Early adolescent girls face high levels of stress: local study 

• Family and teachers’ awareness of stress-related negative mental health outcomes, vital 

By Ruwan Laknath Jayakody

Since there is clear evidence regarding the nature and extent of the psychological problems faced by school-going girls in their early adolescence, a local study noted that both family members and school authorities, especially teachers, should be made aware of the negative mental health outcomes that are connected to stress, so that they could be responsive in helping them cope with such, including with the participation of their peers.

This finding and suggestion was made by H.J. Madhushanthi (attached to the Ruhuna University’s Allied Health Sciences Faculty), S.W. Wimalasekera and C.S.E. Goonewardena (attached to the Sri Jayewardenepura University’s Medical Sciences Faculty), A.A.T.D. Amarasekara (attached to the Sri Jayewardenepura University’s Allied Health Sciences Faculty), and J. Lenora (attached to the Ruhuna University’s Medical Faculty), in an original article on the “Profile of stress among a group of female school children in their early adolescence in the Galle educational zone: A descriptive cross sectional study” which was published in the Galle Medical Journal 26 (2) on 14 August 2021.

Background data

The World Health Organisation (WHO) defines early adolescence as being between the ages of 11 and 14 years, and as noted in “Nutrition in adolescence: Issues and challenges for the health sector: Issues in adolescent health and development” it is a sort of transition from care-dependent childhood to care-independent adulthood, which is marked by significant physical/biological, psychological, and social development and changes. Regarding stress, Madushanthi et al. cited “Effects of stress throughout the lifespan on the brain, behaviour and cognition” by S.J. Lupien, B.S. McEwan, M.R. Gunnar, and C. Heim, which pointed out that with the onset of puberty in female adolescents, owing to the elevated level of gonadal (primary reproductive organs, in this case, the ovaries) hormones, the cortisol (a steroid hormone released in response to stress and low blood glucose concentrations) level generally increases, thus rendering them more vulnerable for stressors, which is likely due to the interaction between gluco-corticoids (corticosteroids hormones) and gonadal hormones. This stress hormone activation shows higher reactivity in female adolescents when compared to males of the same age, as M.R. Gunnar, S. Wewerka, K. Frenn, J.D. Long, and C. Griggs found in “Developmental changes in the hypothalamus-pituitary-adrenal activity over the transition to adolescence: Normative changes and associations with puberty” (the hypothalamus is the part of the brain that controls certain bodily functions including the release of hormones from the pituitary gland, and the pituitary is the part of the brain that controls the functions of the majority of endocrine/hormonal glands).

During adolescence, the subcortical structures of the brain which are connected to emotional and cognitive development undergo marked structural and functional changes. However, stress experienced during this period, as noted by J.N. Giedd and J.L. Rapoport in “Structural magnetic resonance imaging of the paediatric brain development: What have we learned and where are we going?”, can alter the neural architecture within the cortico-limbic (system which integrates emotion with cognition) regions of the brain, thereby adversely affecting both cognitive development and academic outcomes. According to H. Perera’s “Mental health of adolescent school children in Sri Lanka – A national survey” and C. Rodrigo, S. Welgama, J. Gurusinghe, T. Wijeratne, G. Jayananda, and S. Rajapakse’s “Symptoms of anxiety and depression in adolescent students: A perspective from Sri Lanka”, stress in adolescents is associated with adverse physical and psychological consequences, including substance (drug) abuse, poisoning, physical inactivity, and uncontrolled weight gain, and the resultant anxiety and depression are more prevalent among female adolescents than male adolescents.

K.E. Miller and M.J. Jordans also observed in the “Determinants of children’s mental health in war torn settings: Translating research into action” that parents and teachers imposing harsh discipline, and violence seen at home, also leads to adverse mental health problems.

Assessing female students

Hence, Madhushanthi et al. conducted a descriptive, cross-sectional study in schools randomly selected from the Galle educational zone, where 218 female students between the ages of 11 and 14 years living in the city of Galle were recruited.

To assess the students’ socio-economic status and psycho-social adversities, a self-administered socio-demographic questionnaire and the psycho-social adversity scale were used, where in the latter case, the items were scored by interviewing the adolescents in question. Stress in the chosen sample of adolescents was assessed using the self-administered adolescence stress questionnaire (ASQ) – the nine dimensions of which are namely; the stress of home life, school performance, school attendance, romantic relationships, peer pressure, teacher interaction, future uncertainty, school/leisure conflict, and emerging adult responsibilities – measured on a five-point scale where the responses were; Not at all stressful/irrelevant to me, a little stressful, moderately stressful, quite stressful, and very stressful. A score of above three for each domain was considered as the cut-off level to indicate stress. A total score of over 156 out of 250 was used to confirm that the adolescent in question was in a stressed state. To assess the anthropometric measurements, and in particular the nutritional status, the body mass index (BMI), fat mass percentage, waist circumference, hip circumference, waist-to-hip ratio, waist-to-height ratio, the height for age z-score, and the weight for age z-score were calculated.

The mean age of the study participants was 12.31 years. In terms of ethnicity, the majority were Sinhalese. As far as the religion was concerned, the majority were Buddhist. Approximately half (49.5%) had two or three siblings, with the majority (68.3%) being in nuclear families, while the others were living with extended families. The majority (57%) had attained menarche. Just over half (54%) were residing in semi-urban areas.

The mean BMI was 18.22. The majority of the study participants were of normal weight (54.1%), followed by 29.8% who were underweight and 16.1% who were overweight. Furthermore, 77 (35%) were found to be centrally obese. Moreover, even though female adolescents, with the onset of puberty, undergo significant physical changes in terms of the distribution of body fat and muscle mass, there was however no statistically significant difference found with regard to body fat distribution between post-pubertal and pre-pubertal adolescents.

An overwhelming majority of 158 students (72.5%) were found to be in the stressed group, indicative of a high prevalence of stress, while 60 (27.5%) were classified as being in the non-stressed group. It was found that the age-related nutritional parameters were not significantly different between the stressed and non-stressed groups and the socio-economic index and psycho-social adversity index were also not different between the two said groups. It was therefore found that only the level of stress differentiated the two groups.

The ASQ score ranged from 83 to 208, and the mean stress score was 145.4. The factors contributing to inducing stress among female adolescents were with regard to school attendance (93.1%) which is compulsory, uncertainty about the future (92.7%), emerging responsibilities (85.3%), school performance (84.9%) where there was pressure from parents to perform better in school and there was high expectation from teachers and the pressure of studies in a context where they were studying the study material with minimal interest, conflict between school/leisure time (81.7%), romantic relationships (64.7%), stress of home life (61%) and peer pressure (61%), and interactions with teachers (60.1%) where there is a lack of respect on the part of the teachers and disagreements between the teachers and students. The scores for having too much homework (85.3%), too much parental expectation (84.8%), and not having enough time for leisure/recreational activities (81.6%), which created unnecessary psychological burden, were significantly higher amongst the stressed group when compared to the non-stressed group.

Madushanthi et al. noted also that studies by Rodrigo et al. had found that among school students between the ages of 14 and 18 years in the Ratnapura Municipality area, 36% were depressed while 28% were suffering from severe anxiety, with examination related issues, difficulties in studying, and problems with teachers being the causative factors for major depression and anxiety.

Findings and recommendations

It was explained by Madhushanthi et al. that the hormonal and physical changes experienced as a result of undergoing puberty are a stressful experience for the majority of female adolescents, partly since they have to adapt to the monthly menstruation. Madhushanthi et al. also opined that the reserved social lifestyle and conservative cultural norms increases vulnerability to these stressors.

It was also observed by Madhushanthi et al. that the current competitive education system which is heavily exam-oriented, and a school curriculum which demands high levels of memorising capacity, tends to cause stress. In this regard, Madhushanthi et al. reiterated that when students are confined to academic study-based homework activities that restrict their time to engage in play and recreational activities, and when they face pressure from parents to perform well academically by securing high scores at examinations and achieving other academic targets, such pressures lead to negative mental outcomes and undue stress.

This higher academic-related stress experienced by Asian school-aged adolescents is in part attributable to the perceived value of education, Madhushanthi et al. added, noting, yet again, the frequent parental pressure to improve academic success and expectations of such and peer competition. Madhushanthi et al. also pointed out how the tuition class system has affected both students and parents, as students tend to attend such classes even during vacation periods to cover all subjects, while parents pay high tuition fees in the hope of gaining additional academic output.

On the other hand, the instant study found no significant difference in stress due to romantic relationships between the stressed and non-stressed groups, which was to an extent explained by female adolescents likely being reluctant to explain their personal issues. However, Rodrigo et al. noted that the majority of the reported incidents of deliberate self-harm and suicide in adolescents were due to problems involving romantic relationships.

Therefore, Madhushanthi et al. pointed out the importance of establishing sound parent-child and teacher-student relationships in order to secure trust and support so as to overcome anxiety and stress, and in this regard, the provision of a counselling programme in schools and at the community level, and school authorities implementing parental awareness programmes which focus on addressing the negative impacts of parental pressure on academic success, and instead emphasised on the importance of a positive response-based, child-friendly parenting style, which were recommended.