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Outcome of a school-based intervention to promote life-skills amongyoung people in Cambodia
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.ORCID iD: 0000-0002-8052-479X
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
2014 (English)In: Asian Journal of Psychiatry, ISSN 1876-2018Article in journal (Refereed) In press
Abstract [en]

Background Most of the school-based interventions to prevent suicide are from high income countries and there is a need for evidence based interventions in resource-poor settings. The aim of this study is to evaluate the outcome of a school based intervention to reduce risk factors for suicide among young people in Cambodia by promoting life skills.

Method Six classes were randomly selected from two schools each, one designated as experimental and the other as control school, respectively. In experimental school 168 young people (M = 92, F = 76) received 6 sessions of life skills education and in the control school 131 students (M = 53, F = 78) received three general sessions on health. We looked at the pre-post differences on Life-Skills Development Scale Adolescent Form (LSDS-AF)- and Youth Self-Report (YSR) questionnaire to measure the effect size (ES) from the intervention after 6 months. We analyzed the data by stratifying for gender and for those who reported more severe suicidal expressions at baseline (high-risk group).

Results The girls showed improvement in Human Relationship (ES = 0.57), Health Maintenance (ES = 0.20) and the Total Life Skills Dimensions (ES = 0.24), whereas boys with high-risk behavior improved on Human Relationship (ES = 0.48), Purpose in Life (ES = 0.26) and Total Life Skills Dimensions (ES = 0.22). Effect size for YSR-syndrome scores among all individuals showed no improvement for either gender. Among high-risk individuals boys had a small to moderate effect size from intervention on Withdrawn/Depressed (ES = 0.40), Attention problems (ES = 0.46), Rule breaking behavior (ES = 0.36), Aggressive behavior (ES = 0.48) and Externalizing syndrome (ES = 0.64).

Conclusion Promoting life skills in schools may enhance the overall mental health of young people, indirectly influencing suicide, particularly among boys with high-risk behavior in Cambodia.

Place, publisher, year, edition, pages
2014.
Keyword [en]
Outcome; School based intervention; Life skills; Cambodia
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:umu:diva-88194DOI: 10.1016/j.ajp.2014.01.011OAI: oai:DiVA.org:umu-88194DiVA: diva2:714061
Available from: 2014-04-25 Created: 2014-04-25 Last updated: 2015-04-29Bibliographically approved
In thesis
1. ‘Striving to negotiate… dying to escape’: suicidal expressions among young people in Cambodia
Open this publication in new window or tab >>‘Striving to negotiate… dying to escape’: suicidal expressions among young people in Cambodia
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Suicide among young people is a global public health problem, but information on determinants and understanding of suicidal expressions are lacking in low and middle income countries (LMIC). Though school-based interventions are common in many parts of the world, evidence for efficacy is less reported, particularly from post-conflict countries.

Aim To explore suicidal expressions and their determinants with psychosocial and gender perspective in Cambodia and Nicaragua and to evaluate a school based intervention to promote mental health and prevent suicidal behavior among young people in Cambodia.

Method School students between the age of 15-19 from Cambodia and Nicaragua responded to Attitude Towards Suicide (ATTS) and Youth Self-Report (YSR) questionnaires. In addition, Life Skill Dimension Scale Adolescent Form (LSDS-AF) was used in schools in Cambodia, one experimental and the other control, to measure the impact of intervention. Six focus group discussions (FGDs), both gender-specific and mixed groups, were held to understand young people’s perception of gender, culture, religion and media and their impact on suicide among them.

Results Paper I. Revealed few gender differences in suicidal expressions, except girls reporting more attempts than boys. Girls exposed to suicide among friends and partners were likely to report own suicidal expressions and girls with internalizing syndrome were at risk for suicidal expressions.   

Paper II. Cambodian teenagers reported more mental health problems but fewer suicidal expressions as compared to Nicaragua. The determinants varied between countries.  

Paper III. Participants of FGDs mentioned “Plue Plun” male and “Kath Klei” female to describe gender difference in suicidal behavior among young people in Cambodia who found it a challenge to negotiate between traditional and modern values.

Paper IV. Suicide ambiguity in Buddhism, stigmatizing culture and double edged media were seen as suicide-provoking by the young people in Cambodia, who recommended peer-focused, school based program.

Paper V. School based Life Skills Intervention overall benefited girls. Boys with high risk behavior had shown improvement on many Life Skills dimensions, as well as in their mental health profile.

Conclusion The gender and cultural differences in suicidal expressions and their determinants among teenagers emphasize the importance of culturally sensitive and gender-specific suicide prevention programs. The influence of religion and media ought to be considered while planning intervention programs. School-based program may be a window of opportunity to promote mental health and prevent suicide among young people in Cambodia.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2014. 49 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1643
Keyword
Suicidal expressions, Young people, Cambodia
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-88195 (URN)978-91-7601-041-9 (ISBN)
Public defence
2014-05-16, Föreläsningssal A, Psykiatriska kliniken, By 23, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2014-04-25 Created: 2014-04-25 Last updated: 2014-04-25Bibliographically approved

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Jegannathan, BhoomikumarDahlblom, KjerstinKullgren, Gunnar

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