12. michael dunne

THE 2nd INTERNATIONAL CONFERENCE ON PUBLIC HEALTH AMONG GREATER MEKONG SUB-REGIONAL COUNTRIES

Hue College of Medicine and Pharmacy, 30 August 2010

Michael P Dunne, Jiandong Sun, Thai Thanh Truc, Kim Xuan Loan, Nguyen Do Nguyen and Jason Dixon

The influence of educational pressure on the mental health of adolescents in East Asia: Methods and tools for research

One of the most important forms of pressure in daily life.

It varies to some extent across cultures. Compared with Western students, Asian or Asian-background adolescents experience higher levels of academic stress.

Asian students often ―Strive for high academic grades;―Are less satisfied with their academic performance;―Have higher parental expectation of academic

excellence;―Spend more time for academic study, especially outside

of school.

Crystal et al., 1994; Ang & Huan, 2006a2

Academic Stress among Adolescents

3Data source: 2007 China National Juvenile Internet Use Survey

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Huge study burden

Nearly all (97.5%) students do some homework assigned by their teachers every day.

— 11.6% less than ½ hour— 36.8% around 1 hour— 49.1% > 2 hours Nearly two-thirds (65.2%) of the students do some

homework assigned by their parents every day.— 26.9% < ½ hour— 27.6% around 1 hour— 11.6% > 2hours More than one fifth (21.7%) attend extra coaching

classes on weekends or holidays.

Data source: 2008 National Survey on Juvenile Family Education (The All-China Women’s Federation, 2008)

A classroom for grade 12 in a town school

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A classroom for grade 12 in a city school

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Punishment because of poor academic performance

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The situation can be severe Approximately 20% of children and adolescents suffer

from a mental disorder to some extent (WHO, 2005; Belfer, 2008).

Up to half of all adult mental disorders develop during adolescence (Belfer, 2008).

Research gaps in East Asia Current resources and programs on child and adolescent

mental health have been centered in industrialised world (e.g. North America, Australia, Europe).

There are substantial gaps in youth mental health research and treatment services in developing countries.

Adolescent mental health - worldwide

Situation A growing body of research into adolescent mental health

has been conducted in China in recent years. Prevalence of depressive symptoms -- 15% to 55% (Shen et

al., 2005; Stewart, Betson, Lam, Chung, & Chung, 1999). Suicidal thoughts –10-20% (Ji & Chen, 2009; Chen, Dunne and

Han, 2004,2006; Chen, Dunne et al, 2010).

Research Gap Much of the previous research in China has been

descriptive in nature. The influence of some important factors (such as

academic stress) on adolescent mental health remains largely unclear.

Adolescent mental health - China

What are the multidimensional components of academic stress among adolescents?

What individual, family, school and social factors predict academic stress among adolescents?

What are the relationships between academic stress and mental health, taking into account confounding factors?

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Research questions: this study

Cross-sectional questionnaire surveys

Study sample: 2,030 Secondary school students (Years 7-12)

Study locations: Jinan, Shouguang, and Tianliu. Shandong Province

Questionnaire: Demographics; Family factors; School and academic related factors; Peers and friends; Mental health indicators (depression, suicidal behavior,

substance abuse, and happiness).

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Research design and methods in China

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Survey sites

Tianliu

Academic stress: Educational Stress Scale for Adolescents (ESSA) New scale developed for this study 16 items Five factors: Pressure to study, Worry

about grades, Despondency, Self-expectation, and Workload

These factors account for 26.6%, 14.4%, 8.2%, 7.6% and 6.7% of the variance in the 16-item ESSA score, respectively.

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Measurement of educational stress

Depression: Chinese version of the Center for Epidemiological Studies -Depression Scale (CES-D) (Radloff, 1977; Liu, 1999) . 20-item, four factors 4-point Likert scale Validated

Suicidal behaviours and substance use: questions from the youth risk behaviour survey (YRBS) Developed by the US CDC (Eaton et al., 2008; CDC,

2009) Three items for suicidal behaviours (thoughts, plans and

attempts) Two for current substance use (Smoking and drinking)

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Measurement of mental health

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Stages in scale development

Development and validation of the ESSA scale(Sun, Dunne, Hou and Xu, 2010)

Statements Strongly disagree

Disagree Neither agree nor disagree

Agree Strongly agree

I am very dissatisfied with my academic grades

1 2 3 4 5

Future education and employment bring me a lot of academic pressure

1 2 3 4 5

My parents care about my academic grades too much which brings me a lot of pressure

1 2 3 4 5

Academic grade is very important to my future and even can determine my whole life

1 2 3 4 5

I always lack confidence about my academic scores

1 2 3 4 5

I feel that study is a very heavy burden for me 1 2 3 4 5

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Example items and response format of the ESSA

Format of the ESSA scale

Internal consistency The ESSA obtained good internal consistency

(Cronbach's α= 0.81). The coefficients for the five subscales were 0.74,

0.71, 0.66, 0.66 and 0.75 respectively (fair to good consistency).

Test-retest reliability The ESSA and its five subscales all yielded Intraclass

Correlation Coefficient (ICC) of 0.78, 0.75, 0.61, 0.70, 0.59 and 0.62, all indicating good test-retest reliability

All items had moderate to good reliability (ICC ranged from 0.44 to 0.67).

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Internal consistency and test-retest reliability

Demographics Data analysis conducted with 1,627

students (94% of the potential participants)

Male 55%; Female 45% Age 11 to 20 (Mean=15.47, SD=1.85). Almost all (99.5%) were Han Chinese Junior (grade 7-9) 49%; Senior (Grade 10-

12) 51% Urban family 42%; Rural family 58%

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Main survey analysis: Correlations with youth mental health and risk behaviour

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Associations with mental health measuresFactor 1 Pressure to study

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Current research in Viet Nam In September 2010 we will conduct a

survey of approx 1,000 secondary school and high school students in HCMC

Six schools in District 1. MPH projects of Thai Thanh Truc and Kim

Xuan Loan (Atlantic Philanthropies students at QUT)

Incorporates ESSA and the newly revised ACE (Adverse Childhood Experiences) questionnaire from WHO/US CDC (Brown, Butchart et al, 2010)

Aims

To test the psychometric properties of the ESSA scale with a Vietnamese sample

In multivariable models, examine the relative influence of academic stress, ACEs and a range of school and family factors on key aspects of youth mental health and well-being.