From Department of Global and Community Health, George Mason University, USA.　

The Global School-based Student Health Survey (GSHS), which assesses the health behaviors of middle school children, is conducted in participating low- and middle-income countries by national governments in collaboration with the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) [6].

The 2007 India GSHS used a two-stage cluster sampling design to sample 75 nationally-representative Central Board of Secondary Education (CBSE) schools (including government schools, independent schools, Kendriya Vidyalayas, and Jawahar Novodaya Vidyalayas), of which 74 (99%) agreed to participate [7,8]. Within each of the participating schools, several classrooms (usually grades 8, 9, or 10) were randomly sampled, and all students in these classrooms were invited to complete a self-report survey during one class session. Participation was voluntary, and no identifiable information was collected. A total of 8130 students completed the survey, for an 85% participation rate [7]. For this analysis, only data from the 6721 students who were ages 13 to 15 and reported their sex are included.

The mental well-being of students in the past 12 months was measured with key questions about loneliness ("How often have you felt lonely?"), anxiety ("How often have you been so worried about something that you could not sleep?"), and symptoms of depression ("Did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing your usual activities?") [9]. The questions about loneliness and anxiety used a five-point response scale with possible answers of always, most of the time, sometimes, rarely, and never. Responses of always or most of the time were coded as markers of poor mental well-being. The question about symptoms of depression had possible answers of yes and no, with yes indicating poorer mental health status. A fourth question asked about the number of close friends, and an answer of zero close friends was considered a sign of low mental well-being.

Chi-square tests were used to identify differences in responses between age and sex groups. As several differences were observed, age-and sex-adjusted multivariate logistic regression models were used to examine the associations between individual mental health variables and individual parental involvement variables. Due to multicollinearity and interaction between variables, no models included more than one mental health variable or more than one parental involve-ment variable. Any student missing a response for a particular question was excluded from analysis involving that variable. All statistical analyses were conducted using SPSS, version 19 (IBM, New York, USA).

About half of the students reported that their parents checked their homework, understood their problems, and knew how the student spent free time most of the time or always (Table I). Less than 10% reported being lonely or anxious, but nearly one in four reported symptoms of depression. Older children reported lower levels of parental involvement and higher levels of poor mental health than younger students.

TABLE I  Prevalence of Exposures and Outcomes in The Study Population

More girls than boys reported high levels of parental understanding and parental monitoring. Girls also reported more symptoms of poor mental health, with the highest rates of reported loneliness, anxiety, and depression occurring among girls who reported low levels of parental involvement. Age-adjusted logistic regression models showed that high levels of parental involvement were consistently associated with a decreased likelihood of poor mental health for both boys and girls (Table II).

TABLE II	Relation Between Parental Involvement (Always or Most of The Time Vs. Less Often) and Poor Child Mental Health.   

	

This study also showed that high levels of parental involvement with both male and female adolescent children are associated with reduced odds of poor mental health among those children. A similar study of students aged 14-16 years in Finland found that parental knowledge of how children spent their free time was a significant predictor of reduced odds of depression and anxiety [1], but this finding cannot necessarily be generalized to other parts of the world. Thus, this study provides an important new perspective on adolescent mental health in India. The differences in the strength of the associations for boys and girls may be a function of sons and daughters interacting differently with their parents and perceiving parental support differently.

There were several potential limitations of this study. The GSHS only includes data from children who attend school, so the results cannot be generalized to all adolescents in India, and parental involvement levels and mental health symptoms were assessed based on students’ self-reports, which were not validated with direct observation or parental reports.

Even so, this study suggests that parental involvement is an important factor for positive child mental health for both boys and girls. Healthcare providers should encourage parents to be actively involved in their adolescent children’s lives, since healthy mental well-being in adolescence plays a key role in positive physical and psychological development.

Contributors: TH, FA, CMC, JLA, and KHJ all contributed to the conception of the study, the analysis and interpretation of the data, and the writing and critical editing of the manuscript, and all have approved its submission.

Funding: None; Competing interests: None stated.

1. Fröjd S, Kaltiala-Heino R, Rimpela M. The association of parental monitoring and family structure with diverse maladjustment outcomes in middle adolescent boys and girls. Nord J Psychiatry. 2007;61:296-303.

2. Kerr M, Sattin H. What parents know, how they know it, and several forms of adolescent adjustment: further support for a reinterpretation of monitoring. Dev Pscyhol. 2000;36:366-80.

3. Masche JG, Barber BK. Connectedness and separation in parent-adolescent relationships: indicators of a successful identity development? Paper presented at: Biennial Meeting of the Society for Research in Child Development; Apr 19-22; Minneapolis, MN.2001.

4. Dwairy M, Achoui M. Adolescents –family connectedness: A first cross-cultural research on parenting and psychological adjustment of children. J Child Fam Stud. 2010;19:8-15.

5. Dwairy M, Achoui M. Parental control: A second cross-cultural research on parenting and psychological adjustment of children. J Child Fam Stud. 2010;19:16-22.

6. Centers for Disease Control and Prevention. Global School-Based Student Health Survey (GSHS) Overview. Available from http://www.cdc.gov/gshs/pdf/GSHSOVerview.pdf. Accessed March 28, 2012.

7. World Health Organization. Global School-based Student Health Survey: India (CBSE) 2007 fact sheet. Available from http://www.who.int/chp/gshs/india/en/index.html. Accessed March 28, 2012.

8. Government of India, Ministry of Human Resource Development, Department of School Education and Literacy & Department of Higher Education. Annual Report 2007-08. New Delhi: MHRD; 2008.

9. World Health Organization. Global School-based Student Health Survey (GSHS): 2006 India, central board of secondary education (CBSE) GSHS questionnaire. Available from http://www.who.int/chp/gshs/india/en/index.html. Accessed March 28, 2012.

10. Muzammil K, Kishore S, Semwal J. Prevalence of psychosocial problems among adolescents in district Dehradun, Uttarakhand. Indian J Publ Health. 2009;53:18-21.

11. Pathak R, Sharma RC, Parvan UC, Gupta BP, Ojha RK, Goel NK. Behavioral and emotional problems in school going adolescents. Australasian Med J. 2011;4:15-21.