1

MINISTRY OF EDUCATION AND TRAINING
THAI NGUYEN UNIVERSITY

DAM THI BAO HOA
EVALUATING THE EFFECTIVENESS OF EARLY
DETECTION AND INTERVENTION MODEL ON
MENTAL DISORDERS OF STUDENTS FROM 6 TO
15 YEARS IN THAI NGUYEN CITY SPECIALITY: SOCIOLOGY AND HYGIENE HEALTH ORGANIZATION
CODE NUMBER: 62.72.01.64
SUMMARY OF THE doctoral DISSERTATION

Thai Nguyen - 2014
INTRODUCTION

Mental disorders afect about 20% children and adolescents in all
countries over the world. If not detected and prompt treatment, they
can leave severe long consequences for the child itself, and affect the
lives of other members of the family, the community and increase the
society cost burden. However, according to the review of World
Health Organization (WHO), child and adolescent mental health in
many countries were not given adequate attention. Even in the
developed countries like United State, United Kingdom, about 70-80
% of children and adolescents had mental health problems but were
not received appropriate medical services due to barriers on
geography, perceptions, economics, health services, prejudice, stigma
and discrimination.
In Vietnam, the community mental health care program has just
been implemented since 1998 and so far concentrated mainly in
patients with schizophrenia and epilepsy. About 10 years ago,
researches have done some surveys on child and adolescent mental
health as epidemiological studies to determine the burden of disease
in the community, studies to build diagnostic screening tool in the
primary health care, the communication activities to raise awareness
of the community and to cary out som pilot solution interventions on
child and adolescent mental health care.
Thai Nguyen City is the cultural and economical center of the
Northern Mountainous Region of Viet Nam. Besides these
advantages , Thai Nguyen also faced with many complex problems,
especially the problems of children and adolescents, such as stealing,
fighting, truancy, suicide, drug addiction, game addiction Within
the general context of Viet Nam , child and adolescent mental health
care in Thai Nguyen is still being lacked, there is lack of the

Chapter 2
SUBJECTS AND METHODOLOGY
2.1. Subjects, research location and duration of study
2.1.1. Subjects of study
- Students at primary and secondary schools (from 6 to 15 years old).
- Parents of the students.
- Teachers
- School health workers, community health worker.
- Leaders of the school, teachers in charge of the Ho Chi Minh Young
Pioneers, Ho Chi Minh Communist Youth Union in the school
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Inconclusion: students, parents or careers of students disaggre to take
part in the research.
2.1.2. Duration of study: From September 2009 to January 2012.
2.1.3. Research location: Nguyen Viet Xuan Primary School, Hoang Van
Thu Primary School, Doc Lap Secondary School and Nguyen Du
Secondary School of Thai Nguyen city.
2.2. Research Methodology
2.2.1. Design of research
The research was based on:
- Cross-sectional descriptive study
- Intervention study
- Combining qualitative and quantitative study.
The model was biult in figure 2.1

* Sample size:
Applying the formula for sample size for described study:
 
 
2
2
1
2
p 1 p
nZ
p.




- n is minimum number need to be researched;
- Z (1- /2): coefficient of confident limit (with  = 0,05, Z
2
(1-

/2)
= 1,96).
 Students sample size in description research
p : ratio of students with mental disorder according to researches
before, estimated p = 0.2. 1- p = 0,8. ε: desired error, we choosed ε =
7,5 % p. Since then we had n1 = 2794
So, the minimum number need to be researched was 2794 students. In

- Sampling schools: we choose 4 schools by random draw method.
So, we had Hoang Van Thu primary school, Nguyen Viet Xuan
primary school, Nguyen Du secondary school, and Doc lap
secondary school.
- Sampling students: the entire sample; we made a list of all the
students of 4 schools selected. After that, we surveyed under the list and
had 2850 students. Some cases were absence or refused to participate in
the research.
- Sampling parents: Each class chose 5 parents according to the list
of class students with distance k = 7.
2.2.2.2 Intervention study
* Sample size:
 Intervention sample for students was calculated as the sample size
calculation for testing the difference between two rate.
P
1
( 1-p
1
) + p
2
(1-p
2
)
n = z
2
(,)
(p
1-
p
2

 Intervention sample for officers, school teachers, health workers:
all of homeroom teachers, school leaders, school health workers,
teachers in charge of the Ho Chi Minh Young Pioneers Ho Chi Minh
Communist Youth Union in the school and community health workers.
 The sample size for intervention the group of mental disorder students
Due to the nature of public interventions and research ethics, we
treatmented all of the students with mental disorders in the intervention
schools according to the results of the phase 1 survey.
* Choose intervention group: Hoang Van Thu Primary School and
Nguyen Du Secondary School.
Control group: Nguyen Viet Xuan Primary School, Doc Lap
Secondary School.
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- Investigate before, after intervention similar to cross-sectional
survey earlier.
2.2.3. The studied criteria
2.2.3.1. The studied criteria for objective 1
* The general information of research group
- General characteristics of students: age, gender, class
- Personal characteristics of students: illness characteristics, family
circumstances, psychological trauma, of the students with mental disorders.
- General characteristics of parents: age, gender, ethnicity,
education level, occupation, number of children
- General characteristics of teachers: age, gender, ethnicity,
education level, occupational seniority
* The criteria on student mental disorder
- The proportion of students could have mental health problem after
screening (SDQ score > 14).
- The proportion of students with mental disorders according to
ICD10 criteria.

- Opinions on the needs of student mental health care of the
community through group discussions and in-depth interviews.
2.2.3.2. The studied criteria for objective 2
* The studied criteria for building intervention model
- Human Resource: the number of people participated the model.
- Material resource: Number of training and communicating materials,
psychological tests were used, the materials, facilities used in research.
- Organization:
+ Student Mental health care Department in Thai Nguyen city was
established with the responsibilities and duties of each member.
+ Student Mental health care Group was founded in Hoang Van
Thu Primary School and Nguyen Du Secondary School, officials
responsible for each member in the group.
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- Activities:
+ The number of communication sessions for teachers, school
health workers.
+ Number of people attended the media.
+ Number of training and communication materials, number of leaflets
in student mental health care were distributed to parents, teachers.
+ Number of group discussions with staff, teachers, parents.
+ Number of meetings of Student Mental health care Group.
+ The number of students with mental disorder were monitored.
+ The number of students were prevented.
+ The number of students with mental disorders were examinated,
consultated, intervented.
+ The number of parents of the students with mental disorder had
medical advice.
+ The number of students were screened and examinated.
* Indicators to evaluate effectiveness of the model

students at the intervention schools .
- The minutes of group discussion in students with disorders.
- The longitudinal data to track the results of counseling, therapy,
groups of students have been collected from patient examination and
counseling, periodic monitoring.
2.4. Intervention contents
2.4.1. Preparing community
2.4.2. Preparing resources
- Workshops and trainings for teachers, health care workers, school
health workers.
- Skill training for early detection and prevention of The Student
Mental health care Groups.
- Preparing enought training materials, investigation, communication,
reporting forms
- Preparing budget for the study.

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2.4.3. Implementing interventions

Figure 2.2. Student mental health care model
In which, the interventions forcused on:
(1) Early detection of disorders, so could make the diagnosis.
(2) Solving the cases with pharmaceutical, psychological therapy
and improving the environment.
(3) Preventing for all students.
- The Student Mental health care Department would supervise,
monitor the activities of The Student Mental health care Groups.
2.5. Method of assessment
2.5.1. Evaluating the screening results by SDQ25 scale
Suspecting a problem when the SDQ total score > 14 points.

Data were managed on a computer and supported of Epidata
software, were analysed basing on statistical analysis software Stata
10.0 and Epinfo 6:04.
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Chapter 3
OUTCOMES OF THE STUDY
3.1. Status of mental disorders in 6-15 year old students in Thai
Nguyen city and the needs of student mental health care
3.1.1. Status of mental disorders in 6-15 year old students in Thai
Nguyen city
Table 3.1. The general characteristics of the student group
Characteristics
n
%

Age
6 -11 years
1638
57.5
12-15 years
1212
42.5
Gender
Male
1433
50.3
Female
1417
49.7
Ethnicity

Phobias
7
3.0
Attention deficit hyperactivity
75
32.2
Behavious disorders
20
8.6
Other disorders
34
14.6
Mix disorder
91
39.1
Comment: The most common disorders were depression (76%),
attention deficit hyperactivity (32.2%), anxiety (17.6%). Many students
have mix disorders (39.1%).
3.1. 3. The factors related to mental disorders in students
Table 3.9. The relationship between age, sex, ethnicity and
mental disorders in the student
Disorder
Factors
Yes
No
2 , p
n
%
n
%

416
92.2
2 = 0.1
p > 0.05
Kinh
198
8.3
2201
91.7
Comment: There was an association between age and mental
disorders. Group of 12-15 had significantly more disorders than
group 6-11 (p <0.01). 15
Table 3.10 The relationship between stress and mental disorders in
the students
Disorders
Stress
Yes
No
Total
Stress
106
36
142
No stress
127
172
299

parents and mental disorders in the students. p <0.05 in the study
indicated that the knowledge of parents were not good so the disorders
would be higher.
Table 3.12. The relationship between parental attitude about
student mental health care with student disorders
Disorders
Parental attitude
Yes
No
Total
Not good
79
162
241
Good
13
165
178
Total
92
327
419
2 , p
2 = 38.7 ; p < 0.001
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Comment: There is a significant association between attitude of
parents and mental disorders in the students. p <0.001 in the study
indicated that the attitude of parents were not good so the student
disorders would be higher.
Table 3.13. The relationship between parental practice about

92
94
96
98
document
Medical advice
Examination

Figure 3.3 The needs of mental health care for students of parents
Comment: The percentage of parents supported the examination,
early detection and prevention is the highest (96.4%).
90.5
91.7
98.8
80
90
100
Document
Medical advice
Examination

Figure 3.4. The needs of mental health care for students of teachers
Comment: Over 90% of teachers wished to receive materials and
advice, support examination, early detection and prevention for students.
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Table 3.14 The needs of mental health care for students
in group discussion

Contents of discussion
Result

6.7
Want to know how to prevent
60/60
100.0
0
0
Having expert advice when necessary
48/60
80.0
12/60
20.0
Comment: the demand of student mental health care in group
discussions was very high.
3.2. Results in building and evaluating the model for student mental
health care
3.2.1. Building the student mental health care model
3.2.1.1. Human resoursce and organizating the model
Table 3.15 The results of building human for model working in
the intervention groups
Contents
n
Time
(day)
Participants
Numbers of workshop in Department of
Education and Training
01
01
30
Numbers of Student Mental health care

18 /1 school
36
Numbers of students with disorder
were intervented
107
107
Numbers of parents were
intervented
≈ 3-4 l/1 student
≈ 400
Numbers of intervention
≈ 3-4 /1 student
≈ 400
Numbers of students were screened
≈ 2400
≈ 2400
Comment: In two years, 107 students had been monitoring,
counseling, intervention. We adviced for 400 parents respectively.
2400 turns students were monitored and early detected.
(b) Communicating to parents
Table 3.20. Preventing and communicating activities
Activities
The doer
numbers
Result
Delivering materials
for parents
Teachers

02 times

43.6
Medication support
34
20.9
Personal psychology therapy
163
100.0
Counseling for parents
163
100.0
Teachers take part in intervention
163
100.0
Local health workers take part in
163
100.0
Total
163
100.0
Comments: 100% of students with disorders were psychological
interventions such as individual counseling for parents 43.6%
used specialty drugs and 20.9% used other drugs support.
3.2.2. Effectiveness of the detection and early intervention
model for students after 2 years of intervention
3.2.2.1 Effectiveness of changing KAP of parents and teachers
Table 3.28. Effectiveness of changing KAP of parents
KAP
Different
(%) before-
after

after
Effective index (%)
Effectiveness
(%)
Intervention
schools
Intervention
schools
Knowledge
100.0

0

Attitude
44.5
100.2
22.4
77.8
Practice
66.7
343.8
2.4
341.4
Comment: After intervention, good knowledge of teachers
increased 100.0%. The same, attitude increased 44.5%, increased in
practices: 66.7%. Effectiveness of interventions in attitude was
77.8% and practice was 341.4%.
3.2.2.2. Effectiveness of intervention in the students
(a) Effectiveness of intervention on student mental health of
invention schools

Normal
90.9
94.8
92.5
91.5
Effect. index
42.9 %
-13.3 %
Interv. Effect.
56.2 %
Comment: The proportion of students with disorders in the
intervention school significantly reduced when we compared with
before having intervention and with controls (p <0.001).
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(b) Results of counseling and treatmenting of disorder group
Table 3.37 Results of counseling and treatmenting of disorder
group in intervention schools
Result
Number
(n=107)
%
Full recovery
55
51.4
Much relief
26
24.3
Little relief
23
21.5

5
6
2
1
1
01

01
Comment: In 2 years, 56 students have been found to have unusual
signs. Among them, 29 students had disorders. In the control schools,
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only one student had a major depression and had suicidal ideation
which was discovered by teachers and her family.
3.2.2.3. The comments of the school, parents of the intervention results
To assess the results of interventions, in parallel with the evaluation
of the student mental health, assessing KAP of parents and teachers,
we conducted group discussions with the related members. The result
was that most of participants said mental health care was essential;
The activities of the model helped them more understood about the
student mental health and thereby enhanced their capacity for student
mental health care

CONCLUSIONS
Through the research we had some conclusions:
1. The status and the needs of mental health care for 6-15
year old students in Thai Nguyen city
- The proportion of students with disorders were 8.2%. The most
common disorders were depression, attention deficit hyperactivity
disorder and mix disorders.
- The age, stress factors, knowledge and attitude of parents about

- Communicated to parents of students in 2400 turns.
- Early intervention for 163 students with mental health problems.
- Monitoring the model: participated in 18 times of meeting, media
monitoring activities for parents : 4 times; the general supervision of the
operation of the model was 6 times in each intervention school.
2.2. The effectiveness of the model
 The changes in KAP of parents and teachers
- KAP of parents: markedly improved after intervention. Effectiveness in
knowledge gained 680.1%, attitude: 77%, practices: 85.5%.
- KAP of staffs, teachers: markedly improved after intervention. All of
the teachers had good knowledge after intervention; Effectiveness in attitude:
77,8% , and practices: 341,4%.
- There was markedly improving in capacity of student mental
health care of the teachers, local health workers, school health workers.