The aim of this study was to describe the mental health of students in an under-developed nation using indicators measured by the SENA in a sample of Elementary and Secondary School students in Northern Chile.
The results showed that in this youth population, depressive, anxious, and behavioral disorders continue to be the main mental health problems in Elementary and Secondary School students. Furthermore, indicators revealed progressive increases in prevalence during recent years, a finding that coincides with the world epidemiological scenario . Pharmacological and psychotherapeutic treatments are called for, together with educational interventions and other services that not only ensure coverage and quality, but also a timely diagnosis, considering the evolutionary characteristics of development existing between childhood and adolescence [26-28].
Additionally, males showed a higher prevalence of externalizing mental health problems related to aggression and defiant behavior; however, it was females who had the highest rates of mental health problems overall, especially internalized problems. For females, low self-esteem was the main depressive symptom, parallel to somatic complaints, anxiety, and social anxiety. It has been shown that the closer a person gets to adulthood, the greater the probability is that these problems will increase over time. This finding corresponds to results from other studies indicating that anxiety and mood disorders tend to worsen and extend into adulthood to a greater degree than behavioral disorders [29-30], with different incidence rates according to gender. The highest frequency of psychopathologies of an emotional or affective nature is found in the female population .
Among the areas of vulnerability that predispose students to present more severe mental health problems, greater difficulties were found in regulating emotions by attending to, perceiving, and clearly expressing their own emotional states, as well as managing the intensity and duration in an appropriate way, and moderating impulses or frustrations, especially in situations of conflict. This is a finding which, according to other studies, is usually related to anxiety disorders, in which the existence of recurrent and intense fears of the negative evaluation of others makes probable the appearance of insecurities that affect cognitive and especially emotional processes. This behavior can lead to students becoming increasingly evasive and resistant to contact with others. since the emotionally destabilizing situations are all those where they are exposed to judgement or criticism [32-36].
Another important finding related to vulnerability was the search for sensation in the adolescent population, whereby the need to try varied, complex and intense experiences, the desire to take risks, and the susceptibility to boredom increased the probability of exposing oneself to dangers. The search for sensation is characteristic of adolescence, together with susceptibility to influence, fantasy of immunity or invulnerability, and the search for or reaffirmation of identity, autonomy, and group integration where the adoption of risk behaviors is expected . Some studies suggest a relationship between sensation-seeking and exposure to risks, with the existence of behavioral disorders linked to hyperactivity as well as defiant and anti-social behavior [38-39].
We found that the risk factors that do not allow students to face situations perceived as problematic or threatening are due to the lack of social competence, that is, a lack of ability to establish and maintain positive relationships with classmates, and to communicate and behave in an assertive manner while respecting individual or group differences. The degree to which a student has difficulty resolving interpersonal conflicts is based on their awareness and level of self-esteem, as a negative evaluation of self-concept contributes to a reduced capacity for conflict resolution. These findings corresponded with those of other studies in which the excessive use of technology was recognized as one of the primary risk factors negatively impacting not only healthy interpersonal development but also the construction of coherent identities. Expectations and ideals can be a source of stress and anxiety in children and adolescents, as can dysfunctionality and poor familial relationships, experiences of mistreatment, harassment and discrimination, and experiencing poverty and/or humanitarian crises, among others [4, 5].
Finally, the findings of this study reveal the existence of differences in the magnitude and types of emotional or behavioral problems between students belonging to municipal schools and those studying at subsidized or private institutions. Children and adolescents who study in municipal schools have higher scores in the report of contextual conflicts with the family where they perceive tension, communication problems, misunderstanding, loneliness or rejection. Likewise, lower scores are observed in the report of personal resources associated with integration and social competence, where students tend to evaluate negatively their own capacity or ability to initiate and maintain friendship relationships or integrate into groups.
These results reveal the difficulties faced by children and adolescents from vulnerable families, where the lack of resources makes it difficult for parents to adequately raise their children and meet affection, learning, protection or health needs, since they must play the role of provider and work several hours a day neglecting their parenting responsibilities; As a result, their children may perceive an absence of sources of support and this experience may mean that their parents have become helpless or abandoned and that they have become disengaged from their own family [40-42]. Some studies indicate that families with fewer resources are those who face more domestic violence due to setbacks or economic crises, exposing their children to experiences of victimization or poly-victimization that compromise an endemic state of defenselessness where the child or adolescent assumes as permanently probable the aggression or harm of others [43-44]. The latter may explain the finding of this study related to the difficulties students report in feeling able to relate to others or integrate into groups, since experiences of neglect, abandonment, mistreatment or abuse in their family trigger fears that condition their interpersonal development, tending to adopt a defensive attitude that leads them to isolate themselves in order to reduce the likelihood of harm from their peers .
On the other hand, students who belong to private schools tend to present higher scores in internalizing problems during the period of Secondary School associated with both depression, where there are feelings of sadness, frustration, irritability, constant tiredness or fatigue, difficulties in focusing attention, remembering or understanding in addition to isolation or withdrawal, as well as social anxiety whose greatest fear is negative evaluation or rejection by their own peers. This last finding is consistent with the high scores registered in contextual problems related to their own peers where students perceive being constantly rejected or isolated by their peers, the same scenario that is observed in students from subsidized schools. Finally, low scores are observed in relation to the personal resource of self-esteem revealing in students dissatisfaction with themselves and negative evaluations of their self-concept.
The findings described show the difficulties that adolescents enrolled in private or subsidized educational establishments tend to face, whose interpersonal problems and the presence of social anxiety can be explained by the need for acceptance and group membership, For even when they are studying in private schools, their peers tend to make social distinctions that reveal economic inequalities and promote segregation or discrimination, presenting those students who are segregated or discriminated against with feelings of inadequacy and maladjustment, as well as fears and a strong appreciation of the criticism or opinion of others . On the other hand, it has been estimated that families with greater economic resources tend to have high expectations about the educational development and growth of their children, which makes the presence of demands, pressures, criticism, comparisons, disapproval and the absence of recognition of the school performance they observe in them probable; those who tend to present symptoms of depression, such as insecurities, excessive self-criticism, guilt, stress, feelings of inferiority or frustration, low self-esteem and lack of motivation .
It is important to mention that Chile is the ninth most unequal OECD country in the world, where the 10% of the population with the most resources has an income 27 times higher than the 10% most vulnerable in the country, as a result of public policies that allow for a high degree of privatization of basic services, observing important socio-economic gaps that impact the quality of life, these being more visible in the public and private provision of health services, housing, work, security and education .
With regard to the differences between private and public education, it has been noted that the country's most vulnerable student population tends to begin and complete their studies in public educational establishments, whose quality is not comparable to that received by students enrolled in private schools, given the differences in the investment of resources for stimulating learning. Consequently, the socio-economic capacity of families tends to determine the quality of education that their children will receive, in addition to the learning challenges and the magnitude or types of psychosocial problems that they must address .
Chile belongs to the 10% of nations worldwide that do not constitutionally recognize education as a universal right, empowering the market to arbitrate the distribution of resources and the quality of educational training for Chilean children and adolescents according to their social and economic realities, delegating to the most vulnerable families the responsibility of providing quality learning to their children, given that public educational establishments do not have sufficient and necessary resources to do so, promoting profound inequalities that in the long term impede social mobility and determine as permanently probable the condition of vulnerability in families and the low expectations of educational growth or development in their children .
Among the main limitations of this study is the fact that the students’ reading comprehension levels turned out to be a difficulty for the execution of practical indications and instructions regarding the questionnaires. Further, the resistance of educational institutions to collaborate with the study precluded the attainment of a larger sample.
It is important to consider that this research used only self-reports as a means of collecting information regarding students' emotional and behavioral problems, as well as other studies aimed at exploring or analyzing psychological problems in childhood or adolescence and their relationship with family climate, attachment, stress from traumatic experiences and learning difficulties, among others [51-53], this being a limitation that makes it impossible to know the impressions of parents or teachers about the mental health of their children or students. Consequently, this study cannot compare which characteristics, dynamics or modalities should be considered in an intervention or training plan to address mental health problems in children and adolescents that includes both actions in educational and family contexts.
Future studies should consider the design and evaluation of psychosocial interventions aimed at strengthening emotional regulation and self-esteem in school settings, along with exploring and analyzing potential differences between subgroups, especially the most vulnerable (such as immigrants, indigenous peoples, and all those within each educational establishment who present some type of symptomatology), in an attempt to ensure plans of action are available to assist in the care of these children and adolescents.