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Chapter 2

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter includes an overview of relevant literature and studies in the field.

The researcher reviewed the literature and studies that provided information on themes

related to the study as well as previous research that had been undertaken in order to

complete the study. It also provides an overview of the facts on the study’s framework.

Conceptual Literature

Mental Health Among Students

Most mental health disorders have their peak onset during young adulthood. Kessler et

al. [5] observed that by the age of 25 years, 75% of those who will have a mental

health disorder have had their first onset. Among traditional students, the significant

disruptions associated with attending college may exacerbate current psychopathology

that first manifested in childhood and/or trigger its first onset. Similarly, non-traditional

students who may have to attend to the demands of their numerous roles (work and

family) may experience an exacerbation of their symptoms or a relapse. Anxiety

disorders are the most prevalent psychiatric problems among college students, with

approximately 11.9 % of college students suffering from an anxiety disorder [1].

Among the anxiety disorders, social phobia has an early age of onset (median age of

onset between 7–14 years), while panic disorder, generalized anxiety disorders (GAD),

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and post-traumatic stress disorder (PTSD) have somewhat later onsets [6]. Giaconia et

al. [7] found that in a community sample of adolescents the peak risk period for

developing PTSD was between the ages of 16 to 17 years, with approximately one third

of the sample developing the disorder by the age of 14 years [7]. Through a national

mental health survey, Vaingankar et al. [8] examined 6,616 respondents and reported

that the mean age of onset for obsessive-compulsive disorder (OCD) was 19 years of

age and 20 years of age for GAD. Thus, many traditional students with PTSD may have

experienced symptoms before college, whereas those with GAD and OCD may start

experiencing symptoms while in college. Another common mental health problem

among college students is depression, with prevalence rates in college students of 7 to

9 % [1, 9]. Zisook et al. [10] found that over half of all cases of depression had a first

onset during childhood, adolescence, or young adulthood. Similarly, others have shown

an elevated risk for mood disorders beginning in the early teens increasing with age in

a linear fashion. In the National Comorbidity Survey-Replication study, Kessler et al. [6]

reported that one out of every five individuals with depression had their first episode by

the age of 25 years. The onset of bipolar disorder (BAD) appears to follow a similar

trend. Approximately 3.2 % of college students meet the criteria for BAD [1]. An

emerging literature has shown that the majority of adults with BAD have the onset of

their disorder in child and adolescent years, with at least a third of adults with BAD

having their onset before the age of 12 years [11]. Suicide, although not a specific

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diagnosis, is the third leading cause of death among young adults and is a significant

problem among college students [12]. A large survey reported that among 8,155

students, 6.7 % reported suicidal ideation, 1.6 % reported having a suicide plan, and

0.5 % reported making a suicide attempt in the past year [13]. Given that many

students with suicidal ideation do not seek treatment, it is critical to implement

screening strategies to identify them and engage them in treatment [14, 15]. Among

the major risk factors for suicide in this age group are depression [16], hopelessness

[17, 18], and substance use [19, 20]. Eating disorders such as bulimia, anorexia, and

binge eating are common and often have their onset during adolescence with a rapid

increase in risk during early adulthood [21]. For instance, a survey of 2,822 college

students reported that 9.5% of students screened positive for an eating disorder with a

greater proportion of females relative to males (13.5 vs. 3.6 %, respectively) [22]. Stice

et al. [23] found that peak periods of risk for onset was between 17 and 18 years of

age for bulimia nervosa and binge-eating disorder, and was between 18 and 20 years

for purging behavior (feeding or eating disorder not elsewhere classified). They also

found that sub-threshold eating disorders are even more common than full criteria-

eating disorders, with both full and subthreshold disorders associated with significant

impairment [23]. Attention-deficit/hyperactivity disorder (ADHD) onsets during

childhood and persists into adulthood in approximately one half of cases and negatively

affects many critical areas in young adults. Between 2 and 8 % of college students

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suffer from ADHD and approximately one fourth of students receiving disability services

have ADHD [24]. ADHD is associated with poor academic performance [25], social

difficulties, and an increased risk for alcohol and drug use [26] that further exacerbate

difficulties in college. There is a paucity of literature regarding the prevalence of

schizophrenia among college students; however, it appears that symptoms in the

psychotic spectrum are not uncommon among college students. Studies have described

the course of schizophrenia as having its beginning in early adolescence and persisting

into young adulthood. Sham et al. [27] studied 270 schizophrenic probands in an older.

Mental Health During the Pandemic

The impact of the pandemic on Mental Health varies (Pierce et al, 2020). Long-

term unemployed people are most vulnerable to adverse mental health effects (Pierce

et al, 2020) and those who were employed and retired in the months before the

pandemic experience worse than mental health condition (Ferry et al, 2020). Reduced

worse has different effects on the mental health of different group. People who are in a

poor healthy condition or self-issolated and those who have their work reduced due to

care responsibilities, move a higher degree of psychological distress (Ferry et al, 2020).

The higher the work insecurity caused by the pandemic, the more severe the symptoms

of depression (Wilson et al, 2020). As the pandemic continues the fear of the pandemic

itself has not increased mental health problems, but the deterioration of the labor

market increase in the unemployment rate may intensity people’s fear at

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unemployment, there by increasing the degree of mental distress (Timming et al,

2020). In addition due to the lockdown people’s works routines can be broken. Remote

work, interruption of work activities due to lockdown measures or increased work due

to needs of the pandemic may also become factors affecting mental heath (Russi et al,

2020).

Foreign Studies

This study conducted by Ramdas Ransing, Frances Adiukwu and Ganesh Kudva

states that the emergence of mental health problems during a pandemic is extremely

common, though difficult to address due to the complexities of pandemics and the

scarcity of evidence about the epidemiology of pandemic-related mental health

problems and the potential interventions to tackle them. Little attention has been

devoted so far for this topic from policymakers, stakeholders and researchers, resulting

in a lack of replicable, scalable and applicable frameworks to help plan, develop and

deliver mental health care during pandemics. As a response, we have attempted to

develop a conceptual framework that could guide the development, implementation,

and evaluation of mental health intervention during the ongoing COVID-19 pandemic.

This CF was developed by early career psychiatrists from 16 countries that cover all the

WHO regions. Their opinions were elicited via a semi-structured questionnaires. They

were asked to provide their views about the current MH situation in their countries and

to elaborate on existing ‘myths’ and misinformation. They were also asked to name the
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resources available and to propose solutions and approaches to provide accessible and

affordable care. The CF was prepared based on the extant literature and the views

discussed in this group; it illustrates the epidemiology of MH problems, preparedness

plans, stage-specific plans or innovative solutions, opportunities to integrate those plans

and possible outcomes at policy level. This CF can serve as a technical guide for the

future research regarding pandemics. It can be used to monitor trends and to develop

evidence based MH interventions. Still, further research focusing on the individual

components of this framework is needed.

Another study conducted by the Australian researchers states that since the

2000s reports of increased rates of mental ill health among young people worldwide

have received much attention. Several studies indicate a greater incidence of mental

health problems among tertiary students, compared with the general population, and

higher levels of anxiety, in particular, among international students compared with

domestic students. Australia is host to many thousands of international students of an

age when mental illnesses are most likely to surface. However, this issue has received

little attention from Australian researchers. This article reports on in-depth interview

with6 professionals working with international students at an internationalized

university.

Another study conducted by Adrian Furnham and Lorrna Trezise, because of the

psychological stress associated with university life and the physical and mental stress
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associated with migration, researchers have become interested in psychological

problems of foreign students. In this study four groups of foreign students from

different parts of the world were compared with two British groups on a self-report

measure of mental health. No sex difference were found yet the overseas students, as

a whole, showed significantly more disturbance than either British control or first-year,

subjects. However, despite many differences between any of the overseas groups on

the total scale or any sub-scores. Further, with the exception of Malaysian students, the

British subjects were significantly more satisfied with their social lives than the other

groups. These findings are discussed in terms of the literature on life events and illness,

culture shock and migration and mental health.

Another study conducted by Jenny Lee, Matthew Solomon, Tej Stead, Bryan

Kwon and Latha Ganti states that in the beginning of, the novel Coronavirus disease

Covid- caused by the SARS-CoV virus, became a public health emergency in the U.S

and rapidly escalated into a global pandemic. Because the SARS-CoV-2 virus is highly

contagious, physical distancing was enforced and indoor public spaces, including

schools and educational institutions, were abruptly closed and evacuated to ensure

civilian safety. Accordingly, educational institutions rapidly transitioned to remote

learning. We investigated the impacts of the COVID-19 pandemic on domestic U.S.

college students, ages 18-24 years.

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Another Study conducted by Tianchua Chen and Mike Lucock states that higher

education students’ mental health has been a growing concern in recent years even

before COVID-19 pandemic. The stresses and restrictions associated with the pandemic

have put university students at greater risk of developing mental health issues, which

may significantly impair their academic success, social interactions and their future

career and personal opportunities. This paper aimed to understand mental health status

of University students at an early stage in the pandemic and to investigate factors

associated with higher levels of distress. An online survey including demographics,

lifestyle/living situations, brief mental well-being history, questioning relating to COVID-

19 and standardized measures of depression, anxiety, resilience and quality of life was

completed by 1173 students at one University in the North England. We found high

levels of anxiety and depression, with more than 50% experiencing levels above the

clinical cur offs, and females scoring significantly higher than males. The survey also

suggested relatively low levels of resilience which we attribute to restrictions and

isolation which reduced the opportunities to engage in helpful coping strategies and

activities rather than enduring personality characteristics. Higher levels of exercising,

higher levels of tobacco use, and a number of life events associated with the pandemic

and lockdown, such as cancelled events, worsening in personal relationships and

financial concerns. We discuss the importance of longer term monitoring and mental

heal support for university students.

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Local Studies

This study conducted by Grace Zurielle C. Malolos, Maria Beatriz C. Baron,

Faith Ann J. Apat, Hannah Andrea A. Sagsagat, Pamela Bianca M. Pasco, Emma Teresa

Carmela L. Aportadera, Roland Joseph D. Tan, Angelica Joyce Gacutno-Evardone, and

Don Eliseo Lucero-Prisno III states that the coronavirus disease 2019 COVID 19

pandemic has subjected the mental health and well-being of Filipino children under

drastic conditions. While children are move vulnerable to these determines, there

remains the absence of unified and comprehensive strategies in mitigating the

deterioration the of mental health of Filipino children. Existing interventions focus on

more general solutions that fail to acknowledge the circumstances that a Filipino child is

subjected under. Moreover, these strategies also fail to address the multilayered issues

faced by a lower-middle-income country, such as the Philippines. As the mental health

well-being of Filipino children continues to be neglected, a subsequent and enduring

mental health epidemic can only be expected for years to come.

Another study conducted by Antover P. Tuliao states that this study aims

to provide a review of potential barriers to seeking mental health services among

Filipinos. Researchers on help-seeking behaviors among Filipinos living in the Philippines

and other countries e.g., US, Canada, and Australia suggest that mental health services

in the Philippine are inaccessible and monetarily prohibitive, and beliefs about aetiology

and nature nature of mental illness are inconsistent with the medical model. Other
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cultural variables such as shame, stigma, and collectivist beliefs also discourage

Filipinos from seeking help from mental health professionals. Furthermore, these

variables could account for the preference for folk healers and lay networks in treating

mental illness. As such, cultural and economic factors need to be accounted for in

conceptualizing Filipinos’ utilization of mental health services. Implications and

suggestions to aid practice were also discussed.

Another study conducted by John Lally, John Tully, and Rene Samaniego

states that national information on mental health services in the Philippines indicates

that there are substantial gaps and inconsistencies in the delivery of mental healthcare.

The recently enacted Mental Health Act legislation provides a platform for the delivery

of comprehensive and integrated mental health services. However, there remain many

challenges in the provision of accessible and affordable mental healthcare.

Another study conducted by Jennifer V. Ines states that Mental Health

Literacy of 797 first year Filipino college students was examined. Results showed that

55.2% of the sample was able to recognize depression in a given vignette using the

correct label and 95.7% of students expressed intention to seek help from different

sources such as family (58.5%), friends (48.8%), counselor (38.1%), etc., if they

experienced the same problem as the character in the story. Filipino college students

attributed depression to what professionals would commonly describe as triggers such

as day-to-day problems, childhood problems, and guilt over wrongful acts, trauma, etc.
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People they suggested as helpful to a person suffering from depression are counselors,

family, friends, psychologist, and psychiatrist. Social workers, nurses and helplines were

among the least nominated by the participants. Preferences over non-prescribed

products such as tea, organic medicines and vitamins rather than prescribed

medications such as antidepressants and anti-psychotics were apparent. Counseling

was nominated by most college students to be helpful for a depressed individual. Lastly

avoiding stress was viewed as an effective preventive strategy which is contrary to what

professionals recommend. Differences between participants personal and perceived

stigma were also found in the study. Implications of such to proper intervention for

mental illness and importance of improving mental health literacy among Filipino college

students are discussed.

Another study conducted by Alvin Gino M. Bautista and Elizabeth S. Manuel

states that this research was made to assess the mental health and psychological

wellness during the community quarantine of the 500 selected students from the

College of Management and Business Technology (CMBT), of Nueva Ecija University of

Science and Technology (NEUST). The CMBT was located at Sumacab, Cabanatuan

City, Philippines.

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The outcomes of the present study will be beneficial and valuable to the following: To

the students. The result of this study will provide necessary pieces of information of the

mental health of the student which could be a great help to the respondents in

understanding themselves. It can also help them to be more aware about mental and

psychological health through the help of the recommendation of the researchers; To

the Parents. The results of this study will be beneficial to the parents having children

who have the same age bracket as the respondents. The recommendations will help

them in dealing with the problems with their children’s mental health issues which is not

easy to know. To the School. The results of this study can help the school as well as the

guidance counselors to know what the main problem of the students is and immediately

formulate actions to avoid possible negative effects that can harm the well-being of the

students under their supervision. To the Philippine Mental Health Association, Inc. The

results of this study will strengthen their promotion of mental health and the prevention

of mental health disorders.    Lastly, this will also be beneficial to future researchers to

draw pertinent results to their studies.

The researchers used a set of a survey questionnaire in gathering pertinent data. The

questionnaires were disseminated via an online Google form survey sent to the

respondents. After all the data needed were gathered, the frequencies of answers in

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each question were tallied and their percentage was obtained. Through these, the

researchers obtained well conclusions and suitable recommendations.

References

Tianhua Chen, Mike Lucock (2022)

Paola Pedrelli, Maren Nyer, [...], and Timothy Wilens (2014)

Alvin Gino M. Bautista Elizabeth S. Manuel (2020)

Jennifer V. Ines De La Salle University - Manila (2019)

Grace Zurielle C. Malolos, ,* Maria Beatriz C. Baron, Faith Ann J. Apat, Hannah Andrea

A. Sagsagat, Pamela Bianca M. Pasco, Emma Teresa Carmela L. Aportadera, Roland

Joseph D. Tan, , Angelica Joyce Gacutno-Evardone, and Don Eliseo Lucero-Prisno III

(2019)

John Lally, John Tully, and Rene Samaniego (2019)

Collins Opoku Antwi , Michelle Allyshia Belle , Seth Yeboah Ntim , Yuanchun Wu 1,

Emmanuel Affum-Osei , Michael Osei Aboagye and Jun Ren, Department of Psychology,

Zhejiang Normal University (2022)

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AdrianFurnham, LornaTrezise (2002)

Ramdas Ransing, Frances Adiukwu, and Ganesh Kudva Kundadak (2020)

Agnes Yuen-kwan Lai, Letitia Lee, Man-ping Wang, Yibin Feng, Theresa Tze-kwan Lai,

Lai-ming Ho, Veronica Suk-fun Lam, Mary Sau-man Ipand Tai-hing Lam (2020)

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