12. michael dunne


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  • Good afternoon ladies and gentlemen. Welcome to my Confirmation seminar. Here I will talk about the progress on my PhD project to date. The title of my thesis is “Association between academic stress and mental health among Chinese adolescents”. My talk includes three major components: Background information and research questions, methods, and results and implications of the pilot study , and hopefully will be finished in 30-40 minutes . Question time will be after the presentation. Thank you!
  • Among adolescents, academic stress is probably the most important form of stress just like occupational stress among working population. This is not surprising because most adolescents are school students, they spend most of their daytime at school, and academic study is their major job. The heavy academic burden and pressure among Chinese students will illustrated in following slides.
  • These are some results from the 2007 China National Juvenile Internet Use Survey The targeted population is students aged 9-16 years old. When the students were asked “What is the most stressful thing you have experienced?” When the students were asked “What thing you want to do most in the future?”
  • Here are some results from another national survey conducted by The All-China Women’s Federation in 2008. This survey was conducted in a sample of 5040 adolescents and 6552 parents in 10 provinces. According to these results, we can see the huge study burden on Chinese adolescents … Compared with teachers, parents are more merciful ^_^ because they assign less homework for their children. From these results, we can understand the eagerness to raise academic grades from teachers and parents.
  • This is a classroom for grade 12 students in a town school. Look at the books on the desk. They are textbooks, notebooks, and other books related to study. It is difficult to see their faces. They do have a drawer, but it is obvious the drawer is not big enough for so many books. You can imagine the burden they have. Also, you can look at the glasses they wear. Around half of them wear glasses. The higher age, the more students with glasses. Chinese students are not born with bad eyesight. They just use them too much.
  • This is another grade 12 class in a city school. You can see the facilities are a bit better than the town one, but they still don’t have enough room for their books. Even, they have got a shelf to place books. Here one thing need to know, that the classroom is fixed for the same class, and the students attend every subjects in the same classroom. They usually change classroom when they change grade once a year. The books on the shelf are for these students only.
  • These are time tables for senior students in a town (left) and city (right) school. There are a total of 11 classes per weekday. 11 Classes per day * 45 = 8 and half hours Net studying time (exclusive of time breaks between classes). There are only a few “less stressful” classes such as gym and music. Most of these classes are for major (important) subjects (Chinese, Meths, English …).
  • When I am doing the survey, I heard some noise from the next door. A female teacher was scolded and hitting (with a book) some students. And then they were driven out of the classroom. The reason was poor academic performance. Physical punishment is still a very common practice at school, though it is not allowed today theoretically. If the punishment is due to academic performance and not severe, most parents will understand and support teachers’ doing. Most students will also understand and they think this is their fault and blame themselves.
  • After the overview of academic stress, let’s take a look at adolescent mental health. The situation of adolescent mental health is quite severe and beyond what people originally thought. Recent data suggested that: … However, the situation in developing countries is less studied: … This is the overall basis for the present study.
  • The prevalence of depressive symptoms among Chinese adolescents is similar to western countries. The value varies depending upon different instruments and cut-offs used. The prevalence of suicidal thoughts in China is higher than the US 2007 YRBS data. However, there are still gaps in research into mental health in China. …
  • This project is basically a cross-sectional questionnaire survey in Shandong China. There are three study locations … The questionnaire was developed for the present study based on review of the current literature and contains five parts…
  • Shandong is the second most populous province China with 100 million people. Area: 157 thousand KM2 (one-tenth of QLD) Jinan is the capital city of Shandong with about 6, 000, 000 people; Shouguang is a county city with about 300, 000 people; Tianliu is a rural town with about 80, 000 residents.
  • Other variables were measured mainly using existing scales or items Other instruments used: The General Self-efficacy Scale (GSES) The Coping Across Situation Questionnaire (CASQ) Family connectedness scale (4-item) The Parenting Bonding Instrument (PBI, 10-item) School connectedness scale (5-item) The Academic Expectation Stress Inventory (AESI)
  • One major task in the pilot study is to develop the new scale, the ESSA. The process can be divided into three Phases. In phase 1, an initial scale with 30 items was developed based on literature review. 10 of the items were adopted from existing scales. In phase 2, based on discussions with professionals (2), school teachers (4), and students (6), 5 items were removed because of lack of relevance and redundancy, resulting a 25-item scale. In phase 3, the 25-item scale was tested in the pilot study. According to EFA analysis, five items were further dropped because of poor or cross factor loading. The final scale then contains 20 items.
  • These are some examples of the items in the ESSA scale. For each of the statement, students are asked to rate their level of agreement from Strongly disagree (1 points) to Strongly agree (5 points). The total score ranges from 20 to 100 with higher scores indicate higher levels of academic stress.
  • The reliabilities of the ESSA scale were also fair to good. The total scale had good internal consistency All of the four subscales obtained fair-good consistency. A sub-sample (135 students) were surveyed twice (2-week after) to assess the test-retest reliability. All subscales had good test-retest reliability. All items had moderate to good test-retest reliability.
  • 12. michael dunne

    1. 1. THE 2nd INTERNATIONAL CONFERENCE ON PUBLIC HEALTH AMONG GREATER MEKONG SUB-REGIONAL COUNTRIES Hue College of Medicine and Pharmacy, 30 August 2010 Michael P Dunne, Jiandong Sun, Thai Thanh Truc, Kim Xuan Loan, Nguyen Do Nguyen and Jason Dixon The influence of educational pressure on the mental health of adolescents in East Asia: Methods and tools for research
    2. 2. <ul><li>One of the most important forms of pressure in daily life. </li></ul><ul><li>It varies to some extent across cultures. Compared with Western students, Asian or Asian-background adolescents experience higher levels of academic stress. </li></ul><ul><li>Asian students often </li></ul><ul><ul><ul><li>Strive for high academic grades; </li></ul></ul></ul><ul><ul><ul><li>Are less satisfied with their academic performance; </li></ul></ul></ul><ul><ul><ul><li>Have higher parental expectation of academic excellence; </li></ul></ul></ul><ul><ul><ul><li>Spend more time for academic study, especially outside of school. </li></ul></ul></ul><ul><li>Crystal et al., 1994; Ang & Huan, 2006a </li></ul>Academic Stress among Adolescents
    3. 3. Data source: 2007 China National Juvenile Internet Use Survey
    4. 4. Huge study burden <ul><ul><li>Nearly all (97.5%) students do some homework assigned by their teachers every day. </li></ul></ul><ul><ul><li>11.6% less than ½ hour </li></ul></ul><ul><ul><li>36.8% around 1 hour </li></ul></ul><ul><ul><li>49.1% > 2 hours </li></ul></ul><ul><ul><li>Nearly two-thirds (65.2%) of the students do some homework assigned by their parents every day. </li></ul></ul><ul><ul><li>26.9% < ½ hour </li></ul></ul><ul><ul><li>27.6% around 1 hour </li></ul></ul><ul><ul><li>11.6% > 2hours </li></ul></ul><ul><ul><li>More than one fifth (21.7%) attend extra coaching classes on weekends or holidays. </li></ul></ul>Data source : 2008 National Survey on Juvenile Family Education (The All-China Women’s Federation, 2008 )
    5. 5. A classroom for grade 12 in a town school
    6. 6. A classroom for grade 12 in a city school
    7. 7.
    8. 8. Punishment because of poor academic performance
    9. 9. <ul><li>The situation can be severe </li></ul><ul><ul><li>Approximately 20% of children and adolescents suffer from a mental disorder to some extent (WHO, 2005; Belfer, 2008). </li></ul></ul><ul><ul><li>Up to half of all adult mental disorders develop during adolescence (Belfer, 2008). </li></ul></ul><ul><li>Research gaps in East Asia </li></ul><ul><ul><li>Current resources and programs on child and adolescent mental health have been centered in industrialised world (e.g. North America, Australia, Europe). </li></ul></ul><ul><ul><li>There are substantial gaps in youth mental health research and treatment services in developing countries. </li></ul></ul>Adolescent mental health - worldwide
    10. 10. <ul><li>Situation </li></ul><ul><ul><li>A growing body of research into adolescent mental health has been conducted in China in recent years. </li></ul></ul><ul><ul><li>Prevalence of depressive symptoms -- 15% to 55% (Shen et al., 2005; Stewart, Betson, Lam, Chung, & Chung, 1999) . </li></ul></ul><ul><ul><li>Suicidal thoughts –10-20% (Ji & Chen, 2009; Chen, Dunne and Han, 2004,2006; Chen, Dunne et al, 2010) . </li></ul></ul><ul><ul><ul><ul><li>Research Gap </li></ul></ul></ul></ul><ul><ul><li>Much of the previous research in China has been descriptive in nature. </li></ul></ul><ul><ul><li>The influence of some important factors (such as academic stress) on adolescent mental health remains largely unclear. </li></ul></ul>Adolescent mental health - China
    11. 11. <ul><li>What are the multidimensional components of academic stress among adolescents? </li></ul><ul><li>What individual, family, school and social factors predict academic stress among adolescents? </li></ul><ul><li>What are the relationships between academic stress and mental health, taking into account confounding factors? </li></ul>Research questions: this study
    12. 12. <ul><li>Cross-sectional questionnaire surveys </li></ul><ul><li>Study sample: 2,030 Secondary school students (Years 7-12) </li></ul><ul><li>Study locations: Jinan, Shouguang, and Tianliu. Shandong Province </li></ul><ul><li>Questionnaire: </li></ul><ul><ul><li>Demographics; </li></ul></ul><ul><ul><li>Family factors; </li></ul></ul><ul><ul><li>School and academic related factors; </li></ul></ul><ul><ul><li>Peers and friends; </li></ul></ul><ul><ul><li>Mental health indicators (depression, suicidal behavior, substance abuse, and happiness). </li></ul></ul>Research design and methods in China
    13. 13. Survey sites Tianliu
    14. 14. <ul><li>Academic stress: Educational Stress Scale for Adolescents ( ESSA ) </li></ul><ul><ul><li>New scale developed for this study </li></ul></ul><ul><ul><li>16 items </li></ul></ul><ul><ul><li>Five factors: Pressure to study, Worry about grades, Despondency, Self-expectation, and Workload </li></ul></ul><ul><ul><li>These factors account for 26.6%, 14.4%, 8.2%, 7.6% and 6.7% of the variance in the 16-item ESSA score, respectively. </li></ul></ul>Measurement of educational stress
    15. 15. <ul><li>Depression: </li></ul><ul><li>Chinese version of the Center for Epidemiological Studies -Depression Scale (CES-D) (Radloff, 1977; Liu, 1999) . </li></ul><ul><ul><li>20-item, four factors </li></ul></ul><ul><ul><li>4-point Likert scale </li></ul></ul><ul><ul><li>Validated </li></ul></ul><ul><li>Suicidal behaviours and substance use : questions from the youth risk behaviour survey ( YRBS ) </li></ul><ul><ul><li>Developed by the US CDC (Eaton et al., 2008; CDC, 2009) </li></ul></ul><ul><ul><li>Three items for suicidal behaviours (thoughts, plans and attempts) </li></ul></ul><ul><ul><li>Two for current substance use (Smoking and drinking ) </li></ul></ul>Measurement of mental health
    16. 16. Stages in scale development Development and validation of the ESSA scale (Sun, Dunne, Hou and Xu, 2010)
    17. 17. Example items and response format of the ESSA Format of the ESSA scale Statements Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree I am very dissatisfied with my academic grades 1 2 3 4 5 Future education and employment bring me a lot of academic pressure 1 2 3 4 5 My parents care about my academic grades too much which brings me a lot of pressure 1 2 3 4 5 Academic grade is very important to my future and even can determine my whole life 1 2 3 4 5 I always lack confidence about my academic scores 1 2 3 4 5 I feel that study is a very heavy burden for me 1 2 3 4 5
    18. 18. <ul><ul><li>Internal consistency </li></ul></ul><ul><ul><li>The ESSA obtained good internal consistency (Cronbach's α = 0.81 ). </li></ul></ul><ul><ul><li>The coefficients for the five subscales were 0.74, 0.71, 0.66, 0.66 and 0.75 respectively (fair to good consistency). </li></ul></ul><ul><ul><li>Test-retest reliability </li></ul></ul><ul><ul><li>The ESSA and its five subscales all yielded Intraclass Correlation Coefficient (ICC) of 0.78, 0.75, 0.61, 0.70, 0.59 and 0.62 , all indicating good test-retest reliability </li></ul></ul><ul><ul><li>All items had moderate to good reliability (ICC ranged from 0.44 to 0.67 ). </li></ul></ul>Internal consistency and test-retest reliability
    19. 19. <ul><li>Demographics </li></ul><ul><ul><li>Data analysis conducted with 1,627 students (94% of the potential participants) </li></ul></ul><ul><ul><li>Male 55%; Female 45% </li></ul></ul><ul><ul><li>Age 11 to 20 ( Mean =15.47, SD =1.85). </li></ul></ul><ul><ul><li>Almost all (99.5%) were Han Chinese </li></ul></ul><ul><ul><li>Junior (grade 7-9) 49%; Senior (Grade 10-12) 51% </li></ul></ul><ul><ul><li>Urban family 42%; Rural family 58% </li></ul></ul>Main survey analysis: Correlations with youth mental health and risk behaviour
    20. 20.
    21. 21. Associations with mental health measures Factor 1 Pressure to study
    22. 22.
    23. 23.
    24. 24.
    25. 25.
    26. 26. Current research in Viet Nam <ul><li>In September 2010 we will conduct a survey of approx 1,000 secondary school and high school students in HCMC </li></ul><ul><li>Six schools in District 1. </li></ul><ul><li>MPH projects of Thai Thanh Truc and Kim Xuan Loan (Atlantic Philanthropies students at QUT) </li></ul><ul><li>Incorporates ESSA and the newly revised ACE (Adverse Childhood Experiences) questionnaire from WHO/US CDC (Brown, Butchart et al, 2010) </li></ul>
    27. 27. Aims <ul><li>To test the psychometric properties of the ESSA scale with a Vietnamese sample </li></ul><ul><li>In multivariable models, examine the relative influence of academic stress, ACEs and a range of school and family factors on key aspects of youth mental health and well-being. </li></ul>