RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the candidate and address MR.GEO GEORGE

(in block letters)
I YEAR M. Sc. NURSING
MASOOD COLLEGE OF NURSING
BIKARNAKATTA, MANGALORE

2. Name of the Institution MASOOD COLLEGE OF NURSING

BIKARNAKATTA, MANGALORE

3. Course of Study and Subject M. Sc. NURSING

PSYCHIATRIC NURSING

4. Date of Admission to the Course 01.07.2011

5. Title of the study

“EFFECTIVENESS OF A PLANNED TEACHING PROGRAMME ON

KNOWLEDGE REGARDING WARNING SIGNS AND PREVENTION OF
MENTAL ILLNESS AMONG ADOLESCENTS OF A SLECTED GOVERNMENT
COLLEGE, MANGALORE”.

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6. Brief resume of the intended work

6.1 The need for the study

“A good plan today is better than a perfect plan tomorrow”.

- George S Patton-

Mental health is an adjustment of human beings to the world and to each other with a
maximum of effectiveness and happiness. The importance of maintaining a good mental health
is crucial to living a long and healthy life. Good mental health can enhance one’s life, while
poor mental health can prevent someone from living a normal life. Mental wellness is generally
viewed as a positive attribute, such that a person can reach enhanced levels of mental health,
even if the person does not have any diagnosed mental health condition. Mental health
highlights emotional well-being, the capacity to live a full and creative life, and the flexibility
to deal with life's inevitable challenges. The perspectives of mental health may include an
individual's ability to enjoy life and procure a balance between life activities and efforts to
achieve psychological resilience. Mental health is an expression of emotions and signifies a
successful adaptation to a range of demands.1

India is the second most populous country in the world, in which about 22.5 % are
adolescents, who are living in diverse circumstances and have diverse health needs. According
to WHO adolescence is a period of physical growth and intellectual attainment at its peak
coupled with setting of personality traits, decision regarding future profession, and extreme
emotional instability. This is also a period of identity crisis. Good mental health is very
important for youth's success. Mental health plays major role in education, maintaining
relationship, self-esteem and physical conditions.2

Teenage years can be stressful and challenging. Adolescents feel all kinds of pressures-
to do well in school, to be popular with peers, to gain the approval of parents, to make the team,
to be cool. In addition, many teenagers have other special problems. It may be due to parents’
divorce, parent being out of work or the family's financial problems, parent's alcoholism and
poverty. Mental health problems in teens are real, painful and, if left untreated, can have
serious consequences.3

Most people believe that mental disorders are rare and "happen to someone else." In
fact, mental disorders are common and widespread. They can strike anyone at any time. A
mental illness is a disease that causes mild to severe disturbances in thought and/or behavior. It
is estimated that one in ten young people in the United States experiences a serious emotional

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disturbance at some point in their adolescence.4

Adolescent mental health problems are at a point of crisis for our nation. One out of
every ten adolescent has a serious mental health problem, and another 10% have mild to
moderate problems. Mental health problems in adolescent can lead to tragic consequences,
including suicide, substance abuse, inability to live independently, involvement with the
correctional system, lack of vocational success, and health problems. According to National
Institute of Mental Health, the life time prevalence of any mental disorders is 46.3% and life
time prevalence of severe mental disorders are 21.4%. The prevalence rate of major adolescent
mental illnesses like anxiety disorders 25.1%, severe anxiety disorders 5.9%, and panic
disorders is 2.3%, post-traumatic stress disorder is 4.0%, phobia 15.1%, ADHD 9.0%, eating
disorders 2.7%, bipolar disorders 0-3%, depressive disorders 11.2%, schizophrenia 1.1% and
adolescent suicide behaviors 6.9% has been reported.5

In India suicide has become one of the most common causes of death among the
adolescent population. In 2000 the suicide rate was 21.9%, but now it increases to 33.7%.
Depression was found to be four times greater in the urban areas as compared to the rural 6.1
and 1.5 per 1000, respectively. A study conducted by the National Institute of Mental Health &
Neurosciences, Bangalore showed that around 1.5 crore people suffering from mental
disorders in India.6

An epidemiological study was conducted in Goa to estimate the prevalence and

correlates of mental disorders in adolescents. A sample of 2048 were randomly selected from
six urban wards and four rural communities and evaluated on the basis of development and
wellbeing assessment. The result showed that the prevalence of anxiety disorder, suicidal
behavior, and depressive disorders were very common in adolescents. The study concluded
with, weak family support was a critical factor associated with high prevalence of mental
disorders among adolescents.7

As many mental illnesses emerge during adolescence, it is a critical time for prevention
and early intervention. The earlier mental health issues are recognized and treated, the better
the outcome. But in most of the cases people are not aware of these mental illnesses. In order to
reduce the mental health disparities the National Institute of Mental Health developed a five-
year Strategic Plan. Which comprised of increasing the knowledge base by which disparities
are documented and understood, improving outcomes of interventions and services through
research, expanding institutional research infrastructures, research training and career

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development and enhancing public information outreach and dissemination.8

An experimental study was conducted in UK to assess the impact of a mental health

teaching programme among 60 adolescents who classified into experimental classes (School E)
received a six-lesson teaching on mental health and control classes (School C) who did not
receive any teaching. It was assessed on the basis of Mental Health Questionnaire and was
measured at two time points, Time 1 (T1) and Time 2 (T2).The result showed that at T2,
students in School E compared with those in School C had attained more knowledge and
positive attitude towards mental health. The study concluded that the knowledge and positive
attitudes was increased through mental health teaching programme.9

Based on the review of literature and the personal experience of the investigator, it was
found that most of the adolescents have very little knowledge about warning signs and
prevention of mental illness. With this view the investigator felt a need to administer planned
teaching programme to improve the knowledge of adolescents and to assess its effectiveness.

6.2 Review of literature

A study was conducted in Scotland to determine the prevalence of self-harm in

adolescents. A sample of 2008 pupils aged 15–16 years were taken and assessed by
demographic characteristics, lifestyle, life events and problems, social influences,
psychological variables and self-harm. The analysis of result revealed that, self-harm was
reported by 13.8% of the respondents. The 71% of those who had self-harmed had done in the
past 12 months. The findings suggested a role for emotional literacy programmes in schools
and highlighted the importance of promoting positive mental health among adolescents.10

A retrospective study was conducted in All India Institute of Medical Sciences, New
Delhi to evaluate awareness of suicide among youth and to formulate prevention. A sample of
222 cases of suicidal deaths between 10-18 years was assessed through the post-mortem
examination conducted in Department of Forensic Medicine and Toxicology. The result of the
study showed that 55.4% were of girls, Female: Male ratio was 1.24:1and the commonest
method used for committing suicide was hanging (57% in girls, 49.5% in boys) followed by
poisoning (37.4% in girls, 49.5% in boys). The study concluded that there was great
knowledge lag among adolescence and suicide prevention programme strategy based on risk
factors could be more effective.6

A study was conducted in United States to measure the impact of an educational

program on knowledge and attitudes about depression among adolescents. A sample of 100

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were taken and assessed through Adolescent Depression Awareness Program (ADAP). The
result revealed that only 15% of the adolescents were aware about depression and its
consequences and 5% were aware of its interventions. The study concluded that there was great
lack in the knowledge on depression among adolescence and school based education
programme is necessary.11

A study was conducted in United States to validate the effect of metacognitions

questionnaire on knowledge on anxiety disorders among adolescents. A sample of 78
adolescents were taken and assessed on the basis of Metacognitions Questionnaire for
Adolescents (MCQ-A).The result showed that adolescent girls scored higher on the total index
of metacognitive processes than adolescent boys. The study concluded that the preliminary
support for the use of the MCQ-C with a broader age range as well as an association between
metacognitive processes and anxiety symptomatology in adolescents , with implications for
cognitive behavioral interventions with anxious youth.12

A comparative study was conducted in Holland to evaluate the efficacy of a Universal

School-Based Program to Prevent Adolescent Depression. A sample of 260 adolescents were
taken and assigned into 3 groups as Resourceful Adolescent Program-Adolescents (RAP-A),
Resourceful Adolescent Program-Family (RAP-F) and Adolescent Watch, comparison group.
The result showed that significant differences between the RAP and AW groups, X 2(2, N =
192) =10.63, p < .01, with RAP groups showing lower rates of depression and higher rates in
the healthy range. The study concluded that the school-based universal program was effective
to prevent depression in adolescence.13

A study was conducted in United States to assess the effectiveness of the Signs of the
Suicide (SOS) prevention program in reducing suicidal behavior. A sample of 4133 students in
9 high schools was randomly selected to interventional and controlled group and assessed
through Self-administered questionnaire. The result indicated that the youths in the
interventional group were approximately 40% less likely to report a suicide attempt compared
with youths in the control group (OR = e-.47 = 0.63) and the effects of the SOS program on
knowledge and attitudes were modest in magnitude and resulted in effect sizes of one quarter to
one third of a standard deviation (e.g., attitudes: ES = .16/.65 = .25). The study suggested that
SOS was an effective universal school-based suicide prevention program to demonstrate
significant effect of self-reported suicide attempts.14

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6.3 Statement of the problem

Effectiveness of a planned teaching programme on knowledge regarding warning

signs and prevention of mental illness among adolescents of a selected government
college, Mangalore.

6.4 Objectives of the study

The objectives of study are :

 To assess the level of knowledge regarding warning signs and prevention of mental
illness among adolescents of a selected Government College.
 To evaluate the effectiveness of planned teaching programme on warning signs and
prevention of mental illness among adolescents of a selected government college.
 To find out the association between the level of knowledge regarding warning signs
and prevention of mental illness and selected demographic variables.

6.5 Operational definitions

1. Effectiveness: In this study, effectiveness refers to determining the extent to which

the planned teaching programme has achieved the desired effect and is measured in
terms of gain in knowledge score of the adolescents from pre-test to post-test.

2. Planned teaching programme: In this study, planned teaching programme refers to

the systematic, planned teaching strategy designed to provide information to
adolescents regarding warning signs and prevention of mental illness.

3. Knowledge: In this study knowledge refers to the adolescents understanding about

warning signs and prevention of mental illness as measured by a structured
knowledge questionnaire.

4. Warning signs and prevention of mental illness: In this study, warning signs and
prevention of mental illness refers to signs and symptoms of suicidal behavior,
anxiety and depressive disorders and the measures need to be taken by the
adolescents to prevent the occurrence of these illness.

5. Adolescent: In this study adolescent refers to students who are studying in I and II
year Pre-University classes of a selected government college.

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 6.6 Assumptions

The study assumes that:

 Adolescents may have some knowledge regarding warning signs and prevention of
mental illness.

 Planned teaching programme may enhance the knowledge of adolescents regarding

warning signs and prevention of mental illness.

 Adolescents may willingly participate and co-operate in the study.

6.7 Delimitations

This study will be delimited to adolescents who are studying in selected government
college, Mangalore.

6.8 Hypotheses

H1: the mean post-test knowledge score of adolescents will be significantly higher than
the mean pre-test knowledge scores.

H2: there will be significant association between pre-test knowledge score on warning
signs and prevention of mental illness and selected demographic variables.

7. Material and methods

7.1 Source of data

Data will be collected from adolescents who will be available in a selected

government college, Mangalore.

7.1.1 Research design

Pre experimental one group pre-test post-test design will be selected for the study
Pre-test Treatment Post-test

O1 X O2

Pre test
O1 : Administration of structured knowledge questionnaire on warning signs and
prevention of mental illness.
Treatment
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X: Administration of planned teaching programme on warning signs and prevention of
mental illness.
Post test
O2: Administration of same structured knowledge questionnaire on seventh day after
planned teaching programme.

7.1.2 Setting

The study will be conducted in a selected government college, Mangalore.

7.1.3 Population

In this study, population consists of adolescents in selected government college,

Mangalore.

7.2 Methods of data collection

7.2.1 Sampling procedure

The setting for this study will be selected by non-probability purposive sampling technique.
Stratified random sampling is used to select the subjects of the study.

7.2.2 Sample size

In this study, the sample size consists of 60 adolescents.

7.2.3 Inclusion criteria for sampling

 Adolescents who are willing to participate in this study

 Adolescents who are available during the period of data collection

7.2.4 Exclusion criteria for sampling

 Adolescents who are sensitized previously with any related study for a duration
of 3 months.

7.2.5 Instruments intended to be used

The tools used for the study are

 Demographic proforma including age, gender, family size, religion and education.
 Structured knowledge questionnaire on warning signs and prevention of mental
illness.

7.2.6 Data collection method

Prior data collection, permission will be obtained from the college authority concerned
for conducting the study. Subjects will be selected according to the inclusion criteria of the
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study. Purpose and need for the study will be explained to adolescents, consent from
adolescents will be taken. Firstly knowledge of adolescents will be measured by the
structured knowledge questionnaire and planned teaching programme will be administered
to adolescents. After 7 days of PTP, post test knowledge will be measured by using the
same structured knowledge questionnaire. Data collection will be done within a period of
one month.

7.2.7 Plan for data analysis

Data will be analyzed using descriptive and inferential statistics.

Demographic proforma will be assessed using frequency and percentage. Level of
knowledge will be assessed using frequency, mean, and standard deviation. Effectiveness of
PTP can be tested by paired “t”test and association between selected demographic variables
and knowledge score will be tested by chi-square test at P value <0.05 considered as
significant. The results will be presented in the form of frequency tables, diagrams and
graphs.

7.3 Does the study require any investigations or interventions to be conducted

on patients, or other animals? If so please describe briefly.

Yes, in the present study, the investigator plans to use a structured knowledge questionnaire
to evaluate the effectiveness of PTP on warning signs and prevention of mental illness
among adolescents.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes, ethical clearance is obtained from the Ethical Committee on 2 nd

November 2011.

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8. References

1. Mental health. Wikipedia [home page on the internet]. Updated 2011 Dec 5;
Available from: http://en.wikipedia.org/wiki/Mental_health
2. Sreevani R. A guide to mental health and psychiatric nursing. 3 rded. New Delhi:
Jaypee; 2010.
3. Glossary of Symptoms and Mental Illnesses Affecting Teenagers. American
academy of child and adolescent psychiatry [home page on the internet]. 2010 Oct
11; Available from: http://www.aacap.org/cs/root/resources_for_families
/glossary_of_symptoms_and_mental_illnesses_affecting_teenagers
4. Recognizing the Warning Signs of Mental Illness. Ten broeck health care [home
page on the internet]. 2000 Feb; Available from:
http://www.tenbroeck.com/TBResources/treatment/warning.shtml.
5. Statistics. National Institute of Mental health.[home page on the internet].Available
from:http://www.nimh.nih.gov/statistics/1SCHIZ.shtml
6. Lalwani S, Sharma GASK, Kabra SK,, Girdhar S, Dogra TD. Suicide among
Children and Adolescents in South Delhi. Indian journal of psychiatry. 2008 Apr 15;
50 (1):30-33.
7. Pillai A, Patel V, Cardozo P, Goodman R. Non-traditional lifestyles and prevalence
of mental disorders in adolescents in Goa, India. The British Journal of Psychiatry.
2008; 192:45-51.
8. Resnick MD. Protection, resiliency, and youth development. Adolescent Medicine:
State of the Art Reviews. 2000; 11(1): 157-164.
9. Naylor PB. Impact of a mental health teaching programme on adolescents. The
British Journal of Psychiatry. 2009; 194 (4): 365-370.
10. O’ Connor RC, Rasmussen S, Miles J, Hawton K. Self-harm in adolescents: self-
report survey in schools in Scotland. The British Journal of Psychiatry. 2009; 194
(4): 68-72.
11. Brody LR.Adolescent Depression Awareness Programme.John Hopkins Medicine.
[serial on the internet]2010 Mar 3;Available from
http://www.hopkinsmedicine.org/psychiatry/specialty_areas/moods/research/
12. Bacow TL, Pincus DB, Ehrenreich JT. The metacognitions questionnaire for
children: development and validation in a clinical sample of children and adolescents
with anxiety disorders. Journal of anxiety disorders. 2009 Aug; 23(6):727-36.
13. Shochet M, Dadds MR, Denise H, Whitefield K, Harnett PH, Osgarby SM. The
Efficacy of a Universal School-Based Program to Prevent Adolescent Depression.
Journal of Clinical Child & Adolescent Psychology. 2001; 30 (3): 303-315.

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 14. Aseltine RH Jr, James A, Schilling EA. Evaluating the SOS suicide prevention
program: a replication and extension. BMC Public Health. 2007; 161 (7): 1471-
2458.

9. Signature of the candidate

10. Remarks of the guide

11. Name and designation of (in block letters)

11.2 Guide
MRS. KOTEKAR MADHUMITA
ASSOC. PROFESSOR
MASOOD COLLEGE OF NURSING
MANGALORE

11.2 Signature

11.3 Co-guide (if any) MRS. THARA C.M.

ASST. PROFESSOR
MASOOD COLLEGE OF NURSING
MANGALORE

Signature

12. 12.1 Head of the department

MRS. KOTEKAR MADHUMITA

12.2 Signature

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13. 13.1 Remarks of the Chairman and Principal

13.2 Signature

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