MINISTRY OF EDUCATION AND TRAINING THAI NGUYEN UNIVERSITY DAM THI BAO HOA EVALUATING THE EFFECTIVENESS OF EARLY DETECTION AND INTERVENTION MODEL ON MENTAL DISORDERS OF STUDENTS FROM 6
Trang 1MINISTRY OF EDUCATION AND TRAINING
THAI NGUYEN UNIVERSITY
DAM THI BAO HOA
EVALUATING THE EFFECTIVENESS OF EARLY DETECTION AND INTERVENTION MODEL ON MENTAL DISORDERS OF STUDENTS FROM 6 TO
15 YEARS IN THAI NGUYEN CITY
SPECIALITY: SOCIOLOGY AND HYGIENE HEALTH ORGANIZATION
CODE NUMBER: 62.72.01.64
SUMMARY OF THE doctoral DISSERTATION
Thai Nguyen - 2014
Trang 2The dissertation was completed at COLLEGE OF MEDICINE & PHARMACY, THAI NGUYEN
The dissertation is available for reference at:
- The National Medical Library
- Learning Resource Centre of Thai Nguyen University
- Library of Thai Nguyen Medical and Pharmacitical college
Trang 3INTRODUCTION
Mental disorders afect about 20% children and adolescents in all countries over the world If not detected and prompt treatment, they can leave severe long consequences for the child itself, and affect the lives of other members of the family, the community and increase the society cost burden However, according to the review of World Health Organization (WHO), child and adolescent mental health in many countries were not given adequate attention Even in the developed countries like United State, United Kingdom, about 70-80
% of children and adolescents had mental health problems but were not received appropriate medical services due to barriers on geography, perceptions, economics, health services, prejudice, stigma and discrimination
In Vietnam, the community mental health care program has just been implemented since 1998 and so far concentrated mainly in patients with schizophrenia and epilepsy About 10 years ago, researches have done some surveys on child and adolescent mental health as epidemiological studies to determine the burden of disease
in the community, studies to build diagnostic screening tool in the primary health care, the communication activities to raise awareness
of the community and to cary out som pilot solution interventions on child and adolescent mental health care
Thai Nguyen City is the cultural and economical center of the Northern Mountainous Region of Viet Nam Besides these advantages , Thai Nguyen also faced with many complex problems, especially the problems of children and adolescents, such as stealing, fighting, truancy, suicide, drug addiction, game addiction Within the general context of Viet Nam , child and adolescent mental health care in Thai Nguyen is still being lacked, there is lack of the researches on this issue Wishing to find out the status and needs of mental health care for students in Thai Nguyen City and how to help detect the model help to early treatment and prevention of mental health problems for students in accordance with the current conditions of Thai Nguyen, we caried out the research "Evaluating the effectiveness of early detection and intervention model on mental disorders of students from 6 to15 years in Thai Nguyen city" with 2 following objectives:
Trang 41 To describe the status, a number of factors related to student mental health and the needs on mental health care on 6-15 year-old students in Thai Nguyen city in 2009
2 To develop and evaluate the effectiveness of early detection and intervention of mental disorders for students of Hoang Van Thu Primary School, Nguyen Du Secondary School in Thai Nguyen city after 2 years of intervention
THE STRUCTURE OF THE THESIS
The main part of the thesis consists 114 pages It includes the following sections:
Introduction: 2 pages
Chapter 1 - Overview: 28 pages
Chapter 2 - Subjects and methodology: 19 pages
Chapter 3 - Outcomes of the study: 36 pages
Chapter 4 - Comments: 27 pages
Conclusions: 02 pages
The outcomes of the study was displayed in 40 tables, 04 charts, 04 pictures, 01figure and 07 boxes The thesis used 129 literature references, of which, there are 35 Vietnamese literature references, 84 English references
Chapter 2 SUBJECTS AND METHODOLOGY 2.1 Subjects, research location and duration of study
2.1.1 Subjects of study
- Students at primary and secondary schools (from 6 to 15 years old)
- Parents of the students
- Teachers
- School health workers, community health worker
- Leaders of the school, teachers in charge of the Ho Chi Minh Young
Pioneers, Ho Chi Minh Communist Youth Union in the school
Trang 5Inconclusion: students, parents or careers of students disaggre to take part in the research
2.1.2 Duration of study: From September 2009 to January 2012 2.1.3 Research location: Nguyen Viet Xuan Primary School, Hoang Van
Thu Primary School, Doc Lap Secondary School and Nguyen Du Secondary School of Thai Nguyen city
2.2 Research Methodology
2.2.1 Design of research
The research was based on:
- Cross-sectional descriptive study
- Intervention study
- Combining qualitative and quantitativestudy
The model was biult in figure 2.1
Figure 2.1 The research design
Thai Nguyen city
Primary and secondary
schools
Intervention schools Control schools
Intervention schools
Control schools
Trang 6- n is minimum number need to be researched;
- Z (1- /2): coefficient of confident limit (with = 0,05, Z2(1- /2) = 1,96)
Students sample size in description research
p : ratio of students with mental disorder according to researches
before, estimated p = 0.2 1- p = 0,8 ε: desired error, we choosed ε =
7,5 % p Since then we had n1 = 2794
So, the minimum number need to be researched was 2794 students In fact, we studied 2850 students
Parent sample size in description research
p = 0,7 (because of having no data on proportion of parents interested
in child mental health, we used data on proportion of people who were interested in mental health);1- p = 0,3; ε: desired error, we choosed ε
= 6,5 % p Since then we had n2 = 390
Because of community survey, we plus 10% of withdrawn, then parent sample size in description research is from 390 to 429 parents
In fact, we studied 419 parents
School staff sample size:
In which:
- School administrators: 2 people in one school, 4 schools were 8 people
- All of teachers in charge of the class of 4 schools: 84 teachers
- School health worker: there was 1 school health worker in a school, in 4 schools were 4 school health workers
Trang 7In - depth interview: 01 leader of Education and Training Department of Thai Nguyen city, 01 local health leader; in one school: 01 administration member, 01 homeroom teacher representative at each grade, 01 parent in each grade, 01 school health worker
* Techniques of choosing the sample:
- Purposeful sampling: Thai Nguyen city - Thai Nguyen province
- Sampling schools: we choose 4 schools by random draw method
So, we had Hoang Van Thu primary school, Nguyen Viet Xuan primary school, Nguyen Du secondary school, and Doc lap secondary school
- Sampling students: the entire sample; we made a list of all the students of 4 schools selected After that, we surveyed under the list and had 2850 students Some cases were absence or refused to participate in the research
- Sampling parents: Each class chose 5 parents according to the list
of class students with distance k = 7
2.2.2.2 Intervention study
* Sample size:
Intervention sample for students was calculated as the sample size
calculation for testing the difference between two rate
P1( 1-p1 ) + p2(1-p2)
n = z2(,)
(p p )2
Trang 8in the control group
Due to the nature of public interventions and research ethics, the intervention performed on the entire students at one primary school and one secondary school
Intervention sample for parents: similar to the intervention sample
for students
Intervention sample for officers, school teachers, health workers: all of homeroom teachers, school leaders, school health workers,
teachers in charge of the Ho Chi Minh Young Pioneers Ho Chi Minh
Communist Youth Union in the school and community health workers
The sample size for intervention the group of mental disorder students
Due to the nature of public interventions and research ethics, we treatmented all of the students with mental disorders in the intervention schools according to the results of the phase 1 survey
* Choose intervention group: Hoang Van Thu Primary School and
Nguyen Du Secondary School
Control group: Nguyen Viet Xuan Primary School, Doc Lap Secondary School
Trang 9- Investigate before, after intervention similar to cross-sectional survey earlier
2.2.3 The studied criteria
2.2.3.1 The studied criteria for objective 1
* The general information of research group
- General characteristics of students: age, gender, class
- Personal characteristics of students: illness characteristics, family circumstances, psychological trauma, of the students with mental disorders
- General characteristics of parents: age, gender, ethnicity, education level, occupation, number of children
- General characteristics of teachers: age, gender, ethnicity, education level, occupational seniority
* The criteria on student mental disorder
- The proportion of students could have mental health problem after screening (SDQ score > 14)
- The proportion of students with mental disorders according to ICD10 criteria
- The proportion of students with mental disorders by gender
- The proportion of students with mental disorders by grade
- The proportion of students with mental disorders according to ethnic characteristics
* The criteria of knowledge, attitude and practice on student mental health care of parents, teachers
- The percentage of the level of knowledge, attitude and practices of parents on student mental health care
- The percentage of the level of knowledge, attitude and practice of teacher on student mental health care
* The study criteria on the relationship between student mental disorders and other factors
- The relationship between the student mental disorders with psychological trauma
Trang 10- The relationship between the student mental disorders with the knowledge, attitude and practices on student mental health care of parents
* The study criteria on the needs of the student mental health care
- Percentage of parents expected to receive documents on student
mental health care
- The percentage of parents wish to be consulted about student
mental health care
- The percentage of parents support activities for student mental
health care
- The percentage of teachers would like to receive literature on
student mental health care
- Teacher ratio desired being counseled on student mental health care
- Percentage of teachers support activities for student mental health care
- The percentage of members participated in group discussions had
needs about student mental health care
- Opinions on the needs of student mental health care of the
community through group discussions and in-depth interviews
2.2.3.2 The studied criteria for objective 2
* The studied criteria for building intervention model
- Human Resource: the number of people participated the model
- Material resource: Number of training and communicating materials,
psychological tests were used, the materials, facilities used in research
- Organization:
+ Student Mental health care Department in Thai Nguyen city was established with the responsibilities and duties of each member + Student Mental health care Group was founded in Hoang Van Thu Primary School and Nguyen Du Secondary School, officials responsible for each member in the group
Trang 11- Activities:
+ The number of communication sessions for teachers, school health workers
+ Number of people attended the media
+ Number of training and communication materials, number of leaflets
in student mental health care were distributed to parents, teachers + Number of group discussions with staff, teachers, parents + Number of meetings of Student Mental health care Group + The number of students with mental disorder were monitored + The number of students were prevented
+ The number of students with mental disorders were examinated, consultated, intervented
+ The number of parents of the students with mental disorder had medical advice
+ The number of students were screened and examinated
* Indicators to evaluate effectiveness of the model
The output indicators
- The effectiveness in changing knowledge, attitudes and practices
in student mental health care of related subjects
- The improvement of the capacity of teachers, local health officials, school health workers in student mental health care
The impact indicators
- Effectiveness on mental health of students
- Results of consultation, intervention in diseases group
- The number of students with mental disorder were detected early
The effectiveness in qualitative results to assess the
acceptability of community
In-depth interviews, group discussions: school leaders, parents, school health worker, community health worker
2.3 Methods and techniques of data collection
- Screening students by SDQ25 of students, parents and/or teachers
- Clinical examination, diagnosis according to the ICD-10 criteria
Trang 12+ For questionnaires : researchers interviewed directly, then filled
- The minutes of group discussion in students with disorders
- The longitudinal data to track the results of counseling, therapy, groups of students have been collected from patient examination and counseling, periodic monitoring
Trang 132.4.3 Implementing interventions
Figure 2.2 Student mental health care model
In which, the interventions forcused on:
(1) Early detection of disorders, so could make the diagnosis (2) Solving the cases with pharmaceutical, psychological therapy and improving the environment
(3) Preventing for all students
- The Student Mental health care Department would supervise, monitor the activities of The Student Mental health care Groups
2.5 Method of assessment
2.5.1 Evaluating the screening results by SDQ25 scale
Suspecting a problem when the SDQ total score > 14 points
Trang 142.5.2 Evaluating mental disorders in students
According to the ICD-10 criteria (Version for research), Beck depression scale, Zung anxiety scale, Valderbilt attention deficit hyperactivity scale
2.5.3 Evaluating the knowledge, attitudes and practices for the student mental health care
Knowledge: Each correct answer was counted as 1 point, scoring no point with wrong answer The total score was divided into three level by Bloom classify:
- Total score <60% : Poor
- Total score from 60-79% : Average
- Total score ≥ 80% : Good
Attitude: each question and the answer is scored from 1-6 points corresponding to 6 level Total score were assessed:
- Total score < 80 % : Not good
- Total score ≥ 80%: : Good
Practice: Each correct answer was counted as 1 point, no point with wrong answers The total score were assessed:
- Total score < 80 % : Not good
- Total score ≥ 80%: : Good
2.5.4 Evaluating the intervention results of mental disorders
Conducted periodically The final results were analyzed according
to the standard: full recovery, much relief, little relief, no relief
2.5.5 Evaluating the intervention effectiveness
The intervention effectiveness was evaluated basing on “performance indicators” and “effective intervention”
2.5.6 Evaluating the community acceptance for intervention
Based on qualitative research Informations were recorded, classified by content and assessmented the results
2.7 Data processing
Data were managed on a computer and supported of Epidata software, were analysed basing on statistical analysis software Stata 10.0 and Epinfo 6:04