The study found the prevalence of MS among Thai adolescents was 26.4%. It showed a higher rate of the prevalence compared to previous studies [12, 20], which could be due to the different populations, and sources of data. The population used in this study was adolescent 15–24 years in school-based sample, unlike earlier studies, participants were diagnosed or met criteria for diagnosis with mental problem and illness [20]. Regarding source data in previous studies, it was extracted from a part of the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) [12] and free text extracts clinical information that relevant keywords such as instability, mood, affect and emotion [20]. In the current study, we directly collected data from the participants by using ALS-18 questionnaire, which included depression, anxiety, elation, and anger, thereby screening several symptoms.
Being female increased the odds of MS supporting previous researches that revealed emotional problems were more common in school-age girls, and by early adulthood, women are more likely to be diagnosed with a mental health condition than men [27–28]. Attribution explained gender differences in social inequalities, socioeconomic status, ethnicity, sexual orientation, and other factors intersect to impact women throughout the life course affecting their mental health [27].
Bivariate analysis showed the highest MS rate in those nonnormative genders. Although Thai sex norms are modern formations that have undergone a tremendous transformation over the last century, nonnormative gender continues to be less accepted as a gender norm and is still stigmatized [29]. For this reason, this gender is a stressor.
The family history of mental problems increased the odds of MS as scientific research of the phenotypes studies shown the mental illness in family history supports significant for mental health problems and disorders among relatives [30].
Bullying involvement appeared significantly associated with increased odds of MS is supported by previous work of bully and mental problems [31–32]. For problematic social media use, the current study shows both a trend to impact and get problems from social media in daily life was strongly increased the risk of MS also found in psycho-pathological such as depression, anxiety and suicidal ideation [33]. The primary developmental crisis in the adolescent period is self-identity (Erikson's Psychosocial development), the disjunction between a physical change and socially allowed independence. This period, when youth disengage from parents, can result in high levels of conflict and a concurrent status viewed as stressful. It may lead to taking risky behavior.
High expressed emotion in the family increased odds of MS. Family is an essential context for human development and mental health. Interaction patterns, communications, and emotional interactions between family members are associated with anxiety and depression among adolescents [27, 34–35].
Another study conducted in Thailand showed health risk behavior were high among vocational students [18] so that identification and planning of extra activities for delinquent vocational students were required [36] for the social stressor of these programs. We found that the prevalence of MS in vocational schools was higher than in general high schools (29.5% vs 23.7%). However, this alone was not a significant effect on MS in the logistic regression model, but the interaction between vocational school and urban and metropolitan locations significantly increased the risk of mood swings as compared to high school programs in the suburbs.
That the location of the school in the metropolitan area increased the odds of MS is supported by previous studies in Western and Asian countries where higher odds of mental problems were found in metropolitan and semi-rural areas than rural areas [37]. The reality of health problems and mental health problems in urban areas may be related to harmful social fragmentation and having low social capital-behavior networks among people [37]. The current study showed that schools in Bangkok had the highest frequency of MS. The final model presented significant increases in a risk for mood swings as an interaction of vocational schooling and Bangkok/ urban area, consistent with previous health and mental health studies in Thailand [38]. Although the urban areas of Thailand provide better access to health services, they also expose one to health risk and higher living costs. Many rural areas now have more established medical facilities, and local social norms in rural areas are more supportive that positive health factors than in urban life [39].
Our results differed from previous research which reported significantly associated between substance use and mental problems and behavior problems, and suicide risk [40]. With limited numbers, less than 5% of our sample with substance use in subgroups, we did find a positive tendency of illicit substance use such as heroin, sedative use with increased odds of MS.