Asian Nurs Res.  2019 May;13(2):147-153. 10.1016/j.anr.2019.04.001.

Psychological Distress among Adolescents in Laos, Mongolia, Nepal, and Sri Lanka

  • 1Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
  • 2Institute for Health and Society, Hanyang University, Seoul, Republic of Korea.
  • 3School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
  • 4Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea.


The purpose
of this study was to explore psychological distress and examine the relationship between this distress and individual, family, and school factors among adolescents in four low- and middle-income countries (LAMICs) in Asia (i.e., Laos, Mongolia, Nepal, and Sri Lanka).
A total of 4,098 adolescents attending public schools in the four LAMICs were surveyed as part of the Healthy School Development Project, which aimed to develop school capacity for improving (1) health among all school members and (2) the school environment through tailored school health programs. Psychological distress, family factors (i.e., parental understanding and monitoring, and parental tobacco and alcohol use), and school factors (i.e., having close friends, not bullied, school attendance, and health education) were assessed using self-report questionnaires. Data were collected from September to November in 2012 and 2013. Data analysis comprised descriptive statistics, Chi-squared testing, and logistic regression.
Over half of the participants were women (53.2%–64.1%), and 33.7% (in Sri Lanka) to 53.8% (in Laos) were aged older than 15 years. Approximately 32.9% reported the presence of psychological distress; moreover, 7.9%–13.2% reported suicidal ideation. Parental monitoring and being bullied were associated with psychological distress in all four countries.
One-third of adolescents experience psychological distress across these four LAMICs, which poses a substantial public health issue. Adolescents can benefit from family and school-based approaches for screening, ameliorating, and preventing psychological distress.


adolescent; developing countries; school health services; stress, psychological
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