Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Major depressive disorder wikipedia , lookup
Hypothalamic–pituitary–adrenal axis wikipedia , lookup
Epigenetics of depression wikipedia , lookup
Postpartum depression wikipedia , lookup
Biology of depression wikipedia , lookup
Child psychopathology wikipedia , lookup
Behavioral theories of depression wikipedia , lookup
Advanced Science and Technology Letters Vol.104 (Healthcare and Nursing 2015), pp.128-133 http://dx.doi.org/10.14257/astl.2015.104.28 Influencing Factors of Adolescent Girl’s Somatization Jung-hee Jeon Dept. of Nursing, Tongmyong University 428 Sinseon-ro, Nam-Gu, Busan, KOREA [email protected] Abstract. This study aims to identify the factors influencing somatization in adolescent girls. The participants were 866 adolescent girls in B city from 25, July to 30, September, 2013. The data were collected through self-reported questionnaires and analyzed by using PASW 18. There was a significant positive correlation between somatization and their depression, academic stress, perfectionism. The most important influencing factor of the somatization was the depression. The findings of this study suggest that nursing intervention to reduce somatization of adolescent girls should contain strategies to control their depression, academic stress, perfectionism. Keywords: Somatization, Adolescent girls, Influencing factor 1 Introduction 1.1 Need for Study Somatization is a psychological disorder that induces various types of pain and physical discomfort such as continuous headache, indigestion, stomachache, and menstrual pain without pathological opinion. An individual exhibits her emotional hardship through physical discomfort, so it is difficult to approach to the actual problem and help such individual. Main somatization that adolescent girls show are headache, dizziness, abdominal inflation, stomachache, and eye exhaustion [1], and it is reported that 18.3% of adolescent girls, who demonstrates signs of pain such as headache and stomachache, frequently are in pain more than once per week [2]. Somatization experience increases as adolescent girls’ grade level get higher[3], and there was a distinct difference in gender in which adolescent girls experience more somatization compared to adolescent boys[1][3][4]. Adolescent girls with somatization may be isolated from her peers, avoid social relationship, and display problems related to social skills, for example, missing school and going through slump in learning[2][5]. Also, there is a risk that adolescent girls may take an excessive dose of drugs regularly without proper understanding and advice about somatization [6], and it may disrupt daily life and develop into social & ISSN: 2287-1233 ASTL Copyright © 2015 SERSC Advanced Science and Technology Letters Vol.104 (Healthcare and Nursing 2015) emotional maladjustment [7] and an adult’s somatization disorder [8]. According to DSM-Ⅳ-TR(American Psychiatric Association, 2000) somatization disorder usually occurs in teenagers, and it can continue forever without treatment. Therefore, it is important to discover and actively treat somatization disorder at an early stage. Somatization related factors in adolescent girls are psycho-social factors, for example, depression, anxiety, hardship during childhood, academic stress, perfectionism, and social support[3][4][9-11]. Especially, stress is a factor that influences continuity and cause of somatization in adolescent girls. Stress causes physiological symptoms such as headache, stomachache, indigestion during somatization, and stressed responses such as emotional anxiety and depression [12]. When stress levels were higher, somatization intensified [13][14]. During puberty, adolescent girls experience drastic changes physically and mentally, and experience great amounts of stress. Korea’s adolescent girls had higher levels of stress as their grade level went higher. 7 out of 10 female students were stressed from school life, and the highest amount of stress came from academics (50.4%)[15]. Higher level of academic stress led to intensified experience of somatization [16]. Depression is the one of emotional response from stress, but it can also be an influencing factor of somatization [1][4][17]. Higher level of depression leads to intensified experience of somatization [18]. It is reported that perfectionism is closely related to somatization [9]. In an environment forcing competition due to university admission, perfectionist female students don’t have confidence, compulsively pursue perfection since they are afraid of negative evaluation from others, avoid contact with others and create an emotional distance. These all can result in psychological and physical maladjustment such as depression and somatization. Adolescent girls had higher levels of academic stress and depression [14][15], than that of adolescent boys. Adolescent girls had a more perfectionist’s mindset [19] and they were showing more symptoms due to greater vulnerability towards somatization[20][21]. However, it was difficult to find a study that explains adolescent girls’ somatization including various factors and symptoms mentioned above. This study will identify the factors that influence somatization and draw a clear understanding in adolescent girls’ somatization. Then it will seek to prevent somatization and help to relieve symptoms from somatization. 1.2 Purpose of Study 1) Identify the level of academic stress, perfectionism, depression, and somatization in adolescent girls. 2) Identify interrelation between academic stress, perfectionism, depression, and somatization in adolescent girls. 3) Identify factors that influence adolescent girls’ somatization. Copyright © 2015 SERSC 129 Advanced Science and Technology Letters Vol.104 (Healthcare and Nursing 2015) 2 Method of Study 2.1 Design of Study This study is an attempted descriptive investigation report to identify the level of academic stress, perfectionism, depression and somatization in adolescent girls and discover factors that influence somatization.. 2.2 Subjects of Study & Data Collection In this study, we collected data in a middle school and high school in B city with permission from Sept. 30th 2012 to July 25th 2013. It took 10~15 minutes in preparing a survey. We distributed 900 copies of survey and excluded those without enough information. Conclusively, we used 886 copies for analysis. 2.3 Instrument for Study 1) Perfectionism For perfectionism, we used an instrument that Seo[22] developed—validity evaluated from middle/high schoolers—and we used this instrument after receiving approval from the developer. There were total of 31 questions with a 5 point likert scale, and higher points meant higher level of perfectionism. At the time of development of the instrument, its total credibility was Cronbach's α=.90 and the total credibility of this research was Cronbach's α=.92. 2) Depression For depression, we used the CES-D(The Center for Epidemiological StudiesDepression scale) adaption that Cho & Kim[23] adapted and we received approval for the use of the instrument from the Korean adapters. There were total of 20 questions and their range was ‘Very Unusual(Less than a day within a week) 1 point to ‘Mostly’ 4 points. Higher points meant high level of depression. At the time of development of the instrument, its credibility was Cronbach's α=.85 and the total credibility of this research was Cronbach's α=.93. 3) Academic Stress For academic stress, we used the teenager’s academic stress instrument that Oh & Chen[24] developed, and we used this instrument after receiving approval from the developers There were total of 42 questions with a 5 point Likert scale, and higher points meant higher level of academic stress. At the time of development of the instrument, its credibility was Cronbach's α=.91 and the total credibility of this research was Cronbach's α=.94. 4) Somatization For somatization, we used the Adolescent Symptom Checklist: ASC) adaption that Lee[25] adapted and standardized. There were total of 22 questions with a 6 point 130 Copyright © 2015 SERSC Advanced Science and Technology Letters Vol.104 (Healthcare and Nursing 2015) likert scale, and higher points meant higher level of somatization. At the time of Lee’s (2000) research its credibility was Cronbach's α=.89 and the total credibility of this research was Cronbach's α=.91. 2.4 Data Analysis In this research we used the SPSS 18.0 program and analyzed measuring variables’ real number, percentage, average, and standard deviation. For interrelation analysis, we used Pearson’s Correlation Coefficient and for identifying variables that influence somatization, we used stepwise multiple regression analysis. 3 Study Results 3.1. General Characteristic of Study Subjects The total number of subjects in this research was 866 with 342 second grade middle schoolers, 219 first grade high schoolers and 305 second grade high schoolers. Average height was 160.48±5.15 and average weight was 52.27±7.56. Regarding subjects’ health, 51.7% said they were healthy, 37.4% said they were on average, 10.9% said they were unhealthy. 78.9% of the subjects said they don’t exercise regularly, and for taking breakfast, 50.7% said they take breakfast at all times, 27.5% said they usually do, 11% said they usually don’t, and 10,9% said they never take breakfast. 3.2. Level of Academic Stress, Perfectionism, Depression & Somatization of Study Subjects Study subjects’ average academic stress was 119.62±31.80 (with a range from 42 to 210), perfectionism was 88.52±19.17 (with a range from 31 to 155), depression was 34.04±11.17 (with a range from 20 to 80), and somatization was 52.54±17.00 (with a range from 23 to 132). 3.3. Interrelation between Somatization, Academic Stress, Perfectionism & Depression The study subjects’ somatization had an ordered interrelation of r=.370, p<.001 in academic stress, r=.300, p<.001 in perfectionism, r=.523, p<.001 in depression level of interrelation. Copyright © 2015 SERSC 131 Advanced Science and Technology Letters Vol.104 (Healthcare and Nursing 2015) 3.4. Factors that Influence Somatization In order to identify factors that influence study subjects’ somatization, we put somatization as an dependent variable, and put academic stress, perfectionism, depression as independent variables and ran a regression analysis. When we checked the multicollinearity of each independent variables, the number of tolerance was .738 to .837 and VIF was 1.194 to 1.356. Thus, we confirmed that there was no problem with multicollinearity. Analysis results showed that the order of factors that influence female high school students’ somatization were depression, perfectionism, academic stress, and total explanation power of these variables against somatization was 31.7%. 4 Conclusion In this study, factors that influence adolescent girls’ somatization were depression, perfectionism, academic stress, and somatization could be 31.7% explained by these factors. Depression was the most influential factor that directly affected somatization of adolescent girls. From the following results, we can notice that various variables, for example, depression, academic stress are the cause of adolescent girls’ somatization. Since somatization is caused by variety of factors, it is hard to control by just relieving physical symptoms. Therefore, we need to clearly understand and appropriately mediate adolescent girls’ somatization considering various factors—shown in this study—that influence somatization References 1. Kim, S.Y., Ha, E.H.: Validation study of the korean children's somatization inventory for high school students. Cognitive Behavior Therapy in Korea. 9(2), 25-37 (2009) 2. Larsson, B., Sund, A.M.: Emotional/behavioral, social correlates and one-year predictors of frequent pains among early adolescents: Influences of pain characteristics. European J. of Pain. 11(1), 57-65 (2007) 3. Kim, J.M., Jee, H.: A Study on the emotional, cognitive and social variables for somatization by developmental stage. Korean J. of Counseling. 12(4).1109-1130 (2011) 4. Lee, H.J., Sae, M.A.: Factors influencing somatization in adolescents. J. of Korean Society of School Health. 23(1), 79-87 (2010) 5. Konichezky, A., Gothelf, D.: Somatoform disorders in children and adolescents. Harefuah, 150(2), 180-184 (2011) 6. Trafton, J.A., Cucciare, M.A., Lewis, E., Oser, M.: Somatization is associated with nonadherence to opioid prescriptions. J. of Pain, 12(5), 573-580 (2011) 7. Rajindrajith, S., Devanarayana, N.M., Weerasooriya, L., Hathagoda, W., Benninga, M.A.: Quality of life and somatic symptoms in children with constipation: A school-based study. J. of Pediatrics. 163(4), 1069-1072 (2013) doi:10.1016/j.jpeds.2013.05.012 8. Fischer, S., Gaab, J., Ehlert, U., Nater, U.M.: Prevalence, overlap, and predictors of functional somatic syndrome in a student sample. International J.of Behavioral Medicine. 20(2), 184-193 (2013) doi:10.1007/s12529-012-9233-x 132 Copyright © 2015 SERSC Advanced Science and Technology Letters Vol.104 (Healthcare and Nursing 2015) 9. Chung, S.H., Lee, J.Y.: The relation between perfectionism and somatization among children: The moderating effects of stress-coping behaviors. Korean J. of Counseling. 13(2), 1029-1042 (2012) 10. Shannon, R.A., Bergren, M.D., Matthews, A.: Frequent visitors: Somatization in schoolage children and implications for school nurses. The J. of School Nursing, 26(3), 169-182 (2010) doi:10.1177/1059840509356777 11. Shin, H.K.: Effects of depressive mood state on self-focused attention, somato-sensory amplification, somatic attribution, and somatic symptoms in somatization group. The Korean J. of Clinical Psychology. 25(2), 467-488 (2006) 12. Thoits P.A.: Stress and health: Major findings and policy implications. J. of Health and Social Behavior. 51(5), 541-553 (2010) doi:10.1177/0022146510383499 13. Park, M.G, Son, C.N.: Mediating effects of worry in the relation of stress and somatization. Korean J. of Stress Research. 19(4), 361-369 (2011) 14. Ham, J.Y, Park, K.: The relationships of stress, alexithymia and somatization of adolescents-Focused on the high school student-. J. of Student Guidance and Counseling. 18, 7790 (2005) 15. Korean Statistical Information Service, http;//kosis.kr/ebook 16. Choi, E.S.: A study on relationship between high school student's academic stress, somatization symptoms and internal-external locused control [master's thesis]. Seoul: Sogang University (2011) 17. Jeong, Y.J, Ha, E.H.: The modeling effects of the anger expression type on the relationships between adolescent's depression and somatization. The Korean J. of School Psychology. 11(1), 1-18 (2014) 18. Lee, S.J, Ha, E.H.: The mediating effects of cognitive factor on the relationships between female adolescent's depression and somatization. The Korean J. of School Psychology. 7(1), 55-68 (2010) 19. Lee, Y.S, Park, S.Y.: The relationships between adolescent's maladaptive and adaptive perfectionism and worry: The moderating role of problem-solving confidence. The Korean J. of the Human Development. 13(3), 113-129 (2009) 20. Ruchkin, V., Schwab-Stone, M.: A longitudinal study of somatic complaints in urban adolescence: The role of internalizing psychopathology and somatic anxiety. J. of Youth and Adolescence. 43(5), 834-845 (2014) doi:10.1007/s10964-013-9969-9 21. Rhee, H., Holditch-Davis, D., Miles, M.S.: Patterns of physical symptoms and relationships with psychosocial factors in adolescents. Psychosomatic Medicine. 67(6), 1006-1012 (2005) 22. Seo, J.Y.: Validation of perfectionism scale for middle school and high school student [master's thesis]. Seoul; Sookmyung University (2009) 23. Cho, M.J, Kim, K.H.: Diagnostic validity of the CES-D(korean version) in the assesment of DSM-Ⅲ-R major depression. J. Neuropsychiatric Association. 32(3), 381-399 (1993) 24. Oh, M.H, Cheon, S.M.: Analysis of academic stressors and symptoms of juveniles and effects of meditation training on academic stress reduction. J. of Human Understanding and Counseling. 15, 63-95 (1995) 25. Lee, M.S., Choi, Y., You, J.S.: The relationship of somatic symptoms and self-esteem in adolescence. J. Neuropsychiatric Association. 39(2), 323-333 (2000) Copyright © 2015 SERSC 133