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Acta Médica Costarricense
On-line version ISSN 0001-6002Print version ISSN 0001-6012
Acta méd. costarric vol.55 n.1 San José Jan./Mar. 2013
Original
Biopsychosocial
risk and perception of the functionality of the family amongst
adolescents from
sixth grade in the
Daniel Ulate-Gómez
Author’s
affiliations: Centro
Nacional de Control del Dolor y Cuidados
Paliativos (
Abbreviations:
EBAIS, Equipos Básicos de Atención
Integral en Salud
(Basic Health-Team for Integral Attention); PAIA, Programa
de Atención Integral de la Adolescencia
(Comprehensive Care Program for Adolescents). dulateg@hotmail.com
Abstract
Background:
Adolescence is a crucial stage in life. It is characterized by profound
changes
that define the passage from childhood to adulthood. The proactive
detection of
risk factors and an early intervention are essential to prevent risky
behaviors. The objective of the study was to describe the prevalence of
bio
psychosocial risk and how adolescents perceive the functionality of the
family.
Methods:
The study’s population was composed of 124 adolescents in sixth grade.
The
study included both men and women, over the age of 10 years, for whom
their
parents had provided informed consent. They answered 2 questionnaires: Tamizaje de Riesgo
Results:
The most frequent risk factors were: absence of confidant (36.3%),
feeling of
depression (23.4%), participation in fights (12.1%) and death-related
ideas
(8.1%). The prevalence of a functional family was 68.6%, of mild
dysfunction
27.4% and of severe dysfunction, 4%. The perception of a good family
function
by adolescents was related to low biopsychosocial
risk (p=0.011), greater communication with parents (p=0.000), absence
of a
feeling of depression (p=0.002), absence of death-related ideas
(p=0.000) and
absence of suicide attempts (p=0.003).
Conclusions:
The biggest problems found in adolescents were absence of a confidant,
feeling
of depression, participation in fights and death-related ideas. The
functional
family was shown as a protective factor against depressive symptoms,
death-related ideas and suicide attempts.
Keywords:
Adolescent, family, risk-taking, family and community practice, family
relationships.
During an
adolescent’s development, family and
school are the most influential components. Family dysfunction had been
associated with the highest prevalence of risk behaviors in
adolescents; in the
other hand, an adequate family functionality is a protective factor
against the
development of risk behaviors.3
A useful
instrument to explore a family’s functionality
is the Family APGAR, a quick and simple technique developed by Smilkstein in 1978; this instrument has been
incorporating
in the daily practice of a family doctor, as a tool to approach family
problems
and in the research field.4
Researches
had revealed that the use of screening
questionnaires of emotional symptoms and risk behaviors at schools as
an
important strategy for early diagnosis and early implementation of
prevention
and treatment measures.3 Also, this routine application is supported by
parents
and teenagers.5
There is a
biopsycosocial
risk screening instrument widely used in
For all
that has been presented, it was considered of
vital importance to make a study of
The
general objective proposed in this research was to
describe the prevalence of biopsycosocial
risk and
the perception of the family’s functionality of sixth graders in the
Materials
and Methodology
This
current study was of transversal type and had a
quantitative approach with a descriptive scope. The studied population
consisted of
The data
recollection was made through the followed
questionnaires: Risk Screening from the PAIA and Family APGAR. Both
instruments
were applied in a group formation but each teenager answered the
questions
individually and confidentially.
Before
obtaining the analysis information, a review of
each questionnaire was made, to detect which adolescents presented
risks
factors, with the purpose of sending them on time for an adequate
attention by
professionals in psychology, social work and family medicine of
Thereafter,
the data was tabbed and depurated in an
Excel 2007 program. Simple frequencies of all variables were made, and
the
prevalence with its respective 95% confidence indexes was estimated.
For the
quantitative variables, measures of central tendency and dispersion
were
calculated. Statistical association tests between independent variables
(family’s functionality perception) and dependent variables (biopsycosocial risk factors) were made; this
comparison was
made using the Chi square test. The statistical analysis was made with
EPIDAT3.1 and SPSS17. The confidence level was 95% and the statistical
significance level was p<0.05.
Results
The total
of students in sixth grade from this center
was 164. There were 30 parents who didn’t sign the informed consent.
Ten
teenagers that have the informed consent of their parents were exluded, six of these teenagers decided not to
sign the
informed assent and the other four, were absent during the
questionnaire
application date. Thus, only 124 teenagers were part of this study.
According
to age, 46% (CI95% 36,8-55,1)
of the population consisted of male, and 54% (CI95% 44,9-63,2), of
female. The
ages were between 11-14 years old, with an average of 11.66 years old,
with a
standard deviation of 0.75 and a variation coefficient of 6.43%.
According to
residence, almost half of the teenagers lived in zones that belonged to
EBAIS
El Carmen, Manuel de Jesús Jiménez
and La Pitahaya, all attached to
According
to the score obtained on PAIA’s
Risk Screening, each partaker in this research was classify according
to the
level of biopsycosocial risk, in three
groups: low
(0-8 points), intermediate (9-13 points) and high (14 points or
higher). The
average score was 3.07 with a standard deviation (SD) of 2.6 and a
variation
coefficient of 84.62% (Table
1).
The
prevalence of biopsycosocial
risk factors was obtained through PAIA detection instrument, using
dichotomous
closed questions, to determined if the teenager presented a risk
factor,
according to his/her recent behavior (Figure 1).
The data
about how teenagers perceived the
functionality of their families was obtained through Family APGAR.
According to
the scoring, it was stratified in three groups: Good Functionality
(8-10
points), Mild Dysfunction (4-7 points) and Severe Dysfunction (0-3
points). The
average score was 7.7 points, with a SD of 2.01 and a variation
coefficient of
25.9% (Table 2).
Through
the research, a significant relation between a
good family functionality with absence of risk factors was defined:
feeling
depressed (p=0,002), suicide attempts (p=0003) and death ideations
(p=0,000). For
the following variables, an association with family functionality was
not
found: smoking (p=0,794), excessive consumption of alcohol (p=0,263),
drug use
(p=0,263) and involvement in fights (p=0,396) (Table 3).
Also, an
association between perception of a good
family function and the presence of low biopsycosocial
risk was determined (p=0.011). And also, an association between
perception of
functional families and the constant communication with the parents
(p=0,000).
Discussion
In
relation to the prevalence of biopsycosocial
risk groups, the study showed a high percentage of low risk teenagers,
indicating that this group is susceptible to receive primary prevention
measures for risk behaviors.
The
absence of a confident had the highest prevalence
among biopsycosocial risk groups,
presenting in more
than one third of the teenagers among sixth graders. This fact
increases the
probability for teenagers to fall into risk behaviors due to the lack
of social
support, as analyzed in a 2007’s Spanish study.7
The second
more prevalent risk factor in this
population, was feeling depressed in last month; this problem was
present in
almost a quarter of the studied population, with the highest prevalence
obtained in the study by Pérez-Milena and collegues, where 12,9% of teenagers refer
feeling
“sad all the time”.7
The
presence of death ideas had a prevalence of 8.1%. It
draws attention that the prevalence for this risk factor is higher in a
2008’s Chilean study, when it revealed that 6.11% of teenagers refer
feeling “extremely” desperate and senseless, indicating a high risk
of suicide in this group.3
Suicide
attempts had a prevalence of 1.6%. This amount
is considered low when comparing it to a 1999’s national study, when
the
prevalence of hopelessness (indicative of high suicide risk) was close
to 25%
in teenagers of high school 4th and 5th graders.8
However,
the results are still concerning, when taking the Costa Rica’s IV State
of Children and Adolescent Rights as a reference, that reported in
The
prevalence of teenagers involved in fights was of
12.1%; also the prevalence for the use of weapons among sixth graders
had a
prevalence of 1.6%; both factors represent a severe problem in schools.
As
manifested by PAHO (Pan American Health Organization), violence is one
of the
greatest difficulties of public health worldwide, so it is important to
worked
on school, community and family settings to stimulate teenagers to
acquired
preventive abilities against violent behaviors.10
The
prevalence of driving or asking for rides/lifts
was of 2.4% in both cases. These behaviors are life threatening for
this
population and other people as wells. The consequences of this risk
behaviors
are shown in
In
relation to drug use, the prevalence for active
tobacco smoking was of 0.8%, also 0.8% for alcohol drinking in the last
semester and 0.8% for other drugs. Comparing this data, IAFA’s
2006 national research had a prevalence of active tobacco smoking of
4.2%,
alcohol drinking in the last 12 months of 20% and other drugs in 6.6%
among
seventh graders.12
In 2006’s
national study, the onset age reported
for alcohol drinking was 12.85 years old in males, and 13.01 years old
in
females; and the age onset for tobacco smoking was 12.38 years old for
males
and 12.88 years old for females.12 The average age for the
studied
population was 11.66 years old, this number is below the age onset for
tobacco
smoking and alcohol drinking nationwide, justifying that the prevalence
found
in national statistics is lower.
In
relation to sexual intercourse, the prevalence
among sixth graders was 0%. In comparison with Santander and colleagues
study,
developed in Chilean schools, a prevalence of 14.3% was found in
teenagers
under age 13. 3 On national level, 2010’s Sexual and
Reproductive Health poll, stages for sexual intercourse, an average of
onset
age of 15 for males and 16 for females. So, a 0% prevalence of sexual
intercourse in a school population with an average age of 11.66 years
old is
according to
The
prevalence of the family’s functionality
perception on this study demonstrated that 68.6% had a good family
function,
differing totally from a 2008’s Chilean study that reported that 66.5%
of
teenagers perceived their families as dysfunctional;3 however,
there
are important similarities with a 2009’s Spanish study, where teenagers
reporting a good family function was presented in 77% of cases.14 The
prevalence of family dysfunction is 31.4% in this study, similar to
statistics
among general populations from different studies, with a family
dysfunction
between 16 and 35%.7
The fact
that sixth graders perceived their families
as functional is a beneficial factor; it is known that the family
system is
responsible for the teenager growth, fulfilling their tasks to acquired
emotional maturity and that a functional family is and will always be
for a
teenager’s health, the best preventive agent.15
The
perception of a good family function showed a
relation with the presence of low biopsycosocial
risks (p=0,011). This association stands that a good family function
can be a
protective factor against risk behaviors among teenagers; instead, a
family
dysfunction would be related to a higher biopsycosocial
risk, as demonstrated in Roustit and
colleagues
study; that defined an association between family disruption and psycosocial maladjustment in teenagers.16
The
absence of feeling depressed as a risk factor had
been linked to the perception of good family function (p=0,002). So, a
functional family can be a protective factor against development of
depression.
In comparison, Pérez-Milena and colleagues
study in Spain, found an association between family dysfunction and
presence of
depression symptoms, proposing that family dysfunction could be a
predisposing
factor for depression;7 similar to Santander and colleagues
study in
Chile, where the risk to present emotional symptoms was slightly
superior in
families perceived as dysfunctional.3
In other
variable crossing, a good family function was
associated with the absence of suicide attempts (p=0,003), showing that
a
functional family could be a protective factor against suicides in
adolescents.
This is an important finding, since the IV State for Children and
Adolescents
Rights, indicates suicide as one of the greatest problems among
teenagers.9
With the
obtained data in this research, the
association between perception of a good family function and the
absence of
suicide ideas (p=0,000) was found, referring to a protective relation
against
suicide ideas in teenagers with functional families. The above agrees
with the
study results related to depression and suicide attempts references
received by
the Hospital Calderón Guardia’s
Adolescent Clinic, where family dysfunction was a crisis triggers.17
Also, a
relation between perception of family as functional
and constant communication with parents (p=0,000) was defined. This
association
confirms what Santander and colleagues described about teenagers
belonging to
functional families were the ones with better communication with their
parents.3
Finally,
it is recommended that future studies make a cohort
or case-control design, based on this research, to analyze deeper the
relationship of causality between the variables studied. In addition,
it is
necessary that the Caja Costarricense
de Seguro Social continue with the routine
application
of screening and risk assessment of family functioning of adolescents,
both in
schools and in the EBAIS, to ensure comprehensive care of this
population.
Conflict
of Interests:
the author reports none.
Thanks: We thank MSc. Mayra Cartín Brenes for her valuable advice.
References
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