Perspectives of pupils, parents, and teachers on mental health problems among Vietnamese secondary school pupils

Mental health literacy in children and adolescents in low- and middle-income countries: a mixed studies systematic review and narrative synthesis

Mental illnesses are the leading cause of disease burden among children and young people (CYP) globally. Low- and middle-income countries (LMIC) are disproportionately affected. Enhancing mental health literacy (MHL) is one way to combat low levels of help-seeking and effective treatment receipt. We aimed to synthesis evidence about knowledge, beliefs and attitudes of CYP in LMICs about mental illnesses, their treatments and outcomes, evaluating factors that can enhance or impede help-seeking to inform context-specific and developmentally appropriate understandings of MHL. Eight bibliographic databases were searched from inception to July 2020: PsycInfo, EMBASE, Medline (OVID), Scopus, ASSIA (ProQuest), SSCI, SCI (Web of Science) CINAHL PLUS, Social Sciences full text (EBSCO). 58 papers (41 quantitative, 13 qualitative, 4 mixed methods) representing 52 separate studies comprising 36,429 participants with a mean age of 15.3 [10.4-17.4], were appraised and synthesized using narrative synthesis methods. Low levels of recognition and knowledge about mental health problems and illnesses, pervasive levels of stigma and low confidence in professional healthcare services, even when considered a valid treatment option were dominant themes. CYP cited the value of traditional healers and social networks for seeking help. Several important areas were under-researched including the link between specific stigma types and active help-seeking and research is needed to understand more fully the interplay between knowledge, beliefs and attitudes across varied cultural settings. Greater exploration of social networks and the value of collaboration with traditional healers is consistent with promising, yet understudied, areas of community-based MHL interventions combining education and social contact.

Determinants of mental health among youths and adolescents in the digital era: Roles of cyber and traditional bullying, violence, loneliness, and environment factors

Introduction

Although the pathogenesis of depressive disorders is not fully elucidated, untreated adolescent depression can lead to serious sequelae such as impaired academic performance and social functioning, substance use disorders, poor self-esteem, and increased risk for suicidal ideation and attempts. Literature on adolescent mental health in Vietnam is limited, despite increased international awareness of this critical issue. This study aimed to investigate the prevalence and associations of depressive symptoms in Vietnamese adolescents.

Methods

A cross-sectional, self-administered survey was conducted in five provinces of Vietnam among adolescents aged 14 to 24 years. In addition to collecting participants' demographics, a structured questionnaire was developed to examine depressive symptoms, suicidal ideation, loneliness, and cyberbullying victimization. Depressive symptoms and loneliness were assessed via the PHQ-9 and UCLA Loneliness Scale, respectively. Two-tailed Chi-squared, Mann-Whitney, and Kruskal-Wallis tests were performed to examine associations between variables. Multivariate Logistic regression models were conducted to examine the associations between prior-defined variables and positive depressive symptoms.

Results

Among 1,600 respondents, 31.8% of participants reported having mild-moderate or severe depressive symptoms. Participants within the moderate-severe depressive symptom group had significantly lower community cohesion scores than those of participants in normal and mild depressive symptom groups (p < 0.05). Youths living alone were more likely to have moderate-severe depressive symptoms (OR 2.16; 95% CI: 1.09-4.25). Cyberbullying had significant associations with depressive severity (OR 1.93; 95% CI 1.38-2.70).

Conclusion

The findings of this study characterize various risk and protective factors for depression in Vietnamese youths and adolescents. The results highlight the importance of raising awareness and increasing access to educational resources for depression and other mental health illnesses. With the rising prevalence of depression, parents, teachers, and community leaders play a vital role in addressing mental health problems in adolescents.

Conceptualisations of positive mental health and wellbeing among children and adolescents in low- and middle-income countries: A systematic review and narrative synthesis

BACKGROUND

Mental illnesses are the leading causes of global disease burden. The impact is heightened in low- and middle-income countries (LMICs) due to embryonic care systems and extant barriers to healthcare access. Understanding children and adolescents' conceptualisations of mental health wellbeing in these settings is important to optimize health prevention and promotion initiatives.

OBJECTIVE

To systematically review and synthesize children and adolescents' conceptualisations and views of mental health and wellbeing in LMICs.

DESIGN

Ten databases were systematically searched from inception to July 2020 and findings from included studies were synthesized.

RESULTS

Twenty papers met eligibility criteria comprising qualitative, quantitative and mixed methods studies. Children and adolescents identified aspects of mental health and wellbeing, including positive affect and outlook and having sufficient personal resources to face daily challenges. Identified factors recognized the importance of activating both kin and lay networks in supporting and maintaining wellbeing. Conceptualisations of mental health and wellbeing were varied and influenced by culture, developmental stage and gender.

DISCUSSION AND CONCLUSIONS

Irrespective of environmental and sociocultural influences on concepts of wellbeing and mental health, children and adolescents in LMICs can conceptualise these constructs and identify how they pursue positive mental health and wellbeing important for developing age and culture-appropriate community mental health strategies. Our review highlights the need to extend inquiry to wider developmental stages and both across and within specific populations in LMICs.

PATIENT AND PUBLIC INVOLVEMENT

Initial results were presented at stakeholder workshops, which included children, adolescents, parents and health professionals held in Indonesia in January 2019 to allow the opportunity for feedback.

Assessment of a website aimed at providing information on mental health to secondary school students in Can Tho city, Vietnam

BACKGROUND

The stigmatization of mental health problems is a primary barrier for young people to approach mental health services when they suspect they might have such problems. Nevertheless, the internet has become a common platform on which they are likely to seek information on mental health. As such, this study aimed to explore responses from secondary school students in Can Tho city regarding suckhoetre.vn website. This website provided information on health and mental health, and this study assessed the potential relevance, appeal, accessibility, usefulness, and sustainability of the website.

METHODS

A cross-sectional study included 643 secondary school students in Can Tho city selected by cluster sampling. Two weeks after the students were introduced to the website, they were invited to evaluate it using an anonymous questionnaire. The Chi-squared test was used to assess the significance of differences in the distribution of selected students' sociodemographic characteristics.

RESULTS

Most (98.6%) participants visited the website in the two-week period, 74% once or twice a week, the others more often, up to once a day. Their activities included reading information (85.8%), seeking help (17.7%), sharing information (15.5%), giving advice to others (11.0%), and chatting or giving comments (9.8%). Most students rated the website very highly in terms of appeal, relevance, accessibility, and usefulness, and wanted to have access to the website in the future. These findings are positive signals to pursue the possible use of a website on mental health for secondary school students to help raise awareness and support good mental health among adolescents in Can Tho city and beyond.

CONCLUSION

A website designed to provide information to secondary school students appeared to be a promising way to provide access to information on the topic of mental health. The website should be maintained and introduced widely to students, teachers and parents, with regular evaluation of the effectiveness of this website.

Understanding mental health and its determinants from the perspective of adolescents: A qualitative study across diverse social settings in Indonesia

Poor mental health is a leading contributor to the burden of disease experienced by adolescents, including in resource constrained settings. However, little is known about how adolescents in these countries conceptualise mental health and its determinants which is essential to informing effective responses. This study aimed to explore how adolescents in Indonesia (a populous and rapidly developing country) conceptualise mental health and what they identify as important determinants. Eight focus group discussions (FGDs) were conducted with 86 Indonesian adolescents (aged 16-18 years), sampled from schools and community settings from Jakarta and South Sulawesi. FGDs were recorded, transcribed, translated and thematically analysed. Mental health was recognised as a significant concern by adolescents in Indonesia. Good mental health was conceptualised as emotional wellbeing and happiness. By contrast, poor mental health was predominantly described in terms of substantial mental illness manifesting as behavioural and physical disturbance. Further, poor mental health only happened to 'other' people, with stigmatising views prevalent. Absent from the discussions were common symptoms of poor mental health (stress, loneliness, poor sleep) and common mental disorders (e.g. depression, anxiety) or a conceptualisation that reflected poor mental health to be a normal human experience. Discussions around determinants of poor mental health suggested that family connections (particularly with parents), school pressures, and adverse exposures on social media were important drivers of poor mental health, with religion also surfacing as an important determinant. In highlighting mental health as an important issue for Indonesian adolescents, this study provides a foundation for targeted responses.

Role of School Health Officers in Mental Health Care for Secondary School Students in Can Tho City, Vietnam

The objectives of the study were to explore the experiences of school health officers in identifying and managing mental health problems of secondary school students and to gather recommendations from the school officers for improving the effectiveness of mental health care in secondary schools in Can Tho City, Vietnam. We conducted a qualitative study based on in-depth interviews using a semi-structured guideline with 15 school health officers at 15 secondary schools in Can Tho City, Vietnam. Data were analyzed using content-driven analysis to identify recurring themes. The school health officers reported that stress, depression, suicidal ideation, and sexual orientation issues were the most commonly encountered mental health problems among their students. The officers worked with a limited range of interventions for helping these students, such as giving non-narcotic analgesics or advising students to take a short break at school or to go home. Most of them felt that their training was insufficient to deal with mental health problems in an optimal way. They recommended further training to improve their knowledge and skills in recognizing and managing mental health problems in students. They also considered a university-sponsored mental health website a good source of information on mental health care for students. School health officers reported that they did not feel well equipped to manage mental health problems because of insufficient training, lack confidence, and absence of an appropriate network for advice and referral. Updated policies and programs are needed for initial training and refresher courses, which will strengthen the role of school health officers as first line support for secondary school students with mental health problems.

Low Self-Esteem and Its Association With Anxiety, Depression, and Suicidal Ideation in Vietnamese Secondary School Students: A Cross-Sectional Study

Background: There is a correlation between self-esteem in adolescents and risks and protective factors for their health and welfare. The study was conducted to determine the prevalence of low self-esteem and sociodemographic features related to anxiety, depression, educational stress, and suicidal ideation in secondary school students in Vietnam. Methods: A cross-sectional design was employed for this study with participation of 1,149 students in Cantho City in Vietnam. A structured questionnaire was applied to ask about self-esteem, depression, anxiety, educational stress, and suicidal ideation. Results: Students with low self-esteem were detected at a prevalence of 19.4%. High educational stress and physical and emotional abuse by parents or other adults in the household were major risk factors correlated to low self-esteem, while a protective factor for low self-esteem was attending supplementary classes. An association among lower self-esteem and increased anxiety, depression, and suicidal ideation was detected. Conclusions: Self-esteem is associated with anxiety, depression, and academic stress, which significantly affect students' quality of life and links to suicidal ideation. These results therefore suggested the need for a school-based or web-based provision aimed at proactively increasing students' self-esteem and skills for dealing with academic stress.

Impact of parent-adolescent bonding on school bullying and mental health in Vietnamese cultural setting: evidence from the global school-based health survey

Background

The mental well-being of adolescents is a crucial issue affecting lives of both adults and young people. Bullying and mental health problems are important factors that can have a negative impact on the mental well-being of adolescents. Public awareness of mental health problems among adolescents is rapidly growing in Vietnam. However, current approaches to identifying risk factors influencing mental health problems do not pay attention to potentially protective factors. This study was performed to examine the associations between parent–adolescent bonding and mental health outcomes as protective elements during the adolescent period.

Methods

Data collected from 3331 respondents in grade 8–12 as part of the Vietnam Global School-based Student Health Survey (GSHS) 2013 was used for the analysis. A three-stage cluster sample design was used to produce data representative of students. Multivariate logistic regression analysis was performed to examine the association of demographic characteristics and data regarding parent–adolescent bonding associations with status of mental health problems in adolescents.

Results

Parental understanding, parental monitoring were significantly associated with reduced likelihood of being bullied and mental health problems (P < 0.05). However, parental control was significantly associated with greater likelihoods of being physically attacked (adjusted odd ratio (aOR) = 1.36, 95%CI, 1.06, 1.75) and mental health problems, such as suicidal ideation, and loneliness (aOR = 1.96, 95%CI, 1.49, 2.57, aOR = 2.35, 95%CI, 1.75, 3.15, respectively), after adjusting for potential confounders.

Conclusions

The study indicated the significant associations between parental understanding, monitoring and control in a proxy of parent–adolescent bonding and mental well-being during the period of adolescent rebellion. Thus, parent–adolescent bonding in Southeast Asian cultural context may provide an effective means to promote the mental well-being of adolescents.

Neighbourhood influences and its association with the mental health of adolescents in Kuala Lumpur, Malaysia

BACKGROUND

Mental health problems are affecting more children and adolescents worldwide. Individual, family and school factors are often linked with mental health problems among adolescents.

AIM

To determine the neighbourhood factors influencing the prevalence of abnormal mental health status among adolescents in an urban population.

METHOD

A cross-sectional study was conducted among adolescents aged 13, 14 and 16 years old from thirteen secondary schools in Kuala Lumpur using validated questionnaires. A total of 567 adolescents participated in this study.

RESULTS

The prevalence of abnormal mental health status in this study was 4.4%. In multivariable analysis, female (OR = 1.79, 95%CI: 1.11-2.89), having divorced parents (OR = 3.53, 95%CI: 1.96-6.36), high educational stress (OR = 8.18, 95%CI: 4.25-15.75), medium educational stress (OR = 2.99, 95%CI: 1.53-5.83), whose house has been broken in before (OR = 2.02, 95%CI: 1.11-3.68) and living in a neighbourhood with low socioeconomic status (OR = 2.09, 95%CI: 1.23-3.56) were more likely to have abnormal mental health status.

CONCLUSIONS

Neighbourhood factors were found to be significant in determining adolescents' mental health status. The findings emphasize the importance of those in the public health sector to highlight these significant neighbourhood factors to the Ministry of Housing and Local Government. Swift action needs to be taken by the Ministry to provide solutions related to the neighbourhood factors and this can contribute to improvement in the adolescents' mental health.

Bidirectional predictions between Internet addiction and probable depression among Chinese adolescents

BACKGROUND AND AIMS

The aim of the study is to investigate (a) whether probable depression status assessed at baseline prospectively predicted new incidence of Internet addiction (IA) at the 12-month follow-up and (b) whether IA status assessed at baseline prospectively predicted new incidence of probable depression at follow-up.

METHODS

We conducted a 12-month cohort study (n = 8,286) among Hong Kong secondary students, and derived two subsamples. The first subsample (n = 6,954) included students who were non-IA at baseline, using the Chen Internet Addiction Scale (≤63), and another included non-depressed cases at baseline (n = 3,589), using the Center for Epidemiological Studies Depression Scale (<16).

RESULTS

In the first subsample, 11.5% of the non-IA cases developed IA during follow-up, and probable depression status at baseline significantly predicted new incidence of IA [severe depression: adjusted odds ratio (ORa) = 2.50, 95% CI = 2.07, 3.01; moderate: ORa = 1.82, 95% CI = 1.45, 2.28; mild: ORa = 1.65, 95% CI = 1.32, 2.05; reference: non-depressed], after adjusting for sociodemographic factors. In the second subsample, 38.9% of those non-depressed participants developed probable depression during follow-up. Adjusted analysis showed that baseline IA status also significantly predicted new incidence of probable depression (ORa = 1.57, 95% CI = 1.18, 2.09).

DISCUSSION AND CONCLUSIONS

The high incidence of probable depression is a concern that warrants interventions, as depression has lasting harmful effects in adolescents. Baseline probable depression predicted IA at follow-up and vice versa, among those who were free from IA/probable depression at baseline. Healthcare workers, teachers, and parents need to be made aware of this bidirectional finding. Interventions, both IA and depression prevention, should thus take both problems into consideration.

'Hu Hong' (bad thing): parental perceptions of teenagers' sexuality in urban Vietnam

Background

Teenagers under 18 years old in Vietnam are considered as minors who usually lack the autonomy to make decisions. They are also sometimes viewed as contributors to social evils including crime, violence and substance use. Moreover, most Vietnamese teenagers have unsafe sex before marriage. The objective of this study is to explore the parental perceptions relating to their teenagers’ sexuality, particularly the social and cultural forces, that may hinder access to sexuality information.

Methods

Guided by a Community Advisory Board (CAB), this qualitative study uses four focus group discussions (FGDs) consisting of 12 mothers and 12 fathers, as well as twelve individual in-depth interviews (IDIs) with a diverse sample of parents of teens in Ho Chi Minh City (HCMC), Vietnam. Content and discourse analysis were conducted, based on Foucauldian concepts.

Results

Four themes emerged: 1) Meanings of sexuality and sexuality education, 2) Early sexual intercourse destroys teenagers’ future, 3) Teenagers are not hu hong (spoil/bad thing), are innocent and virgin, and 4) Policing and controlling of sexual intercourse among teens. Parents did not view their teenage children as sexual beings; those who are sexual are considered hu hong. Parents believed that teens need to be policed and controlled to prevent them from becoming hu hong, particularly girls. Controlling of sexuality information by parents was therefore common in HCMC, but differed by gender and educational levels of parents. For example, fathers more than mothers were not comfortable teaching their teenage children about sex and sexuality. Parents with higher education police their teenage children’s usage of the Internet and social media, while parents with lower education control who can be friends with their teenage children.

Conclusions

Vietnamese parents in general have negative views of sex and sexuality education for their teenage children. Recognizing that many Vietnamese teenagers have unsafe sex before marriage, parents need to change their perceptions and understand the importance of comprehensive sexuality education (CSE), which are included in UNESCO, UNFPA and UNICEF-developed CSE tools.

Depression, anxiety, and suicidal ideation among Vietnamese secondary school students and proposed solutions: a cross-sectional study

BACKGROUND

There is a rapidly growing public awareness of mental health problems among Vietnamese secondary school students. This study aims to determine the prevalence of anxiety, depression, and suicidal ideation, to identify related risk factors, and to explore students' own proposals for improving their mental health.

METHODS

A cross-sectional study was conducted among 1161 secondary students in Can Tho City, Vietnam during September through December, 2011. A structured questionnaire was used to assess anxiety, depression, suicidal ideation and proposed solutions. Depression was measured using the Center for Epidemiology Studies Depression Scale.

RESULTS

The prevalence estimates of symptoms reaching a threshold comparable to a diagnosis of anxiety and depression were 22.8% and 41.1%, respectively. Suicide had been seriously considered by 26.3% of the students, while 12.9% had made a suicide plan and 3.8% had attempted suicide. Major risk factors related to anxiety and depression were physical or emotional abuse by the family, and high educational stress. As proposed solutions, nearly 80% of students suggested that the academic workload should be reduced and that confidential counselors should be appointed at schools. About half the students stated that the attitudes of their parents and teachers needed to change. A significant majority said that they would visit a website that provided mental health support for students.

CONCLUSIONS

Anxiety, depression, and suicidal ideation are common among Vietnamese secondary school students. There are strong associations with physical and emotional abuse in the family and high educational stress. Academic curricula and attitudes of parents and teachers need to be changed from a punitive to a more supportive approach to reduce the risk of poor mental health. An internet-based mental health intervention could be a feasible and effective first step to improve students' mental health.