Indian Journal of Obstetrics and Gynecology Research

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Indian Journal of Obstetrics and Gynecology Research (IJOGR) open access, peer-reviewed quarterly journal publishing since 2014 and is published under auspices of the Innovative Education and Scientific Research Foundation (IESRF), aim to uplift researchers, scholars, academicians, and professionals in all academic and scientific disciplines. IESRF is dedicated to the transfer of technology and research by publishing scientific more...


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Lakshmi and Rajkumar: KAP study on mental health and reproductive illness among college girls in Madurai, Tamil Nadu


Introduction

The period of adolescence is a period of transition between childhood and adulthood characterized by physical, physiological and physiological changes. As a result, there is growth spurt, puberty and mental maturity. The period of adolescence is vulnerable to certain health problems including sexual abuse and teenage pregnancies, reproductive tract infections, substance abuse and mental health issues including suicidal tendencies. Although both genders are equally vulnerable to most of the adolescent health problems, it is essential to focus issues pertaining to adolescent girls because they are future mothers and they are responsible for a healthy household and healthy family.

Social economically girls represent a vulnerable group because of various factors. In India girls continue to face the wrath of improper family planning which include care of the younger siblings, early marriages and teenage pregnancies. In addition, lack of accessibility and availability of health information and need based health care makes them increasingly vulnerable to various social issues. Although the mortality rates are lowest in adolescent age group, the vulnerability to health problems remains high in the age groups. The common health problem affecting the adolescent girls include nutritional disorders, mental disorders, and reproductive health problems including menstrual problems.

It is important to note that current social and economic development of the country has witnessed wide range of changes in the mental and emotional constitution in all the age groups, especially among the adolescents. The important reasons for this are change in the cultural value complimented with increasing economic stress and dwindling family support. These changes affect the mental health of the adolescents; more so the girls making them succumb to problems sexual and substance abuse.1, 2, 3 According to UNESCO statistics, sexually transmitted disease is a major health problem among adolescents and youth which has an higher incidence among girls compared to boys.4

The vulnerability of any social health issue is highly dependent on the level of awareness among the target population. There is increased risk for mental health problems, when there is lack of knowledge and awareness regarding the specific health issues. It is essential to evaluate the level of knowledge and also the attitude towards mental health, sexual and reproductive health and also substance abuse in order to identify the focal areas which increase the vulnerability of these girls to the mental health problems. Several organisations including WHO, UNFPA, IPA, and UNESCO are striving to create this awareness among the adolescent girls in order to bring out a healthier tomorrow with sound quality of life and well being.5

Objectives

This study was carried out to compare the level of knowledge, attitude and practices regarding mental health between girls studying in women’s college versus Co-education (Co-ed) system.

Materials and Methods

Study setting and participants

This cross-sectional study was carried out among the adolescent girls studying in Colleges in Madurai city. All the co-ed and women’s colleges in the city were contacted for permission and permission was obtained to carry out the study in one women’s College and one co-ed college. All the girls in the each of the colleges participated in this study. The study was carried out for the period of two months. A total of 149 girls from the co-ed college and 112 girls from the Women’s College participated in the study.

Selection criteria

Girls ≤19 years of age were included in the study.

Ethical approval and informed concern

Approval was obtained from the institutional ethics committee prior to the commencement of the study. Each participant was explained in detail about the study and informed consent was obtained prior to the data collection.

Data collection tools

A structured interview schedule was use to obtain information regarding the background characteristics including father’s occupation, source of information and details regarding the mental health pertaining to knowledge, attitude and practices relating to mental health, signs of depression, causes of mental illnesses and type of care to be given mental illnesses.

Data analysis

Data was entered and analysed using SPSS version 20. Chi square test was used to compare the responses between the women’s college and co education college participants. A p value < 0.05 was considered statistically significant.

Results

Both the groups were comparable with respect to their demographic characteristics. Majority of the participants in this study were less than 19 years of age in both a groups. Majority of the participant’s fathers professionals by the occupation (42.9% in women’s college and 51.7% in Co-education College). (Table 1)

Table 1

Personal characteristics of the participants

S. No

Characteristic

Type of college

Women college

Co-education

Frequency

N(112)

Percentage (%)

Frequency

N(149)

Percentage

(%)

1

Age (in years)

<19

59

52.7

100

65.8

>19

53

47.3

49

32.2

2

Socio economic status

Professional

48

42.9

77

51.7

Semi professional

11

9.8

28

18.8

Clerical

27

24.1

17

11.4

Skilled worker

16

14.3

18

12.1

Semi skilled worker

2

1.8

4

2.7

Unskilled worker

3

2.7

3

2.0

Unemployed

5

4.4

2

1.3

3

Medicine during severe pain

Yes

47

42.0

58

38.9

No

65

58.0

91

61.1

4

Irritable in premenstrual period

Yes

85

75.9

50

33.6

No

27

24.1

99

66.4

Figure 1

Source of information regarding mental health

https://typeset-prod-media-server.s3.amazonaws.com/article_uploads/7f9fae9a-1447-432b-8209-4f63759528e4/image/4265eb6e-b27d-4dd1-9cd9-f7d222cab052-uimage.png

Table 2

Knowledge regarding mental health and well being among the participants

S. No

Characteristic

Type of college

Women college

Co-education

Frequency

N(112)

Percentage

(%)

Frequency

N(149)

Percentage

(%)

1

Losing temper for no apparent reasons

Normal

40

35.7

60

40.3

Abnormal

72

64.3

89

59.7

2

Causes of Mental illness

Caused by spirits

9

8.0

53

35.6

Heredity

5

4.5

45

30.2

Environmental problems

83

74.1

41

27.5

Karma

12

10.7

10

6.7

Caused by spirits and environmental problems

1

0.9

-

-

Heredity and environmental problems

2

1.8

-

-

3

Signs of depression

Loss of sleep

35

31.3

49

32.9

Loss op appetite

3

2.7

37

24.8

Excessive eating

5

4.5

26

17.4

Isolation

26

23.1

27

18.1

Lack of self care

24

21.4

10

6.8

More than one sign

17

15.2

4

Self harm

Normal

21

18.7

47

31.5

Abnormal

33

29.5

44

29.6

Needs help of Psychiatrist

54

48.2

58

38.9

Abnormal and needs help of psychiatrist

4

3.6

5

Noticed this behavior in your friends

Withdraw after failure of love affair

41

36.6

43

28.9

Absence to class following it

43

38.4

50

33.5

Suicidal tendency after that

16

14.3

56

37.6

Withdrawal and school absenteeism

3

2.7

All the three

5

4.5

Withdrawal and suicidal tendency

3

2.7

School absenteeism and suicidal tendency

1

0.8

6

Awareness regarding body shaming

Yes

59

52.7

56

37.5

No

53

47.3

93

62.5

Table 3

Attitude towards mental illness

S. No

Characteristic

Type of college

Women college

Co-education

Frequency

N(112)

Percentage

(%)

Frequency

N(149)

Percentage

(%)

1

Should care be sought for those who are unable to control their temper?

Yes

86

76.8

58

38.9

No

26

23.2

91

61.1

2

What should be done if your friends have signs of depression?

Left alone

15

13.4

40

26.8

Needs counseling

78

69.6

39

26.2

Taken for shopping

14

12.5

38

25.5

Taken to a movie

5

4.5

32

21.5

3

Whom to approach for mental problems?

Psychologist

87

77.7

66

44.3

Fortune teller

12

10.7

38

25.5

Spiritual guru

10

8.9

45

30.2

Psychologist and fortune teller

2

1.8

Fortune teller and spiritual guru

1

0.9

Table 4

Practices related to mental illness

S. No

Characteristic

Type of college

Women college

Co-education

Frequency

N(112)

Percentage

(%)

Frequency

N(149)

Percentage

(%)

1

Presence of substance abuse among friends

Yes

55

49.1

95

63.8

No

57

50.9

54

36.2

2

Types of substances abused

Drugs

3

5.5

41

43.2

Alcohol

11

20.0

29

30.5

If any

41

74.5

25

26.3

3

Undergone body shaming

Yes

24

21.4

38

25.5

No

88

78.6

111

74.5

4

Bullying in college

Yes

20

17.9

51

34.2

No

92

82.1

98

65.8

Table 5

Comparison between the girls college and co-ed college students

S. No

Parameter

Girls’ college

Co-ed college

Chi sq

P value

1

Irritable during menstrual period

Present

85(75.9)

50(33.6)

Absent

27(24.1)

99(66.4)

5.6

0.018

2

Source of information

Television

11(9.8)

32(21.5)

Internet

43(38.4)

36(24.2)

Friends

21(18.8)

38(25.5)

11.3

0.023

Teachers

16(14.3)

17(11.4)

Textbook

21(18.8)

26(17.4)

3

Awareness of HIV

Yes

106(94.6)

90(60.4)

40.0

0.0001

No

6(5.4)

59(39.6)

4

Awareness of HPV Vaccine

Yes

60(53.6)

60(40.3)

4.5

0.033

No

52(46.4)

89(59.7)

5

Seeking help for temper control

Yes

86(76.8)

58(38.9)

No

26(23.2)

91(61.1)

37.0

0.0001

6

Cause of mental illness

Caused by spirits

10(8.9)

53(35.6)

Heredity

7(6.3)

45(30.2)

Environmental problems

83(74.1)

41(27.5)

Karma

12(10.7)

10(6.7)

67.6

0.0001

7

Signs of depression

Loss of sleep

51(45.5)

49(32.9)

Loss of apetite

3(2.7)

37(24.8)

Excessive eating

6(5.4)

26(17.4)

Isolating themselves

26(23.2)

27(18.1)

Not taking care of themselves

24(21.4)

10(6.7)

All

2(1.8)

0(0.0)

44.8

0.0001

In our study majority of the participants studying in women’s college cited internet as a major source of information regarding mental health while majority of the participants from co Education College cited friends as key source of information. (Figure 1)

While majority of the participants both the age groups equally felt that loosing temper for no apparent reasons was abnormal, there was a difference in the level of awareness regarding the cause of mental illnesses between the groups. Majority of the participants studying in the women’s college reported that environmental problems are major cause for mental illness (74.1%), participants from co-ed colleges felt that mental illness was caused by spirits (35.6%). with regards to the knowledge level regarding the science of depression, in the women’s college group majority of the participants observed that loss of sleep is a major sign of depression (31.3%). similar finding were observed among participants from co-education college (32.9%). Awareness regarding body shaming was present in 52.7% girls participated studying in women’s college. (Table 2)

The attitude towards health seeking pattern for mental illness showed that majority of the participants in the co-ed group did not feel that help should be sought when a person is unable to control the temper (61.1%). Counselling was an important remedial measure for depression, as reported by 69.6% of the participants in Women’s college as against 26.8% in the co-ed group. (Table 3).

Practice of substance abuse was present among the friends of 53.8% of the participants in co-ed group, compared to 49.1% of the women’s college group. The type of substances abused commonly was drugs in the co education groups (43.2%). (Table 4)

A comparison between both a groups with respect to various aspects of knowledge, attitude and practices regarding mental health was carried out (Table 5) It was observed that awareness regarding HIV was increasingly prevalent among women’s college participants compared to co-education participants (p value < 0.0001). Similarly, the need for seeking help for temper control was increasingly reported among participants in women’s college (76.8%) compared to participants in co education college (38.9%) the observed different was statistically significant (P value < 0.0001). There was also a significant different between both groups with regards to eliciting the signs of depression. (p value < 0.0001)

Discussion

Mental illnesses are an important and emerging health hazard in recent times with increasing morbidity and mortality in the younger age groups. It is pertinent to address this issue at the younger age in order to prevent complications during adulthood. Since recently, India has a witnessed drastic cultural change across all regions and South India is not an exception. There has been a significant change in the scenario of work culture, change in the family composition and exposure to various media which has influenced the thinking and behaviour among youngsters, especially adolescents.

In the emerging digital age, the human interface is drastically coming down, resulting in weakening of relationships within family and outside family, thereby resulting in several mental health risks among the adolescents. There are increasing the incidences of depression, suspense abuse, sexual abuse and suicidal rates among the adolescents and youth of today and this has been largely attributed to the withering of the family bonding and relationship with friends and family at large.

Although both the groups came from similar socio economic background, there was a drastic difference with respect to the knowledge attitude and practices regarding mental health and illnesses between them. The source of information is predominantly based on internet for participants who were studying in women’s college while the source of information was friends among those co-education college students. While majority of the women’s college students had adequate knowledge regarding mental illness in terms of cause of mental illness and science of depression, self harm and awareness regarding body shaming, it was considerably lacking in the other group.

Girls studying in the women’s college showed better attitude towards caring for the mentally ill. Moreover increased prevalence of substance abuse, especially drugs was highly prevalent in co-education college compared to the women’s college. Similarly bullying was also highly prevalent in the co-education college. There was a statistically significant difference in the knowledge regarding the signs of depression, causes of mental illness, causes of HIV infection and HPV vaccine between both the groups. The awareness regarding HIV and HPV vaccine was higher among the girls studying in women’s college. (p value < 0.05).

With regards to knowledge level on mental illness, signs of depression and self-harm were one of the key criteria taken into consideration. In our study we observed that, isolation was said to be an important sign of depression among 23.1 percent of girls in women’s college and 18.1 percent of girls studying in co-education system. In a study done in Karnataka by Saraf G et al., isolation was said to be the most important terminology for depression in 29% of the participants which was similar to our study.6 As far as self-harm was concerned, majority of our participants observed that self-harm required help from psychiatrist, while 31.5% of the girls studying in the co-education college felt that self-harm was normal. In the study done by Saraf G et al., self-harm was identified to be of abnormal in 63%t of the participants, which is similar to our study.6

The impact of mental illness among adolescence is reflected by the magnitude of substance abuse and sexual abuse. This indirectly results in an increased incidence of sexually transmitted infections and diseases including HIV and cervical cancer among women. Our study aimed to estimate the level of knowledge regarding HIV and HPV vaccines. In our study, we observed that, the awareness regarding HIV and HPV was higher among participants studying in women’s college (94.6%) compared to the participants from the co-education college. This association was statistically significant (P value < 0.05). In a study done by Vaidakis D et al., the knowledge regarding HPV vaccine was 43% in their study, which was higher compared to our estimates.7 This reflects that the overall knowledge regarding HIV and HPV vaccines is substantially lower in the study population. In a study done by Sing A et al. the awareness on HIV was 35% in rural area of Gujarat which was similar to our study findings.8

Conclusion

The findings of our study confirm the need for providing a scientific knowledge regarding HIV AIDS, HPV and mental health among the adolescent girls. From our study we observed that the knowledge levels were fairly higher among girls studying in women’s college, probably due to increased access of internet and social media. The interaction among the peers is stronger in this group and there is a lack of inhibition to gain knowledge regarding mental and sexual health issues which has increased their ability to gather information on the same. In contrast among co-education colleges it has been observed that the awareness and the attitude are for poorer compare to their counterparts in women’s college. The reason has not been explored so far but it appears that the interaction is limited in this group, and in addition there could have been restrictions/ hesitation in obtaining the information. However it is to be emphasized that the participants in the co-education college are for more vulnerable and susceptible to sexual abuse, substance abuse and abnormal social behaviours. Therefore the need for an awareness and change in attitude and perception regarding mental and sexual health is warranted in this group.

Source of Funding

None.

Conflict of Interest

The author(s) declare(s) that there is no conflict of interest regarding the publication of this article.

References

1 

WHO factsheets on women’s health. [Internet]. November 2009http://www.who.int/mediacentre/factsheets/fs334/en/.Accessedon

2 

S D Gupta Adolescent and youth reproductive health in India. Status, issues, policies and programs http://www.policyproject.com/pubs/countryreports/ARH_India.pdf.accessedon

3 

A Pandha Advocating for the rights of Children Worldwide Trust. Adolescent girls in India. Accessed on August 2018www.arc-worldwide.org

4 

5 

Studies on adolescent girls. An analytical review. National Institute of Public Cooperation and Child Development.[Internet]. 2008http://nipccd.nic.in/reports/eag.pdf.Accessedon

6 

G Saraf P S Chandra G Desai G N Rao What Adolescent Girls Know about Mental Health: Findings from a Mental Health Literacy Survey from an Urban Slum Setting in IndiaIndian J Psychol Med2018405433910.4103/ijpsym.ijpsym_108_18

7 

D Vaidakis I Moustaki I Zervas A Barbouni K Merakou M S Chrysi Knowledge of Greek adolescents on human papilloma virus (HPV) and vaccinationMed201796110.1097/md.0000000000005287

8 

S Chandrashekarappa N Ramakrishnaiah D Ram R Manjunath Mental health among adolescent girls - An effort to know the association of mental disorders with socio-demographic variablesInt J Med Sci Public Health201651123051110.5455/ijmsph.2016.20042016472



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Article type

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Article page

491-497


Authors Details

S Lakshmi, K Rajkumar


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