1 MINISTRY OF EDUCATION AND TRAINING THAI NGUYEN UNIVERSITY DAM THI BAO HOA EVALUATING THE EFFECTIVENESS OF EARLY DETECTION AND INTERVENTION MODEL ON MENTAL DISORDERS OF STUDENTS FROM 6 TO 15 YEARS IN THAI NGUYEN CITY SPECIALITY: SOCIOLOGY AND HYGIENE HEALTH ORGANIZATION CODE NUMBER: 62.72.01.64 SUMMARY OF THE doctoral DISSERTATION Thai Nguyen - 2014 2 The dissertation was completed at COLLEGE OF MEDICINE & PHARMACY, THAI NGUYEN UNIVERSITY Supervisors: 1. Asso Prof. Nguyen Van Tu, PhD. 2. Tran Tuan, PhD. Critic 1: Critic 2: Critic 3: The dissertation will be defended nationally to the Evaluation Committee At College of Medicine & Pharmacy, Thai Nguyen University. at on 2014. The dissertation is available for reference at: - The National Medical Library - Learning Resource Centre of Thai Nguyen University - Library of Thai Nguyen Medical and Pharmacitical college 1 INTRODUCTION Mental disorders afect about 20% children and adolescents in all countries over the world. If not detected and prompt treatment, they can leave severe long consequences for the child itself, and affect the lives of other members of the family, the community and increase the society cost burden. However, according to the review of World Health Organization (WHO), child and adolescent mental health in many countries were not given adequate attention. Even in the developed countries like United State, United Kingdom, about 70-80 % of children and adolescents had mental health problems but were not received appropriate medical services due to barriers on geography, perceptions, economics, health services, prejudice, stigma and discrimination. In Vietnam, the community mental health care program has just been implemented since 1998 and so far concentrated mainly in patients with schizophrenia and epilepsy. About 10 years ago, researches have done some surveys on child and adolescent mental health as epidemiological studies to determine the burden of disease in the community, studies to build diagnostic screening tool in the primary health care, the communication activities to raise awareness of the community and to cary out som pilot solution interventions on child and adolescent mental health care. Thai Nguyen City is the cultural and economical center of the Northern Mountainous Region of Viet Nam. Besides these advantages , Thai Nguyen also faced with many complex problems, especially the problems of children and adolescents, such as stealing, fighting, truancy, suicide, drug addiction, game addiction Within the general context of Viet Nam , child and adolescent mental health care in Thai Nguyen is still being lacked, there is lack of the researches on this issue. Wishing to find out the status and needs of mental health care for students in Thai Nguyen City and how to help detect the model help to early treatment and prevention of mental health problems for students in accordance with the current conditions of Thai Nguyen, we caried out the research "Evaluating the effectiveness of early detection and intervention model on mental disorders of students from 6 to15 years in Thai Nguyen city" with 2 following objectives: 2 1. To describe the status, a number of factors related to student mental health and the needs on mental health care on 6-15 year-old students in Thai Nguyen city in 2009. 2. To develop and evaluate the effectiveness of early detection and intervention of mental disorders for students of Hoang Van Thu Primary School, Nguyen Du Secondary School in Thai Nguyen city after 2 years of intervention. THE STRUCTURE OF THE THESIS The main part of the thesis consists 114 pages. It includes the following sections: Introduction: 2 pages Chapter 1 - Overview: 28 pages Chapter 2 - Subjects and methodology: 19 pages Chapter 3 - Outcomes of the study: 36 pages Chapter 4 - Comments: 27 pages Conclusions: 02 pages The outcomes of the study was displayed in 40 tables, 04 charts, 04 pictures, 01figure and 07 boxes. The thesis used 129 literature references, of which, there are 35 Vietnamese literature references, 84 English references. Chapter 2 SUBJECTS AND METHODOLOGY 2.1. Subjects, research location and duration of study 2.1.1. Subjects of study - Students at primary and secondary schools (from 6 to 15 years old). - Parents of the students. - Teachers - School health workers, community health worker. - Leaders of the school, teachers in charge of the Ho Chi Minh Young Pioneers, Ho Chi Minh Communist Youth Union in the school 3 Inconclusion: students, parents or careers of students disaggre to take part in the research. 2.1.2. Duration of study: From September 2009 to January 2012. 2.1.3. Research location: Nguyen Viet Xuan Primary School, Hoang Van Thu Primary School, Doc Lap Secondary School and Nguyen Du Secondary School of Thai Nguyen city. 2.2. Research Methodology 2.2.1. Design of research The research was based on: - Cross-sectional descriptive study - Intervention study - Combining qualitative and quantitative study. The model was biult in figure 2.1 To compare To compare To compare Figure 2.1. The research design Thai Nguyen city Primary and secondary schools Intervention schools Control schools The data before The data before Intervention not intervention Intervention schools The data after The data after Control schools 4 2.2.2. Sample 2.2.2.1 Research of description * Sample size: Applying the formula for sample size for described study:     2 2 1 2 p 1 p nZ p.      - n is minimum number need to be researched; - Z (1- /2): coefficient of confident limit (with  = 0,05, Z 2 (1- /2) = 1,96).  Students sample size in description research p : ratio of students with mental disorder according to researches before, estimated p = 0.2. 1- p = 0,8. ε: desired error, we choosed ε = 7,5 % p. Since then we had n1 = 2794 So, the minimum number need to be researched was 2794 students. In fact, we studied 2850 students.  Parent sample size in description research p = 0,7 (because of having no data on proportion of parents interested in child mental health, we used data on proportion of people who were interested in mental health); 1- p = 0,3; ε: desired error, we choosed ε = 6,5 % p. Since then we had n2 = 390. Because of community survey, we plus 10% of withdrawn, then parent sample size in description research is from 390 to 429 parents. In fact, we studied 419 parents.  School staff sample size: In which: - School administrators: 2 people in one school, 4 schools were 8 people - All of teachers in charge of the class of 4 schools: 84 teachers - School health worker: there was 1 school health worker in a school, in 4 schools were 4 school health workers. 5  Qualitative sample: Group discussion: we planed to make 4 group discussions in 4 schools – 1 group discussion in one school. We choosed intentionally 15 people in a school: 01 administration member, 05 homeroom teachers, 01 school health worker, 01 community health worker, 01 teacher in charge of the Ho Chi Minh Young Pioneers, Ho Chi Minh Communist Youth Union, 06 parents. In - depth interview: 01 leader of Education and Training Department of Thai Nguyen city, 01 local health leader; in one school: 01 administration member, 01 homeroom teacher representative at each grade, 01 parent in each grade, 01 school health worker. * Techniques of choosing the sample: - Purposeful sampling: Thai Nguyen city - Thai Nguyen province - Sampling schools: we choose 4 schools by random draw method. So, we had Hoang Van Thu primary school, Nguyen Viet Xuan primary school, Nguyen Du secondary school, and Doc lap secondary school. - Sampling students: the entire sample; we made a list of all the students of 4 schools selected. After that, we surveyed under the list and had 2850 students. Some cases were absence or refused to participate in the research. - Sampling parents: Each class chose 5 parents according to the list of class students with distance k = 7. 2.2.2.2 Intervention study * Sample size:  Intervention sample for students was calculated as the sample size calculation for testing the difference between two rate. P 1 ( 1-p 1 ) + p 2 (1-p 2 ) n = z 2 (,) (p 1- p 2 ) 2 6 In which: p 1 : proportion of children with mental health problem according to previous studies. So, p1= 0,2. P 2: 0,15 proportion which was expected after intervention. The rate expected to reach was 0.15 : is statistical significance and probability of a error type 1. It was estimated 0.1. : is probability of a error type 2. It was estimated 0.1; So the sample capacity was 90%. z 2 (): look up from the table to the value of ,, we had z 2 () = 8,6. From then, it is calculated n = 988; estimated 10% give up, n chosen is 1086 students in the intervention group and 1086 students in the control group. Due to the nature of public interventions and research ethics, the intervention performed on the entire students at one primary school and one secondary school.  Intervention sample for parents: similar to the intervention sample for students  Intervention sample for officers, school teachers, health workers: all of homeroom teachers, school leaders, school health workers, teachers in charge of the Ho Chi Minh Young Pioneers Ho Chi Minh Communist Youth Union in the school and community health workers.  The sample size for intervention the group of mental disorder students Due to the nature of public interventions and research ethics, we treatmented all of the students with mental disorders in the intervention schools according to the results of the phase 1 survey. * Choose intervention group: Hoang Van Thu Primary School and Nguyen Du Secondary School. Control group: Nguyen Viet Xuan Primary School, Doc Lap Secondary School. 7 - Investigate before, after intervention similar to cross-sectional survey earlier. 2.2.3. The studied criteria 2.2.3.1. The studied criteria for objective 1 * The general information of research group - General characteristics of students: age, gender, class - Personal characteristics of students: illness characteristics, family circumstances, psychological trauma, of the students with mental disorders. - General characteristics of parents: age, gender, ethnicity, education level, occupation, number of children - General characteristics of teachers: age, gender, ethnicity, education level, occupational seniority * The criteria on student mental disorder - The proportion of students could have mental health problem after screening (SDQ score > 14). - The proportion of students with mental disorders according to ICD10 criteria. - The proportion of students with mental disorders by gender. - The proportion of students with mental disorders by grade. - The proportion of students with mental disorders according to ethnic characteristics. * The criteria of knowledge, attitude and practice on student mental health care of parents, teachers - The percentage of the level of knowledge, attitude and practices of parents on student mental health care. - The percentage of the level of knowledge, attitude and practice of teacher on student mental health care. * The study criteria on the relationship between student mental disorders and other factors - The relationship between the student mental disorders with psychological trauma. 8 - The relationship between the student mental disorders with the knowledge, attitude and practices on student mental health care of parents. * The study criteria on the needs of the student mental health care - Percentage of parents expected to receive documents on student mental health care. - The percentage of parents wish to be consulted about student mental health care. - The percentage of parents support activities for student mental health care. - The percentage of teachers would like to receive literature on student mental health care. - Teacher ratio desired being counseled on student mental health care. - Percentage of teachers support activities for student mental health care. - The percentage of members participated in group discussions had needs about student mental health care. - Opinions on the needs of student mental health care of the community through group discussions and in-depth interviews. 2.2.3.2. The studied criteria for objective 2 * The studied criteria for building intervention model - Human Resource: the number of people participated the model. - Material resource: Number of training and communicating materials, psychological tests were used, the materials, facilities used in research. - Organization: + Student Mental health care Department in Thai Nguyen city was established with the responsibilities and duties of each member. + Student Mental health care Group was founded in Hoang Van Thu Primary School and Nguyen Du Secondary School, officials responsible for each member in the group. [...]... knowledge Want to know how to detect Want to know how to help Want to know how to prevent Having expert advice when necessary Say yes SL % 55 /60 91.7 52 /60 86. 7 60 /60 100.0 60 /60 100.0 56/ 60 93.3 60 /60 100.0 48 /60 80.0 Say no SL % 5 /60 8.3 8 /60 13.3 0 0 0 0 4 /60 6. 7 0 0 12 /60 20.0 Comment: the demand of student mental health care in group discussions was very high 3.2 Results in building and evaluating the... 91 % 76. 0 17 .6 3.0 32.2 8 .6 14 .6 39.1 Comment: The most common disorders were depression ( 76% ), attention deficit hyperactivity (32.2%), anxiety (17 .6% ) Many students have mix disorders (39.1%) 3.1 3 The factors related to mental disorders in students Table 3.9 The relationship between age, sex, ethnicity and mental disorders in the student Disorder Factors Yes 2 , p No Age 6- 11 n 98 % 6. 0 n 154 0 %... 6- 11 n 98 % 6. 0 n 154 0 % 94.0 Gender 12 -15 Mal 135 127 11.1 8.9 1077 13 06 88.9 91.1 Ethnicity Female Minorities 1 06 35 7.5 7.8 1311 4 16 92.5 92.2 Kinh 198 8.3 2201 91.7 2 = 24 P < 0.01 2 = 1.8 p > 0.05 2 = 0.1 p > 0.05 Comment: There was an association between age and mental disorders Group of 12 -15 had significantly more disorders than group 6- 11 (p 0.05 413 6 419 Comments: No association found between practice of parents with mental disorders in the students (p > 0.05) 3.1.4 The needs of mental health care for students 96. 4 98 96 document 94 89 92 89 Medical advice 90 88 Examination 86 84 Figure 3.3 The needs of mental health care for students of parents... Total 1 06 127 233 36 172 208 2 = 39 ; p < 0.001 142 299 441 Comment: The students having stress would likely more mental disorders (p . trouble in school 55 /60 91.7 5 /60 8.3 Mental health care was necessary 52 /60 86. 7 8 /60 13.3 Want to have more knowledge 60 /60 100.0 0 0 Want to know how to detect 60 /60 100.0 0 0. 0 0 Want to know how to help 56/ 60 93.3 4 /60 6. 7 Want to know how to prevent 60 /60 100.0 0 0 Having expert advice when necessary 48 /60 80.0 12 /60 20.0 Comment: the demand of. , p n % n % Age 6- 11 98 6. 0 154 0 94.0 2 = 24 P < 0.01 12 -15 135 11.1 1077 88.9 Gender Mal 127 8.9 13 06 91.1 2 = 1.8 p > 0.05 Female 1 06 7.5 1311 92.5 Ethnicity