MITR

A longitudinal community based study of adolescent health

Objective
To identify factors that could lead to and prevent risky behaviours among adolescents.

Background

Our work in the area of adolescent health started with a health needs study among students of Std XI. This study highlighted a number of important associations between relationships with parents, mental health problems, educational difficulties and experiences of violence.

In order to obtain more information on these associations, with the aim of developing relevant programs, we conducted a population based cohort study among 12 to 16 year olds in urban (Margao) and rural (Bali) areas of south Goa.

The main aims of the study were to identify the predictors of a healthy adolescence particularly in the areas of sexual health, mental health and educational achievement.

Activities
The study was set in an urban and rural population in the southern district of Goa. The rural study population comprised adolescents living in the catchment area of the Bali Primary Health Center (PHC).

The urban community was located in the city of Margao. Our sample comprised all adolescents aged between 12 and 16 years of age residing in the selected clusters in these areas. The sample was enumerated through two sources: the family registers maintained by the health centres, and eligible adolescents found residing in the area who were identified during the survey. Before starting the study, the research team developed networks and partnerships with key local people such as anganwadi workers, panchayat members, heads of the primary health centres and other stake holders in the community.

Community meetings were arranged for creating awareness about the project in each village. We developed a structured interview, derived primarily from an interview we had used in our earlier research. The interview elicited information on socioeconomic factors; education; neighbourhood; peer relations; parental relationships; substance abuse; violence; reproductive and sexual health; and physical and mental health. We reviewed the entire group of adolescents 18 months later to assess their health and social wellbeing using a similar interview.

Impact
Out of the 2241 adolescent who were met by the researcher, 2054 (91.7%) consented to participate in the study. An ICD-10 mental illness was diagnosed in 37 adolescents (1.81%; 95% CI 1.27-2.48). The most common disorders were anxiety disorders (n= 20), depressive disorders (n= 10), ADHD (n= 4) and conduct disorder (n=3).

Thus overall, we found a relatively low prevalence of diagnosable mental disorders and of those who did have a mental disorder, emotional disorders were the most common. We also found that mental disorders were associated with particular lifestyles-urban, middle-class (for e.g. as reflected by increased risk with English speaking adolescents), and those having a more ‘western’ lifestyle or having a close friend of the opposite sex were more likely to be diagnosed.

Well-recognized risk factors including tobacco use, unsafe neighbourhood and abuse from parents were replicated in our study; a well recognized protective factor was a close relationship with and support from parents.

Of the adolescents we recruited, we managed to carry out follow up interviews with 1784 adolescents. We are currently analysing the data from the longitudinal phase of the project. This data will shed light on the predictors and protective factors for risk behaviours, especially dropping out of school, and the change in health indicators (such as reproductive and sexual health) over time.

The preliminary findings of the Mitr study, notably the very low rates of risk behaviours in young adolescents, has influenced our Yuva Mitr intervention program (see earlier)-for example, we are focusing our interventions on older youth in whom risk behaviours are more common.