A cross-sectional study on the prevalence of anxiety among school students in Teliamura municipality area of Tripura.

BACKGROUND: Anxiety in adolescence has been a serious problem nowadays. It is seen that anxiety among students cause many harms to their mental and physical health affecting their career.
OBJECTIVE: The objective of this study is to know about the burden of anxiety among school students and to find out the association of different grades of anxiety with sociodemographic characteristics and any other factors.
MATERIALS AND METHODS: In a cross-sectional study, 400 school students of Class IX-XII, from four schools of Teliamura Municipality area of Tripura were included during May 2016-June 2016. Required sample from each school was selected by proportion probability sampling. Then, students were selected using systematic random sampling technique until the sample size from each school was reached. Beck anxiety inventory was used to assess the different grades of anxiety among students.
RESULTS: Most of the students were suffering from mild anxiety (49.4%) followed by moderate anxiety (43.3%) and severe anxiety (7.3%). The mean anxiety score of the school students was 16.90 ± 9.02. Female students (10.9%) had more severe anxiety compared to male students (3.8%) and this difference of different grades of anxiety with gender was statistically significant. The association of different grades of anxiety with a history of stressful events in the past 6 months was found to be statistically significant.
CONCLUSION: Anxiety was present in each age group and females were suffering more with severe anxiety. Future research on academic anxiety should be done to combat against this problem of anxiety among school students. Copyright:

INTRODUCTION

Everybody feels anxiety in day-to-day life. Anxiety is felt when we face a certain event in life like facing an interview or appearing in the examination. Anxiety is an emotional state arising in situations of impending danger and manifested in expectation of unfavorable events. Anxiety manifests itself as a feeling of helplessness, uncertainty of oneself, lack of sufficient strength in the face of external factors, and exaggeration of their potency and strength.[1]

In general, anxiety can be either a trait anxiety or a state anxiety. A trait anxiety is a stable characteristic or trait of the person. A state anxiety is one which is aroused by some temporary condition of the environment such as examination, accident, and punishment. Academic anxiety is a kind of state anxiety which relates to the impending danger from the environments of the academic institutions, including teachers, certain subjects such as mathematics, science, and language.[23]

Anxiety disorders are the most common mental health problem in women and are second only to substance use disorders in men.[4] Anxiety in adolescence has been a serious problem nowadays. Various circumstances such as the death of a close friend, parent or sibling, rejection from peer group, chronic illness, psychological or sexual abuse, and a physical disorder may lead to a higher risk of developing anxiety. The most common sources of day-to-day stress for adolescents are changes in their body, academic stress, which includes exam fear, competition, preparing for examination, classwork preparation, type of syllabus and overwork, problems with peers, unsafe living environment/neighborhood.[1]

It is seen that anxiety among students causes many harms to their mental and physical health affecting their career. In this context, the present study was conducted to know about the burden of anxiety along with distribution of different grades of anxiety among students of Teliamura Municipality area Tripura and to find out the association of different grades of anxiety with sociodemographic characteristics and any other factors such as addiction history and stressful event in the past 6 months.

MATERIALS AND METHODS

In a cross-sectional study among School students of Class IX–XII, four H.S Schools of Teliamura Municipality area, Khowai district of Tripura were included in this study. The study was conducted during the period of May 2016–June 2016. Assuming 50% as the prevalence of anxiety among school students, the sample size was 400. Required sample from each school was selected by proportion probability sampling. Total number of students of Class IX–XII of each school was listed (sampling frame) consecutively from Class IX to XII. Then, students were selected using systematic random sampling technique till the sample size from each school was reached. A predesigned and standard schedule was used for data collection. The schedule has three parts, first part was on different sociodemographic characteristics (age, gender, religion, caste, etc.,), the second part was on behavioral characteristics such as addiction history, type of addiction, history of stressful events in the past 6 months, and the third part was on beck anxiety inventory. It was used to assess the different grades of anxiety among students. Data were collected by interviewing each sampled student of schools during the study period. Anxiety symptoms were translated to them in local language by expert researcher.

Beck anxiety inventory

The beck anxiety inventory is a widely used and well-validated tool for measuring the severity of anxiety. The beck anxiety inventory probes 21 symptoms and takes 10–15 min to complete the interview and score the results. Each item is scored on a 4-point inventory, ranging from 0 = not at all bothering to 3 = severely bothering. Sum of score all parameters was done for categorization of different grades of anxiety (0–21 = low anxiety/mild anxiety, 22–35 = moderate anxiety, 36 and above = potentially concerning levels of anxiety/severe anxiety).[5]

Data analysis and ethical consideration

Collected data were compiled and analyzed on the Statistical Package for the Social Sciences (SPSS – Inc., SPSS for Windows, version 16.0. Chicago, IL, USA). From there, frequency distribution, percentage, proportion, mean and standard deviation values were calculated in appropriate situations. Chi-square test was used to find out any association of academic anxiety with sociodemographic and other study variables. Value of P < 0.05 was considered as statistically significant. The study was conducted after getting permission from the Institutional Ethics Committee. Consent from teachers and ascent from students was obtained from the students before conducting the study.

RESULTS

Profile of sample population

The study was conducted among 400 school students of Teliamura Municipality area, Khowai district of Tripura. Majority of the study participants were from the age group of 14–16 years (57.5%). The mean age of the study participants was 16.14 ± 1.25. The study comprised almost equal proportion of both genders, i.e., 208 males (52.0%) and 192 females (48%). Most of the students were Hindu (99.5%), and majority of the participants were from general category (34.7%) followed by schedule caste (30.3%) and OBC (29.5%). Among the school students, 9.5% of students had a history of addiction and 5.2% are addicted regularly to smoking and smokeless tobacco. Of 400 students, 13 students (3.3%) have given history of stressful events in the past 6 months [Table 1].

Table 1

Sociodemographic and behavioral characteristics, history of stressful events of the study population (n=400)

	Frequency (%)
Sociodemographic characteristics
Age (years)
14-16	230 (57.5)
17-19	164 (41.0)
≥20	6 (1.5)
Gender
Male	208 (52.0)
Female	192 (48)
Caste
General	139 (34.7)
ST	22 (5.5)
SC	121 (30.3)
OBC	118 (29.5)
Religion
Hindu	398 (99.5)
Muslim	2 (0.5)
Behavioral characteristics and history of stressful events
History of addiction
Yes	38 (9.5)
No	362 (90.5)
Type of addiction (smoking/smokeless tobacco)
Regularly	21 (5.2)
Occasionally	17 (4.3)
Not applicable	362 (90.5)
Stressful events in the past 6 months
Yes	13 (3.3)
No	387 (96.7)

Magnitude of anxiety

In the present study, it was seen that students were suffering from very low-to-severe level of anxiety. Most of the students were suffering from low anxiety (49.4%) followed by moderate anxiety (43.3%) and severe anxiety (7.3%) according to beck anxiety inventory [Table 2]. The mean anxiety score of the school students was 16.90 ± 9.02.

Table 2

Prevalence of different grades of anxiety among school students according to the beck anxiety inventory (n=400)

Anxiety category	Frequency (%)
Mild anxiety/low anxiety	198 (49.4)
Moderate anxiety	173 (43.3)
Severe anxiety/potentially concerning levels of anxiety	29 (7.3)
Total	400 (100)

Association of anxiety with sociodemographic characteristics, history and type of addiction, and history of stressful events in the past 6 months

Table 3 shows different grades of anxiety, i.e., from low-to-severe level of anxiety was present in each age group. Moderate level of anxiety has been found in each age group, 14–16 years (38.3%), 17–19 years (50%) and 20, and above (50%). Severe level of anxiety was seen among students between 14–16 years (7.4%) and 17–19 years (7.3%) age group.

Table 3

Association of different grades of anxiety with sociodemographic characteristics and other factors (n=400)

Sociodemographic characteristics and other factors	Anxiety category			Total	P
	Mild anxiety, n (%)	Moderate anxiety, n (%)	Severe anxiety, n (%)
Age groups (years)
14-16	125 (54.3)	88 (38.3)	17 (7.4)	230 (100)	0.186
17-19	70 (42.7)	82 (50.0)	12 (7.3)	164 (100)
20 and above	3 (50.0)	3 (50.0)	0 (0.0)	6 (100)
Gender
Male	130 (62.5)	70 (33.7)	8 (3.8)	208 (100)	0.000
Female	68 (35.4)	103 (53.6)	21 (10.9)	192 (100)
Religion
Hindu	197 (49.5)	172 (43.2)	29 (7.3)	398 (100)	0.920
Muslim	1 (50.0)	1 (50.0)	0 (0.0)	2 (100)
Class
Class IX	77 (75.5)	21 (20.6)	4 (3.9)	102 (100)	0.000
Class X	34 (31.8)	62 (57.9)	11 (10.9)	107 (100)
Class XI	49 (65.3)	26 (34.7)	0 (0)	75 (100)
Class XII	38 (32.8)	64 (55.2)	14 (12.1)	116 (100)
History of addiction
Yes	18 (47.4)	17 (44.7)	3 (7.9)	38 (100)	0.836
No	180 (49.7)	155 (42.8)	27 (7.5)	362 (100)
Type of addiction
Occasionally	10 (58.8)	6 (35.3)	1 (5.9)	17 (100)	0.967
Regularly	11 (52.4)	9 (42.9)	1 (4.8)	21 (100)
Not applicable	177 (48.9)	158 (43.6)	27 (7.5)	362 (100)
Any stressful event in the past 6 months
Yes	2 (15.4)	7 (53.8)	4 (30.8)	13 (100)	0.001
No	196 (50.6)	166 (42.9)	25 (6.5)	387 (100)

It was seen that 10.9% of female students had severe anxiety and 3.8% of male students have severe anxiety. The difference of different grades of anxiety with gender was statistically significant. In respect to religion, among Hindu students, 49.5% have mild anxiety, 43.2% have moderate anxiety, and 7.3% have severe anxiety. The difference of different grades of anxiety among Hindu and Muslim was not statistically significant. Severe anxiety was found the highest in Class XII students (12.1%), followed by Class X students (10.9%). The distribution of different grades of anxiety in different classes was found to be statistically significant.

The present study showed that among 38 addicted students, 47.4% of students had mild anxiety followed by moderate anxiety (44.7%), and severe anxiety (7.9%). The difference of different grades of anxiety with a history of addiction and type of addiction was not statistically significant. Association of different grades of anxiety with a history of stressful events in the past 6 months was found to be statistically significant.

DISCUSSION

Anxiety had impact on student's academic achievement. It decreases students learning capabilities and hinders excellent academic performance. In general, there are five factors personal, familial, institutional, social, and political, which lead students toward severe anxiety disorders sometimes. Severe anxiety disorders lead to cognitive distortions, psychosomatic complaints, headaches, stomach ache, fainting, etc. The educational psychology literature reports that consequences of severe anxiety include cautious or rigid thinking, limited responsiveness, interference with cognitive processes, diminution of complex intellectual processing and problem solving, heightened susceptibility to persuasion, higher likelihood of imitating models and increased attention to oneself rather than to the environment.[6]

In the present study, it was seen that different grades of anxiety was present among majority of the school students. Mild anxiety is usually a good thing as it helps a person to perform his or her duty sincerely and timely. Very little anxiety often leads a person detached from self, others as well as the real world.[5] Banga also found different level of anxiety in private senior school students of Kangra district, Shimla.[3]

It was seen that female students were more affected with severe anxiety compared to their male counterparts. This shows female students were more vulnerable to develop anxiety and needed special attention to combat against anxiety disorder in this age group. Pomerantz et al., in their study, found that girls out performed boys across all four subjects but were more prone to internal distress than boys and girls doing poorly in school were the most vulnerable to internal distress.[7] Attri and Neelam in a similar study found girls suffered significantly more with academic anxiety than boys.[8] In contrary to that, Pramod concluded, with reference to Indian culture, that boys manifested more futuristic orientation than girls and therefore, boys have more academic anxiety than girls.[9] Deb et al., in their study, among adolescent school students of Kolkata found that mean anxiety score in the case of adolescent boys was slightly higher than for adolescent girls. Further analysis of data revealed that 20.1% of boys and 17.9% of girls were suffering from high anxiety as measured using the State-Trait Anxiety Inventory.[10]

Whereas a study conducted by Thakur and Kumar[11] in Ludhiana district of Punjab, Bihari[2] in North East India, Mahato and Jangir[12] in a study in Minicoy Island shows that anxiety did not differ significantly with respect to gender. Mattoo and Nabi found that there was no significant difference in the academic anxiety scores between male and female respondents.[13] Das et al., in their study, in Malda, among school students found that boys were less anxious than girls as the mean score of girls was higher than boys students with respect to academic anxiety.[14] Fatma in a study among students of Uttar Pradesh found significant difference between male and female adolescents in relation to their anxiety.[15] Khemka and Rathod in their study also found significant difference in the anxiety of male and female students of secondary schools. Female students were more academic anxious than male students.[16] Kaur and Chawla in their study also found, girls particularly were highly tensed at this stage because on the one hand, they wanted to secure good percentage for getting admission for their future education and on the other hand, they also wanted to prove themselves better than boys in this highly competitive age.[17] It was seen that Class XII and Class X students were more affected with severe anxiety. This might be due to increase stress and pressure of secondary and higher secondary examination in coming future.

We could not use academic anxiety scale specific for adolescent due to nonavailability of the study tool, which is a limitation of this study. The present study may help to develop an insight into school authorities so that they can find the reasons of anxiety in school students. The results of this study may provide ways of solving the problems related to the anxiety of adolescent students. Joshi et al. in a similar study on adolescent anxiety suggested the opening of counseling center in school for adolescent students as well as for parents, to be served by expert counselor or expert child psychologist if required.[18] The findings of this research study have pointed out the serious problem of the anxiety of adolescent school students. Students should feel free to express their views; lesser restrictions should be imposed on them by the school as well as parents. Therefore, teachers in schools and parents at home must assist students in the management of their anxiety through counseling sessions, relaxation, and behavioral techniques.

CONCLUSION

It was seen in this study that, all the students are suffering from mild-to-moderate anxiety which is a matter of serious concern. Different grades of anxiety were present in each age group and females were suffering more with severe anxiety. Anxiety in any form can affect the performance of the student and lead to other comorbidities in future. Academic curriculum in school should be flexible enough to give some amount of time for relaxation and make school environment friendlier for the students. Future research on preventive strategies among adolescent school students should be done to combat against this modern-day problem of anxiety and reduce the burden of anxiety disorder in this age group.

Financial support and sponsorship

This study was financially supported by ICMR, New Delhi, India.

Conflicts of interest

There are no conflicts of interest.