Parental Engagement and Adolescents Mental Health Wellbeing: Cross-Sectional Study from Sri Lanka

Background: Parental engagement is one of the key factors that can influence adolescents mental health status, although these associations are not fully measured in the local context. This study will estimate the prevalence and association of parental engagement with adolescents and mental health status in Sri Lanka. Method: This current study is a secondary analysis of nationally representative data for Sri Lanka. The data was collected from 3262 school attending students in grades 8-12 in the Sri Lankan Global School-based health survey (GSHS) 2016. A two-stage cluster sample design was used to select the representation of samples. The binary variables i.e. loneliness, anxiety and suicidal ideation, were modelled using multivariable logistic regression models with predictors representing gender, age, grade, parental supervision and parental understanding. Result: It is estimated that the prevalence of parental supervision and parental understanding is 85.3% and 78.5%, respectively. The analysis of both good parental supervision and parenting understanding has reduced the loneliness, anxiety and suicidal thoughts among the adolescents population, compared to those who don't have good parental engagement. Conclusion: It is seen that there is a higher prevalence of parental and children engagement in Sri Lanka compared to other demographical regions. However, the prevalence of mental health remains higher as compared to the global average. The results suggest that national policies and programs should be integrated for both parents and children. Parents need more knowledge on good parenting, while adolescents need support on coping with their mental health.


Introduction
Parental engagement towards adolescents significantly impacts their health, developmental outcome, and risk behaviors [1]. The age between 13 -19 years is a critical transition period to adulthood, in which adolescents continuously changes physically, mentally and psychologically [2]. Around 10-20% of these young people, especially those who live in lower-middle-income countries, suffer from different types of mental health problems [3]. Increased mental health issues and attempts to self-harm among adolescents and young people are challenged worldwide. In this age group, parental engagement in their lives can help them to learn about minimizing stress, as well as maintaining good physical and mental health. In a study among Canadian adolescents, it has been seen that good parental involvement is more strongly associated with a reduction in suicidal thoughts and attempts [4].
Additionally many previous studies have confirmed that strong bonding between parents and children results in a significant decrease in developing the risk of mental health problems [5,6], substance abuse [7] and violence [8]. There is a limitation in studies of different cultural contexts on the association between parental engagement and adolescent mental health [9], which has also been explored in many published studies conducted in western countries indicating individuality and independence. However, in the Sri Lankan context, collectivism should consider the parent-child relationship [10] [12]. To evaluate mental health issues, three domains have been used, i.e. loneliness, anxiety and suicidal ideation [13,14]. The World Health Organization (WHO), along with Central disease prevention (CDC), collaboratively designed the Global school-based health survey (GSHS), which provides an excellent understanding of relationship analysis between parental engagement and mental health. Given the background on the importance of adolescent mental wellbeing, the present study aims to identify the correlation between parental engagement on adolescents mental health to have a better understanding of the country context, which will support the development of children mental health programs.

Method
Study source: This study is an analysis of secondary data from the Global-School based health survey, which is available in the WHO (World Health Organization) microdata library online [15]. The students self-report their responses to each question in the questionnaire. The WHO jointly develops the questionnaire, CDC (Centers for Disease Control and Prevention) and other united national agencies to measure the adolescents behavioral lifestyle, the environment they are exposed to, protective and negative factors that impact their life. In previous studies also validate the GSHS as acceptable validly [16].

Sampling technique and sample size:
The students study population was selected by using two-stage clustering methods. In the first stage, schools were selected based on the probability proportional to the number of enrolments in classes 8-13. Total 40 schools were selected Appendix 01.
In the second stage, the classroom was chosen randomly from the selected school. All students in the selected school were eligible to participate. The and the likelihood ratio test. We generated the odds ratio (OR) and respective 95% confidential interval from the final multiple logistic regression model.

Discussion
The present study was conducted to examine the association of parental engagement on adolescents mental health among school attending students between grades 8-13. The prevalence of parental engagements was estimated as Parental supervision (85.3%) and Parent understanding (85%), which is higher compared to other regional studies [17].
While the prevalence of mental health among adolescents was estimated as loneliness (30.8%), anxiety (20.2%) and suicidal ideation (3.7%), these rates are higher than the global average [3]. We observed that parental understanding and parental supervision had reduced the risks of loneliness, anxiety and suicidal ideation in adolescents. It has been observed that mental health problems are more experienced by females than males, which is consistent with other published reports that females seek more help than males [18]. However, many other factors contribute negatively to mental health in females, such as social-economic disadvantage, violence, inequality and taking care of their siblings [19]. Loneliness is a destress and painful experience that is characterized by dissatisfaction with social relationships [20]. We have found that loneliness experienced by adolescents can be reduced by good parental engagement, which is similar to other studies stating that parental warmth [21], degree of the relationship and parenting style act as a protecting factor against loneliness [22].
We noted that good parental engagement had reduced anxiety among adolescents. Anxiety is a severe functional impairment and distress which results in problems associated with society, family and schooling. It is believed that 60% of children with an anxiety disorder are familial [23]. And twofold higher if one of their parents have an anxiety disorder [24].
The study suggests that environmental and genetic factors play an essential role in the familial transmission of anxiety [25]. Three different parenting styles can be considered for a better understanding of the psychology of parental attitudes towards their children and anxiety: permissive, authoritarian and authoritative styles.  [28].
Suicide rates are a higher and common problem in the South Asian region [29]. Our study indicates that parental supervision and better understanding have reduced suicidal thoughts among adolescents.
A study from four thousand households in Sri Lanka has shown that household environment has a significant association with the risk of suicide more than the community influences [30]. Grade  Adolescents were more likely to attempt suicide when they have conflict, negative arguments, expressing anger, verbalized hostility by parents or close members [31]. But substance abuse like alcohol doubles the risk of suicidal ideation. The suicide epidemic of the country remains a serious problem, but its peak dropped down after the 1990s due to policy amendments by the presidential task force on suicide prevention in 1997 [32].