FACTORS THAT INFLUENCE MENTAL HEALTH STATUS OF

ADOLESCENTS AS PERCEIVED BY SECONDARY SCHOOL TEACHERS IN

ENUGU STATE

ABSTRACT

Adolescence is a critical period of development characterized by significant physical,

cognitive, and socio-emotional changes. It is during this stage that individuals undergo
rapid growth and face unique challenges, including those related to mental health.
Adolescents are susceptible to various mental health issues, ranging from mood disorders
like depression and anxiety to behavioral disorders and substance abuse. This study
aimed to explore the factors that influence the mental health status of adolescents, as
perceived by secondary school teachers in Enugu State. The descriptive survey research
design was employed in the study and the population comprised all secondary school
students in Enugu state. A sample of 945 respondents was drawn using multi stage
sampling technique. Data was collected using a self-developed and modified
questionnaire with a reliability of 0.88 Cronbach alpha and generated data were
analysed using descriptive statistics of frequency counts and percentages and inferential
statistics of regression models and t-test at 0.05 alpha level. The result of the study
showed that respondents recorded poor mental health status and that there was
significant difference in mental health status of male and female respondents with the
former recording a higher level of mental health status. Findings also showed that
psychological factors of self-esteem (R = 0.427, Adj. R 2 = 0.221, p=0.000<0.05), self-
efficacy (R = 0.140, Adj. R2 = 0.019, p=0.000<0.05) as well as the joint effect of these
factors (R = 0.632, Adj. R2 = 0.387, p=0.000<0.05) significantly predicted mental health
status of the respondents. It was also found that social factors of relationship factors (R =
0.836, Adj. R2 = 0.698, p=0.000<0.05) and academic factors (R = 0.424, Adj. R 2 =
0.180, p=0.000<0.05)also significantly predicted mental health status of the respondents
while familial factors (R = 0.045, Adj. R 2 = 0.001, p=0.000<0.05) did not significantly
predict it. Joint effects of social factors (R = 0.879, Adj. R 2 = 0.773, p=0.000<0.05) as
well as the joint effects of psycho-social (R = 0.970, Adj. R 2 = 0.941, p=0.000<0.05)
factors were also found to predict mental health status of respondents thus providing
insight for necessary school health educational strategies. From the findings of the study,
it was concluded that secondary school students in Enugu state record poor mental
health status and that male adolescents have better mental health status than their female
counterparts. Devising appropriate and responsive school health educational
interventions among other actions were recommended.

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 CHAPTER ONE

INTRODUCTION

Background to the study

Adolescence is a critical period of development characterized by physical, cognitive, and

emotional changes. Adolescence is a crucial stage characterized by significant biological,

psychological, and social transformations. For students, the majority of whom are adolescents or

young adults, this period represents a transitional phase filled with both excitement and

challenges. During adolescence, the development of social autonomy becomes paramount, with

friends and peers gaining increased importance compared to parents. Alongside this shift,

adolescents often grapple with uncertainties such as fear of rejection, struggles in establishing

independence, and ambivalence towards their parents (Jong, 2011). These internal and external

factors, originating from the adolescent's psyche and the surrounding environment, exert a

profound influence on their mental health status.

During this stage, adolescents are vulnerable to various mental health issues, such as

anxiety, depression, and behavioral problems. The mental health status of adolescents can

significantly impact their overall well-being, academic performance, and future prospects.

Mental health is a crucial aspect of leading a fulfilling life. It encompasses various capacities

such as forming and maintaining relationships, pursuing education, work, and leisure interests,

and making everyday decisions about important aspects of life like education, employment, and

housing. Disruptions to a person's mental well-being can negatively impact these capacities and

choices, resulting in decreased functioning at an individual level and broader welfare losses at

the household and societal level (World Health Organization, 2012). According to the WHO,

mental health is commonly defined as a state of well-being where individuals recognize their

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own abilities, cope with normal life stressors, work productively, contribute to their

communities, and handle challenges effectively.

Mental health is not an isolated state but rather a result influenced by various factors.

Donatelle (2013) identified several factors that can impact mental and psychological health,

including family, social support systems, community, and life span and maturity. Therefore,

mental well-being is not solely determined by individual characteristics but is also influenced by

socioeconomic circumstances and the broader environment in which individuals live. These

determinants or factors interact dynamically, either posing a threat to or protecting an

individual's mental health state. From the earliest days of our lives, we seek connection and

strive to communicate and build relationships with others. People play a significant role in

shaping our experiences, emotions, and aspirations, enriching the fabric of our personalities and

lives (Hales, 2012).

Positive determinants of mental health at the individual level, as stated by the World

Health Organization (2012), include self-esteem, confidence, problem-solving abilities, stress

management skills, effective communication, physical health and fitness, and a healthy self-

concept. Oluwadamilola (2014) emphasized that a healthy self-concept is fundamental for a

child's positive development and overall well-being. A child with a healthy self-concept

perceives themselves as loved and valuable, enabling them to reach their full potential and

perform well academically. A healthy self-concept empowers individuals to set goals, make

decisions, embrace learning, foster better relationships with family and friends, exhibit self-

control, and possess strong interpersonal skills. On the other hand, negative determinants of

mental health include low self-esteem, cognitive/emotional immaturity, difficulties in

communication, medical illness, and substance use. Low self-esteem can be particularly

3
detrimental to an individual. While a healthy self-esteem enhances academic performance,

healthy relationships, and overall success, low self-esteem in children can lead to disciplinary

issues, learning difficulties, and depression. Research indicates a correlation between low self-

esteem during adolescence and an increased likelihood of problems in adulthood, such as

depression, anxiety, employment challenges, poor physical health, increased tobacco use, and

involvement in criminal behavior (Oluwadamilola, 2014).

Among students, the most common mental disorders identified are mood disorders,

anxiety disorders, eating disorders, personality disorders, schizophrenia, dementia, and attention

deficit disorder (Donatelle, 2013). However, there is a paucity of research focusing on the factors

that influence the mental health status of adolescents from the perspective of secondary school

teachers in Enugu State. Existing studies often focus on clinical or individual factors, neglecting

the social and environmental factors that can significantly impact the mental health of

adolescents. By exploring the perceptions of secondary school teachers, this study aims to fill

this gap in the literature and provide a comprehensive understanding of the factors that influence

the mental health status of adolescents in Enugu State.

Statement of the problem

The mental health status of adolescents is a matter of great concern, as it significantly

affects their overall well-being and development. Adolescence is a period characterized by

various biological, psychological, and social changes that can impact mental health. Internal

factors, such as self-esteem, coping skills, and emotional regulation, interact with external factors

in the environment to influence adolescents' mental health status. These external factors include

family dynamics, peer relationships, school environment, socioeconomic factors, cultural

influences, and community support systems. Research has shown that mental health problems are

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prevalent among adolescents. Studies indicate high rates of anxiety, depression, self-harm, and

other mental health disorders during this developmental stage.

Poor mental health status in adolescents can have profound consequences on various

aspects of their lives. It can negatively impact their academic performance, interpersonal

relationships, and overall quality of life. Adolescents with mental health issues may experience

difficulties concentrating, lower self-esteem, increased risk-taking behaviors, substance abuse,

social withdrawal, and reduced engagement in school activities. Addressing these consequences

is crucial for promoting the well-being and potential of adolescents.

The research topic aims to explore the perceptions of secondary school teachers in Enugu

State regarding the factors that influence the mental health status of adolescents. The study

intends to identify the factors they perceive as influential in adolescent mental health. This

understanding can inform the development of targeted interventions and support systems that

address the specific needs of adolescents in Enugu State.

Objective of the Study

The objective of this study is mainly to examine the perceptions of secondary school teachers in

Enugu State regarding the factors that influence the mental health status of adolescents.

Specific Objectives of the Study

The objectives of the study will be:

1. To determine the prevalence of mental health problems among secondary school

students in Enugu state

2. To identify psychological factors that predict mental health problems of secondary school

students in Enugu state

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 3. To identify social factors that predict mental health problems of secondary school

students in Enugu state

4. To examine how these psychological factors affect the mental health of the students

5. To examine how these social factors affect the mental health of the students

Research Questions

The research questions derived from the specific objectives are as follows:

1. What is the prevalence of mental health problems among secondary school students in

Enugu State?

2. Which psychological factors predict mental health problems among secondary school

students in Enugu state?

3. Which social factors predict mental health problems among secondary school students in

Enugu state?

4. How do these psychological factors affect the mental health of secondary school students

in Enugu state?

5. How do these social factors affect the mental health of secondary school students in

Enugu state?

Significance of the Study

This study holds several implications and significance:

1. Practical significance: The findings of this study will provide valuable insights into the

factors affecting the mental health of adolescents in Enugu State. This information can be

used to develop evidence-based interventions and support strategies that address the

mental health needs of adolescents in secondary schools.

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 2. Policy implications: The study findings can inform policymakers and education

authorities in Enugu State about the importance of promoting mental health awareness

and implementing supportive policies for adolescents in schools.

3. Professional development: The study can contribute to the professional development of

secondary school teachers by increasing their awareness and understanding of the factors

that influence the mental health status of adolescents. This knowledge can enhance their

ability to create a supportive and conducive learning environment.

4. Research contribution: This study will add to the existing body of knowledge on

adolescent mental health in Enugu State, specifically focusing on the perspectives of

secondary school teachers.

Scope of the Study

This study will focus on the factors that influence the mental health status of adolescents as

perceived by secondary school teachers in Enugu State, Nigeria. The study will involve

secondary school teachers from public and private schools within the state, and data will be

collected through interviews, questionnaires, and observations. The study will not directly

involve students or other stakeholders in the education system.

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 CHAPTER TWO

REVIEW OF LITERATURE

This study is designed to explore the perceptions of secondary school teachers in Enugu State

regarding the factors that influence the mental health status of adolescents.. A number of

researches centering on some variables of interest in the study have been conducted. This chapter

of the study is devoted to identifying, locating and reviewing these previous studies and related

theoretical frameworks and models. Related literatures were reviewed along the understated sub-

themes:

Theoretical Framework

The understated theory and model apposite to the study were reviewed:

- The Social Identity Theory

- The PRECEDE Model

Theoretical Review

Concept of Health

Concept of Mental Health

Characteristics of Mentally Healthy Individuals

Qualities of Self-Actualized Individuals

Characteristics of Mentally Unhealthy Individuals

Factors that Influence Mental Health Status

Strategies to Enhance Mental Health

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Mental Health Disorders

Signs of Disorders

Causes of Mental Health Disorders

Mental Health Threats on Campus

Classification of Mental Health Disorders

Determinants of mental health and well-being

Approaches to treat/improve the mental health of individuals

Empirical Review

Epidemiology of Mental Health Problems

Epidemiology of Mental Health Problems among Adolescents

Psychological and Social Risk Factors of Mental Health Problems among Adolescents

Social Support and Mental Health Problems

Life Satisfaction

Psychological Environment in relation to Mental Health

Social Environment in Relation to Mental Health

Psychological Factors Predicting Mental Health Problems

Social Factors Predicting Mental Health Problems

Appraisal of Literature

Theoretical Framework

There are various theoretical foundations that will assist in providing an in-depth

explanation of this study. Theories are scientific principles that explain phenomena. They are set
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of facts, propositions, or principles analyzed in their relation to one another and used, especially

in science, to explain phenomena. In this study, theories that suitably explain each variable of

study are the social identity theory of self-concept/self-esteem and the precede model.

Social Identity Theory of Self-concept and Self-esteem

According to Tajfel and Turner’s social identity theory, self-concept/self-esteem is

composed of two key parts: personal identity and social identity. An individual’s personal

identity includes such things as personality traits and other characteristics that make each person

unique. Social identity includes the groups people belong to including their community, religion,

college, and other groups. Social identity is a person’s sense of who he or she is based on his or

her group membership(s). Henri Tajfel proposed that the groups (i.e. social class, family, and

others) which people belonged to were an important source of pride and self-esteem. Groups

give individuals a sense of social identity and a sense of belonging to the social world. In order

to increase our self-image we enhance the status of the group to which they belong. People can

also increase their self-image by discriminating and holding prejudiced views against the out

group (McLeod, 2008).

Social identity theory lends credence to this study because orphans belong to a group that is

exposed to discrimination and prejudice and this may affect their self-esteem negatively.

Moreover, in a bid to fit in to a better social group or class, undergraduate students may take

measures, which may expose them to exploitation and abuse.

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The Precede Model

The precede is a conceptual framework which comprises three basic tenets. These tenets

appraise the factors predisposing, enabling and reinforcing certain health behaviour and

condition. Predisposing factors refer to antecedents of a health situation. In the case of

psychosocial factors predisposing University of Ibadan adolescents to mental health problems,

knowledge, attitude, peer pressure, and values are suspected to be common factors. Enabling

factors are those factors that foster the behaviour, while reinforcing factors are factors that are

responsible for the sustenance of the condition.

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 Predisposing factors Behaviour and Life
Style
 Psycho-social factors
 Familial expectation  Low self esteem
 Stress  Inadequate rest
 Ethnics Schedule  Stress
 Lack of self esteem  Maladaptive  Healthy or
 Distraught
coping mechanism unhealthy
Relationship
 Poverty  Drug Abuse and behaviour
 Peer influence Misuse  Vulnerability
 Socio-economic status  Drinking Alcohol  Psychological
and Social
development

Environment

Reinforcing Factors  Dysfunctional Family

 Peer influence  Abusive Relationship
 Familial influence  Peer Pressure
 Significant loss  Drug Availability
Enabling Factors
 Personality Disorder  Public
 Lack of Knowledge
 Psychological Disturbance Misconception
 Freedom of choice
 Genetic Predisposition
 Chronic Pain
 Disease
 Socio-economic status
 Lack of Knowledge
 Poverty
 Family History

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Figure 2.0: The psychosocial predictors of mental health of adolescents using

PRECEDE model. (Adapted and modified from Oxford Journals, 2015)

Theoretical Review

CONCEPT OF HEALTH

The concept of health and the WHO definition Etymologically the English word ‘health’

literally means wholeness, being whole, complete, sound or well. To ‘heal’ literally means to

make whole. Both words go back to the old English word ‘hal’ and the old German word ‘Heil’.

The ancient Greek word for health is euexia, which means to be in a vital and resilient state.

Hygiea is the name of the goddess of health, the daughter of Asclepios, who represents a good

way of living. The Greek, English and German words for health are etymologically unrelated to

the words illness and disease. Whereas the English word wholeness is more of a static concept,

the Greek words for health emphasize good functioning and the activity of the whole body.

Health is a universal phenomenon and operates at different dimensions, hence its

ambiguity. There have been numerous definitions proffered for health signifying that there is no

strait jacket definition which completely captures the nature of the concept. However, one of the

most frequently cited definition is the World Health Organization’s agreed definition in 1948.

Emiola (2008) quoting Nieman (2003) noted that the three dimensions of health are

tightly interdependent and that quality of life demands that each receives balanced attention.

Health is therefore, a resource for life that enables people to lead individual, social and

productive lives (Ofili, 2013).

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CONCEPTS OF MENTAL HEALTH

Mental health is an individual and personal matter. It involves a living human organism

or, more precisely, the condition of an individual human mind. A social environment or culture

may be conducive either to sickness or health, but the quality produced is characteristic only of a

person; therefore, it is improper to speak of a "sick society" or a "sick community." Within the

different definitions of mental health, it is assumed that the concept is wider than the absence of

mental disorders. It is the ability to manage its own life and the emotions within a wide range of

variations without losing the value of what is real and precious. In speaking of a person's mental

health, it is advisable to distinguish between attributes and actions. The individual may be

classified as more or less healthy in a long-term view of his behaviour or, in other words,

according to his enduring attributes. Or, his actions may be regarded as more or less healthy--that

is, appropriate--from the viewpoint of single, immediate, short-term situation. Standards of

mentally healthy, or normal, behaviour vary with the time, place, culture, and expectations of the

social group. In short, different peoples have different standards. Mental health is one of many

human values; it should not be regarded as the ultimate good in itself. No completely acceptable,

all-inclusive concept exists for physical health or physical illness, and, likewise, none exists for

mental health or mental illness. A national program against mental illness and for mental health

does not depend on acceptance of a single definition and need not await it. Many scientific

investigators have thought about the psychological content of positive mental health. A review of

their contributions reveals six major approaches to the subject: a. Attitudes of the individual

toward himself; b. Degree to which person realizes his potentialities through action; c.

Unification of function in the individual's personality; d. Individual's degree of independence of

social influences; e. How the individual sees the world around him; and f. Ability to take life as it

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comes and master it. One value in American culture compatible with most approaches to a

definition of positive mental health appears to be this: An individual should be able to stand on

his own two feet without making undue demands or impositions on others. The need for more

intensive scientific research in mental health is underscored.

Udoh and Ajala (1991), quoting the renowned psychologist, Sigmund Freud, defined

mental health as the ability to work and love. The utter simplicity of this definition has rendered

it myopic in our complex present day. Man is in this present day plagued continually various

mental illness predictor than ever before. Such arise from daunting expectations, environmental

disturbances such as technologies and automobiles, and inherent factors masked by the

individual personal make-up. Several attempts by present day scholars have been made but it

must be mentioned that there are just few definitions which have been universally accepted.

More than five decades ago, the World Health Organization (WHO) defined health as

being more than freedom from illness, disease and debilitating conditions (Agbanusi, Ibeagha &

Emeahara, 2008). Corbin, Welk, Lindsey & Corbin (2003), described health as optimal well-

being that contributes to quality of life. It is more than freedom from disease and illness, though

freedom from disease is important to good health. Optimal health includes high-level mental,

social, emotional, spiritual, and physical wellness within the limits of one’s hereditary and

personal ability. Mental health is a component of optimal health. It refers to a person’s health of

the mind (Ofili 2013). Mental health is a crucial component of overall wellness (Hales, 2012).

According to World Health Organization (WHO), mental health is not just the absence of

any mental disorder or abnormality, but the state of well-being in which the individuals realizes

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his or her potentials and can cope with the normal stresses of life, can work productively and

fruitfully, and is able to make positive contribution to his or her community.

Mental health can also mean the capacity of individuals within the groups and the

environment to interact with one another in ways that promote subjective well-being, optimal

development and use of mental abilities (cognitive, affective and relational) and achievement of

individual and collective goals (Jacobs & Ogundele, 2014). Mental health is the emotional and

spiritual resilience which enables one to enjoy life and to survive pain, disappointment and

sadness (Okere, 2011). Ibe, Ogbe, Eze and Agu (1991) defined mental health as the full and

harmonious functioning of the personality. It is that wholesome state of an attractive personality

and happiness. Hales (2012), described mental health as the ability to perceive reality as it is, to

respond to its challenges, and to develop rational strategies for living. The mentally healthy

person does not try to avoid conflicts and distress but can cope with life’s transitions, traumas,

and losses in a way that allows for emotional stability and growth.

According to Landers (2008), mental health is “emotional, behavioural and social

maturity or normality; the absence of a mental or behavioural disorder; a state of psychological

well-being in which one has achieved a satisfactory integration of one’s instinctual drives

acceptable to both oneself and one’s social milieu; an appropriate balance of love, work and

leisure pursuits”. Mental health includes both emotional stability and maturity of character, and

also the strength to withstand stress inherent in living in today’s society without undue physical

or psychological discomfort. Mental health also implies the ability to judge reality accurately and

to see things in terms of their long rang rather than short term values.

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 William Glaser (1965) in his text “Reality Therapy”, states that mental health is

synonymous with responsibility. He defines responsibility as the ability to fulfil one’s needs, and

to do so in a way that does not deprive others of the ability to fulfil their own needs. He indicates

that each individual has two basic needs; the need to love and be loved, and the need to feel

worthwhile both to oneself and to others. A responsible person is one who does what gives him a

feeling that he is worthwhile to other persons.

Johoda (1958) in her “Current Concepts of Positive Mental Health” describes three ideas

that characterize the mentally healthy self. She indicates that a person is mentally healthy when –

(a) he understands himself, including his own motivation, drives, wishes and desires, (b) he

accomplishes self-realization and self-actualization. This is the result of a person being able to

take an objective view of himself from a long-term perspective. It also has to do with what a

person has made of himself, up to the date of assessment, and (c) he has an integrated balanced

personality. This means he is flexibly balanced in the face of stress. He can meet his daily

demands without going into pieces.

Abraham Maslow sets out a five level hierarchy of human needs which have tremendous

effect on mental health: physiological needs (hunger, thirst and sex), safety need, and need for

love, esteem and self-actualization needs, the satisfaction of which enhance mental health.

Characteristics of Mentally Healthy People

Mental health includes mental, emotional, social and spiritual dimensions of health

(Donatelle, 2013). According to Hales (2012), the characteristics of emotionally healthy persons,

identified in an analysis of major studies of emotional wellness, include the following:

1. Determination and effort to be healthy

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 2. Flexibility and adaptability to a variety of circumstances

3. Development of a sense of meaning and affirmation of life

4. An understanding that the self is not the centre of the universe

5. Compassion for others

6. The ability to be unselfish in serving or relating to others

7. Increased depth and satisfaction in intimate relationship and

8. A sense of control over the mind and body that enables the person to make health-

enhancing choices and decision

Also, Hales (2012), identifies the characteristics of the mentally healthy persons which include:

1. The ability to function and carry out responsibilities

2. The ability to form relationships

3. Realistic perceptions of the motivation of others

4. The ability to adapt to change and to cope with adversity

Donatelle (2013) stated that the characteristics of mentally healthy people include the following:

1. Feel good about themselves

2. Feel comfortable with other people and express respect and feel compassion towards

others

3. Control tension and anxiety

4. Meet the demands of life

5. Value diversity

6. Appreciate and respect nature

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Donatelle (2013), further identifies additional characteristics of mentally healthy people. They

include:

1. Works to improve in all areas, recognize strengths and weakness

2. Possesses zest for life; spiritually healthy and intellectually thriving

3. Healthy relationships with family and friends, capable of giving and receiving love and

affection

4. High energy, resilient, enjoys challenges, focused

5. Has strong social support, may need to work on improving social skills but usually no

major problems

6. Realistic sense of self and others, sound coping skills, open minded

7. Has occasional emotional “dips: but over all good mental/emotional adaptors

8. Adapt to changes easily, sensitive to others and environment

9. Has strong social support and healthy relationship with family and friends

Qualities of self-actualized people as predictors of mental health

The mentally healthy people must meet the basic needs before the above stated

characteristics are achieved. Hales (2012), reported that to attain the highest level of

psychological health, the need for safety and security, love and affection, and self-esteem must

first be satisfied. During the 1960s, Abraham Maslow eloquently described an idea of mental

health in his book toward a psychology of being. He stated that there is a hierarchy of needs,

safety, being loved, maintaining self-esteem, and self-actualization. When urgent needs like the

need for food, water, shelter, sleep and safety are satisfied, less urgent needs take priority.

According to Maslow, people who live at their fullest have achieved self-actualization; he

thought they had fulfilled a good measure of their human potential and share certain qualities.

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Maslow, (1987) asserted that self-actualized people have attained high level of mental health

because they possess the following qualities:

1. Realism

2. Acceptance

3. Autonomy

4. A capacity for intimacy and

5. Creativity

Realism

Self-actualized people are able to deal with the world as it is and not demand that it be

otherwise. If you are realistic, you know the difference between what is and what you want. You

also know what you can change and what you cannot. Unrealistic people often spend a great deal

of time and energy trying to force the world and other people into their ideal picture. Realistic

people accept evidence that contradicts what they want to believe, and if it is important evidence

they modify their beliefs.

Acceptance

Mentally healthy people can largely accept themselves and others. Self-acceptance means

having a positive self-concept, or self-image, or appropriately high self-esteem, such people have

a positive but realistic mental image of themselves and positive feelings about who they are,

what they are capable of, and what roles they play. People who feel good about themselves are

likely to live up to their positive self-image and enjoy success that in turn personal worth-it does

not mean being egocentric or “struck” on yourself”. Being able to tolerate our own helps us

tolerate the imperfections of others.

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Autonomy

Psychological healthy people are able to direct themselves, acting independently of their

social environment. Autonomy is more than freedom from physical control by something outside

the self. Many people for example, shrink from expressing their feelings because they fear

disapproval and rejection. They respond only to what they feel as outside pressure. Such

behaviour is other-directed. In contrast, inner directed people find guidance from within, form

their own values and feelings. They are not afraid to be themselves. Psychologically free people

act because they choose to, not because they are driven or pressured. They have an internal locus

of control and a high level of self-efficacy.

Autonomy can give healthy people certain child like qualities; very small children have a quality

of being “real”. They respond in a genuine, spontaneous way to whatever happens without

pretence. Being genuine means not having to plan words or actions to get approval or make an

impression. It means being aware of feelings and being willing to express them-be in unselfish-

consciously oneself. This quality is sometimes called authenticity.

A capacity for intimacy

Healthy people are capable of physical and emotional intimacy. They can expose their

feelings and thought to other people. They are open to the pleasure of intimate physical contact

and to the risk and satisfaction of being close to others in a caring, sensitive way.

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Creativity

Mentally healthy people are creative and have a continuing fresh appreciation for what

goes on around them. They are not necessarily great poets, artists, or musicians, but they do live

their everyday lives in creative ways: “A first rate soup is more creative than a second rate

painting” creative people seem to see more and to be open to new experiences; they don’t fear

the unknown or need to minimize or avoid uncertainty.

We must not consider ourselves failures if we do not become self-actualized in every way or at

every moment. Self-actualization is an ideal to strive for even if we never or only occasionally

attain it to the fullest degree.

Characteristics of Mentally Unhealthy Individuals

According to Donatelle (2013) the characteristics of mentally unhealthy people include:

1. No zest for life; pessimistic/cynical most of the time; spiritually down

2. Shows poorer coping than most, often overwhelmed by circumstances

3. Has regular relationship problems, find that others often disappoint

4. Has serious boots of depression, “down” and tired much of the time; has suicidal

thoughts

5. Tends to be cynical/critical of others; tends to have negative/critical friends

6. A “challenge” to be around, socially isolated

7. Lacks focus much of the time, hard to keep intellectual acuity sharp

8. Experience many illness, headaches, aches and pains, get cold/infections easily and

9. Quick to anger, sense of humour and fun evident less often.

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Factors that influence Mental Health

According to Dontelle (2013), the factors that influence mental health are:

1. The family

2. Social supports

3. Community

4. Personality

5. Self-efficacy and self-esteem

6. Life span and maturity

Strategies to Enhance Mental Health

Dontelle, (2013) stated the strategies to enhance mental health. These include:

1. Find a support group

2. Complete required tasks

3. Form realistic expectations

4. Make time for yourself

5. Maintain physical health

6. Examine problems and seek needed help and

7. Get adequate sleep

Mental Health Disorders

Mental health has been described at a state of equilibrium that considers the self and

community in both their subjective and objective forms. The description of mental health

disorders therefore will be trading along the same trend. Regular wellness is a life style approach

23
in seeking advanced states of well-being physical and psychological. Mental health disorders

address all the aberrations which include all manner of strains when thinking patterns descend

from mediocrity to pathology. According to Bernards(2006), a mental disorder is a psychological

pattern, potentially reflected in behaviour, that is generally associated with distress or disability

and which is not considered part of normal development of a person’s culture. Hales (2012),

reported that psychiatrists define it as a clinically significant behavioural psychological

syndrome or pattern that is associated with the present distress a painful symptom or disability

(impairment in one or more important areas of functioning or with a significantly increased risk

of suffering death, pain, disability, or an important loss of freedom). Hales (2012), quoted the

U.S. government’s definition of a serious mental illness as “a diagnosable mental behavioural, or

emotional disorder that interferes with one or more major activities in life, like dressing, eating

or working”.

It is a construct defined by a combination of how a person feels acts, thinks or perceives.

Mental health disorders are those major changes in a person’s thinking, emotional state and

behaviour and disrupt the person’s ability to work and carry on their usual personal relationships.

Also, it may be associated with particular regions or functions of the brain or the entire nervous

system, often in a social context.

Mental health problems affect one in every five young people at any given time (U.S.

Department of Health and Human Services, 1999) although severity varies greatly. Individuals

are regarded as possessing a “serious emotional disturbance” when a mental disorder disrupts

daily functioning in home, school, or community. If a child or adolescent is able to function well

in at least two of those three areas, it is unlikely that he or she has a serious mental health

disorder.

24
 Recognition of the signs and symptoms of mental health disorders is important because

early intervention may be critical to restoring health. Mental health disorders are typically

marked by disruption of emotional, social, and cognitive functioning. Those disorders that most

commonly affect adolescence are anxiety disorders, which manifest through phobias, excessive

worry and fear, and nervous conditions; and depression disorders, characterized by states of

hopelessness or helplessness that are disruptive to day-to-day life. Other mental health conditions

affecting youth include bipolar disorder, conduct disorder, attention-deficit/hyperactivity

disorder, learning disorders, eating disorders, autism, and childhood-onset schizophrenia.

Signs of Disorders

Mental health disorders seldom simply appear in full bloom. Instead, they are often

preceded by symptoms of deteriorating health and functioning. The primary differences between

developmentally common behaviour and nascent mental health disorders are in symptom

severity and duration, and the extent to which the behaviour causes disruption to daily life. Early

onset mental disorders may be episodic at first, but tend to increase in severity, duration, and

level of disruption over time. Family members and friends are often the first to notice early

symptoms. It is important to recognize that perceptions of what constitutes good or poor mental

health will vary from culture to culture. Such variation may affect how serious disorders are

expressed, detected, and interpreted. Sensitivity to cultural difference is critical to effective

detection, intervention, prevention, and treatment.

Causes of Mental Health Disorders

Although it is often possible to identify triggers for particular episodes of mental illness,

identifying the underlying etiology is often more difficult. In many cases, mental illness emerges

as a consequence of biological and environmental interactions. For example, the predisposition

25
for disorders such as schizophrenia, bipolar disorder, and depression are genetically heritable and

may be activated by particular environments (Pickler, 2005). Environmental factors that lead to

chemical imbalances in the body or damage to the central nervous system may also create

biological vulnerabilities. When these vulnerabilities are coupled with environmental conditions

high in chaos and low in security and safety (such as exposure to violence, including witnessing

or being the victim of abuse; stress related to chronic poverty, discrimination, or other serious

hardship; and the loss of important people through death, divorce, or broken relationships),

mental disorders may result (Perry, 2002). However, it is important to note that while research on

the etiology of mental illness has been fruitful, not all individuals at risk for mental illness

develop it and many individuals with no apparent risk do. Also, having a genetic predisposition

does not mean that developing a mental illness is predetermined or those parents with a similar

condition are to blame. Much remains to be learned in this area.

Mental Health Threats on Campus

Mental health problems are common among the University students and appear to be

increasing (Donatelle, 2013). The University students tend to have similar psychological health

threats. However, the most common psychological health disorders identified among the

University students include:

1. Mood disorders

2. Personality disorder

3. Schizophrenia

4. Eating disorder

Mood Disorders: This can be chronic therefore; chronic mood disorders are described as

disorders that affect how you feel, such as persistent sadness or feelings of euphoria. Mood

26
 disorders include: major or clinical depression, dysthymic disorder, bipolar disorder, and

seasonal affective disorder (Donatelle, 2013).

Major or Clinical Depression: The simplest definition of major depression is sadness that

doesn’t end. The incidence of major depression has soared over the last two decades,

especially among young adults. Major depression can destroy a person’s joy for living. Food,

friends, sex, or any form of pleasure no longer appeals.

The characteristics/symptoms of major depression include:

1. Feeling depressed, sad, empty, discouraged and tearful

2. Loss of interest or pleasure in once enjoyable activities

3. Eating more or less than usual and either gaining or losing weight

4. Having trouble sleeping or sleeping much more than usual

5. Feeling slowed down or restless and unable to sit still

6. Lack of energy

7. Feeling helpless, hopeless, worthless, and inadequate

8. Difficulty concentrating

9. Difficulty thinking clearly or making decisions

10. Persistent thought of death, or suicide

11. Withdrawal from others, lack of interest in sex

12. Physical symptoms (headaches, digestive problems, aches and pains).

Classification of Mental Health Disorders

In classifying mental health disorders the disease model which according to Tyer and

Steinberg (2005), is not an etiological model is very popular. It is an effort to diagnose individual

27
disorders without any recourse to the cause in anyway. In general sense, all the schools of

thought agreed to this classification but the systems used in diagnose vary between them. At this

juncture, it is worth mentioning that irrespective of diagnostic approach, syndromes and

conditions are classified or categorized and not individuals. In the word of WHO (2001), anyone

can suffer from one or more disorders of either a mental or physical nature at different times in

their lives; a person should never be equated with physical or mental disorder.

According to Gazzaniga and Heatherton (2006), there are many different categories of

mental health disorder, and many different facts of human behaviour and personality that can

become disordered. However, they can be generally categorized into three broad classes namely

Psychoses, Neuroses and the class that falls outside these two classes called Personality

disorders. In the words of Craig (2000), the Psychoses are those mental health disorders in which

people’s capacity to recognize reality, their thinking processes, judgements and communications

are seriously impaired with the presence of delusions and hallucinations. The class can further be

subdivided into ‘organic’ and ‘functional’ Psychoses. When the psychotic symptoms are traced

to brain dysfunction, they are termed organic. Psychoses are mental health issues which are

characterized by distortions of thinking, perception and mood but cannot be traced to an organic

condition. Examples of this class are Schizophrenia, melancholia, distemia, etc.

The Neuroses on the other hand are those mental health disorders characterized by the

heightening of normal human experience but to levels that interfere with a person’s ability to

function. Neuroses are found to be less severe than Psychoses. The major difference between

these two classes of mental health disorders is that the neuroses are not very different from the

general population except in the degree of the symptoms they experience. Neuroses disturb the

body and can cause an increased heart rate, irregular breathing, muscular tension and increased

28
sweating. Examples of this condition include anxiety, obsessive, compulsive disorder, fear that

becomes unrealistic and immobilizing (phobias), etc.

Schizophrenia: This is the most chronic and disabling of mental disorders, with psychotic

symptoms first appearing in the late teens or early twenties. Although men and women alike are

affected and the lifetime morbidity risk is around 1% with little difference between them, there

are differences in the age of onset, pattern of symptoms, brain structure impairment, response to

treatment and outcome. Lifetime onset age differs significantly between men and women, where

men get ill with schizophrenia, on average, 4–6 years earlier than women. However, Lewine

concluded that sex, and not gender, was a significant predictor of age at first hospitalization,

while the gender perspective may best serve other aspects such as neuropsychological

functioning (Afifi, 2007).

Depressive and anxiety disorders: Depression and anxiety are the most common co-

morbid disorders, and a significant gender difference exists in the rate of co-morbidity. Their

diagnosis is often associated with somatic complaints, and is known to affect around one in five

people in the general community, and more than two in five primary care attenders in many

countries. Gender differences in rates or correlates of depression exist but may differ for

different countries (Afifi, 2007).

Anxiety, worry, and stress are all a part of most people's life today. But simply

experiencing anxiety or stress in and of itself does not mean you need to get professional help or

you have an anxiety disorder. In fact, anxiety is a necessary warning signal of a dangerous or

difficult situation. Without anxiety, we would have no way of anticipating difficulties ahead and

preparing for them.

29
Anxiety becomes a disorder when the symptoms become chronic and interfere with our daily

lives and our ability to function. People suffering from chronic anxiety often report the following

symptoms:

 Muscle tension

 Physical weakness

 Poor memory

 Sweaty hands

 Fear or confusion

 Inability to relax

 Constant worry

 Shortness of breath

 Palpitations

 Upset stomach

 Poor concentration

These symptoms are severe and upsetting enough to make individuals feel extremely

uncomfortable, out of control and helpless.

Anxiety disorders fall into a set of separate diagnoses, depending upon the symptoms and

severity of the anxiety the person experiences. The anxiety disorders discussed in this series on

anxiety are:

30
Generalized Anxiety Disorder (GAD)

Generalized anxiety disorder (GAD) is more than the normal anxiety people experience

day to day. It’s chronic and exaggerated worry and tension, even though nothing seems to

provoke it. Having this disorder means always anticipating disaster, often worrying excessively

about health, money, family, or work. Sometimes, though, the source of the worry is hard to

pinpoint. Simply the thought of getting through the day provokes anxiety. People with GAD

can’t seem to shake their concerns, even though they usually realize that their anxiety is more

intense than the situation warrants — that it’s irrational. People with GAD also seem unable to

relax. They often have trouble falling or staying asleep. Their worries are accompanied by

physical symptoms, especially trembling, twitching, muscle tension, headaches, irritability,

sweating, or hot flashes. They may feel lightheaded or out of breath. They may feel nauseated or

have to go to the bathroom frequently. Or they might feel as though they have a lump in the

throat. Many individuals with GAD startle more easily than other people. They tend to feel tired,

have trouble concentrating, and sometimes suffer depression, too. Usually the impairment

associated with GAD is mild and people with the disorder don’t feel too restricted in social

settings or on the job. Unlike many other anxiety disorders, people with GAD don’t

characteristically avoid certain situations as a result of their disorder. However, if severe, GAD

can be very debilitating, making it difficult to carry out even the most ordinary daily activities.

GAD comes on gradually and most often hits people in childhood or adolescence, but can begin

in adulthood, too. It’s more common in women than in men and often occurs in relatives of

affected persons. It’s diagnosed when someone spends at least 6 months worried excessively

about a number of everyday problems.

31
Specific Symptoms of Generalized Anxiety Disorder

Excessive anxiety and worry (apprehensive expectation), occurring more days than not

for at least 6 months, about a number of events or activities (such as work or school

performance). The person finds it difficult to control the worry.

The anxiety and worry are associated with three (or more) of the following six symptoms (with

at least some symptoms present for more days than not for the past 6 months; children do not

need to meet as many criteria–only 1 is needed).

 Restlessness or feeling keyed up or on edge

 Being easily fatigued

 Difficulty concentrating or mind going blank

 Irritability

 Muscle tension

 Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

Additionally, the anxiety or worry is not specifically about having a Panic Attack (though

panic attacks can occur within a person with GAD), being embarrassed in public (as in Social

Phobia), being contaminated (as in Obsessive-Compulsive Disorder), being away from home or

close relatives (as in Separation Anxiety Disorder), gaining weight (as in Anorexia Nervosa),

having multiple physical complaints (as in Somatization Disorder), or having a serious illness (as

in Hypochondriasis), and the anxiety and worry do not occur exclusively during Posttraumatic

Stress Disorder (PTSD).

32
 The anxiety, worry, or physical symptoms cause clinically significant distress or impairment

in social, occupational, or other important areas of functioning.

The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of

abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur

exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental

Disorder.

Since all anxiety disorders can have medical cause or component, it is important for

individuals to be thoroughly medically checked out before consulting psychological or

psychiatric care. For instance, individuals who drink a lot of caffeine can present with many

similar symptoms of anxiety, and even panic attacks. A good medical examination will rule out

this and other biological or environmental causes and possibilities.

Anxiety is often a component found within many other mental disorders as well. The most

common mental disorder which presents with anxiety is depression. Clinicians generally regard

such anxiety as a good sign, because it means that the individual hasn't simply accepted their

depressed mood as they would a free meal... They are depressed and they are anxious because

they are concerned about the ego dystonic nature of their depressed mood. A thorough initial

evaluation is rudimentary to ruling out other possible and more appropriate diagnoses.

Treatment for generalized anxiety disorder (also known as GAD) is varied and a number of

approaches work equally well. Typically the most effective treatment will be an approach which

incorporates both psychological and psychopharmacologic approaches. Medications, while

usually helpful in treating the bodily symptoms of acute anxiety (e.g., panic attacks), are best

33
used for this disorder as a short-term treatment only (a few months). Clinicians should be

especially watchful of the individual becoming psychologically or physiologically addicted to

certain anti-anxiety medications, such as Xanax.

Psychotherapy

Psychotherapy for GAD should be oriented toward combating the individual's low-level,

ever-present anxiety. Such anxiety is often accompanied by poor planning skills, high stress

levels, and difficulty in relaxing. This last point is important because it the easiest one in which

the therapist can play an especially effective teaching role.

Relaxation skills can be taught either alone or with the use of biofeedback. Education

about relaxation and simple relaxation exercises, such as deep breathing, are excellent places to

begin therapy. While biofeedback (the ability to allow the patient to hear or see feedback of their

body's physiological state) is beneficial, it is not required for effective relaxation to be taught to

most people. Progressive muscle relaxation and more general imagery techniques can be used as

therapy progresses. Teaching an individual how to relax, and the ability to do it in any place or

situation is vital to reducing the low-level anxiety levels. Individuals who learn these skills,

which can be taught in a brief-therapy framework, go on to lead productive, generally anxiety-

free lives once therapy is complete. A common reason for failure to make any gains with

relaxation skills is simply because the client does not practice them outside of the therapy

session. From the onset of therapy, the individual who suffers from GAD should be encouraged

to set a regular schedule in which to practice relaxation skills learned in session, at least twice a

day for a minimum of 20 minutes (although more often and for longer periods of time is better).

34
Lack of treatment progress can often be traced to a failure to follow through with homework

assignments of practicing relaxation.

Reducing stress and increasing overall coping skills may also be beneficial in helping the

client. Many people who have GAD also lead very active (some would say, "hectic") lives.

Helping the individual find a better balance in their lives between self-enrichment, family,

significant other, and work may be important. People who have GAD have lived with their

anxiety for such a long time they may not recognize a life without constant worrying and

activity. Helping the individual realize that life doesn't have to boring just because one isn't

always worrying or doing things may also help.

Individual therapy is usually the recommended treatment modality. Many times people

who present with GAD feel a bit awkward discussing their anxiety in front of others, especially

if they are less than accepting. A clear distinction should be made at the onset of the evaluation

to differentiate GAD from social phobia, however, and the appropriate diagnosis should be

made. It would be unwise to recommend group therapy to someone who had social phobia or

GAD early on, because of the social component to either disorder. Placing a person into a group

setting without minimal interpersonal and relaxation skills being taught first in individual therapy

is a recipe for disaster and early treatment termination.

Non-specific factors in therapy are important to these patients, as they will make the most

beneficial gains in a supportive and accepting therapeutic environment. Simply listening to the

individual and offering objective feedback about their experiences is likely helpful. Examining

stressors in the client's life and helping the individual find better ways of handling these stressors

is likely to be beneficial. Modeling techniques of appropriate social behaviors within therapy

35
session may help. Clinicians should not confuse GAD with specific phobias, which have much

more acute and traumatic symptoms. In the same respect, treatments for specific phobias

generally are neither appropriate nor effective with GAD. Some clinicians easily confuse this

important distinction.

Medications

Medication should be prescribed if the anxiety symptoms are serious and interfering with

normal daily functioning. Psychotherapy and relaxation techniques can't be worked on

effectively if the individual is overwhelmed by anxiety or cannot concentrate. The most

commonly prescribed anti-anxiety agent for this disorder has historically been benzodiazepines,

despite a dearth of clinical research that shows this particular class of drugs is any more effective

than others. Diazepam (Valium) and lorazepam (Ativan) are the two most prescribed

benzodiazepines. Lorazepam will produce a more lengthy sedating effect than diazepam,

although it will take longer to appear. Individuals on these medications should always be advised

about the medications' side effects, especially their sedative properties and impairment on

performance.

Tricyclic antidepressants often are an effective treatment alternative to benzodiazepines

and may be a better choice over a longer treatment period.

Medication for this disorder should only be used to treat acute symptoms of anxiety. Medication

should be tapered off when it is discontinued.

36
Self-Help

Self-help methods for the treatment of this disorder are often overlooked by the medical

profession because very few professionals are involved in them. Many support groups exist

within communities throughout the world which are devoted to helping individuals with this

disorder share their commons experiences and feelings of anxiety. Individuals should first be

able to tolerate and effectively handle a social group interaction. Pushing an individual into a

group setting, whether it be self-help or a regular group therapy experience, is counterproductive

and may lead to a worsening of symptoms.

 Panic Disorder (including panic attacks)

 Social phobia (also known as social anxiety disorder)

 Specific phobias (also known as simple phobias)

Clinical depression goes by many names -- depression, "the blues," biological depression,

major depression. But it all refers to the same thing: feeling sad and depressed for weeks or

months on end (not just a passing blue mood). This feeling is most often accompanied by

feelings of hopelessness, a lack of energy (or feeling "weighed down"), and taking little or no

pleasure in things that gave you joy in the past. A person who's depressed just "can't get moving"

and feels completely unmotivated to do just about anything. Even simple things -- like getting

dressed in the morning or eating -- become large obstacles in daily life. People around them --

their friends and family -- notice the change too. Often they want to help, but just don't know

how. We've compiled a library of depression resources for you to explore. We encourage you to

take your time with these resources, print out things you'd like to read more carefully, and bring

anything you have additional questions about to your family doctor or a mental health

37
professional. Depression is readily treated nowadays with modern antidepressant medications

and short-term, goal-oriented psychotherapy.

Depression is the common cold of mental disorders — most people will be affected by

depression in their lives either directly or indirectly, through a friend or family member.

Confusion is commonplace about depression, for example, about what depression exactly is and

what makes it different from just feeling down. There is also confusion surrounding the many

types of depression (e.g., unipolar depression, biological depression, manic depression, seasonal

affective disorder, dysthymia, etc.) that people may experience. There have been so many terms

used to describe this set of feelings we’ve all felt at one time or another in our lives, to one

degree or another, that it is time to set the record straight.

Depression is characterized by a number of common symptoms. These include a

persistent sad, anxious, or “empty” mood, and feelings of hopelessness or pessimism. A person

who is depressed also often has feelings of guilt, worthlessness, and helplessness. They no longer

take interest or pleasure in hobbies and activities that were once enjoyed; this may include things

like going out with friends or even sex. Insomnia, early-morning awakening, and oversleeping

are all common.

Appetite and/or weight loss or overeating and weight gain may be symptoms of

depression in some people. Many others experience decreased energy, fatigue, and a constant

feeling of being “slowed down.” Thoughts of death or suicide are not uncommon in those

suffering from severe depression. Restlessness and irritability among those who have depression

is common. A person who is depressed also has difficulty concentrating, remembering, and

trouble making decisions. And sometimes, persistent physical symptoms that do not respond to

38
traditional treatments — such as headaches, digestive disorders, and chronic pain — may be

signs of a depressive illness.

What differentiates occasionally feeling down for a few days from depression is the severity of

the symptoms listed above, and how long you’ve had the symptoms. Typically, for most

depressive disorders, you need to have felt some of those symptoms for longer than two weeks.

They also need to cause you a fair amount of distress in your life, and interfere with your ability

to carry on your normal daily routine.

Depression is a severe disorder, and one that can often go undetected in some people’s

lives because it can creep up on you. Depression doesn’t need to strike all at once; it can be a

gradual and nearly unnoticeable withdrawal from your active life and enjoyment of living. Or it

can be caused by a clear event, such as the breakup of a long-term relationship, a divorce, family

problems, etc. Finding and understanding the causes of depression isn’t nearly as important as

getting appropriate and effective treatment for it.

Grief after the death or loss of a loved one is common and not considered depression in

the usual sense. Teenagers going through the usual mood swings common to that age usually

don’t experience clinical depression either. Depression usually strikes adults, and twice as many

women as men. It is theorized that men express their depressive feelings in more external ways

that often don’t get diagnosed as depression. For example, men may spend more time or energy

focused on an activity to the exclusion of all other activities, or may have difficulty controlling

outbursts of rage or anger. These types of reactions can be symptoms of depression.

39
Warning Signs & Symptoms of Depression

Not everyone who is depressed experiences every symptom. Some people experience a few

symptoms, some many. Severity of symptoms varies with individuals and also varies over time.

Depression

 Persistent sad, anxious, or empty mood

 Feelings of hopelessness, pessimism

 Feelings of guilt, worthlessness, helplessness

 Loss of interest or pleasure in hobbies and activities that were once enjoyed, including

sex

 Decreased energy, fatigue, being “slowed”

 Difficulty concentrating, remembering, or making decisions

 Insomnia, early-morning awakening, or oversleeping

 Appetite and/or weight loss or overeating and weight gain

 Thoughts of death or suicide; suicide attempts

 Restlessness, irritability

 Persistent physical symptoms that do not respond to treatment, such as headaches,

digestive disorders, and chronic pain

In order for depression to be diagnosed, the person must experience these symptoms every day,

for at least 2 weeks.

40
Types of Depression

Depressive disorders come in many different types, but each type has its own unique

symptoms and treatments.

Major depression, the most common type of a depressive disorder, is characterized by a

combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy once

pleasurable activities. Such a disabling episode of depression may occur only once but more

commonly occurs several times in a lifetime. Mental health professionals use the checklist of

specific symptoms to determine whether major depression exists or not. Depression is also rated

by your diagnosing physician or mental health professional in terms of its severity — mild,

moderate, or severe. Severe depression is the most serious type.

A less severe type of depression, dysthymia, involves long-term, chronic symptoms that

do not disable, but keep one from functioning well or from feeling good. Many people with

dysthymia also experience major depressive episodes at some time in their lives. Another type of

depression is experienced as a part of bipolar disorder, also called manic-depressive illness. Not

nearly as prevalent as other forms of depressive disorders, bipolar disorder is characterized by

cycling mood changes: severe highs (mania) and lows (depression). Sometimes the mood

switches are dramatic and rapid, but most often they are gradual.

When in the depressed cycle, an individual can have any or all of the symptoms of a

depressive disorder. When in the manic cycle, the individual may be overactive, over talkative,

and have a great deal of energy. Mania often affects thinking, judgment, and social behaviour in

ways that cause serious problems and embarrassment. For example, the individual in a manic

41
phase may feel elated, full of grand schemes that might range from unwise business decisions to

romantic sprees. Mania, left untreated, may sometimes even worsen into a psychotic state.

The most commonly diagnosed form of depression is Major Depressive Disorder, which

is characterized by a depressed mood for more than two weeks, among other symptoms. The

depressed mood affects all facets of the person’s life, including work, home life, relationships

and friendships. A person with this kind of depression often finds it difficult to do much of

anything or get motivated, so even going to seek treatment for this condition can be challenging.

Another type of depression is called Dysthymia. Dysthymia is similar to Major

Depressive Disorder, but the symptoms occur over a much longer period of time – more than 2

years. This is considered a chronic form of depression, and treatment can be challenging as an

individual with Dysthymia has often already tried all manner of treatment. Individuals diagnosed

with this condition can also suffer from occasional bouts of Major Depressive Disorder.

A third type of depression is referred to as Adjustment Disorder with Depressed Mood.

This condition is diagnosed when a person is adjusting to some new facet or change in their lives

that has caused a great deal of stress. This disorder can even be diagnosed when a person is

experiencing a good event in their life – such as a new marriage or a baby being born. Because

the individual usually just needs a little additional support in their lives during this stressful time,

treatment is time-limited and simple. Another kind of depression is called Seasonal Affective

Disorder. People with Seasonal Affective Disorder suffer the symptoms of a Major Depressive

Disorder only during a specific time of year, usually winter. This appears to be related to the

shorter days of winter, and the lack of sunlight in many parts of the country.

42
 Depression is also a symptom of other disorders, such as Bipolar disorder. Bipolar

disorder is sometimes considered a “mood disorder,” but is not a form of depression. Bipolar

disorder is characterized by swings of a person’s mood from depression to mania (mania is

characterized by lots of energy and a person feeling like they are on top of the world and can do

almost anything, often trying to do just that). After pregnancy, hormonal changes in a woman’s

body may trigger symptoms of depression. More than half of the women suffering from

postpartum depression will experience it again with the birth of another child. It is critical to

identify this danger and treat it early. During pregnancy, the amount of two female hormones,

oestrogen and progesterone, in a woman’s body increases greatly. In the first 24 hours after

childbirth, the amount of these hormones rapidly drops back down to their normal non-pregnant

levels. Researchers think the fast change in hormone levels may lead to depression, just as

smaller changes in hormones can affect a woman’s moods before she gets her menstrual period.

Like any mental disorder, depression is best diagnosed by a mental health professional,

such as a psychologist or psychiatrist, who has specific experience and training in making an

accurate diagnosis. While a family physician or general practitioner can also make a diagnosis of

depression, you should also obtain a referral to a mental health professional for follow-up care.

The Causes of Depression

The most important thing to know about the causes of depression is that we don’t really

know the answer to this question. It is generally believed that all mental disorders are caused by

a complex interaction and combination of biological, psychological and social factors. This

theory is called the bio-psycho-social model of causation and is the most generally accepted

theory of the cause of disorders such as depression by professionals. However, some types of

43
depression run in families, suggesting that a biological vulnerability can be inherited. This seems

to be the case with bipolar disorder. Studies of families in which members of each generation

develop bipolar disorder found that those with the illness have a somewhat different genetic

makeup than those who do not get ill. However, the reverse is not true: Not everybody with the

genetic makeup that causes vulnerability to bipolar disorder will have the illness. Apparently

additional factors, possibly stresses at home, work, or school, are involved in its onset. In some

families, major depression also seems to occur generation after generation. However, it can also

occur in people who have no family history of depression. Whether inherited or not, major

depressive disorder is often associated with changes in brain structures or brain function.

People who have low self-esteem, who consistently view themselves and the world with

pessimism or who are readily overwhelmed by stress, are prone to depression. Whether this

represents a psychological predisposition or an early form of the illness is not clear. In recent

years, researchers have shown that physical changes in the body can be accompanied by mental

changes as well. Medical illnesses such as stroke, a heart attack, cancer, Parkinson’s disease, and

hormonal disorders can cause depressive illness, making the sick person apathetic and unwilling

to care for his or her physical needs, thus prolonging the recovery period. Also, a serious loss,

difficult relationship, financial problem, or any stressful (unwelcome or even desired) change in

life patterns can trigger a depressive episode. Very often, a combination of genetic,

psychological, and environmental factors is involved in the onset of a depressive disorder.

44
ANXIETY

Anxiety, worry, and stress are all a part of most people's life today. But simply

experiencing anxiety or stress in and of itself does not mean you need to get professional help or

you have an anxiety disorder. In fact, anxiety is a necessary warning signal of a dangerous or

difficult situation. Without anxiety, we would have no way of anticipating difficulties ahead and

preparing for them. Anxiety becomes a disorder when the symptoms become chronic and

interfere with our daily lives and our ability to function. People suffering from chronic anxiety

often report the following symptoms:

 Muscle tension

 Physical weakness

 Poor memory

 Sweaty hands

 Fear or confusion

 Inability to relax

 Constant worry

 Shortness of breath

 Palpitations

 Upset stomach

 Poor concentration

These symptoms are severe and upsetting enough to make individuals feel extremely

uncomfortable, out of control and helpless.

45
ADULT DISORDERS

Common Disorders

 Alcohol/Substance Abuse

 Alcohol/Substance Dependence

 Anxiety Disorders

 Adult Attention Deficit/Hyperactivity Disorder(ADHD/ADD)

 Bipolar Disorder

Acute Stress Disorder is characterized by the development of severe anxiety, dissociative,

and other symptoms that occurs within one month after exposure to an extreme traumatic stressor

(e.g., witnessing a death or serious accident). As a response to the traumatic event, the

individual develops dissociative symptoms. Individuals with Acute Stress Disorder have a

decrease in emotional responsiveness, often finding it difficult or impossible to experience

pleasure in previously enjoyable activities, and frequently feel guilty about pursuing usual life

tasks. A person with Acute Stress Disorder may experience difficulty concentrating, feel

detached from their bodies, experience the world as unreal or dreamlike, or have increasing

difficulty recalling specific details of the traumatic event (dissociative amnesia).

In addition, at least one symptom from each of the symptom clusters required for Post-

traumatic Stress Disorder is present. First, the traumatic event is persistently re-experienced (e.g.,

recurrent recollections, images, thoughts, dreams, illusions, flashback episodes, a sense of

reliving the event, or distress on exposure to reminders of the event). Second, reminders of the

trauma (e.g., places, people, and activities) are avoided. Finally, hyper arousal in response to

46
stimuli reminiscent of the trauma is present (e.g., difficulty sleeping, irritability, poor

concentration, hyper vigilance, an exaggerated startle response, and motor restlessness).

Specific Symptoms of Acute Stress Disorder:

Acute stress disorder is most often diagnosed when an individual has been exposed to a

traumatic event in which both of the following were present:

 The person experienced, witnessed, or was confronted with (e.g., can include learning of)

an event or events that involved actual or threatened death or serious injury, or a threat to

the physical integrity of self or others

 Though not required, the person’s response is likely to involve intense fear, helplessness,

or horror

Either while experiencing or after experiencing the distressing event, the individual has 3 or

more of the following dissociative symptoms:

 A subjective sense of numbing, detachment, or absence of emotional responsiveness

 A reduction in awareness of his or her surroundings (e.g., “being in a daze”)

 Derealisation

 Depersonalization

 Dissociative amnesia (i.e., inability to recall an important aspect of the trauma)

The traumatic event is persistently re-experienced in at least one of the following ways:

recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving the

experience; or distress on exposure to reminders of the traumatic event. Acute stress disorder is

also characterized by significant avoidance of stimuli that arouse recollections of the trauma

47
(e.g., avoiding thoughts, feelings, conversations, activities, places, and people). The person

experiencing acute stress disorder also has significant symptoms of anxiety or increased arousal

(e.g., difficulty sleeping, irritability, poor concentration, hyper vigilance, exaggerated startle

response, motor restlessness).

For acute stress disorder to be diagnosed, the problems noted above must cause clinically

significant distress or impairment in social, occupational, or other important areas of functioning

or impairs the individual’s ability to pursue some necessary task, such as obtaining necessary

assistance or mobilizing personal resources by telling family members about the traumatic

experience.

Determinants of mental health and well-being

A commonly used definition of mental health is “... a state of well-being in which the

individual realizes his or her own abilities, can cope with the normal stresses of life, can work

productively and fruitfully, and is able to make a contribution to his or her community”.

Reference to this definition makes it clear that mental or psychological well-being is influenced

not only by individual characteristics or attributes, but also by the socioeconomic circumstances

in which persons find themselves and the broader environment in which they live (Figure 2):

 Individual Attributes and behaviours: These relate to a person's innate as well as learned

ability to deal with thoughts and feelings and to manage him/herself in daily life

('emotional intelligence'), as well as The capacity to deal with the social world around by

partaking in social activities, taking responsibilities or respecting the views of others

('social intelligence’).

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An individual’s mental health state can also be influenced by genetic and biological factors; that

is, determinants that persons are born or endowed with, including chromosomal abnormalities

(e.g. Down's syndrome) and intellectual disability caused by prenatal exposure to alcohol or

oxygen deprivation at birth.

 Social and economic circumstances: The capacity for an individual to develop and

flourish is deeply influenced by their immediate social surroundings –including their

opportunity to engage positively with family members, friends or colleagues, and earn a

living for themselves and their families –and also by the socio-economic circumstances in

which they find themselves. Restricted or lost opportunities to gain an education and

income are especially pertinent socio-economic factors.

 Environmental factors: The Wider socio cultural and geopolitical environment in which

people live can also affect an individual’s, household’s or community’s mental health

status, including levels of access to basic commodities and services (water, essential

health services, the rule of law), exposure to predominating cultural beliefs, attitudes or

practices, as well as by social and economic policies formed at the national level; for

example, the ongoing global financial crisis is expected to have significant mental health

consequences, including increased rates of suicide and harmful alcohol use.

Discrimination, social or gender inequality and conflict are examples of adverse

structural determinants of mental wellbeing.

49
 Individual
attributes and
behaviour

Mental
health and
wellbeing
Social and
Environmental
economic
Factors
circumstances

Figure 2.1 Contributing factors to mental health and well-being WHO (1986).

It is important to emphasize that these different determinants interact with each other in a

dynamic way, and that they can work for or against a particular individual’s mental health state.

Approaches to treat/improve the mental health of individuals

Mental Health professionals, in an attempt to treat or improve the mental health of

individuals, adopted various approaches which include biomedical (use of medications),

psychotherapy, medication and relaxation among others. These approaches are highlighted

below:

Biomedical (use of medication)

Psychiatric drugs: Medication that alters brain chemistry and relieves psychiatric

symptoms has brought great hope and helps million of people. The recent development of a new

generation of more precise and effective psychiatric drugs, success rates for treating many

common and disabling disorders-depression, panic disorders, Schizophrenia and others- have

50
soared. Often used in conjunction with psychotherapy, sometimes used as the primary treatment,

these medications have revolutionized mental health care.

Psychiatric drugs are now among the most widely prescribed drugs in the United States

and are increasingly being used in combination of two or more medications. Serotonin-boosting

medications (SSRIs) have become the drugs of choice in treating depression. They are also

effective in treating obsessive compulsive disorder, panic disorder, social phobia, post-traumatic

stress disorder, premenstrual dysphonic disorder, and generalized anxiety disorder. In patients

who don’t respond, psychiatrists may add another drug to boost the efficacy of the treatment.

According to various studies, 5 to 7 percent of college students take antidepressant medications.

Direct-to-consumer advertisements for antidepressant drugs can influence student’s perception of

what is wrong with them. In one study, college women were more likely to rate themselves as

having mild-to-moderate depression as a result of reading pharmaceutical company information

for popular antidepressants. People with serious mental illnesses, including depression and

bipolar disorder often use at least one alternative health-care-practice, such as yoga or

meditation. In recent survey of women with depression, about half (54 percent) reported trying

herbs, vitamins, and manual therapies such as massage and acupressure. Some “natural”

products, such as herbs and enzymes, claim to have psychological effects. However, they have

not undergone rigorous scientific testing.

St. John’s wort has been used to treat anxiety and depression in Europe for many years.

Data from clinical studies in United States do not support the efficacy of St. John’s Wort for

moderate to severe depression. In ten carefully controlled studies, the herb did not prove more

effective than a placebo. However, more than two dozen studies have found that St. John’s wort

51
was similar in efficacy to standard antidepressants. Side effects include dizziness, abdominal

pain and bloating, constipation, nausea, fatigue, and dry mouth. St. John’s wort can lower the

efficacy of oral contraceptives and increase the risk of unwanted pregnancy (Hales, 2012).

Psychotherapy

The term psychotherapy refers to any type of counselling based on the exchange of words

in the context of the unique relationship that develops between a mental health professional and a

person seeking help. The process of talking and listening can lead to new insight, relief from

distressing psychological symptoms, changes, in unhealthy or maladaptive behaviours, and more

effective ways of dealing with the world. “Spirituality oriented” psychotherapy pays particular

attention to the roles that religion and spiritual and religious beliefs play in an individual’s

psychological life (Shafranske, 2008).

Landmark research has shown that psychotherapy does not just benefit the mind but

actually changes the brain. In studies comparing psychotherapy and psychiatric medications as

treatment for depression, both proved about equally effective. But a particular group of patient-

those who has lost a parent at an early age or who had experienced childhood trauma, including

physical or sexual abuse-gained greater benefits with talk therapy (Gabbard & Glen, 2009).

The most common goal of psychotherapy is to improve quality of life. So, mental health

professionals today are trained in a variety of psychotherapy techniques and tailor their approach

to the problem, personality, and needs of each person seeking their help. Because skilled

therapists may combine different techniques in the course of therapy, the line between the

various approaches often blurs. Because insurances companies and health professionals are

adopting a time-limited format in order to make the most of every session, regardless of the

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length of treatment. Brief or short-term psychotherapy typically focuses on a central theme,

problem, or topic may continue for several weeks to several months. The individuals most likely

to benefit are those who are interested in solving immediate problem rather than changing their

characters, who can think in psychological terms, and who are motivated to change (Hales,

2012).

Psychodynamic psychotherapy

For the most part, today’s mental health professionals base their assessment of

individuals on a psychodynamic understanding that take into account the role of early experience

and unconscious influences in actively shaping behaviour.(This is the psychodynamic).

Psychodynamic treatments work toward the goal of providing greater insight into problems and

bringing about behaviour changes. Therapy may be brief, consisting 12 to 25 sessions, or may

continue for several years (Hales, 2012).

Cognitive-Behavioural Therapy (CBT)

Cognitive-behaviour therapy (CBT) focuses on inappropriate or inaccurate thoughts or

beliefs to help individuals break out of a distorted way of thinking. The techniques of cognitive

therapy include identification of an individual’s beliefs and attitudes, recognition of negative

thought patterns, and education in alternative ways of thinking. Individuals with major

depression or anxiety disorders are most likely to benefits, usually in 15 to 25 sessions. However,

many of the positive messages used in cognitive therapy can help anyone improve a bad mood

on negative outlook (Wright and Jesse, 2008).

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Behavioural therapy

Strives to substitute healthier way of behaving for maladaptive patterns used in the past.

Its premise is that distressing psychological symptoms, like all behaviours, are learner responses

that can be modified or unlearned. Some therapists belief that changing behaviour also changes

how people think and feel. As they put it, “change the behaviour, and the feelings will follow”.

Behaviour therapies work best for disorders characterized by specific, abnormal patterns of

acting-such as alcohol and drug abuse, anxiety disorder, and phobias-and for individuals who

want to change bad habits (Hales, 2012).

Interpersonal Therapy

Interpersonal therapy (IPT), originally developed for research into the treatment of major

depression, focuses on the relationships in order to help individuals deal with unrecognized

feelings and needs and improve their communication skills. IPT does not deal with the

psychological origins of symptoms but rather concentrates on current problems of getting along

with others. The supportive, emphatic relationship that is developed with the therapies, who

takes an even more active role than in psychodynamic psychotherapy, is the most crucial

component of this therapy. The emphasis is on the here and now and on interpersonal-rather than

intrapsychic- issues. Individuals with major depression, chronic difficulties developing

relationships, and chronic mild depression are most likely to benefit. IPT usually consists of 12

to 16 sessions (Markowitz and John, 2008).

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Empirical Review

Epidemiology of Mental Health Problems

Data emanating from several studies have presented the state of mental health of various

groups of people and different countries. The Global Burden of Disease project initiated and

executed by the World Health Organization indicates there are significant and increasing levels

of mental disorders among the global adult and young adult population. “Among women, major

depression is the leading cause of years lived with disability, while anxiety ranks 6th in this list;

among men, major depression ranks 2nd, drug use disorders rank 7th, alcohol use disorders rank

8th and anxiety ranks 11th (WHO, 2014). In addition, an estimated one in four or five young

people (aged 12-24) will suffer from a mental disorder in any one year, notwithstanding

substantial variations in prevalence between regions.

The sixty-fifth World Health Assembly (2012) reported concern that millions of people

worldwide are affected by mental disorders, and that in 2004, mental disorders accounted for

13% of the global burden of disease, defined as premature death combined with years lived with

disability, and also that, when taking into consideration only the disability component of the

burden of disease calculation, mental disorders accounted for 25.3% and 33.5% of all years lived

with a disability in low- and middle-income countries, respectively. Findings reported by

Afifi(2007) stated that Mental health problems are among the most important contributors to the

global burden of disease and disability, and that Mental and behavioural disorders are estimated

to account for 12% of disability-adjusted life-years lost globally and 31% of all years lived with

disability at all ages and in both sexes, according to year 2000 estimates.

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Epidemiology of Mental Health Problems among Adolescents

The emotional difficulties of University students have become more complex and more

severe than in the past. In one national survey, more than 80 percent of directors of counselling

centres reported an increase in the number of students with serious mental disorders. Alcohol

abuse was slightly more common among university students. Depression disorders and anxiety

disorders affected almost equal percentages of university students (Hales, 2012). Some schools

are setting up screening programmes to identify students who may be at risk to themselves and

others. In another national survey of more than 5,000 men and women between the ages of 19-25

– the traditional age range for adolescents almost half reported some type of mental health

problems in the past years. So it should come as no surprise that students will face these issues

too.

A study conducted in Texas in 2007 found out that “more than 8% of youths experienced

at least one major depressive episode in the past year, fifty percent of students age 14 and older

who have mental illness drop out of high school, children with mental illness are more than three

times as likely to be arrested before leaving school than other students, and these same students

fail more courses, earn lower GPAs, miss more days of school, and are retained more often than

other students with other types of disabilities” (Bottoms & Noel, 2009). Likewise, “previous

studies showed that University students come to Universities overwhelmed with economical

demands, and suffer from psychosocial and mental health problems and according to Kirtzow

(2003), university students seem to come to colleges unprepared to manage complicated life

stressors that they are expected to confront during their university life”(Hamdan-mansour,

Dardas, Abulsbaa, & Nawafleh, 2012: Hamdan-Masour, Halabi, & Dawani, 2009). This

56
increased the risk to psychosocial and mental disturbances may impair social functioning and

academic performance.

Psychological and Social Risk Factors of Mental Health Problems among Adolescents

The risk factors for mental health problems are widely known and include sexual and

physical abuse during childhood; family, school and community violence: poverty, social

exclusion and educational disadvantage. Psychiatry disorders, parent’s drug abuse and conjugal

violence also increase the risks for adolescents as the exposition to social alterations and

psychological distress that accompany armed conflicts, natural disasters and other humanitarian

crises. The stigma driven to the individuals with mental disorders and the human rights

violations that are subjected to, amplifies the adverse consequences.

Psychological factors

 sadness or depression

 grief

 loneliness and isolation

 anxiety

 stress

 lack of satisfaction with life

 negative style of talking

 difficulty communicating

 trouble handling disagreements

 low self-esteem

 making negative social comparisons to others

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  negative attitudes about aging and mortality

 inappropriate self-expectations

 chronic or severe mental illness

 problematic use of substances, including medications

 heavy alcohol consumption

 smoking

 physical illness or impairment

 chronic illness

 poor nutrition

 physical inactivity

Family and social factors

 isolation

 lack of family support

 limited social network

Life events and situations

 caring for someone with an illness or disability

 death of family member, especially spouse

 divorce or family breakup

 unemployment

 other adverse or stressful life events

 retirement

 unsatisfactory workplace relationships

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  workplace-related injury

 living in a nursing home

 economic deprivation

 recent immigration or resettlement

 homesickness or culture shock

 elder abuse

 violence

Community and cultural factors

 low socio-economic status

 lack of support services, including transport, shopping and recreational facilities

 limited mental health service

 social and environmental barriers

 stigma and discrimination

 inadequate housing

 language barriers

Also, other risk factors include:

Certain factors may increase your risk of developing mental health problems, including:

 Having a blood relative, such as a parent or sibling, with a mental illness

 Stressful life situations, such as financial problems, a loved one's death or a divorce

 An ongoing (chronic) medical condition, such as diabetes

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  Brain damage as a result of a serious injury (traumatic brain injury), such as a violent

blow to the head

 Traumatic experiences, such as military combat or being assaulted

 Use of alcohol or recreational drugs

 Being abused or neglected as a child

 Having few friends or few healthy relationships

 A previous mental illness

The effects of mental health problem can be temporary or long lasting. You also can have more

than one mental health disorder at the same time. For example, you may have depression and a

substance use disorder.

Social Support and Mental Health Problems

Social support refers to the experience being valued, respected, cared about, and loved by

others who are present in one’s life. It may come from different sources such as family, friends,

teachers, community, or any social groups to which one is affiliated. Social support can come in

the form of tangible assistance provided by others when needed which includes appraisal of

different situations, effective coping strategies, and emotional support. Social support is an

element that can help individuals to reduce the amount of stress experienced as well as to help

individual cope better in dealing with stressful situations. It has long been recognized that the

characteristics and quality of social support are central to the individual's adjustment. The quality

of social support perceived and received has been reported by several studies to correlate more

positively with mental health than the quantity of support received (Nahid & Sarkis, 1994;

Holahan et al., 1995).

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 Support from family and friends have been found to reduce the impact of psychological

problems among students (Calvete & Connor-Smith, 2006). Villanova and Bownas (1984) for

example found that social support could help students to cope with everyday life stressor and

lighten the burden of academic workload. Without enough support from family and friends, they

would be in trouble and are vulnerable to depression, stress and anxiety. This finding was

supported by Dollete et al. (2004) who found that social support could act as a protective factor

that could decrease psychological problems among students such as stress. A study by Wentzel

(1998) found that social support provides motivational influence on students’ performance.

This is because social support includes social resources that individuals perceive to be

available or that are actually offered to them which could help protect against psychological

problems. According to Teoh and Rose (2001), lower level of social support is one of the

predictors of psychological problems. It is associated with higher level of depression, anxiety,

attention problems, thought problems, social problems, somatic complaints, and lower self-

esteem. These notions are supported by the study of Friedlander, Reid, Shupak, and Cribbie

(2007) on 128 first year undergraduate students. It was found that students who perceived that

their social resources increased had lower level of psychological problems. This shows that the

impact of a stressful situation for example can be decreased when students have good social

support. Advice and encouragement from sources of support may also increase the likelihood

that an individual will rely on active problem solving and information seeking. These may assist

students in dealing with various stressors in the environment and facilitate a positive adjustment

process. The supportive actions provided by the social support are thought to buffer the impact of

stress by increasing the effectiveness of coping efforts, which in turn decrease distress among

students ( Holahan, et al., 1995; Lakey & Cohen, 2000). For example, receiving emotional

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support and companionship may encourage effective adaptation among students in facing and

coping with uncontrollable events.

Life Satisfaction

Life satisfaction describes how a person perceives his or her life presently and how he or

she feels about the future. It is a measure of well-being, as well as a logical, global judgment.

Life satisfaction means having a favourable attitude towards one's life in general. The criteria

used to measure life satisfaction include economic standing, amount of education, experiences,

and a person’s residence and others (“Life Satisfaction,” 2012). Life satisfaction mirrors

experiences that have affected a person in a positive way. These experiences often motivate

people to pursue and reach their goals (“Life Satisfaction,” 2012). Two types of emotions, hope

and optimism; affect how people perceive their lives. These two emotions consist of cognitive

processes that are usually geared towards the perception of goals and attaining those goals. An

individual’s perception of his or her life satisfaction can be influenced by his or her mood and

outlook to life (Bailey, Eng, Trisch, & Snyder, 2007).

PSYCHOLOGICAL AND SOCIAL ENVIRONMENT

It is difficult to define ‘’psychosocial environment’’ against the background of the highly

varied social, economic and cultural contexts of different countries and their social standards and

value systems. It includes a complex of psychosocial factors which are defined as “those factors

affecting personal health, health care and community well-being that stem from the psychosocial

make-up of individuals and the structure and functions of social groups”. They include cultural

values, customs, attitudes, habits, beliefs, morals, religion, education, lifestyles, community life,

and health services, social and political organization.

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 In addition to this broad aspect of psychosocial environment, man is in constant

interaction with that part of the social environment known as “people”. He is a member of a

social group, the member of a family, of a caste, of a community and a nation. Between the

individual and other member of the group, there can be harmony or disharmony, interests and

points of view that are shared or that are in conflict. The behaviour of one individual can affect

others more or less directly; conflict and tension between the individual and the group as a whole

or between the individual and other members of the group can yield great distress. The law of the

land, customs, attitudes, beliefs, traditions, all regulate the interactions among groups of

individuals and families.

The impact of social environment cannot be overemphasized as it has protective and

predisposing, positive and negative ramification for the health of individuals and communities. A

favourable social environment can improve health, provide opportunities for man to achieve a

sense of fulfilment, belonging, and add to the quality of life. Unfavourable social environment

potentially leads to mental distress and ultimately increased DALYs. Therefore, customs and

traditions favouring health must be preserved. Beneficial social behaviour (e.g., community

participation) protective and cohesive social network are some socially mental health promoting

and stress reducing aspects.

Psychosocial factors can also affect negatively man’s health and well-being. For

example, poverty, urbanization, migration and exposure to stressful situations such as

bereavement, desertion, loss of employment, birth of a handicapped child, academic failure may

produce feelings of anxiety, depression, anger, frustration, and so forth; and these feelings may

be accompanied by physical symptoms such as headache, palpitation and sweating. But these

emotional states also produce changes in the endocrine, autonomic and motor systems, which, if

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prolonged and in interaction with genetic and personality factors, may lead to structural changes

in various bodily organs. The resulting psychosomatic disorders include conditions such as

duodenal ulcer, bronchial asthma, hypertension, coronary heart disease, mental disorders and

socially deviant behaviour (e.g., suicide, crime, violence, drug abuse). Of primary concern is

coronary heart disease which is a slowly developing disease with long latent period and which

may be related to lifestyle and psychosocial stress (Park, 2012).

Recognizing the fact that man today is viewed as a social being and an “agent” of his

own diseases; his state of health is determined largely by what he does or fails to do. This

indicates that the psychosocial factors which the individual, group of people or community is

exposed to needs to be examined. Only then can suitable and target specific interventions be

planned, implemented, monitored and evaluated, and followed-up for maximum yield and

efficient result.

Psychological and Social Factors Predicting Mental Health Problems

Psychological Factors

Self-esteem

Self-esteem is one of the most valuable resources that an adolescent and a young can have.

Researchers have shown that a teenager with a great sense of self-esteem will learn more

effectively, will establish more profitable relationships, can better take the advantage of

opportunities and will be self-sufficient and productive. He also has a clear vision to his life path

than an adolescent with low self-esteem. Self-esteem refers to how one evaluates oneself in

positive and negative terms. Persons with good self- esteem realize that they are special and

unique and that they do not need to be someone else. They can make mistakes, fail or receive

criticism without concluding that they are worthless, and they do not hinge their esteem on

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people or things. On the other hand people who lack self-esteem often do things to win the

approval of others, rather than for self satisfaction.

Persons with good self-esteem tend to cope better with stressful situations because they

view such situations as challenges rather than stressors. They also find it easier to commit

themselves to families, interpersonal relationships and organizations, as they believe that they

have something to offer. They accept that we all need help and encouragement at various times

in our lives.

Self- efficacy

Self-efficacy is defined as people's beliefs about their capabilities to produce designated

levels of performance that exercise influence over events that affect their lives. Self-efficacy

beliefs regulate human functioning through cognitive, motivational, affective, and decisional

processes. These beliefs affect whether individuals think in self-enhancing or self-debilitating

ways, how well they motivate themselves and persevere in the face of difficulties, the quality of

their emotional life, and vulnerability to stress and depression. People with a high sense of

coping efficacy adopt strategies and courses of action designed to change hazardous

environments to benign ones. In this mode of affect regulation, efficacy beliefs alleviate stress

and anxiety by enabling individuals to mobilize and sustain coping efforts. Self-efficacy operates

as a cognitive regulator of stress and anxiety arousal.

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Social Factors

Familial Factors

Mental illness has been identified as the leading contributor to the burden of disease and

injury among young Australians, aged 15 to 24 years, with anxiety and depression occurring at

high rates for both males and females (AIHW, 2007). Family cohesion is believed to have strong

positive effects on the outcome of children with early emotional experiences playing a critical

role in affecting adult behaviour, neuropsychiatric disorders and physical and mental health

(Diamond, 2007). Environmental risk factors that increase the likelihood of mental health

problems include marital discord between parents, social isolation, failure to achieve

academically, stressful life events, deficits in interpersonal skills, parenting characteristics, and

community and cultural factors (such as socioeconomic disadvantage) (AIHW, 2007; Barrett and

Farrell, 2007). On the other hand, protective factors include parental attachment, social support,

positive school environment, economic security, positive health behaviours, and a array of social

skills such as positive peer and adult interaction, empathy and critical problem solving skills

(AIHW, 2007; Barrett and Farrell, 2007; Harvey and Delfabbro, 2004). Parental attachment can

serve as a preventive factor for mental disorders (Barrett and Farrell, 2007) and dysfunctional

parent-child relationships or severe family disruptions can contribute to co-morbid psychological

and drug disorders (Marsh and Dale, 2005). Further, it has been shown that depressive

symptomatology is related to the level of support, attachment and approval that adolescents

experience in the family environment (Sheeber et al.,1997). Weak parent-child relationships can

be characterised by poor communication, conflict or a perception on the young person’s part of

an absence of parental love (Marsh and Dale, 2005).

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Academic Factors:

The transition from high school to tertiary institution of learning is a major life change

for many youth. Attending tertiary institution of learning offers students with learning

experiences and opportunities for psychosocial development (Friedlander, Reid, Shupak, &

Cribbie, 2007; Tao, Dong, Pratt, Hunsberger, & Pancer, 2000). However, students are often

not sure of their abilities to cope with these demands (Dwyer & Cummings, 2001). Most students

are bound to move away from home to attend higher institution of learning. Such transition to

higher institutions or colleges usually reduces contact and social support from friends and family

members. Difficulties in handling the stressors/challenges associated with the transition may lead

to decreased academic performance and increased psychological distress (Friedlander et al.,

2007).

Relationship factors:

One area that can be impacted by mental-health conditions during adolescence and young

adulthood is the development of safe and healthy relationships with peers, parents, teachers and

romantic partners. In fact, adolescence is the developmental period that is critical for identity

formation and taking on roles, especially with peers. Many mental-health conditions negatively

affect a youths’ ability to successfully form supportive and healthy relationships and manage

conflict within these relationships. For example, at least one in four adolescents experiences

symptoms of depression (Kessler, 2005), which commonly includes irritability, anger and

avoidance of social interaction. These symptoms can lead youth to withdraw from others as well

as be rejected by their peers, which can exacerbate depressive symptoms further and limit

opportunities for social skills development. Similar social challenges occur for youth with

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anxiety, whereby they tend to avoid social interaction and may be rejected by their peers because

of their anxious behaviour.

Appraisal of Literature

Haney and Durlak (Haney and Durlak, 1998) wrote a meta-analytical review of 116

intervention studies adolescents. Most studies indicated significant improvement in adolescents’

self-esteem and self-concept, and as a result of this change, significant changes in behavioural,

personality, and academic functioning. Durlak reported on the possible impact improved self-

esteem had on the onset of social problems. However, their study did not offer an insight into the

potential effect of enhanced self-esteem on mental disorders. Empirical studies over the last 15

years indicate that self-esteem is an important psychological factor contributing to health and

quality of life (Evans, 1997). Recently, several studies have shown that subjective well-being

significantly correlates with high self-esteem, and that self-esteem shares significant variance in

both mental well-being and happiness (Zimmerman, 2000). Self-esteem has been found to be the

most dominant and powerful predictor of happiness (Furnham and Cheng, 2000). Indeed, while

low self-esteem leads to maladjustment, positive self-esteem, internal standards and aspirations

actively seem to contribute to ‘well- being’ (Garmezy, 1984; Glick and Zigler, 1992).

Several mental health-promoting school programs that have addressed self-esteem and

the determinants of self-esteem in practice, were effective in the prevention of eating disorders

(O’Dea and Abraham, 2000), problem behaviour (Flay and Ordway, 2001), and the reduction of

substance abuse, antisocial behaviour and anxiety (Short, 1998).

It can be argued that the dependent variable and the family cohesion index is problematic

because of joint determination. In other words, if the respondent suffers from poor mental health,

68
problems with family relationships can develop. One way around this would be to use a lagged

variable of family conflict. This would allow past family cohesion measures to influence current

mental health, and disallow the possibility of reverse causality (i.e current mental health

affecting past relationships). As such it must be emphasised that no statements are being made to

indicate any casual relationships between personality and mental health (Tan,2007).

Using a midlife sample (ages 35–86) obtained from the MIDUS II study, this analysis

explored whether children sustained long-term detriments associated with the parental discord

and family disunity. In particular, the analyses explored whether children involved in familiar

conflict had elevated mental health risks or reduced connection or solidarity with family

members compared to those children who were not involved in family conflict. These effects

were measured in midlife, on average 36 years after the family conflict had occurred, as a way to

focus on the long-term consequences that persist after the immediate or initial periods of

adjustment that children face on parental discord (Allison & Furstenberg, 1989; Amato &

Cheadle, 2005; Hurre et al., 2006).

In sum, experiencing familiar conflict appears to have a long-lasting effect on the child’s

mental health and family solidarity: Those who experienced parental discord exhibited a

significantly higher risk for depression as well as lower levels of family solidarity during midlife

and older ages; compared to those children who had cordial family relationships throughout their

childhood and adult lives. Those who experienced relationship conflicts exhibited a significantly

higher risk for mental health problems as well as lower levels of family solidarity during midlife

and older ages. These findings support previous research that has suggested that the negative

consequences of stress from familiar and relationship conflicts are present throughout the life

69
course and are manifested through lower levels of family solidarity (Hurre et al., 2006,

Wolfinger, 1999). Furthermore, these findings, along with previous research (Amato & Cheadle,

2005; Hurre et al., 2006), indicate that familiar relationships and family solidarity affect later life

outcomes such as depression and family relationships.

In conclusion, the present study provides significant information pertaining to the

relationship between the psychological and social factors predicting mental health problems

amongst students. However, students and educators should be aware of social support and

existence of mental problems so that these problems might be under control.

70
 CHAPTER THREE

METHODOLOGY

This chapter focuses on the methodology employed in the study. It is discussed under the

following sub-headings:

1. Research Design

2. Population

3. Sample and Sampling Technique

4. Research Instrument

5. Validity and Reliability of Research Instrument

6. Procedure for Data Collection

7. Procedure for Data Analysis

Research Design

The descriptive survey research design was used for this study. This is considered

appropriate because, it enables a researcher to carefully describe, interpret and explain factual

and detailed information about the variables of interest (Kerlinger, 2000). This design is selected

as the most suitable since the study is intended to examine and report the relationship among the

variables of interest how they naturally occur without manipulation.

As a structure, it provides a specific outline, scheme, and paradigm of operation of the

variables and as a strategy, and it provides more specifically, the methods to be used in gathering

and analyzing data. In other words, it indicates how the research objectives will be accomplished

and how the problems encountered in the research will be tackled (Bamigboye, Lucas, Agbeja,

Adewale, Ogunleye and Fawole 2006).

71
Population

Population is described as the totality of all elements, subjects, or members that possess a

specific set of one or more common definite attributes (Ogundipe, Lucas & Sanni, 2006). The

population of this study comprised all secondary school students in Enugu state, Nigeria.

Sample and Sampling Technique

The sample size for this study was nine hundred and forty-five (945) respondents which

were drawn from randomly selected secondary schools in Enugu state. The sample for the study

was drawn using a multi-stage sampling procedure. Simple random sampling technique was

employed to select fifteen respondents from each level thereby making a total of forty-five

respondents from each department and thus bringing the total sample size to 945 respondents.

Research Instrument

The research instrument for this study was a self-developed questionnaire. The

instrument comprises four sections (A-D). Section A will focus on demographic variable of the

respondents while section B to D will be used to elicit information in the variables to be tested in

the hypotheses. The scales were designed to address the independent variables and the dependent

variables of the study. It was designed in line with modified Rating type scale, and was related as

follows: 4- Always, 3- Often, 2- Rarely, 1- Never.

Section A: Socio-Demographic characteristics. This contains questions pertaining to

ascertaining the demographic information of the respondents. It covered age, sex, marital status,

religion, level of study, course of study, department and ethnic group.

Section B: Psychological Factors

Self Esteem Scale: This scale is designed to measure the self-esteem of the respondents.

The scale was self developed and it has a total of ten items constructed along four point rating

72
scale. All the five items (1,2,4,6,7) that positively worded, are scored 4 points for Always, 3 for

Often, 2 for Rarely and 1 for Never while the five items (3,5,8,9,10) which are negatively

worded are to be scored on the reverse thus, making the highest score possible score 40 and

lowest possible score 5.

Self Efficacy Scale: This scale is designed to measure the self efficacy of the

respondents. The scale is modified from the General Self Efficacy Scale developed by Schwarzer

and Jerusalem, (1995). The scale was originally created to assess a general sense of perceived

self-efficacy with the aim in mind to predict coping with daily hassles as well as adaption after

experiencing all kinds of stressful life events and can be modified to suit any particular area of

interest. The scale is designed along a four point rating scale from Always to Never. In scoring

the scale, since all the items are positively worded 4 for Always, 3 for Often, 2 for Rarely and 1

for Never. Therefore, the highest possible score is 40 while the lowest possible score is 5.

Validity and Reliability of the Instrument

The validity of an instrument refers to the ability of an instrument to measure what it

purports or set out to measure and how well it measures it. To measure Validity, draft copies of

the questionnaire was presented to experts in mental health metrics for critics who will facilitate

objective criticism that will lead to subtraction, addition, suggestion and modification of the

research instrument. However, the instrument was given to the researcher’s supervisor for

comments, addition and suggestion. All comments, suggestions and modifications was studied

carefully and utilized, for improving the quality of the instrument.

Reliability refers to the degree of consistency of an instrument in measuring what it is

designed to measure. Reliability has to do with the precision of an instrument; it refers to the

73
extent to which an instrument would yield the same results if administered on the same

respondents on different occasions, other things being equal. Reliability according to Olayinka,

Taiwo, Raji-Oyelade and Farai (2006), is concerned with the consistency and dependability of

measuring instrument, i.e. it is an indication of the degree to which it gives the same answers

over time, across similar groups and irrespective of who administers it. The instrument was pre-

tested and the reliability was examined using cronbach alpha test of reliability. The cronbach

alpha measure of the reliability test was used to identify the level of internal consistency of the

instrument which yielded 0.88 coeffcient.

Procedure for Data Collection

The questionnaire was administered by the researcher and with the help of six trained

research assistants to facilitate smooth conduct of the exercise. On the spot administration

technique was used, as such; the completed copies of the questionnaire were collected from the

participants on the spot. The rationale for using this method is to minimize loss of questions and

ensure high level of return.

Procedure for Data Analysis

The returned instruments were sorted and those completely filled was entered into a

coded format on the SPSS. The coded data was analyzed using descriptive statistics of frequency

count and percentages for demographic variables, research questions 1, while inferential

statistics of t-test was used to analyze research questions 2 and 3 and regression models was

employed to analyze the research hypotheses at 0.05 alpha level.

74
75
 CHAPTER FOUR

RESULTS AND DISCUSSION OF FINDINGS

This study was designed to explore the perceptions of secondary school teachers in Enugu State

regarding the factors that influence the mental health status of adolescents. This chapter of the

study focuses on the presentation of the result of the study based on analysis of data generated

and the discussions of these findings. The chapter is presented in four sections beginning with

the demographic characteristics of the respondents, the answering of research questions, test of

hypotheses and concluded with the discussions of findings.

Demographic Characteristics of Respondents

Table 4.1: Distribution of Respondents by Sex

Age Frequency Percent

MALE 433 46.2

FEMALE 505 53.8

Total 938 100.0

MALE
46%

FEMALE
54%

76
Fig. 4.1: Distribution of Respondents by Sex

The findings of the study as shown in the table and figure above revealed that female

respondents accounted for the largest proportion of the respondents at 53.8% while their male

counterparts accounted for the remaining 46.2%.

Distribution of Respondents by Religion

Table 4.2: Distribution of Respondents by Religion

Religion Frequency Percent

CHRISTIANIT
715 76.2
Y

ISLAM 223 23.8

Total 938 100.0

77
 ISLAM
24%

CHRISTIANITY
76%

Fig. 4.2: Distribution of Respondents by Religion

The table and graph above showed that Christian respondents accounted for the largest

proportion at 76.2% while Muslim respondents accounted for the remaining 23.8%.

Distribution of Respondents by Ethnic Group

Table 4.3: Distribution of Respondents by Ethnic Group

Religion Frequency Percent

YORUBA 632 67.4

IGBO 199 21.2

OTHERS 107 11.4

Total 938 100.0

78
 OTHERS
11%

IGBO
21%

YORUBA
67%

Fig. 4.3: Distribution of Respondents by Ethnic Group

The findings of the study showed that Yoruba respondents accounted for the largest percentage

at 67.4% followed by Igbo respondents who accounted for 21.2% of the respondents with

respondents from other tribes accounting for the remaining 11.4%.

79
RESEARCH QUESTIONS

Question One

What is the mental health status of secondary school students in Enugu state?

Table 4.4: Mental Health Status of Respondents

Always

Often

Rarely

Never
Items

Frequency of feeling depressed 187 434 229 88

(19.9%) (46.3%) (24.4% (9.4%)
)
Frequency of feeling anxious 192 381 302 63
(20.5%) (40.6%) (42.9% (6.7%)
)
Feeling of emotional stability 107 188 381 262
(11.4%) (20.4%) (40.6% (27.9%)
)
Difficulty in sleeping - 142 394 402
(15.1%) (42.0% (42.9%)
)
Feeling of aggression 142 139 373 284
(15.1%) (14.8%) (39.8% (30.3%)
)
Feeling withdrawn from others - 139 306 493
(14.8%) (32.6% (52.6%)
)
Feeling inferior to peers and acquaintances 102 119 289 428
(10.9%) (12.7%) (30.8% (45.6%)
)
Suicidal thought 142 260 223 313
(15.1%) (27.7%) (23.8% (33.4%)

80
 )
Experiencing irrational fears/phobias 142 324 139 333
(15.1%) (34.5%) (14.8% (35.5%)
)

The findings of the study as shown in the table above revealed that respondents demonstrated a

relatively poor mental health status. 19.9% of the respondents reported always feeling depressed

with 46.3% reporting feeling depression often. In the same vein, 20.5% of the respondents stated

that feel anxious always with a higher percentage, 40.6% reporting feeling of anxiety often while

42.9% reported this feeling rarely. On emotional stability, only 11.4% reported always feeling

emotionally stable with 20.4% reporting this feeling always. Findings further showed that 15.1%

of the respondents reported always nursing suicidal thought with 27.7% stating that they have

suicidal ideation often. 15.1% reported irrational phobias always with 34.5% reporting this

feeling often.

Research Question Two

Will there be gender difference in the mental health status of secondary school students in Enugu

state?

Table 4.5: t-test Table of Gender Difference in Mental Health Status

Variable Sex N Mean Std. Dev. df tcal tcrit P

Mental Health MALE 936 50.22 1.96 0.000

433 21.2448 2.24848
Status 7

FEMAL
505 15.8515 .81145
E

81
The finding of the study as shown in the t-test table indicates that there is significant gender

difference in mental health status among the respondents. The calculated t value, t cal is 50.227

which is greater than the critical t, t crit. which at df of 936 is read off at infinity yielding 1.96.

Moreover, the p value at 0.000 is also less than the 0.05 significance alpha thus confirming that

there is significant gender difference in mental health status among the respondents. Findings

revealed that male respondents recorded better mental health status as they recorded a lower

mean at 21.2448 compared to their female counterparts who recorded a mean value of 15.8515.

Hypothesis One

Self-esteem will not significantly predict mental health status of secondary school students in

Enugu state

Table 4.6: Predictive Effect of Self-Esteem on Mental health status

R 0.472

R Square 0.222

Adjusted R Square 0.221

ANOVA

Sum of square df Mean square F Sig.

Regression 267.57 0.000

2066.842 1 2066.842
5

Residual 7229.989 936 7.724

82
Total 9296.832 937

a Predictors: (Constant) (Self-esteem)

b Dependent Variable: (Mental health status)

The finding of the study as shown in the table indicates that self-esteem is a significant predictor

of mental health status among the respondents (R = 0.427, p=0.000<0.05). The findings of the

study further revealed that 22.1% (Adj. R2 = 0.221) of the variance in mental health status among

the respondents were accounted for by self-esteem. The results from the regression analysis

shows that there was significant predictive effect of self-esteem on mental health status; F (1,

936) = 267.575, p=0.000<0.05. Based on this, the research hypothesis which states that self-

esteem will not significantly predict mental health status among secondary school students in

Enugu state is rejected and the alternate hypothesis upheld.

Hypothesis Two

Self-efficacy will not significantly predict mental health status of secondary school students in

Enugu state

Table 4.7: Predictive Effect of Self-efficacy on Mental health status

R 0.140

R Square 0.020

Adjusted R Square 0.019

ANOVA

Sum of square df Mean square F Sig.

Regression 182.114 1 182.114 18.701 0.000

Residual 9114.718 936 9.738

83
Total 9296.832 937

a Predictors: (Constant) (Self-efficacy)

b Dependent Variable: (Mental health status)

The finding of the study as shown in the table indicates that self-efficacy is a significant

predictor of mental health status among the respondents (R = 0.140, p=0.000<0.05). The findings

of the study further revealed that 1.9% (Adj. R2 = 0.019) of the variance in mental health status

among the respondents were accounted for by self-efficacy. The results from the regression

analysis shows that there was significant predictive effect of self-efficacy on mental health

status; F (1, 936) = 18.701, p=0.000<0.05. Consequently, the research hypothesis which states

that self-efficacy will not significantly predict mental health status among secondary school

students in Enugu state is rejected and the alternate hypothesis upheld.

Hypothesis Three

The joint effect of self-esteem and self-efficacy will not significantly predict mental health status

of secondary school students in Enugu state

Table 4.8: Joint Predictive Effect of self-esteem and self-efficacy on Mental health status

R 0.632

R Square 0.388

Adjusted R Square 0.387

ANOVA

Sum of square df Mean square F Sig.

Regression 3609.222 2 1804.611 296.66 0.000

84
 4

Residual 5687.610 935 6.083

Total 9296.832 937

a Predictors: (Constant) (Joint effect of self-esteem and self-efficacy)

b Dependent Variable: (Mental health status)

The finding of the study as shown in the table indicates that joint effect of self-esteem and self-

efficacy is a significant predictor of mental health status among the respondents (R = 0.632,

p=0.000<0.05). The findings of the study further revealed that 38.7% (Adj. R 2 = 0.387) of the

variance in mental health status among the respondents were accounted for by joint effect of self-

esteem and self-efficacy. The results from the regression analysis shows that there was

significant predictive effect of joint effect of self-esteem and self-efficacy on mental health

status; F (1, 935) = 296.664, p=0.000<0.05. Therefore, the research hypothesis which states that

the joint effect of self-esteem and self-efficacy will not significantly predict mental health status

of secondary school students in Enugu state is rejected.

Hypothesis Four

Academic factors will not significantly predict mental health status of secondary school students

in Enugu state

Table 4.9: Predictive Effect of Academic factors on Mental Health Status

R 0.836

R Square 0.699

85
Adjusted R Square 0.698

ANOVA

Sum of square Df Mean square F Sig.

Regression 2169.39 0.000

6494.668 1 6494.668
9

Residual 2802.163 936 2.994

Total 9296.832 937

a Predictors: (Constant) (Academic factors)

b Dependent Variable: (Mental health status)

The finding of the study as shown in the table indicates that academic factors is a significant

predictor of mental health status among the respondents (R = 0.836, p=0.000<0.05). The findings

of the study further revealed that 69.8% (Adj. R 2 = 0.698) of the variance in mental health status

among the respondents were accounted for by academic factors. The results from the regression

analysis shows that there was significant predictive effect of academic factors on mental health

status; F (1, 936) = 2169.399, p=0.000<0.05. Based on this, the research hypothesis which states

that academic factors will not significantly predict mental health status among secondary school

students in Enugu state is rejected and the alternate hypothesis upheld.

Hypothesis Five

Relationship factors will not significantly predict mental health status of secondary school

students in Enugu state

Table 4.10: Predictive Effect of Relationship Factors on Mental Health Status

86
R 0.424

R Square 0.180

Adjusted R Square 0.179

ANOVA

Sum of square df Mean square F Sig.

Regression 205.23 0.000

1671.916 1 1671.916
7

Residual 7624.916 936 8.146

Total 9296.832 937

a Predictors: (Constant) (Relationship factors)

b Dependent Variable: (Mental health status)

The finding of the study as shown in the table indicates that relationship factors is a significant

predictor of mental health status among the respondents (R = 0.424, p=0.000<0.05). The findings

of the study further revealed that 17.9% (Adj. R 2 = 0.179) of the variance in mental health status

among the respondents were accounted for by relationship factors. The results from the

regression analysis shows that there was significant predictive effect of relationship factors on

mental health status; F (1, 936) = 205.237, p=0.000<0.05. Therefore, the research hypothesis

which states that relationship factors will not significantly predict mental health status among

secondary school students in Enugu state is rejected and the alternate hypothesis upheld.

Hypothesis Six

Familial factors will not significantly predict mental health status of secondary school students in

Enugu state
87
Table 4.11: Predictive Effect of Familial factors on Mental Health Status

R 0.045

R Square 0.002

Adjusted R Square 0.001

ANOVA

Sum of square df Mean square F Sig.

Regression 18.486 1 18.486 1.865 .172

Residual 9278.345 936 9.913

Total 9296.832 937

a Predictors: (Constant) (Familial factors)

b Dependent Variable: (Mental health status)

The finding of the study as shown in the table indicates that familial factors is not a significant

predictor of mental health status among the respondents (R = 0.045, p=0.000<0.05). The findings

of the study further revealed that 0.01% (Adj. R 2 = 0.001) of the variance in mental health status

among the respondents were accounted for by familial factors. The results from the regression

analysis shows that there was no significant predictive effect of familial factors on mental health

status; F (1, 936) = 2169.399, p=0.000<0.05. Therefore, the research hypothesis which states that

familial factors will not significantly predict mental health status among secondary school

students in Enugu state is not rejected.

Hypothesis Seven

The joint effect of academic factors, relationship factors and familial factors will not

significantly predict mental health status of secondary school students in Enugu state

88
Table 4.12: Joint Predictive Effect of academic factors, relationship factors and familial

factors on Mental health status

R 0.879

R Square 0.773

Adjusted R Square 0.773

ANOVA

Sum of square df Mean square F Sig.

Regression 1061.85 0.000

7189.023 3 2396.341
3

Residual 2107.808 934 2.257

Total 9296.832 937

a Predictors: (Constant) (Joint effect of academic factors, relationship factors and familial

factors)

b Dependent Variable: (Mental health status)

The finding of the study as shown in the table indicates that joint effect of academic factors,

relationship factors and familial factors is a significant predictor of mental health status among

the respondents (R = 0.879, p=0.000<0.05). The findings of the study further revealed that

77.3% (Adj. R2 = 0.773) of the variance in mental health status among the respondents were

accounted for by joint effect of academic factors, relationship factors and familial factors. The

results from the regression analysis shows that there was significant predictive effect of joint

effect of academic factors, relationship factors and familial factors on mental health status; F (1,

934) = 1061.853, p=0.000<0.05. Therefore, the research hypothesis which states that the joint

89
effect of academic factors, relationship factors and familial factors will not significantly predict

mental health status of secondary school students in Enugu state is rejected.

90
Hypothesis Eight

Psycho-social factors (self-esteem, self-efficacy, academic factors, relationship factors, and

familial factors) will not significantly predict mental health status of secondary school students

in Enugu state

Table 4.13: Predictive Effect of Psycho-Social Factors on Mental Health Status

R 0.970

R Square 0.941

Adjusted R Square 0.941

ANOVA

Sum of square df Mean square F Sig.

Regression 2999.16 0.000

8752.838 5 1750.568
7

Residual 543.994 932 .584

Total 9296.832 937

a Predictors: (Constant) (self-esteem, self-efficacy, academic factors, relationship factors, and

familial factors )

b Dependent Variable: (Mental health status)

The finding of the study as shown in the table indicates that the joint effect of psycho-social

factors is a significant predictor of mental health status among the respondents (R = 0.970,

p=0.000<0.05). The findings of the study further revealed that 94.1% (Adj. R 2 = 0.941) of the

variance in mental health status among the respondents were accounted for by joint effect of

psycho-social factors. The results from the regression analysis shows that there was significant

91
predictive effect of psycho-social factors on mental health status; F (1, 935) = 29996.167,

p=0.000<0.05. Therefore, the research hypothesis which states that the joint effect of psycho-

social factors will not significantly predict mental health status of secondary school students in

Enugu state is rejected.

CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATION

SUMMARY

Mental health has suffered significant neglect in health education and health sciences

because of poor consciousness and awareness of the importance of this dimension of health.

Physical health has enjoyed a high level of patronage among experts neglecting emotional health

which is central to even physical health. Some physical health conditions termed psycho-somatic

diseases are fundamentally due to poor mental health which manifest in physical or physiological

signs and symptoms. In this twenty-first century which is characterized by peculiar health

challenges, lifestyle diseases and health conditions are common causes of health problems.

Adolescents are faced with a number of stressors which predispose them to mental health

problems and disorders. These disorders are not considered threatening because only marked

mental health problems are termed health disorders. Understanding predictors of mental health

status is central to improving the health and well-being status of adolescents which are keys to

academic excellence. It is against this backdrop that this study was designed to explore the

perceptions of secondary school teachers in Enugu State regarding the factors that influence the

mental health status of adolescents..

The study was reported in five chapters beginning with the first chapter which has the

background to the study, statement of problem, research objectives, research questions, and

92
hypotheses, delimitation of the study, significance and definition of terms. The main objective of

the study was to explore the perceptions of secondary school teachers in Enugu State regarding

the factors that influence the mental health status of adolescents.. Two research questions and

eight hypotheses were raised to guide the study towards realizing these objectives. The second

chapter of the study was focused on the review of related literature and theoretical framework.

The self-identity theory and PRECEDE model were used in the study. The third chapter centered

on the methodology used in carrying out the study.

The descriptive survey research design was employed in the study and the population

comprised all secondary school students in Enugu state. A sample of 945 respondents was drawn

using multi stage sampling technique. Data was collected using a self-developed and modified

questionnaire with a reliability of 0.88 Cronbach alpha and generated data were analysed using

descriptive statistics of frequency counts and percentages and inferential statistics of regression

models and t-test at 0.05 alpha level. The result of the study showed that respondents recorded

poor mental health status and that there was significant difference in mental health status of male

and female respondents with the former recording a higher level of mental health status. Findings

also showed that psychological factors of self-esteem, self-efficacy as well as the joint effect of

these factors significantly predicted mental health status of the respondents. It was also found

that social factors of relationship factors and academic factors also significantly predicted mental

health status of the respondents while familial factors did not significantly predict it. Joint effects

of social factors as well as the joint effects of psycho-social factors were also found to predict

mental health status of respondents thus providing insight for necessary school health

educational strategies.

Conclusion

93
 From the findings of the study, it is concluded that secondary school students in Enugu

state record poor mental health status and that male adolescents have better mental health status

than their female counterparts. It is also concluded that psychological factors of self-esteem and

self-efficacy predict mental health status just as academic factors and relationship factors. This

therefore provides empirical basis for a responsive school health educational strategies to address

these factors found to predict mental health status of respondents.

Recommendations

Based on the findings and conclusions of the study, the following are recommended:

 There is a pressing need for a school health education policy which must have mental

health as a component to be formulated and implemented in the University

 Devising school health educational therapies to counter stressors predisposing students to

poor mental health status is highly recommended

 Decentralizing and strengthening the students counseling unit of the University is highly

recommended to bring this counseling service to the door steps of students. It is

important to have this unit set up in every hall of residence and faculties in the University

to address the issue of accessibility

 The Youth Friendly Centre must be upgraded and repackaged to provide sound emotional

health development platform for adolescents in the University

 The University community radio could be put into active use in helping adolescents build

resilience against stressors in the university community that could predispose them to

poor mental health status

94
  The alarming level of suicidal ideation recorded in this study sounds the death knell for

the enormity of poor mental health status of adolescents in the University. There is

therefore the need to adopt psychological therapies to build students resilience and

internal conflict resolution skills.

 Strengthening the mental health department currently created at the Jaja Clinic and

creating awareness of its existence and essence must be ensured to help address mental

health issues among adolescents and other members of the University of Ibadan

community. The University community radio can be effectively put into good use for this

purpose.

Suggestion for Future Studies

It is suggested that this same study be replicated in other geo-political zones of the

country and the result obtained compared for similarities and variance. It is also important to

conduct further studies to understand the pathways to resolving mental health challenges among

adolescents in Nigerian universities. Studies investigating other factors not included in this study

like socio-economic factors might be useful in boosting local research on the predictors of

mental health status of adolescents in Nigerian universities.

95
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 APPENDIX 1

QUESTIONNAIRE ON FACTORS THAT INFLUENCE MENTAL HEALTH STATUS OF

ADOLESCENTS AS PERCEIVED BY SECONDARY SCHOOL TEACHERS IN ENUGU STATE

SECTION A: SOCIO-DEMOGRAPHIC DATA

Instruction: Please tick (√) in the space as it reflects your opinion

1. Sex 1 Male [ ] 2 Female [ ]

2. Age: 16-20 ( )

21-25 ( )

26-30 ( )

31 and above ( )

3. Marital status 1 Single [ ] 2 Married [ ] 3 Divorced[ ] 4 Separated [ ]

4. Level of Study ………………………...
5. Course of study ……………………….
6. Religion 1 Christianity [ ] 2 Islam [ ] 3 Traditional 4 others
(specify)……………………………
7. Ethnic Group 1 Yoruba [ ] 2 Hausa [ ] 3 Igbo [ ]

SECTION B:
PSYCHOLOGICAL PREDICTORS OF MENTAL HEALTH

S/N ITEM Always Often Rarely Never

A. SELF ESTEEM
1. I feel that I am a person of worth, at least on an
2. I feel that 1 have a number of good qualities.
3. All in all, I am inclined to feel that I am not a
4. Ifailure.
am able to do things as well as most other people.
5. I feel I do not have much to be proud of.
6. I take a positive attitude toward myself.
7. On the whole, I am satisfied with myself.
8. I wish I could have more respect for myself.
9. I certainly feel useless at times.
10. At times I think I am not good at all.
SN ITEM Always Often Rarely Never
B. Self efficacy
1 I can manage to solve difficult issues

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 2 If someone opposes my decisions I can find ways to
get what I want
3 It is easy for me to stick to my aims and accomplish
my goals
4 I am confident that I could deal efficiently with
unexpected events
5 I know how to handle unforeseen situations
6 I can solve most of my personal problems myself
7 I can remain calm when facing difficulties because I
can rely on my coping abilities
8 If I am in trouble, I can usually think of a solution
9 When I am confronted with any problem, I can
usually find several solutions
10 I can usually handle whatever issue that comes my
way

SECTION C

Social Predictors of Mental Health

S/N ITEM Always Often Rarely Never

ACADEMIC FACTOR
1. I find it very difficult to cope with the demands of study
2. My academic work is so tasking
3. I find it difficult to keep up academic pace with my course
mates
4. I feel I am not doing as well as I should do
5. I am always worried because of my academic
Standing
6. I wish I can improve tremendously on my academics

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7. I will be happier if I could get commendation for
academic exploits
8. My academic is among the top of my worries as a student
9. 1 feel anxious before and during examination

10. 1 get worried every time my result is released because of my

performance

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S/N ITEM Always Often Rarely Never
RELATIONSHIP FACTOR SCALE
1. I have experienced a heart break
2. I will never give my heart in love again
3. 1 wish 1 never fell in love with a particular person that jilted
me
4. From my experience, it is difficult to find true love
5. From my experience, people just make use of others to get
what they want in relationships
6. True love does not exist
7. I am a victim of serial heart breaks
8. I wish people I love could just love me the way I love them

9. I feel so downcast when the person I love deserts me

10. I hate heart breaks that I feel like dying whenever I
experience one

S/N ITEM Always Often Rarely Never

FAMILIAR FACTOR
1. My family issue is a constant source of worry to me
2. My relatives’ tend to complicate matters when I discuss my
challenges with them
3. I feel mentally disturbed as a result of the pressure of the
expectations of my family
4. I try to talk to my parents about anything that
bothers me
5. I experience irrational fears when conversing with my parents
6. I always enjoy the time spent with my family members
7. My relatives’ opinion about me makes me have low self
esteem?
8. I do have misunderstandings or quarrel with my family
members

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SECTION D

MENTAL HEALTH STATUS

S/N ITEM ALWAYS OFTEN RARELY NEVER

1. How regularly do you get depressed?
2. How frequently are you anxious?
3. How frequently do you feel emotionally stable?
4. How frequently do you have difficulty sleeping?
5. How frequently do you become aggressive towards
others when you are stressed?
6. How regularly do you become withdrawn away from
others when you are stressed?
7. Do you usually have feelings that others are better than
you?
8 Have you ever thought of committing suicide?
9. Experiences of irrational fears/phobias
10. How frequently are you involved in behaviours you
should be ashamed of if they became public?

Thank you for your cooperation

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