0 5.4 1.6 The factors that affected the students SDQ were investigated. It was found that the SDQ scores are high in the students whom are older, in those who lives with relatives, in those who have divorced or separated family type, whose parents are irrelevant, whose family income is bad, in those whose relations are bad with the family or the people, in those who has problems in the continuation of human relations, in those who has a health problem , whose monthly income is not enough and in those who works somewhere else (p< 0.05). 4. Discussion Because of effort for search of the identity, a change in the character of the family and friend relations, adolescents may frequently faced with mental problems and there may be seen changes or cycles in their emotional states. For this reason the adolescents must be carefully analyzed in terms of mental health. In this study, it is seen that the students got the highest point from the peer problems sub-scale from the SDQ (Graphic 1). One distinctive feature of the adolescent period is the increased importance of the peer group. In adolescent period a great importance is given to the peers because of giving an advice, being together, building up a behaviour model, supporting and serving a feedback, being a source because of personal character and about ability. Most of the adolescent conveyed that they don’t prefer their family, they prefer their peer synergy. Many of the adolescents aren’t peer group centred, but they are sensitive to peer specific affects in different periods under specific conditions. While the adolescent get bigger he or she expose identity social role and social state and they become lower addicted to their peer acceptance and support. The studies which have been made in Turkey showed that peer relations are very important in adolescents’ mental health (Eskin et al., 2008; Özcan et al., 2005). In spite of peer group become important with the adolescent period for the young people their family don’t lose their importance for them (Eskin et al., 2008). Family is still the basic confidence source for the child of this period. For this reason it is estimated that the adolescent relation with the family must or have an effect on the adolescent mental health. Our findings also certify this opinion. The results of the studies made before are parallel with our finding (Eskin et al., 2008; Maedows et al., 2006). While in this study the peer problems are the most important problem in this group, Ramos et al., (2003) found the most important problems as emotional symptoms and conduct problems, with the same
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scale which has been applied to the children aged 6-11, and for Keskin and Çam (2008), the hyperactivity and peer problems are the main problem that they found in their study which has been applied to the children aged 11 to 15. So we can say that while getting older the adolescent allow away from their conduct problems and the problems of peer problems and emotional symptoms are seen mostly. In this study, %24.9 of the students is risky in means of mentally and their mental problems levels are higher (Table 2). Whereas, in our country this rate has been found between % 60.2-69.4 with the help of the General Health Questionnarie 12 or 28 (GHQ 12 or 28) which has been made with the students (Çağan & Pehlivan 2012; Küçük & Bayat 2012; Bağcı et al., 2004; Eskin 2000). This may result from because of the different surveying equipment. In this study, it has been determined that the students who are older and their relations with their family or their friend relations are bad have higher SDQ points. The findings of the study are fit with Kucuk and Bayat’s (2012) findings. Even so, in Eskin’s study which has been made in 2000, it has been seen that the older adolescents face more mental problems. In the study of Bagcı et al., (2004) the adolescent who have relation problems with their friends and family have more mental problems, and it has been seen that in Cagan and Pehlivan study (2012) the family structure don’t affect the students mental health. In this study, it can be seen that the students whose family income are bad, whose Money isn’t enough and the one who has a health problem, have more mental problems than others. The findings of Ozmen et al., study (2008) also support these findings. Hatun et al., (2003) declared that, in a society the mostly affected group from the destitution are the children while the destitution affected their physical development and health negative causing psychosocial problems and affected the mental development negatively. Some findings have been obtained from the studies made in overseas. It has been also declared that destitution have a close relation with mental diseases, in most of the children who lives indigent areas have mental problems, the children whose family is poor and have a serious economic loos have greater depression, anxiety and antisocial behaviours (Patel et all. 1998; Xue et all. 2005). In this study, it is seen that the ones who have mental problems before, have higher mental points. Cagan and Pehlivan’s study [1] also support this finding. This study which has been made in a city in the east and which don’t get enough portion in means of social comfort and only limited with the adolescent who trains in first class of the high school, constitutes the limited horizon of this study. For the generalization of the findings to whole of the adolescent in our country, the similar study must be made in different places with different cultural or socioeconomic characters. In conclusion, mental problems are prevalent in high school students. The implementation of therapeutic, structured mental support program to adolescences with mental problems could be beneficial improving mental status of these individuals. I can recommend, in order to remove students’ depressive mood which increased with sense of worthlessness and inadequacy, to increase students’ self confidence and esteem, to increase and support their self expression opportunities. Students should be encouraged to professional help when needed.
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