University of Oxford

Prevalence Of Stress Among School Children In Kerala

INTRODUCTION

Stress is defined as the adverse relation of the people to excessive pressure or other types of demand placed on them (Jone Parry, 2005).

It is a condition or feeling experienced when a person perceives that “demands exceed the personal and social resources the individual is able to mobilize” (Sofronoff. Dr, 2005).

That is when environmental demands strain an organism’s adaptive capacity it results in both psychological as well as biological changes that could place a person at risk for illness (Cohen, 1995). Stress occurs when pressure exceeds his or her perceived ability to cope. (Centre for stress management, 2003).

            Things that cause us stress are called stressors (Rubin.et.al, 1993).Internal sources of stress include hunger; pain; sensitivity to noise, temperature change, and crowding (social density); fatigue; and over- or under-stimulation from one’s immediate physical environment. External stressors include separation from family, change in family composition, exposure to arguing and interpersonal conflict, exposure to violence, experiencing the aggression of others (bullying), loss of important personal property or a pet, exposure to excessive expectations for accomplishment, “hurrying,” and disorganization in one’s daily life events (Bullock, 2002). Children are affected by stress, just as are adults, but the mechanisms of the effects are not necessarily the same. Theorists believe that children’s behavior represent their struggles to manage and react to stressful events (Kochenderfer.et.al, 2002).

A certain amount of stress is normal and not always bad. Sometimes stress can push a child on to greater achievement. Unfortunately, children are becoming highly stressed at younger and younger ages today. Stress varies from child to child, and how much stress one can easily handle varies, too. (Youngs, 1995).

Problems begin when ordinary stress becomes too much stress or distress that results in both psychological and biological changes that could place a person at a risk for illness. Today stress levels among children have been going up dangerously due to the pressure of their academic or cultural activities. Not all children can cope with such high levels of expectation and parents do not seem to realize or accept that their children are under severe pressure,” says Elizabeth Vadakkekkara, child psychologist and the director of Thrani (The Hindu, 2003).

            Some studies, especially in Sweden, indicate that psychosomatic symptoms are common in children with stress, the most frequent being: tiredness, stomach ache, headache, and psychological problems that can be triggered by different day to day situations in the child’s life, like school demands and administration of time for homework (Brobeck.et.al, 2007).

            Stress is most often seen as an overt physical reaction: crying, sweating palms, running away, aggressive or defensive outbursts, rocking and self-comforting behaviours, headaches and stomach aches, nervous fine motor behaviours (e.g., hair twirling or pulling, chewing and sucking, biting of skin and fingernails), toileting accidents, and sleep disturbances (Stansbury,et.al,2000). Experts point out  that children may react globally through depression and avoidance; excessive shyness; hyper-vigilance; excessive worrying; “freezing up” in social situations; seemingly obsessive interest in objects, routines, food, and persistent concern about “what comes next”; and excessive clinging (Dacey, 2000) in this content the present study was undertaken to study about stress in school children in Kerala.

Objective of the study

            To understand the prevalence of stress and stress levels in school children of Kerala.

METHODOLOGY

This is a school based study evaluating children of all grades from L.K.G to XII, in order to cover all age groups from 4-17 years. Subjects were taken from seven identified schools from the capital city of Kerala, the southern state of India. Trivandrum district was specifically selected with an assumption that being the capital of the state the cosmopolitan population of the district will give a representative cross section of the school children of the whole state.

School children between age of 4 and 17, were screened from seven schools of Trivandrum district through purposive random sampling giving due representation to government and private management and to the syllabi (state and central) followed in the schools. Two divisions randomly selected from each class of the identified schools were screened to get a sample of 30 children with stress from each age group giving equal representation to boys and girls. Thus a total of 667 students were screened to get the desired sample. A standardized stress assessment scale was used to collect the data from the sample. As locally suitable relevant scales for assessing stress in children of different age were not available an appropriate scale using standard procedure was developed after review of literature and in consultation with experts suitable for different children of 4-17 years. The three point scale gives the total stress score based on which the levels of stress in children are divided into low, medium and high. The split-half reliability coefficients were calculated for the different components of the whole test after correction, using Spearman-Brown Prophecy Formula (Garret, 1969). The reliability coefficient of the Stress Assessment Scale was found to be 0.99 for all the three scales.

            The data collected was analysed statistically to understand the prevalence of stress among children and also to find out the variation in stress based on age, and gender.

RESULTS

       The results obtained are discussed below.

            The results indicate that 93 to 100% of the children aged 4 to 17 years showed medium to moderate stress while 1.9% severe stress. Only 1.79% came under normal group. This suggests that in every age more than 90% of the school children of the state are facing above normal levels of stress and tension. This can be in any area of their life either in family or in their school and the causes can be many. This result agree with the observations made by many psychologists, doctors and counsellors that most of the children of today  are facing severe stress  which they find very hard to cope up with. Many of the psychosomatic problems and suicides commonly seen in our children are found to be the results of this stress

The study further reveals that the stress rate is high at the age of 4, 7, 8, 12, 13 and 15, (100%). Also more than 97% of the children above 10 years showed above average stress. More number of children with severe stress was observed at the age of 14 whereas the majority of the children between 13 to15 showed moderate or severe level of stress than any other age groups.

Similar results were obtained in a study done in Brazil by C. R. Sbaraini and L. B. Schermann (2007). According to the study, of the total sample of 883 children studied, 27.2% of children over 10 years and 18.2% of 14 year old children showed a significantly higher prevalence of stress (Sbaraini.et.al, 2007). In a study on specific stressors in children by Danielle. Brooks, it was shown that of the 23 children studied between the age group of 8-12, 6 boys and 7 girls showed stress related symptoms.

            In order to find out whether age or sex has any influence on stress further comparisons were made .

                     The results reveal that when boys and girls are compared, majority of girls were found to have more stress than boys .  Severe stress was seen in both genders between the ages of 12 – 16. 100% of children, both boys and girls, in the age of 4, 7, 12, 13, and 15 showed stress. Of the total number of boys rated (339), 331(97.6%) of them showed stress above average. Similarly of the total number of girls studied (328), 324(98.8%) of them showed stress. The study points out that there is gender and age variation in stress levels of children. Statistical analysis (t test) was further carried out to see whether variations shown between the stress in boys and girls and also between different age groups are significant statistically.

From the table it can also be observed that though girls in general show more stress than boys in majority of the groups, the variation is not very significant .except at the age of 14, where it is statistically significant at 1% level (t-3.27%).

The table also reveals that out of the total number of stressed girls maximum numbers of stressed girls (66.7%) are found to be at the age of 14 and minimum number of stressed girls (59.2%) at 10 years of age. Analysis revealed that there is significant difference at 0.01 level between boys and girls at the age of 14. Though there is no significant statistical difference between boys and girls in other age groups, the variation is noted in all age groups with girls suffering more than boys.

The study suggests that girls tend to face more stress at their preadolescent and adolescent stage .Many of them may be at the beginning of puberty, which normally occurs earlier than boys. During this phase, many physiological and emotional changes begin to occur that can generate stress. This could be one of the reasons for the increased stress seen among girls at this age than boys.

According to a study by Danielle Brooke, although the types of stressors experienced by school-age children are similar between the sexes,   there are differences in how males and females assess their stressors. More girls (41.2%) than boys (16.2%) in his study rated their stressor as “it upset me a lot.” Similarly, in another study females were found to rate 14 or 20 stressors more than males (Lewis, et.al, 1984). The female children in Sharrer and Ryan-Wenger’s study (Sharrer, et.al, 2002) were found to describe significantly more symptoms at an average of 2.8, compared to 1.8 for the males. Research has shown that women are more likely to report symptoms and seek healthcare than men (Centre for disease and prevention, 2005).

In another study, done between 1987 and 1999, it was revealed that levels of psychological distress increased from 19% to 33% in girls, compared to an increase from 13% to 15% in boys. Stress was found to be more in girls from middle-class backgrounds. Worries about schoolwork, relationships, weight and looks increased notably in adolescent girls. The combination of educational stressors together with those associated with achieving and maintaining a feminine identity (weight, body shape etc) affected the mental health of females more.”(Sarah-Kate, 2003).The study also indicated   that academic achievement is identified as a new pressure in 15-year- old girls. In Kerala girls now days out-perform boys in almost every school subject indicating that they are likely to face educational stress.

  Another study was reported in the journal ‘Paediatrics’ which examined correlation of stress fractures in pre-adolescent and adolescent girls (Keith, et.al, 2004). Stress fractures can be defined as skeletal defects that result from the repeated application of stress lower than that required to fracture a bone in a single loading (Martin, et.al, 1987). According to the study approximately 2.7% of the girls had a history of stress fracture, where 3% of then were engaged in disordered eating (using fasting, diet pills, laxatives, or vomiting to control weight), while 16% participated in more than 16 hours per week of moderate to vigorous activity. This could be one of the reasons for more stress in the pre-teen girls in this study too.

According to Sax, Leonard (Sharrer, et.al, 2002), There are NO differences in what girls and boys CAN learn.  But there are BIG differences in the best ways to teach them.”  A study on stress management, explains that students, who have developed a proper attitude to learning, and good learning techniques and habits, should not have to worry about stress. Stress is essential for effective study and memory, but it is the excess stress – anxiety, worry, fear of failure etc. – which creates a level of stress high enough to cause loss of memory and memory blocks in examinations.  This is what students fear, that they will not remember what they have learned. Of course, if they haven’t learned the work in first place, stress or no stress will make no difference .

A study reported to determine the prevalence rates and severity of depression, anxiety and stress among Saudi adolescent boys indicated that of 1723 male students studied, 59.4% had at least one of the three disorders, 40.7% had at least two and 22.6% had all the three disorders. Moreover, more than one third of the participants (38.2%) had depression, while 48.9% had anxiety and 35.5% had stress. Depression, anxiety and stress were strongly, positively, and significantly correlated (Khalid, et.al, 2000).

            Girls and boys experience distinctly different patterns of stress during adolescence that may leave girls more vulnerable to depression, according to research on stress patterns in adolescence boys and girls (www.cfah.org). It is reported that while adolescent girls and boys experience similar levels of stress, adolescent girls are more likely to experience stress in their relations with parents and friends, whereas adolescent boys’ stress is more likely to emerge from trouble in school or other factors outside their relationships with others. Girls and boys experienced about the same levels of stress, which tended to increase with age. Girls may be particularly prone to depression during adolescence. They may experience higher levels of the types of stress associated with depression and may be more reactive to these types of stress than boys.

                                                    CONCLUSION

            The study in general points out that majority of the children studied have pressure of one thing or another that leads to mild or moderate level of stress in them. The study results emphasise the fact that contradictory to the common belief that only adults suffer from stress and stress related problems, children from a very young age itself suffer from tension and stress of different types at varying levels. Stress is normal part of life that can either help us learn and grow or can cause us significant problems but severe stress releases powerful neuro-chemicals and hormones that prepare us for action (to fight or flee). If we don’t take action, the stress response can lead to health problems. Prolonged, uninterrupted, unexpected, and unmanageable stresses are the most damaging types of stress.

The study concentrated mainly in understanding the prevalence of stress in children and the results point out that majority of children are suffering from mild to moderate levels of stress that can lead to many problems in present and future. Here further research on the causes leading to this state in children needs immediate attention. So also the measures to overcome this condition needs further probe.

Since more children than expected are suffering from stress, it is important to understand the factor that is giving the pressure and tension to children. As the stressors vary with age, culture and society the causes have to be identified first. Our increasing knowledge about the importance and impact of stress on young children should be put to good use in reducing stress factors for young children and in assisting children to increase coping strategies and healthy responses to manage the unavoidable stresses in their lives.

Every child’s mental health is important, many children have mental health problems, and these problems are real and painful and can be severe. The more we understand the challenges of the young people we serve, the more effective and life changing our services become. Awareness-raising is needed for parents, teachers and professionals to take joint action to relieve the suffering caused by stress in many of these children. It is proved that stable family and happy school where there is love, care and concern with less mental pressure is of paramount importance in the alleviation of child stress and that should be the goal of parents and teachers so as to help them to face the challenges of life confidently and positively. However, the findings point to the need for an urgent, more detailed research on large sample for a better understanding of childhood stress and its causes.

REFERENCES

  1. Brobeck E, Marklund B, Haraldsson K et al. Stress in children: how fifth-year pupils experience stress in everyday life. Scand J Caring Sci 2007; 21:3 9.
  2. Bullock, J. Bullying: Childhood Education. 78(3). 130-133; 2002).
  3. Centre for Disease and Prevention (2005). Centre for Disease Control and Prevention, National Centre for Health Statistics. Retrieved on May 27, 2005 from the worldwide web: www.cdc.gov/nchs.
  4. Centre for Stress Managemnet, 2003. Definition of Stress. Vol. 2004. www.managing stress.com/articles/definition, html.
  5. Cohen, S.; Kessler, R.C.; & Gordon, L.U. (1995). Strategies for measuring stress in studies of psychiatric and physical disorders. In Cohen, S.; Kessler, R.C.; & Gorden, L.U. (Eds). Measuring Stress. A Guide for Health and Social Scientists. Oxford: Oxford University Press.
  6. Dacey, J. S.,& Fiore, L.B.(2000).’Your anxious child. San Francisco: Jossey-Bass.
  7. ‘Danielle N. Brooks .Specific Stressors and the Specific Stress Symptoms They Elicit in School-Age Children, The Ohio State University College of Nursing.
  8. Dr. Kate Sofronoff. Anxiety and stress in children with Asperger Syndrome, School of psychology: University of Queensland; 2005.

J Sports Sci. 1987; 5:155–163.

  1. Health fears for teen girls as stress levels double in 12 years” Sunday Herald, the, March 23, 2003 by Sarah-Kate Templeton

10. Jone Parry, 2005. Farmers, Farm workers and work related stress. Health and Safety Executive Publishers, London, 3-18 pp.

11. Keith J. Loud, Catherine M. Gordon, Lyle J. Micheli and Alison E. Field,               “Correlates of Stress Fractures among Preadolescent and Adolescent Girls”  Paediatric 2005; 115; e399-e406 DOI: 10.1542/peds.2004-1868

12. Khalid S Al-Gelban, MD, SSCFM, CABFM, JBFM, ’ Depression, anxiety and stress among Saudi adolescent school boys, ‘Department of Family and Community Medicine, College of Medicine, King Khalid University.

13. Kochenderfer-Ladd, B., & Skinner, K. (2002). Children’s coping    strategies: Moderators of the effects of peer victimization? Developmental Psychology, 38(2), 267-278.

14. Lewis, C.E., Siegel, J.M., & Lewis, M.A. (1984). Feeling Bad: Exploring Sources of Distress among Pre-Adolescent Children. American Journal of Public Health, 74(2), 117-122.

15. Martin AD, McCulloch RG. Bone dynamics: stress, strain and fracture.

16. Prevalence of childhood stress and associated factors: a study of schoolchildren in a city in Rio Grande do Sul State, Brazil,  C. R. Sbaraini and L. B. Schermann, 24/Sep/2007, Cad. Saúde Pública, Rio de Janeiro

17.  Rubin, Z, Peplau, L. A., & Salovey, P. (1993), Psychology and Health. In DeRocco, M, Mancuso, T, & Piland, S. (Eds). Psychology. (pp. 426-432).  Boston, Ma: Houghton Mufflin Company.

18. Sharrer VW, Ryan-Wenger NA. School Age Children’s Self Reported Stress Symptoms. Paediatric Nursing, 28(1): 21-27; 2002.

19. Stansbury, K., & Harris, M. L. (2000). Individual differences in stress reactions during a peer entry episode: Effects of age, temperament, approach behaviour, and self-perceived peer competence. Journal of Experimental Child Psychology, 76(1), 50-63

20. The Centre for the Advancement of Health, 1999.  http://www.cfah.org

http://www.scienceblog.com/community

21. The Hindu, “Concern over high stress levels among students”Monday, Feb 24, 2003.

22. The Journal of the Royal Society for the Promotion of Health, “Stress Management: Student Stress: Study Stress: Exam Stress Depression”, Vol. 127, No. 1, 33-37(2007) DOI: 10.1177/1466424007070492.

23. Youngs, Bettie. B. (1995) Stress and your child: Helping Kids Cope with the Strains and Pressures of Life. New York: Fawcett Columbine.

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