Parental perceptions of child mental health symptoms, causes and responses among cambodian and its correlation with their children mental health

VIETNAM NATIONAL UNIVERSITY HA NOI UNIVERSITY OF EDUCATION PHAN RATHA “PARENTAL PERCEPTIONS OF CHILD MENTAL HEALTH: SYMPTOMS, CAUSES AND RESPONSES AMONG CAMBODIAN AND ITS CORRELATION W

VIETNAM NATIONAL UNIVERSITY HA NOI

UNIVERSITY OF EDUCATION

PHAN RATHA

“PARENTAL PERCEPTIONS OF CHILD MENTAL HEALTH: SYMPTOMS, CAUSES AND RESPONSES AMONG CAMBODIAN AND ITS CORRELATION WITH THEIR CHILDREN MENTAL HEALTH”

MASTER’S THESIS IN PSYCOLOGY

HANOI, VIETNAM: April, 2016

VIETNAM NATIONAL UNIVERSITY HA NOI

UNIVERSITY OF EDUCATION

PHAN RATHA

“PARENTAL PERCEPTIONS OF CHILD MENTAL HEALTH: SYMPTOMS, CAUSES AND RESPONSES AMONG CAMBODIAN AND ITS CORRELATION WITH THEIR CHILDREN MENTAL HEALTH”

MASTER’S THESIS IN PSYCOLOGY Major: Clinical psychology of children and adolescents

Code: Pilot

HANOI, VIETNAM: April, 2016

SUPERVISOR’S RESEARCH SUPERVISION STATEMENT

TO WHOM IT MAY CONCERN

Name of program: Master’s degree of Art in Clinical Psychology, specializing in Child and Adolescent Clinical Psychology

Name of candidate: Phan Ratha

Title of research: ―PARENTAL PERCEPTIONS OF CHILD MENTAL HEALTH: SYMPTOMS, CAUSES AND RESPONSES AMONG CAMBODIANS AND ITS CORRELATION WITH THEIR CHILDREN MENTAL HEALTH‖

This is to certify that the research carried out for the above titled master’s thesis was completed by the above named candidate under my direct supervision This thesis material has not been used for any other degree I played the following part in the preparation of this thesis:

Supervisor (s)………

Date………

CANDIDATE’S STATEMENT

TO WHOM IT MAY CONCERN:

This is to certify that the thesis that I (Phan Ratha) am submitting, hereby entitled Parental Perception of Child Mental Health (Symptoms, Cause and Treatment Options) among Cambodians and its correlation with their children’s mental health, for the degree of Master of Arts in Clinical Psychology at the University of Education, Vietnam National University-Hanoi is entirely my own work and, furthermore, that it has not been used to fulfill the requirements of any other qualification in whole or in part, at this or any other University or equivalent institution No reference to, or quotes from this document, may be made without the written approval of the author

Signed by: ………

Date: ………

Countersigned by the Chief Supervisor ………

Date: ………

Second supervisor (if any) ………

Date: ………

ACKNOWLEDGEMENTS

This thesis could not have been completed without the help of many people who gave their support, advice, encouragement, and understanding I would like to show my deepest gratitude to the following people whom I will never forget

First of all, I would like to give many thanks to my respectful mother, Sous Lon, and grandparents, who have always financially and emotionally supported me Secondly, my appreciation is extended to Associate Professors Dr Bahr Weiss and

Dr Dang Hoang Minh for initiating and approving to release the first English classes for master’s level psychology courses in Vietnam National University, Hanoi to Cambodian students

Additionally, I would like to express my sincerest thanks to Dr Amie Pollack and Dr Cindy J Lahar, Dr Poch Bunnak and Dr Tran Thanh Nam who are

my kind and intelligent supervisors for their advice, encouragement, and consultation so that I would be able to successfully complete the thesis writing process from beginning to end Without their technical support and professional guidance, constructing the thesis could not have been done properly

Furthermore, I would like to convey my thanks to lecturer Mr Sareth Khann and Mr Bunna Peoun who assisted me by frequently providing feedback to enhance this report Moreover, my sincere thanks are delivered to all professors in the master’s program, who tried their best to provide me with valuable knowledge and useful skills to conduct research and write the thesis

Finally, I cannot forget to say thanks to my classmates who provided warm learning environment as well as Vietnamese and Cambodian friends who frequently pushed me to focus on thesis tasks and provided a lot of feedback

TABLE OF CONTENTS

PART I - BACKGROUND 8

1.1 Background of the Study 8

1.2 Problem Statement 9

1.3 Importance of the study and policy implications 10

1.4 Purposes of the study / The Aim of Research (Research Questions): 11

1.5 Objectives of the study: 11

1.6 Hypotheses for the study: 12

1.7 Scope and Limitation 12

PART II - LITERATURE REVIEW 12

2.1 Introduction to mental health and mental disorders 12

2.1.1 Worldwide epidemiological research regarding prevalence of mental disorders 12

2.1.2 Impact of mental health problems 12

2.1.3 Common causes of mental health problems 12

2.2 Mental Health Literacy 12

2.2.1 What is mental health literacy? 12

2.2.2 Mental health literacy regarding help-seeking behaviors 12

2.2.3 Factors influencing mental health literacy and help-seeking behavior 12

2.3 Parental influences on child mental health development and treatment 12

2.3.1 How parental factors put children at risk or help them recover from mental health problems 12

2.3.2 How parental mental health literacy affects identification, help seeking, and recovery from childhood mental health problems 12

2.4 Cambodian Mental Health Perceptions 12

2.4.1 Rates of child and adult mental health in Cambodia 12

2.4.2 Cambodian mental health literacy and seeking-help behavior 12

PART III - RESEARCH METHODOLOGY 12

3.1 Participants 12

3.2 Sampling procedure 12

3.3 Data Collection and Procedures 12

3.4 Measurements (Scale) 12

3.5 Statistical Data Analysis 12

3.6 Ethical Considerations 12

PART IV – RESULTS AND DISCUSSION 12

4.1 Descriptive Results 12

4.2 Perceptions of the cause and consequences of specific child mental health problems 12

4.3 Health-seeking behavior for mental health issues in children 12

4.4 Analysis of parental perceptions 12

4.5 Exploratory Factor Analysis 12

4.6 Explore the factors may influence parental perceptions of child mental health 12 PART V - CONCLUSION AND FURTURE RECOMMENDATION 12

5.1 Conclusion 12

5.2 Recommendations 12

REFERENCES 13

LIST OF TABLES

Table 1 Demographics by location (percentages reported for urban versus rural) 12

Table 2 Responses to vignette of child with somatoform disorder 12

Table 3 Responses to vignette of child with separation anxiety disorder 12

Table 4 Responses to vignette of child with Attention Deficit Hyper-active Disorder (ADHD) 12 Table 5 Responses to vignette of child with tic disorder 12

Table 6 Responses to vignette of child with aggressive behavior 12

Table 7 Responses to vignette of child with depressive disorder 12

Table 8 Responses to vignette of child with Posttraumatic Stress Disorder (PTSD) 12

Table 9 Parental perception of causes of child mental health by demographic info 12

Table 10 Factorial analysis of cause of children mental health 12

Table 11.Correlations between parent perception factors, and demographic characteristics 12

LIST OF FIGURES

Figure 1 Level of education completed by mothers by residential area 12 Figure 2: Level of education for fathers 12 Figure 3 Household’s income by location 12

PART I - BACKGROUND 1.1 Background of the Study

The healthy development of children is an important concern for families and societies around the world Given a nurturing environment, children have the opportunity to grow into successful and productive members of society Raising children to be physically and mentally healthy requires much effort and serious care from parents or caregivers Mental health problems in children are a crucial influence on child development Understanding the symptoms and causes of mental health problems will help parents effectively support their children and promote

their cognitive, social and emotional development (MoH, 2005; TPO 2005)

―There is no health without mental health‖ said Ban Ki Moon on October 10thWorld Mental Health Day, 2011 This message encouraged public and private sectors to take into account citizens’ mental health care, children included Improving people’s quality of life and mental health is a priority for the World Health Organization (WHO) Worldwide epidemiological data indicate that about 20% of children and adolescents suffer from mental disorders with types of disorders varying by cultural context This finding is alarming and suggests that early intervention for mental health care is needed (Saxena, Thornicroft, Knapp; Whiteford, 2007) Another global study focused solely on children, conducted both

in developing and developed nations, and showed that 10% to 15% of children suffer from mental health disorders with 3% to 4% of children having significant developmental delays or mental retardation (Dom Nokteok, 2010) This finding was very similar to a study (WHO, 2007) conducted by Seven Nation Collaborative Study on children aged 0-12 in the Philippines which found that 16% of children in

the Philippines had mental disorders

Regionally, a recent study (Weiss, Dang, & Nguyen, 2013) revealed that 13% of Vietnamese children (aged 6-16) suffer from mental health problems, indicating that 2.7 million of Vietnamese children need access to mental health services Studies have also looked at what factors place children at risk for mental health problems Weiss and colleagues (2013) found that parental income and education play an important role as risk factors for Vietnamese child behavioral and

12-emotional problems Another evidenced-based study of Spanish National Health Survey (SNHS) with Spanish representative found a strong correlation between parental education and child mental health among 4 to 10 year olds This finding was not seen among children aged from 12 to 15 years olds Parental education was

a much greater risk factor for child mental health than family’s income or social status (Songego, Llacer, and Galan, 2013) Therefore, parental education appears to

be a strong risk factor for parent-reported child mental health

Parenting behavior appears to be an important factor in the development of child mental health disorders One study demonstrated that parenting style plays a crucial role in child mental health; parents with strong interpersonal relationships with their children had children with fewer mental health problems (Bolghan-Abadi, Kimiaee & Amie, 2011) Furthermore, research has shown that family interventions that use specific parenting skills are the most effective strategy to reduce child behavioral problems (Hutching & Lane, 2005)

Research on child mental health is complicated by cultural variability in perceptions of mental health, parenting behaviors, and parent reporting styles A study of Vietnamese parents living in Australia indicates that these parents identified psychotic symptoms, disorientation, and suicidal thoughts and behavior as psychopathological for their child’s mental illness Additionally, parents in the study believe that the most likely causes of child mental illnesses were metaphysical and supernatural, biological/chemical unrest, and traumatic experiences

(McKelvey, Baldassar, Sang, & Roberts 1999) Another study (Shanley, 2008) was

conducted in New Zealand to better understand multiple perspectives of parent’s report of child mental health symptoms As a result, a parent-report measure was developed that is designed to be consistent with the cultural setting

1.2 Problem Statement

Professionals and experts have a deep understanding of the causal, developmental and maintaining factors of children's mental health problems Research on psychopathology indicates the following: 1) the interaction between multiple biological, psychological and social factors cause children's mental health problems (Shirk, Talmi, & Olds, 2000), 2) "One disorder can result from multiple

pathways and one pathway can have multiple results" (Hudson, Kendall, Coles, Robin, & Webb, 2002), 3) child psychopathology can be also developed from the increase of risk factors, especially exposure to risk factors during critical developmental periods which can accelerate the chance of developing mental health disorders (Shirk et al., 2000), and 4) risk and protective factors can be nonlinear, bi-directional, or reciprocal Children and their environments are not mutually disconnected; they constantly have reciprocal interactions and continually evolve over time (Shirk et al., 2000; Kazdin, Kraemer, Kessler, Kupfer, & Offord, 1997)

It is ambiguous whether Cambodian parents are able to understand this complicated picture of the cause, development and maintaining factors of children's mental health problems The first mental health literacy study in Australia (Jorm, Barney, Christensen; Highet, Kelly, 2006) (by using vignettes) on depression and schizophrenia indicated that many people cannot correctly describe psychiatric symptoms for a disorder and various evidence also reveals that changing perception and beliefs about mental disorders will influence behavior Parents are more likely

to endorse a disease model when conceptualizing child mental health problems A disease model, which first originated in medicine, describes maladaptive functioning as a syndrome that is either present or absent (Shirk et al., 2000; Sroufe, 1997) For example, a parent who views their child's depression as either present or absent would likely endorse the disease model, negating the notion that mental health problems exist on a continuum of severity

Importantly, other literature shows that one key factor involved in parental help-seeking for child mental health services is misperceptions of child mental health symptoms or disagreement between parents regarding child mental health (Shanley, 2008) Although there is an emerging literature on perceptions of mental health disorders in Cambodia (See Chapter 2.2), there is no current literature on review of child mental health disorders yet in Cambodia Hence, scientific research

on Cambodian parental views of child mental disorders must be further explored

1.3 Importance of the study and policy implications

It is expected that this empirical study will generate many significant scientific findings relevant to child mental health, family functioning and social development