VIETNAM NATIONAL UNIVERSITY HA NOI UNIVERSITY OF EDUCATION PHAN RATHA “PARENTAL PERCEPTIONS OF CHILD MENTAL HEALTH: SYMPTOMS, CAUSES AND RESPONSES AMONG CAMBODIAN AND ITS CORRELATION WITH THEIR CHILDREN MENTAL HEALTH” MASTER’S THESIS IN PSYCOLOGY HANOI, VIETNAM: April, 2016 VIETNAM NATIONAL UNIVERSITY HA NOI UNIVERSITY OF EDUCATION PHAN RATHA “PARENTAL PERCEPTIONS OF CHILD MENTAL HEALTH: SYMPTOMS, CAUSES AND RESPONSES AMONG CAMBODIAN AND ITS CORRELATION WITH THEIR CHILDREN MENTAL HEALTH” MASTER’S THESIS IN PSYCOLOGY Major: Clinical psychology of children and adolescents Code: Pilot Supervisor: Dr Amie Pollack Dr Dang Hoang Minh HANOI, VIETNAM: April, 2016 SUPERVISOR’S RESEARCH SUPERVISION STATEMENT TO WHOM IT MAY CONCERN Name of program: Master’s degree of Art in ClinicalPsychology, specializing in Child and Adolescent Clinical Psychology Name of candidate: Phan Ratha Title of research: ―PARENTAL PERCEPTIONS OF CHILD MENTAL HEALTH: SYMPTOMS, CAUSES AND RESPONSES AMONG CAMBODIANS AND ITS CORRELATION WITH THEIR CHILDREN MENTAL HEALTH‖ This is to certify that the research carried out for the above titled master‘s thesis was completed by the above named candidate under my direct supervision This thesis material has not been used for any other degree I played the following part in the preparation of this thesis: Supervisor (s)…………………………… Date……………………………………… CANDIDATE’S STATEMENT TO WHOM IT MAY CONCERN: This is to certify that the thesis that I (Phan Ratha) am submitting, hereby entitled Parental Perception of Child Mental Health (Symptoms, Cause and Treatment Options) among Cambodians and its correlation with their children‘s mental health, for the degree of Master of Arts in Clinical Psychology at the University of Education, Vietnam National University-Hanoi is entirely my own work and, furthermore, that it has not been used to fulfill the requirements of any other qualification in whole or in part, at this or any other University or equivalent institution No reference to, or quotes from this document, may be made without the written approval of the author Signed by: ……………………………… Date: …………………………………… Countersigned by the Chief Supervisor ……………………………………… Date: ………………………………… Second supervisor (if any) …………………………………………………… Date: ………………………………… ACKNOWLEDGEMENTS This thesis could not have been completed without the help of many people who gave their support, advice, encouragement, and understanding I would like to show my deepest gratitude to the following people whom I will never forget First of all, I would like to give many thanks to my respectful mother, Sous Lon, and grandparents, who have always financially and emotionally supported me Secondly, my appreciation is extended to Associate Professors Dr Bahr Weiss and Dr Dang Hoang Minh for initiating and approving to release the first Englishclasses for master‘s level psychology courses in Vietnam National University, Hanoi to Cambodian students Additionally, I would like to express my sincerest thanks to Dr Amie Pollack and Dr Cindy J Lahar, Dr Poch Bunnak and Dr Tran Thanh Namwho are my kind and intelligent supervisors for their advice, encouragement, and consultation so that I would be able to successfully complete the thesis writing process from beginning to end Without their technical support and professional guidance, constructing the thesis could not have been done properly Furthermore, I would like to convey my thanks to lecturer Mr Sareth Khann and Mr Bunna Peoun who assisted me by frequently providing feedback to enhance this report Moreover, my sincere thanks are delivered to all professors in the master‘s program, who tried their best to provide me with valuable knowledge and useful skills to conduct research and write the thesis Finally, I cannot forget to say thanks to my classmates who provided warm learning environment as well as Vietnamese and Cambodian friends who frequently pushed me to focus on thesis tasks and provided a lot of feedback TABLE OF CONTENTS PART I - BACKGROUND .1 1.1 Background of the Study 1.2 Problem Statement .2 1.3 Importance of the study and policy implications 1.4 Purposes of the study / The Aim of Research (Research Questions): 1.5 Objectives of the study: 1.6 Hypotheses for the study: .5 1.7 Scope and Limitation PART II - LITERATURE REVIEW 2.1 Introduction to mental health and mental disorders 2.1.1 Worldwide epidemiological research regarding prevalence of mental disorders .6 2.1.2 Impact of mental health problems 2.1.3 Common causes of mental health problems .10 2.2 Mental Health Literacy 11 2.2.1 What is mental health literacy? 11 2.2.2 Mental health literacy regarding help-seeking behaviors 12 2.2.3 Factors influencing mental health literacy and help-seeking behavior .13 2.3 Parental influences on child mental health development and treatment 15 2.3.1 How parental factors put children at risk or help them recover from mental health problems 15 2.3.2 How parental mental health literacy affects identification, help seeking, and recovery from childhood mental health problems 19 2.4 Cambodian Mental Health Perceptions 22 2.4.1 Rates of child and adult mental health in Cambodia 22 2.4.2 Cambodian mental health literacy and seeking-help behavior 23 PART III - RESEARCH METHODOLOGY 26 3.1 Participants 26 3.2 Sampling procedure 26 3.3 Data Collection and Procedures 27 3.4 Measurements (Scale) 27 3.5.Statistical Data Analysis .28 3.6 Ethical Considerations .29 PART IV – RESULTS AND DISCUSSION 30 4.1 Descriptive Results 30 4.2 Perceptions of the cause and consequences of specific child mental health problems 35 4.3 Health-seeking behavior for mental health issues in children 45 4.4 Analysis of parental perceptions 54 4.5 Exploratory Factor Analysis 57 4.6 Explore the factors may influence parental perceptions of child mental health 60 PART V - CONCLUSION AND FURTURE RECOMMENDATION 62 5.1 Conclusion 62 5.2 Recommendations 65 REFERENCES 67 LIST OF TABLES Tables Page Table Demographics by location (percentages reported for urban versus rural) 31 Table Responses to vignette of child with somatoform disorder 38 Table Responses to vignette of child with separation anxiety disorder 39 Table Responses to vignette of child with Attention Deficit Hyper-active Disorder (ADHD) 40 Table Responses to vignette of child with tic disorder 41 Table Responses to vignette of child with aggressive behavior 42 Table Responses to vignette of child with depressive disorder 43 Table Responses to vignette of child with Posttraumatic Stress Disorder (PTSD) 44 Table Parental perception of causes of child mental health by demographic info 56 Table 10 Factorial analysis of cause of children mental health 58 Table 11.Correlations between parent perception factors, and demographic characteristics 61 LIST OF FIGURES FIGURE Page Figure Level of education completed by mothers by residential area 33 Figure 2: Level of education for fathers 34 Figure Household‘s income by location 35 PART I- BACKGROUND 1.1 Background of the Study The healthy development of children is an important concern for families and societies around the world Given a nurturing environment, children have the opportunity to grow into successful and productive members of society Raising children to be physically and mentally healthy requires much effort and serious care from parents or caregivers Mental health problems in children are a crucial influence on child development Understanding the symptoms and causes of mental health problems will help parents effectively support their children and promote their cognitive, social and emotional development (MoH, 2005; TPO 2005) ―There is no health without mental health‖ said Ban Ki Moon on October 10th World Mental Health Day, 2011 This message encouraged public and private sectors to take into account citizens‘ mental health care, children included Improving people‘s quality of life and mental health is a priority for the World Health Organization (WHO) Worldwide epidemiological data indicate that about 20% of children and adolescents suffer from mental disorders with types of disorders varying by cultural context This finding is alarming and suggests that early intervention for mental health care is needed (Saxena, Thornicroft, Knapp; Whiteford, 2007) Another global study focused solely on children, conducted both in developing and developed nations, and showed that 10% to 15% of children suffer from mental health disorders with 3% to 4% of children having significant developmental delays or mental retardation (Dom Nokteok, 2010) This finding was very similar to a study (WHO, 2007) conducted by Seven Nation Collaborative Study on children aged 0-12 in the Philippines which found that 16% of children in the Philippines had mental disorders Regionally, a recent study (Weiss, Dang, & Nguyen, 2013) revealed that 1213% of Vietnamese children (aged 6-16) suffer from mental health problems, indicating that 2.7 million of Vietnamese children need access to mental health services Studies have also looked at what factors place children at risk for mental health problems Weiss and colleagues (2013) found that parental income and education play an important role as risk factors for Vietnamese child behavioral and Not at all true completely true 11 Child has not taken on enough responsibility 12 Child has not gotten this own way 13 Child has a learning disability 14 Child has not been able to control his emotions 15 Child has had trouble fitting in with other children his age 16 Child has not had friends that are good role models 17 Child has had difficulty making friends 18 Child has been lazy or not tried hard enough 19 Child has not responded well to authority figure 20 Child has had difficulty expressing his true feeling 21 Child has had poor social skills 22 Child has been bulled by peer 23 Child did not play with enough other children when he was young 24 Child has found school work too hard 25 Child is not as smart as other children 26 Child has been purposely trying to upset someone else 27 Child has not gotten the attention he wants 28 Child has felt overwhelmed or confused 29 Child has experienced some form of abuse 4 32 Child has had difficulty adjusting to change in primary caregiver 33 Child has had difficulty adjusting to a move 34 Child has been neglected or did not receive proper care 35 He has had difficulty adjusting to change 36 A new person has been introduced to child‘s family Not at all true completely true (Sexual, physical, verbal or emotional) 30 Of fate Not at all true completely true 31 Child has witnessed some form abuse or violence (Spousal violence) (Food, shelter…) (Brother, sister, spouse…) 37 Of child‘s parent commit Karma in their previous life 38 Child has experienced difficult custody or count proceedings 39 Child was separated from someone close (other than me) 40 Of bad luck 4 42 Parents or caregiver has not known enough how to parent 43 Parents or caregiver has not supported a child enough 44 Of a lack of resources at school to help a child 45 Child have lived in a bad neighborhood 46 Child has copied the problem from his / her parent 47 Child has copied the problem from his other parent or caregiver 48 Parent have not spent enough time with my child 49 Parents have not known enough about how to parent 50 The school has disciplined a child differently 4 52 Parent or caregiver has not spent enough time with a child 53 Of discrimination or prejudice 54 Too much stress has prevented his parent or caregiver from parenting of the child Not at all true completely true 41 His other parents or caregiver has discipline a child from the way a child From the way parent at home Not at all true completely true 51 The school has not made enough effort to help a child or to understand his problem As well as s/he could have 55 Parents have supported their children enough 56 Parents have had physical or mental health problem that 4 Has prevented them from parenting as well as they would like 57 Too much stress has prevented parents from Preventing as well as parents would like 58 Of his school teacher or principal D Treatments Option for Children Mental Health We are interested in parents‘ thoughts about different types of treatments a child with mental health problems might receive Please read the description of each type of treatment and answer the questions that follow Please imagine that there are no problems with accessing or affording the treatment Religious/Spiritual Assistance The child receives religious assistance to improve his problem The child would be required to get help from religious representative who have magic (or ―spiritual‖) power like Buddhist monk or fortune teller They will conduct religious ceremony and blessing to the child I believe this treatment would be helpful effective I believe this treatment is likely to result in permanent improvement Overall, I like this kind of treatment Not at Complet all true ely True 5 Traditional Healer The child acquires traditional medicines (herbs, roots trees….etc) from skillful and community-recognized traditional healer to make child‘s problems better I believe this treatment would be helpful effective I believe this treatment is likely to result in permanent improvement Overall, I like this kind of treatment Not at Complet all true ely True 5 Medication from the West The child receives medication (a pill) to improve his problem The child would be required to take this medicine at regular times every day A doctor would prescribe the medication (pill) The parents and the child would see the doctor as needed to monitor the child‘s health while taking this medication I believe this treatment would be helpful effective I believe this treatment is likely to result in permanent improvement Overall, I like this kind of treatment Not at all Complet true ely True 5 Individual Counseling A trained professional works one–on one with the child to help him/her cope with manage or improve his mental health problem The child is the ONLY person involved in this treatment (other family members would NOT be directly involved in this treatment) I believe this treatment would be helpful effective I believe this treatment is likely to result in permanent improvement Overall, I like this kind of treatment Not at all Complet true ely True 5 5 Counseling of Parent(s) A trained professional works on-on-one with the parents of the child to help the parents learn ways to cope with, manages, or improves the child‘s problem The child would NOT be involved in this treatment I believe this treatment would be helpful effective I believe this treatment is likely to result in permanent improvement Overall, I like this kind of treatment Not at Complet all true ely True 5 6.Counseling for Parent(s) and Child A trained professional works together with both the parents and the child at the same time to help everyone learn ways to cope with, manage, or improve the child‘s problem Comple Not at tely all true I believe this treatment would be helpful effective I believe this treatment is likely to result in permanent improvement Overall, I like this kind of treatment True 5 Help from the Child’s School People at the school work with the child to help him/her learn ways to cope with, manage, or improve his problem For example, the school may provide extra help through special classes or programs or provide strategies in the classroom to help his/her behavior or emotion I believe this treatment would be helpful effective I believe this treatment is likely to result in permanent improvement Overall, I like this kind of treatment Not at Complet all true ely True 5 PART IV: Strength and Difficulty Questionnaire (SDQ) For each item, please mark the box for Not True, Somewhat True or Certainly True It would help us if you answered all items as best you can even if you are not absolutely certain or the item seems daft! Please give your answers on the basis of the child's behavior over the last six months or this school year Behavior and Emotion of Children 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Considerate of other people's feelings Restless, overactive, cannot stay still for long Often complains of headaches, stomach-aches or sickness Shares readily with other children (treats, toys, pencils etc.) Often has temper tantrums or hot tempers Rather solitary, tends to play alone Generally obedient, usually does what adults request Many worries, often seems worried Helpful if someone is hurt, upset or feeling ill Constantly fidgeting or squirming Has at least one good friend Often fights with other children or bullies them Often unhappy, downhearted or tearful Generally liked by other children Easily distracted, concentration wanders Nervous or clingy in new situations, easily loses confidence Kind to younger children Often lies or cheats Picked on or bullied by other children Often volunteers to help others (parents, teachers, other children) Thinks things out before acting Steals from home, school or elsewhere Gets on better with adults than with other children Many fears, easily scared Sees tasks through to the end, good attention span Not Truesomewhat Certainly TrueTrue 2 2 0 12 2 0 0 0 0 1 1 1 1 2 2 2 2 0 1 2 2 0 1 2 2 Appendix C-Tables and Figures Graphs of gender, marital status and religion by location 80% 71% 70% 65% 60% 50% 40% 35% Male 29% 30% Female 20% 10% 0% Urban (%) 100% 90% 90% Rural (%) 87% 80% 70% 60% 50% Urban (%) 40% Rural (%) 30% 20% 7% 10% 7% 3% 6% 0% Married Separated/divorce Widow/widower 120% 100% 95% 100% 80% 60% Urban (%) Rural (%) 40% 20% 1% 2% 2% 0 0% Buddhism Islamic Christian Other Figure Occupation of participants by residential area 85% 0.9 0.8 0.7 0.6 0.5 32% 0.4 34% 26% 0.3 0.2 0.1 Urban (%) 9% 2% 8% 0 Rural (%) 4% Table.1 Demo-graphic characteristic of respondents Variables Urban (N=100) Rural(N=100) Sex Male (N = 68) 35% 29% Female (N = 132) 65% 71% Married (N=177) 90% 87% Separated/Divorced (N=14) 7% 7% Widow/Widower (N=9) 3% 6% Buddhist 95% 100% Islamic 1% 0% Christian 2% 0% Others 2% 0% Unemployed 0% 2% Housewives 32% 9%% Market Sellers 34% 0% Farmers 0% 85% Professionals 26% 0% Other 8% 4% None 3% 27% Primary school 20% 58% Secondary school 22% 12% High School 33% 3% Bachelor degree 18% 0% Higher 4% 0% None 2% 20% Primary school 10% 43% Secondary school 16% 30% High School 32% 7% Marital Status Religion Occupation Level of Education of mother Level of Education of father Bachelor degree 28% 0% Higher 12% 0% Less than $100 12% 73% $100 - $300 25% 25% $300 - $500 22% 1% $500 - $700 17% 1% $700 - $900 9% 0% Over $900 `15% 0% Household Income From Table.2 to Table 8, please find in the full format Table Parental perception of causes of child mental health by demographic info Variables Mean SD Rural 2.44 0.496 Urban 2.20 0.491 Married 2.33 0.504 Separated /divorce 2.19 0.564 Widow/Widower 2.40 0.493 less than 100$ 2.40 0.565 100$-300$ 2.27 0.41 300$-500$ 2.22 0.509 500$-700$ 2.24 0.541 700$-900$ 2.39 0.503 Over-900$ 2.26 0.408 2.30 0.602 Primary school 2.38 0.472 Secondary school 2.41 0.446 High school 2.24 0.498 Bachelor degree 2.23 0.545 Higher 1.76 0.481 (T-test=-3.33, P=0.0010.05) Marital Status (F-test=0.877, P=0.498>0.05) Monthly income F-test= 1728, P=0.130>0.05) Education of mother didn‘t attend school (F-test= 0.956, P=0.446>0.05) Education of father didn‘t attend school 2.43 0.572 Primary school 2.38 0.505 Secondary school 2.36 0.505 High school 2.21 0.452 Bachelor degree 2.30 0.559 Higher 2.16 0.433 2.81 0.268 *House wife 2.22 0.452 Market seller 2.30 0.537 *Farmer 2.42 0.504 Professionals 2.27 0.517 Other 2.01 0.448 2.31 0.531 Market seller 2.25 0.477 *Farmer 2.43 0.501 *Professionals 2.31 0.467 Other* 1.90 0.509 (F-test=2.400, P=0.04