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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 36  |  Issue : 4  |  Page : 333-337

Family-related factors and its impact on psychosocial health of school-going adolescents of Urban Rishikesh, Uttarakhand


Department of Community and Family Medicine, AIIMS, Rishikesh, Uttarakhand, India

Date of Submission10-May-2020
Date of Decision04-Jun-2020
Date of Acceptance10-Jun-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. Jatin Chaudary
Department of Community and Family Medicine, AIIMS, Rishikesh, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_100_20

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  Abstract 


Background: Psychosocial problems occur in a wide variety of settings, and they often have a negative impact on adolescents' mental health. The family environment influences the psychosocial development of adolescents in this transitional phase. This study was conducted to find the association between psychosocial problems and the family environment. Materials and Methods: We conducted a cross-sectional study for 6 months among school-going adolescents of urban Rishikesh, Uttarakhand. In this study, a self-administered questionnaire consisting of Youth-Pediatric Symptom Checklist and family-related factors was given to the students. The data were compiled and analyzed using appropriate statistical analysis. Results: A total of 400 adolescent students participated in the study. The prevalence of psychosocial problems was 40.7%. Psychosocial problems were significantly associated with family-related factors which were further divided into three subgroups. First, the family environment which includes problems in the family (61.8%), parents understanding each other (61.8%), and participants feeling happy at home (34.2%). The second subgroup was parent–child relationships such as parents pay attention (27.9%), understanding parents (30.3%), and parents unhappy with participant's academic performance (63.6%). The third subgroup was parenting style such as parents allow children to take their own decisions (23.4%), parents comparing their child with other children (63.6%), parents are strict (63.1%), getting pocket money (35.7%), and interfering parents (64.3%). There was no significant association found between getting pocket money and psychosocial problems. Conclusion: Family-related factors have a significant impact on adolescents' psychosocial health; thus, targeted interventions are required. It is of paramount importance to educate parents, community stakeholders, and schools regarding psychosocial problems in adolescents.

Keywords: Adolescents, family, psychosocial problems, Rishikesh


How to cite this article:
Chaudary J, Kishore S, Bhadoria AS, Aggarwal P. Family-related factors and its impact on psychosocial health of school-going adolescents of Urban Rishikesh, Uttarakhand. Indian J Soc Psychiatry 2020;36:333-7

How to cite this URL:
Chaudary J, Kishore S, Bhadoria AS, Aggarwal P. Family-related factors and its impact on psychosocial health of school-going adolescents of Urban Rishikesh, Uttarakhand. Indian J Soc Psychiatry [serial online] 2020 [cited 2021 Jan 28];36:333-7. Available from: https://www.indjsp.org/text.asp?2020/36/4/333/305938




  Introduction Top


Adolescence is a time of heightened sensitivity to social influences and has a greater tendency toward emotional stimulation. Adolescents are full of energy, and these influences can result in their indulgence in risky behaviors and in making them more reckless. The future of the country and the quality of life largely depends on how well the adolescents can pass through this phase. The UNICEF and WHO define adolescents globally as an age group of 10–19 years, where 10–14 years of phase is called early adolescence and 15–19 years is called late adolescence. The needs of adolescents vary as they are not a homogeneous group, depending on their age, sex, sociocultural context, marital status, level of living arrangements, rural–urban residence, migration status, sexual activity, etc.[1]

Adolescence is a phase where puberty sets in leading to growth and development of secondary sexual characteristics and psychological changes in a child's body. During this critical phase, support and understanding of parents are really important in enabling the adolescent to meet and accept the biological, psychological, and social changes as well as challenges.[2]

The term psychosocial problems include emotional and behavior disorders, internalizing problems such as depression and anxiety, attention problems such as attention deficit hyperactivity disorder, substance abuse, externalizing problems such as conduct disorder, oppositional defiant disorder, suicide ideation, and suicide.[3]

Several risk factors have been identified in contributing to these psychosocial problems in adolescents such as family environment, individuality, and society. Indian families have a well-defined value system, which is our heritage, and these values are related to social relations and recommendations of the ideal way of life. Adolescents across all sections of the society thus have a family that supports them to deal or overcome the challenges of the transition to adulthood. The family has a potent role in influencing adolescents. The needs and interests of adolescents change during this phase which may be difficult for their parents to meet. The adolescent begins to behave as an independent individual, and the parents resist this independence which can lead to resistant behavior. On the contrary, positive factors such as a good connection with family and society help to protect adolescents from engaging in risky behaviors, thereby preventing psychosocial problems and promoting health.[4]

Thus, this study was conducted to find the impact of family-related factors on psychosocial health of school-going adolescents of Rishikesh, Uttarakhand.


  Materials and Methods Top


Study area

A school-based cross-sectional study was conducted among adolescents of age group 10–19 years in urban Rishikesh, Uttarakhand. The study was conducted for a period of 6 months, June to November 2019.

Sample size and sampling

The sample size was calculated taking the prevalence of psychosocial problems among school-going adolescents as 31.2%,[5] absolute precision of 6.24%, nonresponse rate of 10%, and applying design effect of 1.75 and 95% confidence level. After calculation, the sample size came out to be 400.

The sampling technique used to conduct this study was multistage random sampling. At the first stage, eight wards of the total 40 (20%) wards were selected by simple random sampling method. In the second stage, one high or higher secondary school from either government or private sector was selected by simple random sampling in the chosen ward. In the third stage, one class from each selected school (5th–12th) was selected by simple random sampling without replacement. Once a class was selected, the same class was not included while selecting classes from other schools.

Study method

The students were briefed about the study and were asked to sit separately such that they are focused and cannot see each other's responses while filling the questionnaire. After the briefing session, the students who gave written assent to participate in the study were included. A self-administered structured questionnaire was distributed among the students. The questionnaire had Youth-Pediatric Symptom Checklist (Y-PSC) which was used to screen adolescents for psychosocial problems and questions regarding the family environment. Students were asked not to write their name, roll number, and the name of the school to make them comfortable and ensure their privacy. All the questions were thoroughly explained to them, and they were allowed to ask any doubts they had while giving a response. The questionnaire was framed in English as well as Hindi language for better understanding and self-explanation of the questions. After filling the questionnaire, the students were asked to put it in the drop box, which was kept in the class, such that the identity of the student is kept hidden.

Study tool

Y-PSC is a screening checklist for psychosocial problems. There are two versions of PSCs available: parent completed version and youth self-report version. In this study, self-reported Y-PSC was used. It consists of 35 items, rated and scored as 0 – “never,” 1 – “sometimes,” and 2 – “often.” These scores are added altogether for each of the 35 items, with a possible range of scores from 0 to 70. There are two questions in the end for suicidality, Q36 and Q37, which are recent suicide ideation in the last 3 months and past suicide attempt, respectively. If any questions are left blank, they are scored as 0. If four or more items are left blank, the questionnaire is considered invalid. The total score was recoded into a dichotomous variable with a cutoff score of 30, indicating the presence of psychosocial problem or not, and also, if any of the two questions regarding suicidality was positive, the student was considered to have psychosocial problem irrespective of the score. Y-PSC only indicates the likelihood that a youth is at risk for a significant mental health problem or suicide, and its result is not a diagnosis or a substitute for clinical evaluation.[6],[7] The questionnaire for family-related problems was developed and validated by pilot testing.

Study variables

Family-related factors were divided into three subgroups such as problems related to the family environment which include questions such as do you feel happy at home, are there problems in your family, and do parents understand each other. The second subgroup was parent–child relationship such as do parents understand you, do parents pay enough attention, and parents are unhappy with your studies. The third subgroup includes parenting style such as parents are strict with you, parents compare you with others, do you get pocket money, do parents always interfere in your work, and do your parents allow you to take your own decisions.

Statistical analysis

The data were entered into MS Excel sheet 2013 and exported to IBM SPSS (Statistical Package for Social Sciences, IBM Corp, Armonk, NY) version 23.0 for analysis. Descriptive statistics were used to describe categorical variables as proportion or percentages. In inferential statistics, Chi-square test was used to compare proportions and odds ratio was calculated.

Ethical consideration

The Institute Ethics Committee of All India Institute of Medical Sciences, Rishikesh, gave ethical approval for conducting the study. Written informed assent from the students and consent from the respective principals of the schools were taken before conducting the study. The purpose of the study was informed to the parents through students a day before the study was conducted.


  Results Top


It was observed from the study that the prevalence of psychosocial problems among school-going adolescents was 40.7% using Y-PSC. The checklist has further four components such as internalizing problems, externalizing problems, attention problems, and suicide ideation. The present study showed that 36.8% of the participants had internalizing problems, 14.8% and 15.5% had attention and externalizing problems, respectively, whereas 24% of the participants had ideated suicide in the past 3 months. [Table 1] shows the distribution of study participants according to various family-related factors. It was observed that 43.3% of the adolescents had problems in the family, 77.3% of the parents do not understand each other, 28.5% of the adolescents felt their parents do not understand them, adolescents who felt their parents do not pay attention were 29.3%, students whose parents were unhappy with their performance in academics were 46%, 46.3% of the adolescents felt their parents always interfere in their work, and 46.5% of the adolescents were not allowed to take their own decisions. Fifty-five percent of the study participants marked yes to being compared with other children by their parents, 42% of the adolescents felt their parents were strict, 16% of the adolescents do not feel happy at home, and 65% of the adolescents do not get pocket money.
Table 1: Distribution of study participants according to family-related factors

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[Table 2] shows a significant association of the following family-related variables as reported by the study participants, with psychosocial problems using Chi-square statistics such as problems in the family (61.8%), parents understanding each other (61.8%), parents pay attention (27.9%), parents understanding them (30.3%), parents unhappy with their study (63.6%), who felt their parents interfere in their work (64.3%), parents allow to take own decisions (23.4%), parents compare with other children (63.6%), parents are strict (63.1%), and feeling happy at home (34.2%). There was no significant association between getting pocket money (35.7%) and psychosocial problems.
Table 2: Association of psychosocial problems among adolescents with family-related factors

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The odds of having psychosocial problems was higher in adolescents who had problems in the family, whose parents were unhappy with their academic performance, whose parents were strict, parents who interfered in their work, and parents who compared them with other children, whereas the factors that were protective of psychosocial problems were parents understanding each other, parents understanding them, parents who pay attention toward their children, parents allowed them to take their own decision, and students who felt happy at home.


  Discussion Top


The present study showed that the prevalence of psychosocial problems among school-going adolescents was 40.7% which was slightly higher than a study conducted in Dehradun, Uttarakhand, that showed a prevalence of 40.5%.[8] The prevalence in the present study was much higher than a study conducted in Pune, 15.2%.[9] In this study, the various factors related to the family environment were checked, and their association with psychosocial problems in adolescents was seen. It was observed in our study that 61% of the adolescents had some kind of problem in their family which led to psychosocial problems in them. This was in line with other literature findings identifying family dimension as a significant factor for psychosocial problems among adolescents.[10] This was also observed by a study done in Nepal which showed a higher prevalence of 76.8% of adolescents who had family problems such as a dispute had psychosocial problems.[11] In another study conducted in Chandigarh, 34.4% of the adolescents who had a dispute between parents showed behavioral problems.[12] A study conducted among adolescent students revealed that half of the study participants were worried about problems at home and at least 14% had thought of killing themselves due to the toxic environment at home.[13]

In Haryana, a study on adolescent students reveals that family environment plays an important role in the development of aggressive tendencies.[14] Family is an integral part of life. A supportive family can help in the proper development of adolescents, whereas a dispute in the family can induce stress and affect their psychosocial health.

In the present study, 24.7% of the adolescents whose parents do not understand each other and 71.9% who felt their parents do not understand them had a higher risk of having psychosocial problems. Similar kinds of findings were found in a study done in Chennai where 31.6% of the adolescents whose parents fight with each other and had no understanding between them had an impact on the psychosocial health of these adolescents.[15] Another study in Nepal mentioned that unfavorable family environment is a risk factor for behavioral problems in children.[16],[17] Empirical findings reveal that decreased family cohesion and increased conflict between parents can inadvertently provide family environment that is associated with increased feeling of loneliness, which may lead to psychosocial problems among adolescents.[18]

The present study showed that adolescents who did not feel happy at home had higher psychosocial problems as compared to those who do. This is similar to a study conducted in Nepal which showed that adolescents who did not feel good about their family environment and were not happy at home had five times higher psychosocial problems.[19] Adolescents whose parents were unhappy with their academic performance had higher psychosocial problems. This could be because adolescents experience stress, and it affects their physical and psychological health, most commonly of students. Anxiety, depression, and anxiousness to perform better and pressure from parents are correlated to the academic performance which leads to their poor performance.[20] Another study in Egypt showed that students who were socially and mentally healthy performed better in academics than those who were not.[21]

Availability of pocket money was the factor that was not significantly associated with psychosocial problems in adolescents. On the contrary, a study done in Nepal in school-going adolescents showed that students who were not getting pocket money were at higher risk of having psychosocial problems as compared with those who got pocket money. Pocket money could impart a sense of responsibility in adolescents. It helps them learn skills for managing finances. It has been seen that adolescents not getting enough pocket money develop deviant antisocial behaviors, such as stealing.[11],[22]

The study had limitations as the study involves only school-going adolescents of urban Rishikesh, the findings cannot be generalized to adolescents who are not going to school. The study area was the urban areas of Rishikesh; thus, the results could not be extrapolated to rural areas.


  Conclusion Top


The study reported an alarming situation of psychosocial problems among school-going adolescents in Rishikesh. Family factors were closely related to psychosocial problems. Friendly family structures and environments need to be advocated where adolescents can nurture and grow, resulting in good psychosocial health. Further research should be done to identify other factors than those mentioned in the present study and their impact on psychosocial health of adolescents. Various interventions at the family level should be identified such as encouraging family members to be more receptive to the needs of the adolescents when called upon. A noteworthy fraction of adolescent students having psychosocial problems is attributed greatly to family-related characteristics. Managing the family-related factors mentioned in this study should be the primary area of focus for positive psychosocial development of adolescent students.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Adolescents in India, UNICEF. Available from: http://4dj7dt2ychlw3310xlowzop2.wpengine.netdna-cdn.com/wp content/uploads/2016/09/Adolescents_in_India.pdf. [Last accessed on 2019 Dec 10].  Back to cited text no. 1
    
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Youth-Pediatric Symptom Checklist (Y-PSC). Available from: https://mmcp.health.maryland.gov/epsdt/healthykids/AppendixSection4/PSC-Y%20Teen%20Screen.pdf. [Last accessed on 2019 April 10]  Back to cited text no. 7
    
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Adhikari RP, Upadhaya N, Gurung D, Luitel NP, Burkey MD, Kohrt BA, et al. Perceived behavioral problems of school aged children in rural Nepal: A qualitative study. Child Adolesc Psychiatry Ment Health 2015;9:25.  Back to cited text no. 16
    
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