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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 22  |  Issue : 2  |  Page : 221-226

Predictors of emotional and behavioural problems amongst children of North East India: A hospital-based study


1 Ph.D Scholar, Department of Psychiatric Nursing, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India
2 Professor & Head, Department of Psychiatric Nursing, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India
3 Assistant Professor, Department of Psychiatric Nursing, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India

Date of Submission02-Jun-2021
Date of Decision26-Oct-2021
Date of Acceptance18-Nov-2021
Date of Web Publication10-Dec-2021

Correspondence Address:
Mrs. Amina Ahmed
Department of Psychiatric Nursing, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijcn.ijcn_42_21

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  Abstract 


Mental health problems in early childhood have negative consequences in later life, and risk factors put an extra burden on their health outcome. Hence, researchers aimed to determine the predictors of emotional and behavioural problems amongst the children. A quantitative approach and cross-sectional descriptive design was used to conduct this study amongst 100 parents of children who attended a Tertiary Mental Healthcare Institute of North East India. Participants were selected by using systematic random sampling technique. Data were collected by using Socio Demographic Proforma, Alabama Parenting Questionnaire and Strengths and Difficulties Questionnaire. Data were analyzed by using stepwise multiple linear regression techniques to determine predictors of emotional and behavioural problems amongst the children. Findings revealed that age of the child and inconsistent discipline are the significant predictors of the emotional problems, poor monitoring/supervision is the significant predictor of conduct problems, age of the child, poor monitoring/supervision and inconsistent discipline are significant predictors of hyperactivity; gender of the child is the significant predictor of peer problems and poor monitoring/supervision and corporal punishment are the significant predictors of the total difficulties. Findings also revealed that positive involvement is the significant predictor of pro-social behaviour. These findings confirmed that negative parenting practices, age and gender of the child are the risk factors for the emotional and behavioural problems amongst the children. Therefore, health professionals working with children need to consider these factors in planning a comprehensive intervention package for better outcome.

Keywords: Behavioural problems, children, emotional problems, parent, parenting practices, Predictors


How to cite this article:
Ahmed A, Baruah A, Ahmed N. Predictors of emotional and behavioural problems amongst children of North East India: A hospital-based study. Indian J Cont Nsg Edn 2021;22:221-6

How to cite this URL:
Ahmed A, Baruah A, Ahmed N. Predictors of emotional and behavioural problems amongst children of North East India: A hospital-based study. Indian J Cont Nsg Edn [serial online] 2021 [cited 2022 May 28];22:221-6. Available from: https://www.ijcne.org/text.asp?2021/22/2/221/332201




  Introduction Top


Childhood is the most rapidly growing phase of human life. In this period, they are especially vulnerable to psychological, emotional, intellectual challenges. Worldwide, 10%–20% of children are suffering from mental health problems.[1] The prevalence rate varies across India from 15% to 31.8%.[2],[3],[4],[5] Mental health problems in early childhood have negative consequences in later life such as poor scholastic achievement, peer rejection, poor employment prospects, antisocial behaviours, teenage pregnancy and substance use[1],[6] and create a significant burden not only on family and community but also on public health, resources and workforce of low-and middle-income countries.[7]

Earlier studies reported many risk factors which influences the emotional and behavioural problems of children, those were multiple psychosocial and biological factors[8] familial and environmental adversity,[9] socioeconomic status and child academic performance,[3] abnormal psychological environment,[10] negative parenting[10],[11],[12] and poor parenting practices.[13],[14] Most of these studies are done amongst community and school-going children and explorations of these factors amongst clinical population are less. Moreover, the presence of these factors amongst children with mental health problems may lead to poor prognosis. Hence, researchers felt the necessity to conduct this study in a tertiary healthcare setting to determine the predictors of emotional and behavioural problems amongst children.


  Materials and Methods Top


A quantitative approach and cross-sectional descriptive design were used for this study. This study was conducted over a period of 4 months from January 2021 to April 2021 amongst 100 parents of children (6–17 years) registered for the first time for treatment in outpatient department of Child and Adolescent Psychiatry of a Tertiary Mental Healthcare Institute of Northeast India. Participants who were not the primary caregiver or have been suffering from severe psychological or neurological problems and children who were diagnosed with Severe Psychosis, Biopolar affective disorder, Schizophrenia were excluded from the study. Participants were recruited using systematic random sampling technique. Institutional Ethical Committee has approved this research protocol, and written consent was obtained from each participant prior to data collection. Confidentiality and anonymity were assured to each participant.

Data were collected using Socio Demographic Proforma, Alabama Parenting Questionnaire (APQ) and Strengths and Difficulties Questionnaire (SDQ). Socio demographic Performa is a self-structured tool consisted of variables related to parent (age, gender, education, occupation, marital status, number of children, family type, family income, any history of illness, substance use, presence of conflict between parent and residence) and child (age, gender, birth order). APQ is a standard tool developed by Frick PJ. It is a 5 point Likert scale consists of 42 items and five domains; positive parenting, positive involvement, poor monitoring/supervision, inconsistent discipline and corporal punishment. Tool consists of 35 items that assess these five parenting constructs and seven additional items those measure specific discipline practices.[15] Elevated scores were considered to be those scores that are one standard deviation above the mean for the positive parenting scales (parental involvement and positive parenting) on the APQ and scores that are 1 standard deviation below the sample mean for negative parenting scales (poor monitoring/supervision, inconsistent discipline, and corporal punishment).[16] All subscales had moderate to adequate internal consistency, validity, and good test–retest stability.[17] SDQ was used to assess the behavioural and emotional problems of children which is a 3-point Likert scale consists of 25 items divided into five domains such as emotional symptoms, conduct problems, hyperactivity, peer problems and prosocial behaviours. Addition of scores of all four domains was the score for total difficulties, and score of prosocial behaviours independently gave the score for social behaviour of child. The scores were further categorised as normal (score ≤13) and high (borderline (14–16) and abnormal (17–40). Similarly, each subscale was also categorised into normal, high and abnormal.[18] Cronbach's alpha was found to be above 0.70 for all SDQ subscales except peer problems and for total difficulties.[19]

Data were analyzed using both descriptive and inferential statistics. The categorical variables were analysed using frequency and percentage distributions and quantitative variables were summarized by mean and standard deviation and the response variables such as emotional problems, conduct problems, peer problems, total difficulties and pro-social behaviours were separately modeled by considering positive involvement, positive parenting, poor monitoring/supervision, inconsistent discipline, corporal punishment, specific discipline practices, and socio demographic variables of the participants (age, gender, education, occupation, family income, marital status, family type, number of child, any history of illness, substance use and presence of conflict between parent and residence) and the children (age, gender and birth order) as independent variables.

The assumptions of multiple linear regression models for each of the response variable were tested. Result indicates that stepwise multiple linear regression models were fitted for all the response variables. All the predictors with P < 0.05 were included in the final model of each of the response variables.


  Results Top


Sociodemographic characteristics of participants and children

Findings revealed that the mean and standard deviation of participants' age were 40.83 and 9.534, respectively. Out of 100 participants, 51% were females, majority (37%) had primary to middle level education, 25% each had no formal education and had high to higher secondary level education and 13% were graduation and above. Regarding occupation, majority (43%) were unemployed, 25% were farmer or daily wage earners, 17% were businessmen, 8% had private service and 7% had government job. Most of the participants, 51%, had family income per month less than Rs. 10000, 89% were married, 81% had nuclear family, 74% had 2–4 numbers of children and 91% were from rural areas. According to the participants self-report, 28% of the parents had a history of chronic physical illness, 11% had a history of certain type of psychiatric illness and 26% had a history of taking substance. Regarding fights with their spouse, 52% had a history of occasional fights and 3% had a history of frequent fight.

Findings further revealed that the mean and standard deviation of children's age were 13.48 and 2.976, respectively. Majority, 59%, of the children were male, 53% were in between 2nd to 4th birth order.

Parenting practices and children's emotional and behavioural problems

[Table 1] summarises the parenting practices of parents which revealed that mean and standard deviation (SD) scores of positive involvement, positive parenting, poor monitoring/supervision, inconsistent discipline, corporal punishment and specific disciplinary practices were 21.60 ± 6.231, 12.82 ± 2.966, 19.97 ± 9.007, 18.37 ± 4.362, 7.20 ± 2.651 and 13.68 ± 1.858, respectively.
Table 1: Descriptions of parenting practices of parents (n=100)

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[Table 2] summarises the emotional and behavioural problems of children which revealed that mean and SD scores of emotional symptoms, conduct problems, hyperactivity, peer problems, prosocial behaviours and total difficulties were 4.03 ± 2.765, 5.60 ± 2.582, 6.30 ± 2.580, 4.66 ± 2.021, 4.24 ± 2.731 and 20.58 ± 5.339, respectively.
Table 2: Descriptions of emotional and behavioral problems of children (n=100)

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Predictors of emotional and behavioural problems amongst the children

[Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8] represent the stepwise multiple linear regression analysis to find out the predictors of the following response variables: Emotional problems, conduct problems, hyperactivity, peer problems, total difficulties and prosocial behaviours, respectively. Results from these regression models indicated that age of the child (β = 0.390, P = 0.000*) is the significant predictor of the emotional problems. The predictor in the model explained 17.8% of the variance (R2 adjusted = 0.178; F = 11.687, P = 0.000*) and the model was found to be statistically significant. Poor monitoring/supervision (β=0.397, P = 0.000*) is the significant predictor of conduct problems. The predictor in the model explained 34.5% of the variance (R2 adjusted = 0.345; F = 8.438, P = 0.000*) and the model was found to be statistically significant. Age of the child (β = −0.356, P = 0.000*), poor monitoring/supervision (β = 0.191, P = 0.040*) and Inconsistent discipline (β = 0.228, P = 0.017*) are significant predictors of hyperactivity. The predictors in the model explained 35.1% of the variance (R2 adjusted = 0.351; F = 11.696, P = 0.000*) and the model was found to be statistically significant. Gender of the child (β = −0.225, P = 0.027*) is found to be the significant predictor of peer problems. The predictor in the model explained 13.6% of the variance (R2 adjusted = 0.136; F = 4.895, P = 0.001*) and the model was found to be statistically significant. Poor monitoring/supervision (β = 0.345, P = 0.001*) and corporal punishment (β = 0.303, P = 0.025*) are the significant predictors of the total difficulties. The predictors in the model explained 23.1% of the variance (R2 adjusted = 0.231; F = 6.960, P = 0.000*) and the model was found to statistically significant. Positive involvement (β = 0.259, P = 0.010*) is the significant predictor of pro-social behaviour. The predictor in the model explained 12% of the variance (R2 adjusted = 0.120; F = 5.488, P = 0.002*) and the model was found to be statistically significant.
Table 3: Multiple linear regression model of emotional problems with the predictors

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Table 4: Multiple linear regression model of conduct problems with the predictors

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Table 5: Multiple linear regression model of hyperactivity with the predictors

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Table 6: Multiple linear regression model of peer problems with the predictors

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Table 7: Multiple linear regression models of total difficulties with the predictors

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Table 8: Multiple linear regression models of pro-social skills with the predictors

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  Discussion Top


Predictors of emotional problems

The current study revealed that the age of the child is the significant positive predictor of the emotional problems. This finding is supported by studies conducted by Aboobaker et al.[10] and Mowafy et al.[20] which reported that emotional problems increase with increasing adolescent's age.

Predictors of conduct problems

The present study revealed that poor monitoring/supervision to their children's behaviour is the significant positive predictor of conduct problems. It is quite normal for the children to want to fulfil their desires immediately and want to avoid unwanted situations. As a part of growing, if they are effectively monitored and supervised, they learn how to be patient, ask politely or handle frustration or disappointment. This finding is supported by a study conducted amongst clinical population by Frick et al.[21] which revealed that parent's poor monitoring and supervision to their children's (6–17 years) behaviour was moderately predictive of conduct problems. Another study conducted by Wasserman et al.[22] also reported similar finding that is parents who fail to monitor their child, more likely to have conduct problem amongst their children.

Predictors of hyperactivity

Current study revealed that age of the child is the significant negative predictor for their hyperactivity problems, i.e., hyperactivity decreases as child grows older. This finding is supported by studies conducted by Sayal et al.[23] and Caye et al.[24] which reported that younger children are more likely to receive a clinical diagnosis of ADHD. Study findings further reported that poor monitoring/supervision is the significant positive predictor of hyperactivity. This finding corroborates with the study done by Murray et al.[25] which revealed that mothers of ADHD children were having poor monitoring to their child behaviour. Current study findings also revealed that inconsistent discipline is the significant positive predictor of hyperactivity. Similar finding is reported by Ellis et al.[26] which revealed that maternal inconsistent discipline was associated with children's ADHD. This finding is also corroborated with the study done by Hawes et al.[27] which revealed that inconsistent discipline is uniquely associated with prospective hyperactivity/inattention across childhood.

Predictors of peer problems

The present study finding revealed that male gender of the child has more peer problems than female gender. This finding is supported by a study conducted by Altay et al.[28] which revealed that boys have a more negative interaction with their peers than the girls and girls show more prosocial behaviour than boys.

Predictors of total emotional and behavioural difficulties

Poor monitoring/supervision is the significant positive predictor of the total difficulties. Similar finding has been observed in the study done by Finkenauer et al.[29] which reported that adaptive parenting behaviour (high parental acceptance, strict control and monitoring, and little use of manipulative psychological control) negatively related with emotional and behavioural problems amongst children. The current study finding also corroborates with the study done by Sekaran et al.[30] and Braza et al.[31] which revealed that negative parenting practices are positively associated with emotional and behavioural problems amongst children. Corporal punishment is also found to be the significant positive predictor of total difficulties. This finding is supported by the studies conducted by Hecker et al.[32] and Nijhara et al.[33] which reported that physical force or corporal punishment has an impact on child mental health. In spite of having the established fact about the crippling effect of physical force to discipline children in earlier studies, it is still considered quite normal to slap, hit push or grab children to instill fear and curb behaviour.

Predictors of pro-social behaviours

Positive involvement is turned out to be the most significant positive predictor of pro-social behaviours. As positive involvement increases pro-social behaviour increases. A study conducted by Altay et al.[28] supported these findings which reported that the children whose mothers showing authoritative parenting style (reasonable demands and high responsiveness) demonstrate more prosocial behaviours.

Strength, limitation and future direction

The strength of the study is that all the participants were selected using systematic random sampling technique and the participants were selected from clinical population; hence findings cannot be generalized for general community population at large.

This is a cross-sectional study; however, a longitudinal study to explore how these risk factors influence children's mental health over a period of time would be essential. Nurses working with children in any setting may incorporate these findings in planning a comprehensive intervention package for both children and parents for better outcome. The findings may be published in social media to help parents to understand the effects of parenting on physical and emotional behaviours of children.


  Conclusion Top


Current study findings confirmed that negative parenting practices, age and gender of the child are the risk factors for the emotional and behavioural problems amongst the children. Therefore, any health professionals working with children need to consider these factors in planning a comprehensive intervention package focusing on prevention, early identification and effective immediate intervention for children and their parents.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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