Keywords
Adolescent girls, menstrual problems, mental health, lifestyle
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Bhalerao V, Gotarkar S, Muneshwar K and Vaishnav DL. A Cross-sectional study to assess the mental health problems during menstrual cycle among adolescent girls in the rural area of Wardha District [version 1; peer review: awaiting peer review]. F1000Research 2024, 13:436 (https://doi.org/10.12688/f1000research.146475.1)
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Study Protocol
A Cross-sectional study to assess the mental health problems during menstrual cycle among adolescent girls in the rural area of Wardha District
[version 1; peer review: awaiting peer review]
PUBLISHED 02 May 2024
OPEN PEER REVIEW
REVIEWER STATUS
This article is included in the Datta Meghe Institute of Higher Education and Research collection.
Abstract
Corresponding author:
Vijay Bhalerao
Competing interests:
No competing interests were disclosed.
Grant information:
The author(s) declared that no grants were involved in supporting this work.
Copyright:
© 2024 Bhalerao V et al.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Bhalerao V, Gotarkar S, Muneshwar K and Vaishnav DL. A Cross-sectional study to assess the mental health problems during menstrual cycle among adolescent girls in the rural area of Wardha District [version 1; peer review: awaiting peer review]. F1000Research 2024, 13:436 (https://doi.org/10.12688/f1000research.146475.1)
First published: 02 May 2024, 13:436 (https://doi.org/10.12688/f1000research.146475.1)
Latest published: 02 May 2024, 13:436 (https://doi.org/10.12688/f1000research.146475.1)
Introduction
Adolescent girls frequently experience menstrual problems. The three most prevalent menstruation disorders in teenagers are dysfunctional uterine bleeding and amenorrhea, according to Gueydan and McAnamey (1982), who reviewed several studies on this subject.1 The Latin term “Adolescere,” which means “to grow in maturity,” is the source of the English word “adolescence. Adolescents between the ages of 10 and 19 years were considered adolescents. In addition to physical growth and maturity, adolescence is a time of cerebral and emotional growth.2 According to McEvoy et al. (2004), menstrual problems such as amenorrhea, heavy vaginal bleeding, menstrual cramps, and menstrual syndrome are typical causes for teenage females to consult a doctor.1
In India, only 30% of healthcare services are available in rural areas, while 70% are available in metropolitan areas. Most teenage girls and young women do not seek healthcare services because of ignorance, lack of education, cultural taboos, and male domination. At the same time, the high incidence of nutritional deficiency among adolescent girls causes more significant reproductive issues at a young age. Menstrual issues may affect 75% of girls and are the main reason for frequent absences in school.3 Teenagers frequently relapsed into psychiatric illnesses during the study period. This is because they do not realize the problems that might arise during menstruation or how to address them. Nearly 25% of teenagers struggle with psychological issues including isolated physical health issues. The statement mentioned above demonstrates how crucial it is for students or teenagers to understand how psychological issues might return during menstruation.4
To our knowledge, little research has been conducted on how these characteristics relate to menstrual symptoms among teenage girls. When determining the etiology of menstrual problems, examining the relationship between them and menstrual symptoms is critical, because menarche occurs later in puberty. During pubertal years, there are increases in depressive symptoms, anxiety, and smoking behavior. The main goals of this study were to: a) describe differences in self-reported menstrual symptoms in adolescents regarding smoking behavior. b) Examine the relationship between depressive symptoms, anxiety, and menstrual symptoms. c) To examine whether smoking moderates this relationship.5 Age, ethnicity, family history, smoking, physical activity, and nutritional choices are only a few variables that might impact menstrual cycles.6 Menstrual abnormalities can be significantly exacerbated or caused by stress. There is evidence linking stress to
There are several irregularities, including menorrhagia, oligomenorrhea, dysmenorrhea, and PMS.7 Menstrual abnormalities can be significantly exacerbated or caused by stress, and there is evidence linking stress to several irregularities, including menorrhagia, oligomenorrhea, dysmenorrhea, and PMS.7 The early detection of the causes of typical teen menstruation patterns may aid in their prevention, improve adolescent girls’ reproductive health, and enhance their standard of life.8 In every menstrual cycle, females of reproductive age experience dramatic changes in the levels of sex hormones (such as progesterone and estrogen). According to the points mentioned above, a contradiction also appears that suggests that menstruation has favorable effects on adolescent girls.9,10 They are concerning menstruation. People maintain a relatively conservative mentality in a society dominated by cultural and religious constraints. Adolescent girls, on the other hand, typically have unfavorable views and ideas about menstruation due to cultural standards.11,12 Several factors influence the duration and regularity of the menstrual cycle, including sociodemographic profile, psychological stress, disturbed sleep level, rigorous physical exercise, and food.13
Rationale
Rural studies were more numerous among adolescent girls across rural locations than in rural ones. The majority of research has examined awareness, attitude, conception, beliefs, cultural elements, factors, experiences, general well-being, sanitation, seeking support behavior, knowledge, perceptions, practices, prevalence, and menstruation issues. Very few Indian studies have been conducted in this community. Most of these occurred in schools. Although urban research outnumbered rural research, several studies have examined menstruation in adolescent females from rural and urban regions. More research needs to be done on menstruation in non-schooled adolescents and on interventions. Most studies have emphasized menstrual patterns, customs, and issues.6,12,14,15 Most Indian studies were community-based; only a few were conducted in rural areas.
Methods
Study setting/place
Eligibility criteria
The inclusion criteria were adolescent girls aged 15–19 years who attained menstruation. Exclusion criteria: Girls younger than 15 years and above 19 years, as well as those who were hesitant and uncomfortable asking for information to participate in the study, were excluded.
The pre-validated questionnaire will be used to collect data in the rural part of the Wardha district in Central India.
Study participants/population
This study will be conducted among adolescent girls aged 15-19 in the rural area of the Wardha district. Google and paper-based forms will be used to contact individuals and invite them to participate in the study. They will be given access to the online and offline questionnaires. The data tool will be in print format and will be available in Marathi, English, and Hindi.
This study will be conducted among adolescent girls aged 15-19 in the rural area of the Wardha district.
Variables
This study examined variables related to menstruation problems, knowledge, attitude, and practice. Age at menarche, days of the cycle: The individual’s stress, worry, and sadness levels rose when menstrual symptoms were more intense. The duration, length, and amount of menstrual bleeding did not significantly correlate with menstrual symptoms such as anxiety, depression, or stress, according to the Pearson correlation test. Menstruation-related distress (MEID-Q) and the Hamilton Depression Rating Test (HDRS). Percentage of mental health among adolescent girls living in rural areas.
Table 1. The key parameters, including their variables, data sources, and methods of data collection, are essential components to be identified.
Data collection procedure
The tool comprises an offline consent form and online questionnaire. The data collection process involved the use of the Kobo collection tool. Each survey ensured anonymity and included a page with permission for information and details about the objectives of the study.
Data collection tools
The tool consists of an online questionnaire and offline collection of data. The questionnaire was produced using the Kobo collection app and offline forms. The first component of the questionnaire concerned the individual’s demographic information. The Menstrual Distress Questionnaire (MEDI-Q) examines and evaluates adolescent girls’ overall distress throughout their mental health. The MEDI-Q questionnaire tool has been validated among people aged 15 to 19, with established concurrent and criterion validity in many languages and a test-retest reliability of 0.61.16,17
The following section goes through the scale’s item numbering system item by item, using the prefix “H” for HAM-D items and “A” for a typical subscale item, followed by the item’s name, as it appears on the scale to measure mental depression and mental stress. This item is specific to depressed mood, which, according to our standards, is any feeling of emotion, including those mentioned in the item’s label, as well as low, blue, sad, dysphonic, sobbing, etc. Other negative mood states (e.g., anxiety, tension, anger, and irritability).18,19
Sample size
Menstruation has an impact on mental health, according to a prior study conducted by Field.20
The sample size was calculated using the following article, and the proportion of sleep disturbance was found to be 61.6%.
The sample size was calculated using the following equation: Where Alpha (α) is 0.05, proportion (p) is estimated to be 0.61, and the error estimate (d) is 0.05.
The sample size of this study was 364. The rate of sleep disturbance in adolescent girls living in rural areas was examined using data; therefore, the sample size was 364 adolescent girls.
Sampling method
We used a simple random sampling method. Adolescent girls will be comfortable sharing study information related to menstruation and mental health effects during menstruation. The adolescent girls did not hesitate to participate in the interviews.
Analysis plan
The Statistical Package for the Social Sciences SPSS 24.0 software [SPSS 24.0 Download - spss.exe (informer.com)] will analyse the data after converting it to an MS Excel spreadsheet. We will calculate descriptive statistics, including the mean, mode, and median, for variables such as age and period. We then used the chi-squared test to analyze the data.
Expected outcomes/result
Adolescent girls experience menstruation-related psychosocial issues that are not an uncommon sight. Menstrual distress, burden, stigma, lack of counselling services, lack of preparation menarche, lack of easy access to clean resources, privacy concerns when changing pads are necessary, lack of facilities for disposing sanitary napkins, and inadequate psychological and social support. Most girls experienced stress, mood swings, and restlessness during their menstrual cycle. These findings were consistent with those of previous studies have discovered that the majority of girls were agitated during menstruation. Approximately 25% of them felt ashamed and guilty about their pubertal changes, and experienced menarche in fear, shyness, and sadness. On the first day of menstruation, girls report psychological problems such as anxiety, trouble concentrating, sadness, irritability, and excitement.8 Approximately two-thirds of teenagers in the current study were unaware that menarche occurred earlier.
Possible confounders
When assessing mental health symptoms, several factors may need to be considered, including age, education, marital status, socioeconomic status, lifestyle, baseline symptoms of mental health disorders, frequency of sleep, sadness, anxiety, depression, and stress. Demographic profiles and mental health issues will be used to analyze and assess these variables.
Limitations of the study
Throughout the study, the researcher approached the community base to conduct research in and around the Wardha district. Consequently, the researcher will be unable to assess the mental health issues faced by adolescent girls in rural and urban communities. No standardized questionnaire will be used in the study to measure their mental health issues.
Implementation
Individual understanding: Menstruation is a natural psychological process in adolescent girls and how to deal with it. Enabling encouraging menstruation is typical of non-taboos and non-myths, with no restrictions.
Practice improves psychological health by using materials to absorb and collect menstruation blood prevention and clean facilities to change and dispose of the materials (at home, school, work facility for menstruation hygiene, and pain management demonstration of how to use MHH materials). Improved accessibility of menstrual products. Adolescent girls encounter considerable psychosocial challenges during menstruation, including limited access to clean materials, a lack of privacy for change pads, sanitary napkin disposal facilities, sociocultural constraints, and psychological and social support.
Discussion
Most females experienced stress, mood swings, and restlessness during their periods. These results were in line with those of other studies, which showed that most females experienced irritation during their periods. Almost one-fourth of them felt ashamed and guilty about their pubertal changes and were terrified, shy, and depressed during menarche.14 Note that although menstruation occurs in teenagers as young as 10 years old, this condition is not regarded as a disorder or sickness. However, in actuality, this can happen owing to the influence of the child’s intrinsic factor, which nutrition and hormonal conditions can impact, and most anxiety is caused by adolescents feeling unprepared.4
Different age groups; socioeconomic, cultural, and geographic factors; and diverse accepted methods and instruments may contribute to the variance. According to the study’s findings, there is a positive correlation between periods of menstruation symptoms during the premenstrual, menstrual, and postmenstrual periods and the symptoms of anxiety, stress, and depression. As a result, menstrual symptoms increase the severity of depressive disorders, anxiety, and stress. Premenstrual symptoms were positively correlated with sadness, anxiety, and stress disorders, and a study on 18-28-year-old students in Zahedan using a questionnaire with 20 questions reported low back pain, abdominal bloating, and tender breasts as the most prevalent pre-menstruation signs.21
This suggests that random variables blame the mean-score disparity. The current findings are consistent with earlier research, which indicated that emotional well-being was lower during the premenstrual period. Unlike previous studies, the results showed that emotional well-being did not improve during the follicular phase.9
Low socioeconomic position, regional distribution, psychosocial factors frequently linked to menstruation disorders, inadequate environmental stimuli, poor food, nutritional anemia, and age at menarche were all prevalent in the study population. Most problems are preventable and a positive outlook is required.3
Specifically, a higher N170 amplitude was observed in the current study in response to amorous male reactions in the follicular phase. Bias against people of the opposite or same sex might explain this result. Numerous studies have shown that attractive individuals of the opposite sex elicit more powerful and immediate responses than attractive individuals of the same sex. Because of this, women in the follicle stages of their period most strongly replied to the man’s friendly face. Since the emotional faces may be more “intense” or “provocative” to the brains than the other faces, the variations in N170 amplitude triggered by the emotional expressions in the present study and further investigations may be attributable to this.10
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Ethics and consent
The Dtta Meghe Institute of Higher Education and Research (DU),Ethical Approval (DMIHER (DU)/IEC/2023/42) was granted by Institutional Ethical committee on Human Research for this study on dated 20/12/2023 additionally, written informed consent will be obtained from all participants before their inclusion in the study. Privacy and confidentially will be maintained throughout the study. Measures will be taken to minimize any potential harm or risks to the participant’s such as referral for medical consultation if needed.
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how to cite this article
Bhalerao V, Gotarkar S, Muneshwar K and Vaishnav DL. A Cross-sectional study to assess the mental health problems during menstrual cycle among adolescent girls in the rural area of Wardha District [version 1; peer review: awaiting peer review]. F1000Research 2024, 13:436 (https://doi.org/10.12688/f1000research.146475.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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