J. S. S. College of Nursing

J. S. S. College of Nursing

J. S. S. COLLEGE OF NURSING

1ST MAIN, SARASWATHIPURAM, MYSORE

SYNOPSIS SUBMISSION

BY:

Ms. THUSHARA VASUKUTTAN

1ST YEAR M.Sc NURSING

J. S. S. COLLEGE OF NURSING

1STMAIN, SARASWATHIPURAM

MYSORE - 570009

GUIDE:

Dr N V MUNINARAYANAPPA

PROFESSOR AND HOD PSYCHIATRIC NURSING

P.G. STUDIES COORDINATOR CUM VICEPRINCIPAL

J. S. S. COLLEGE OF NURSING

1STMAIN, SARASWATHIPURAM

MYSORE – 570009

BATCH: 2010 – 2012

PROFORMA FOR REGISTRATION OF

SUBJECTS FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS
(IN BLOCK LETTERS) / Ms. THUSHARA VASUKUTTAN
1ST YEAR MScNURSING
JSSCOLLEGE OF NURSING
1STMAIN, SARASWATHIPURAM
MYSORE-570009.
2. / NAME OF THE INSTITUTION / JSS COLLEGE OF NURSING
MYSORE
3. / COURSE OF STUDY AND SUBJECT / 1ST YEAR M.Sc NURSING,
PSYCHIATRIC NURSING
4. / DATE OF ADMISSION TO THE COURSE / 26.05.2010
5. / TITLE OF THE TOPIC / “A Descriptive And Comparative Survey Of Depression And Suicide Risk Among Residential And Non Residential Adolescent Girls Of Selected Educational Institutions Of Mysore”

6. BRIEF RESUME OF THE INTENDED WORK

6.0 INTRODUCTION

Adolescence is a transition period from childhood to adulthood and is characterized by a spurt in physical, endocrinal, emotional, and mental growth, with a change from complete dependence to relative independence. The period of adolescence for a girl is a period of physical and psychological preparation for safe motherhood. As the direct reproducers of future generations, the health of adolescent girls influences not only their own health, but also the health of the future population. Almost a quarter of India's population comprises of girls below 20 years.1

Numerous factors may predispose adolescent girls to depression. These include the increase in hormones associated with puberty, changes in body shape and emerging sexual identity, family stressors such as divorce and peer pressure. Separation associated with leaving for college is another stressor which may predispose to depression. Adolescents who develop depression often have recurrences in adulthood and a more severe course. Early detection is essential to minimize recurrences and morbidity from the illness.2

Adolescents who have low self esteem are highly self critical, and who feels little sense of control over negative events are particularly at risk to become depressed when they experience stressful events. Adolescent girls are twice as likely as boys to experience depression. In adolescents depressed mood is common because of normal process of maturing, independence conflicts with parents, failure at school, death of a friend or relative, influence of sex hormones, child abuse, any illness, family history of depression etc. There are also associated symptoms like difficult concentration, irritable mood, memory loss, excessive sleeping during day time, fatigue, loss of interest in activities, temper etc.3

School depression is a type of depression that occurs in school going children. Number of students are affected by depression every year and due to the age group that can be affected by depression it is important at the first sign to have the child diagnosed. Following are the symptoms of school depression viz, inability to concentrate while studying, irritation at school without proper reason , poor apetite, sleeping problems which consists of too little sleep or too much sleep, little interest in extracurricular activities, nervousness or hesitation with out any reason, fatigue, negative thoughts and poor self confidence. Some of the causes that may lead to depression in school children are extra pressure of parents and teachers to perform well in examination, too much expectation from parents, book worms, low self confidence, fear of bad performance in studies, no friends, and inferiority complex4.

Depression is a common disorder among children (less than 18 years). Approximately 5% of children at any one time may suffer from serious depression. The prevalence of depression increases with age, especially after the onset of puberty. There is no gender related difference in the prevalence of depression among pre-adolescent children. However, onset of puberty is associated with a marked increase in the rate of depression among females, with a female to male ratio of 2:1. It is often during adolescence that depression first manifests itself in girls, and for the first time girls outnumber boys 2:1 in prevalence of the illness. It is estimated that 4.7% of the teenage population suffers from depression. Common symptoms of adolescent depression are irritability, hopelessness, anhedonia, changes in sleep and appetite, academic decline, reduced energy, reduced social interactions, somatic symptoms, and suicidal ideation. Depression in children and adolescents is associated with an increased risk of suicidal behaviours. Depression and suicide can destroy the very essence of a teenager’s personality, causing an overwhelming sense of sadness, despair, or anger.2

Suicide is the act of a human being intentionally causing his or her own death. Suicidal ideation in adolescents is a sign of severe distress and is predictor of poor overall functioning in later life. Suicide is often committed out of despair, or attributed to some underlying mental disorder which includes depression,panic disorder, alcoholism and drug abuse, lack of parentsupport, negative life events, diminished family cohesion5.Depression is a serious problem that impacts every aspect of a teen’s life. Left untreated, teen depression can lead to problems at home and school, drug abuse, self-loathing—even irreversible tragedy such as homicidal violence or suicide. It comes to no surprise to discover that adolescent depression is strongly linked to teen suicide.An alarming and increasing number of teenagers attempt and succeed at suicide. In depressed teens who also abuse alcohol or drugs, the risk of suicide is even greater. The reasons behind a teen's suicide or attempted suicide can be complex. Although suicide is relatively rare among children, the rate of suicides and suicide attempts increases tremendously during adolescence.6

Parents should be particularly aware of the risk of depression in children who have had long-term or chronic illnesses, who have been abused or neglected, have experience a recent trauma, or lost a loved one. The National Institute of Mental Health also reports that teenage girls are more likely to develop depression than teenage boys (NIMH, 2000).6

Fortunately teenage depression and suicide risk can be treated, and as a concerned parent, nurse teacher or friend. By learning the symptoms of depression and suicide risk and expressing concern when spotting the warning signs. Numerous studies have examined the incidence of suicidal thoughts and suicide attempts by age, race, educational level, family back ground, religion, socio economic status, sexual orientation and other demographic variables.3The nurses must make it clear to adolescents that suicidal behaviour is not confidential and person must be told. The nurses should explore the following areas like seriousness of attempts, mental status of adolescents; extend of environmental stress and likelihood of repeated suicide attempts.

6.1 NEED FOR THE STUDY

Adolescent girl depression is quite common among the teen years for many females. Although these girls seem to be more common than in boys according to statistics, it may only be the case because girls tend to seek out help more frequently than do boys.6 Depressive disorders are identified by the World Health Organization as priority mental health disorderof adolescence because of its high prevalence, recurrence, ability to cause significant complications and impairment. Across the globe, the lifetime prevalence for major depression in adolescence is 15% to 20% with a recurrence rate of 60–70% often resulting in suicide, school dropout, pregnancy, substance abuse, progressing in to adult depression, functional disability and significant impairment.7

Population studies show that at any one time between 10 and 15 percent of the child and adolescent population has some symptoms of depression. The prevalence of the full-fledged diagnosis of major depression among all children ages 9 to 17 has been estimated at 5 percent. Estimates of 1-year prevalence in children range from 0.4 and 2.5 percent and in adolescents, considerably higher. The prevalence of depression among adolescents among primary-care paediatric care settings in India is 11.2% and recognizing adolescent depression becomes a responsibility of paediatricians. However, up to 50% of depressed adolescents are not diagnosed in primary-care settings.8

A number of epidemiological studies have reported that up to 2.5 percent of children and up to 8.3 percent of adolescents in the U.S. suffer from depression. An NIMH-sponsored study of 9- to 17-year-olds estimates that the prevalence of any depression is more than 6 percent in a 6-month period, with 4.9 percent having major depression. Studies indicate that one in five children have some sort of mental, behavioral, or emotional problem, and that one in ten may have a serious emotional problem. Among adolescents, one in eight may suffer from depression. Of all these children and teens struggling with emotional and behavioral problems.9

A cross-sectional study involving a predominantly adolescent school population was conducted to determine the prevalence and clinical characteristics of depression in adolescents in the city of Mersin, Turkey. The prevalence of depression according to the CBDI (cut-off point: 19) was found to be 12.55% in this study group, with a significantly higher prevalence of depression in girls than in boys.10

A cross sectional study of prevalence of depression in adolescent students of a public school in Pune showed that 15.2% of school-going adolescents were found to be having evidence of distress (GHQ-12 score e"14); 18.4% were depressed (BDI score e"12); 5.6% students were detected to have positive scores on both the instruments. Economic difficulty, physical punishment at school, teasing at school and parental fights were significantly associated with higher BDI scores, indicating depression. The study highlights the common but ignored problem of depression in adolescence. The study recommends that teachers and parents be made aware of this problem with the help of school counselors so that the depressed adolescent can be identified and helped rather than suffer silently.11

Depression in children and adolescents is associated with an increased risk of suicidal behaviours.Theconsequences of untreated depression can be increased incidence of depression in adulthood, involvement in the criminal justice system, or in some cases, suicide.Adolescent suicide is now responsible for more deaths in youths aged 15 to19 than cancer Suicide is the third leading cause of death among young people ages 15 to 24. Even more shocking, it is the sixth leading cause of death among children ages 5-14.5

The age-specific mortality rate from suicide was 1.6 per 100,000 for 10- to 14-year-olds, 9.5 per 100,000 for 15- to 19-year-olds. The age-specific mortality rate from suicide was 1.6 per 100,000 for 10- to 14-year-olds, 9.5 per 100,000 for 15- to 19-year-olds (i.e., about six times higher than in the younger age group.8

The highest suicide rate in the world has been reported among young women in South India by a new study. According to the World Health Organization, as it brings to light Asia's suicide problem. The suicide rate in India is 10.3. In the last three decades, the suicide rate has increased by 43%. The average suicide rate for young women aged between 15 to 19living around Vellore in Tamil Nadu was 148 per 100,000. This compares to just 2.1 suicides per 100,000 in the same group in the UK. India’s youth suicide rate in 2005 – 2007 was 6.9 per 100,000 between youths aged 15 to 24. Substantially lower than rate of 9.4 in 1995-1997.12

In 2004, an estimated 14.0 percent of adolescents aged 12 to 17 (approximately 3.5 million adolescents) had experienced at least one major depressive episode (MDE) in their lifetime, and an estimated 9.0 percent (2.2 million adolescents) experienced at least one MDE in the past year. Rates of past year MDE varied by age group. Adolescents aged 16 or 17 were more than twice as likely to report past year MDE as those aged 12 or 13 (12.3 vs. 5.4 percent).13

Numerous studies have examined the incidence of suicidal thoughts and suicide attempts by age, race, educational level, family background, religion, socioeconomic level, sexual orientation, and other demographic variables.According to the Surgeon General, a youth commits suicide every two hours in our country. Suicide claims more adolescents than any disease or natural cause. Adolescents now commit suicide at a higher rate than the national average of all ages. Suicide rates for adolescent females have increased between two to three fold. Problem turns out to be depression, it still needs to be addressed, the sooner the better.8

A cross sectional study was conducted on school students to find out stress, psychological health, and presence of suicidal ideas in Chandigarh. Results revealed that the students with academic problems and unsupportive environment at home perceived life as a burden and had higher rate of suicide ideation.14

A longitudinal study was conducted to evaluate the influence of frequent change of residence on risk of attempted and completed suicide among children and adolescents. Researchers found out that frequent change of residence may induce stress among children’s and therefore increase their risk of suicidal behaviour. More research is needed to explore this association.15

Left untreated, teen depression can lead to problems at home and school, drug abuse, self-loathing—even irreversible tragedy such as homicidal violence or suicide. It comes to no surprise to discover that adolescent depression is strongly linked to teen suicide. There are few studies conducted in India comparing residential and non residential adolescent girlsand how these girls can be helped. So the researcher finds it relevant from the above described facts and findings to take up the study. Conducting research in this area enriches nurses’ awareness more about depression and suicide risk and their prevention strategies. So the investigator aimed this study to explore depression and suicide risk among residential and non residential adolescent girls in India.

6.2 REVIEW OF LITERATURE

Suicide is the third leading cause of death among adolescents and teenagers. According to the National Institute for Mental Health (NIMH), about 8 out of every 100,000 teenagers committed suicide in 20007. For every teen suicide death, experts estimate there are 10 other teen suicide attempts.In a survey of high school students, the NationalYouthViolencePreventionResourceCenter found that almost 1 in 5 teens had thought about suicide, about 1 in 6 teens had made plans for suicide, and more than 1 in 12 teens had attempted suicide in the last year. As many as 8 out of 10 teens who commit suicide try to ask for help in some way before committing suicide, such as by seeing a doctor shortly before the suicide attempt. In the last three decades, the suicide rate has increased by 43%.16

A pilot study conducted to detect suicide risk in adolescent and adults seeking treatment in an emergency department. An advanced practice nurse verbally administered the RSQ to a convenience sample of 104 patients ages 12 to 82. Psychometric analysis was used. Study showed approximately 30% all patients who participated screened positive for suicide risk. Nurses in all health care settings need to initiate suicide screening and implement nursing interventions directed towards suicide prevention.17

A study done to find out relationships between adolescents' self-reports of perceived parental style, pessimism, and the spectrum of suicidal behavior in a sample of Australian high school students with mean age 15.8. Three hundred and seventy students completed questionnaire. Multiple regression analysis was adopted. This study examined a possible relationship between negative perceptions of parental style and adolescent suicidal behavior being mediated through a sense of hopelessness. Results showed that there was a high level of suicidal behavior reported, with suicidal adolescents perceiving their parents to be significantly more critical, less caring and more overprotective.18

A study investigated the mechanisms underlying peer contagion of depressive symptoms in adolescence. Five annual measurements of data were gathered from a large community-based network of adolescents with mean age of 14.3 years. Results showed that, after controlling for selection and deselection of friends on the basis of depressive symptoms, peers' depressive symptoms predicted increase in adolescents' depressive symptoms over time. Results suggest that peers' depressive symptoms place adolescents at risk of developing depressive symptoms through increasing in failure anticipation.19

A study was conducted to investigate whether yearly prevalence rates of adolescent suicidal episodes follow different patterns by sex. A longitudinal categorical data was used with a sample of 1248 aged between 11 to 19. Multiple-group growth models revealed that peak levels of past-year ideation and plans occurred during mid adolescence for girls, but slowly increased through late adolescence for boys. Results found that prevalence patterns for attempts were very similar for boys and girls, with both increasing through mid adolescence and then declining, although girls' risk declined slightly more rapidly. This information may help alert gatekeepers to developmental periods during which boys and girls are particularly vulnerable to suicide-related experiences, and also may help inform the timing of preventive efforts.20

A longitudinal studywas conducted to investigate the association between childhood adversities,interpersonal difficulties during adolescence, and suicide attemptsduring late adolescence or early adulthood.A community sample of 659 families from UpstateNew York was interviewed in 1975, 1983, 1985 to 1986, and 1991to 1993. During the 1991-1993 interview, the mean age of theoffspring was 22 years.Results indicated that maladaptive parenting and childhood maltreatmentwere associated with an elevated risk for interpersonal difficultiesduring middle adolescence and for suicide attempts during lateadolescence or early adulthood. These interpersonal difficulties may playa pivotal role in the development of suicidal behaviour. Youthswho are at an elevated risk for suicide may tend to be in needof mental health services that can help them to cope with anextensive history of profound interpersonal difficulties, beginningin childhood and continuing through adolescence.21

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A study done to assess the specific influence of family relationship difficulties, over and above the effect of depression, on the risk of adolescent suicidal behaviour. The study was based on the clinical data summaries, “item sheets,” of children and adolescents who attended the Maudsley Hospital during the 1970s and 1980s.284 cases of suicidal behaviour , defined as suicidal ideas, attempts, opr threats were compared with 3054 non suicidal controls with mean age 13.9, using stepwise logistic regression controlling for age and sex.They concluded the study as although depression is the largest single risk factor for teenage suicidal behaviour, family relationship difficulties make a significant independent contribution to this risk.22