IOSR Journal of Nursing and Health Science (IOSR-JNHS)

e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 10, Issue 6 Ser. VI (Nov. – Dec. 2021), PP 44-51
www.iosrjournals.org

Assessment of Parents’ Awareness regarding their

Children Mental Health Status in Eastern Region- KSA
1.
Ragaa Gasim Ahmed Mohmmed.
Assistant professor in Pediatric Nursing, Faculty of Applied Medical Sciences, Nursing Department, Albaha
University, Saudi Arabia
2.
Amira Mohammed Saad Mohammed .
Assistant professor of Pediatric nursing, College of Applied Medical Sciences, Nursing Department, Hafr Al
Batin University, Saudi Arabia.
3.
Magda Mubarak Merghani.
Assistant professor, College of Applied Medical Sciences, Nursing Department, Hafr Al Batin University, Saudi
Arabia.
4.
Salma Moh Gomaa.
Assistant professor, College of Applied Medical Sciences, Nursing Department, Hafr Al Batin University, Saudi
Arabia

Abstract: Childhood mental disorders are the most widespread problem in our society. The consequences of
not addressing the mental health and psychological development of children and adolescents extend into
adulthood limiting their opportunities for a fulfilling life.
Aim: This study aimed to assess parents’ awareness of their children’s mental health status in the eastern
region of Saudi Arabia.
Method: A quantitative research design was used for this study and a descriptive cross-sectional survey with
simple random sampling was conducted among 368 parents in Eastern Region-Saudi Arabia.
Results: The results of this study show that most of the 282 parents were female (76.6%), had a university
degree (48.1%), and were not employed (73.4%). Most of the children were female (54.6%) and lived with both
parents (97.8%). 90.8% of parents had never been gone to a mental health clinic to assess their children’s
mental health.
CONCLUSION: This study shows that most parents did not visit a mental health clinic when they noticed
abnormal physical and emotional signs in their children, and they never visited a mental health clinic to assess
their child’s mental health.
Keywords: children, mental health status, parents’ awareness.
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Date of Submission: 15-12-2021 Date of Acceptance: 31-12-2021
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I. Introduction
According to the World Health Organization (WHO), 10-20% of children and adolescents worldwide
have mental health problems, considering only the most severe cases, and these are 4-6%.(1) Half of the mental
health problems begin in childhood. (2) Having mental health in childhood means achieving developmentally
and emotionally. (3) The diagnosis is often not made until the school years or before, and sometimes it is not
made early at all. (4) Parenting programs are the most effective interventions to improve children's mental health
(5)
, especially when the father is involved. (6)
Although Australia has been at the forefront of research into the treatment of mental disorders in
adolescents and adults, childhood mental health has been largely ignored. (7.8) Children who lack adequate
emotional support and are constantly in stressful situations caused by poverty, poor nutrition, parental stress, or
inadequate parenting are at higher risk of experiencing toxic stress. (9)
Mental health problems in children include different types of physical and emotional symptoms. (10)
However, physical symptoms and living with pain for a long period can negatively affect a child's self-esteem.
Frustration due to physical limitations can also occur. Both physical and psychological factors are often
interrelated. (11) Pediatric patients with chronic daily headaches are more likely to develop psychiatric disorders.
When muscles are tense and contracted over a long period, it can trigger other responses in the body and even
promote stress-related disorders. Muscle tension in the neck, head, and shoulder can also have chronic effects on
mood. (12) Most children complain of abdominal pain and bowel problems that are related to their mood. (13)

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 Assessment of Parents’ Awareness regarding their Children Mental Health Status in Eastern ..
Changes in eating habits may be associated with other symptoms of mental disorders such as fatigue and lack of
satisfaction with activities. (14) In addition, there are physical symptoms such as headaches, migraines, muscle
tension, diarrhea, stomach pain, appetite changes, and sleep disturbances. (14)
For emotional symptoms such as lethargy, sadness or frustration, muddled thinking, excessive anxiety,
extreme mood swings, withdrawal from friends and activities, low energy, or sleep disturbances, a parent may
notice these symptoms when spending time with the child, or the child may constantly complain or urge a parent
to stay around. (15)
Emotional disturbance is usually associated with poor academic, occupational, and psychosocial
performance. (16) Problems in school, usually either emotional or behavioral, often begin at school age, and these
problems include frequent absences from school and lack of concentration in school. (17) From time to time,
children may have fears and anxiety; however, the persistence of these feelings for a prolonged period can be
psychologically damaging to the child. (18) Usually, the main trigger for children's anger is frustration and not
getting what they want. (19) Daydreaming by a child who cannot distinguish between reality and fantasy can be
considered a symptom of mental illness. (20) All children can have problems with concentration and
hyperactivity, but if these problems are persistent and/or severe, children may need additional support to
increase their chances of learning and developing effectively. (21) Insomnia can exacerbate the effects of
mental disorders and vice versa. (22) The child's ability to establish a good relationship with his friends provides a
good psychological and health condition. (23)
It is important to remember that many disorders such as anxiety, attention deficit hyperactivity
disorder, and depression occur in childhood. (24) Therefore, children's mental disorders must be treated early
because most mental disorders that are not treated in early childhood lead to permanent consequences. (25,1)
Untreated disorders are associated with the fact that these children do not know how to seek help, so it
is the responsibility of parents not to recognize mental disorders in their children. In general, if a child's
behavior persists for a few weeks or longer and causes distress to the child or his or her family, it is a serious
problem for which help should be sought (Abera, Robbins, and Tesfaye, 2015). (26) The benefits of seeking help
early have been demonstrated, as early help-seeking provides the opportunity for early intervention, better long-
term mental health outcomes, and a higher quality of life for children and their parents. (27)
Childhood mental disorders are the most prevalent problem in society. According to the World Health
Organization, 10-20% of children and adolescents suffer from mental disorders, but most do not seek help or
receive treatment. The consequences of not treating children and adolescents' mental health and psychological
development extend into adulthood, limiting their opportunities to lead fulfilling lives. (27) According to King
Salman Center for Disability Research, 34% of Saudis are diagnosed with a mental illness at some point in their
lives. Mental disorders often occur in adulthood, and most of them had a cause related to their childhood. (28)
This study will help determine parents' awareness of their children's mental health status, and the results of this
study will directly benefit the community and parents.

II. Methods
STUDY DESIGN:
The research design used in this study is a quantitative and specifically a descriptive cross-sectional
survey to collect information on parents' awareness of their children's mental health status in the Eastern Region
- KSA.
Place of the study:
The study was conducted randomly through social media in the Eastern Region. Eastern Region is
administratively located in Saudi Arabia and consists of 11 governorates (Dammam, Alahsa, Hafir albatin,
Aljubail, Alqtif, Alkoubar, Alkhafiji, Ras tannrah, Buqayq, Annuayriah, Qaryah Alulya). The population of
Eastern Region is (5,148,598), which is 15% of the Kingdom's population, of which 2,045,335 are women and
3,103,263 are men. According to the General Authority for Statistics (GAStat), the number of Family
Registrations is (138490), which is 2.62%. The study was conducted for over 3 months, that is, February 2021up
to April 2021.

POPULATION & SAMPLE:

The target population for this study was all parents living and having children in Eastern Region which was 368.
Probability sampling was used to select the study units. Simple random sampling was used.
Sample Size:
The sample size was calculated and drowns by using Steven K. Thompson equation, (2012).

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 Assessment of Parents’ Awareness regarding their Children Mental Health Status in Eastern ..
Where:
N = population size
P = Population proportion = 0.5
d = margin of error = (0.05)
Z= confidence level 95% =1.96
N (population size) is approximately 140000 driven from the General Authority for Statistics-KSA)

Sample size = 383 Families (368 in the main study, 15 in pilot study)
DATA MANAGEMENT
Data were collected by a structured questionnaire created by using "Google forms" after being modified based
on the pilot study and the expert report. Data was collected by publishing a questionnaire that elicited the level
of awareness of parents regarding physical and emotional problems and the importance of seeking pediatric
mental health services.
DATA ANALYSIS
The data were categorized, coded, and analyzed according to an appropriate statistical method using the
program Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics were used to describe
the main variables of the sample.
ETHICAL CONSIDERATION
In the data collection form the information was made clear to the parents who participate in the study. A clear
and simple explanation of the purpose of the study and its importance was presented. Participation was
voluntary and participants had the right to withdraw. The researchers emphasized that the information obtained
would be kept credential and used only for the sake of the study. Participants were reminded that their
participation would not result in any harm or conflict.
PILOT STUDY
The pilot study conducted included 15 parents to assess the validity of the questionnaire used for data collection.
Furthermore, necessary modifications were made. The design used for the pilot test was a descriptive one and
the questionnaire was completed by the 15 parents. Cronbach's alpha was used (0.8).

III. Results
Table 3.1: Frequencies and percentages of demographic variables of the whole sample (No = 368).
Statement Frequency Percentage
Parents gender
Male 86 23.4
Female 282 76.6
Total 368 100.0
Father’s level of education Intermediate school 52 14.1
Secondary school 111 30.2
University 162 44.0
Post-university 43 11.7
Total 368 100.0
Mother’s level of education Intermediate 53 14.4
Secondary 125 34.0
University 177 48.1
Post-university 13 3.5
Total 368 100.0
Father employed No 45 12.2
Yes 323 87.8
Total 368 100.0
Mother employed No 270 73.4
Yes 98 26.6
Total 368 100.0
Marital status Married 356 96.7
Divorced 5 1.4
Widowed 7 1.9
Total 368 100.0

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 Assessment of Parents’ Awareness regarding their Children Mental Health Status in Eastern ..
Child lives with Mother 8 2.2
Both parents 360 97.8
Total 368 100.0
Child gender Male 167 45.4
Female 201 54.6
Total 368 100.0
Place of residence Ehsaa 37 10.1
Gatif 274 74.5
Taroot 10 2.7
Damam 15 4.1
Alrabiea 19 5.2
Safwa 13 3.5
Total 368 100.0

Table 3.2: Assessment of awareness of parents regarding physical symptoms of child's mental health.
(N=368)

Statement Frequency Percentage Mean SD t-value Sig

1-Does your child become easily tired, show Never 178 48.4
little energy?
Sometime .55 .560 18.801 .000
178 48.4
s
12 3.3
Often
2-Has your child suffered from pain? Never 201 54.6
Sometime 16.712 .000
157 42.7 .48 .552
s
Often 10 2.7
3-had your child got muscle strain? Never 294 79.9
Sometime .000
70 19.0 .21 .435 9.346
s
Often 4 1.1
4-Does your child suffer from Never 320 87.0
.000
migraines? Sometime .15 .398
42 11.4 7.076 .
s
Often 6 1.6
5-Had your child got diarrhea? Never 240 65.2
.000
Sometime
120 32.6 .37 .527 13.465 .
s
Often 8 2.2
6-Did your child suffer from loss of appetite? Never 124 33.7
.000
Sometime
195 53.0 .80 .356 23.299 .
s
Often 49 13.3
7-Has your child suffered from Never 172 46.7
abdominal pain? Sometime
176 47.8 .59 .593 18.976 .000
s
Often 20 5.4

Table 3.3: Assessment of parent’s awareness regarding emotional symptoms of child mental health. (N=368)
Statement Mean SD t-value Sig
Frequency Percentage
1-Did your child spend
Never 174 47.3
more time alone? .59 .607 18.648 .000
Sometimes 171 46.5
Often 23 6.3
2-Did your child show less Never 204 55.4 .000
15.870
interested in school? Sometimes 140 38.0 .51 .618
Often 24 6.5
3-Did your child have daydream Never 185 50.3
17.108 .000
too much? Sometimes 136 37.0 .62 .7011
Often 47 12.8
4-Was your child afraid
Never 120 32.6
of new situations? .000
Sometimes 206 56.0 .79 .630 24.012
Often 42 11.4
5-Did your child feel sad, Never 200 54.3
.000
unhappy? Sometimes 153 41.6 .50 .577 16.546
Often 15 4.1
6-Was your child is irritable, Never 78 21.2 .000
.99 .643 29.488
angry? Sometimes 216 58.7

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 Assessment of Parents’ Awareness regarding their Children Mental Health Status in Eastern ..

Often 74 20.1

7-Did your child have troubles in Never 211 57.3

concentrating Sometimes 134 36.4 .49 .613 15.304 .000
Often 23 6.3
8-Did your child have troubles in
Never 219 59.5
sleeping?
Sometimes 127 34.5 .46 .608 14.668 .000
Often 22 6.0
9-Did your child worry Never 254 69.0
.000
a lot? Sometimes 104 28.3 .34 .528 12.248
Often 10 2.7
10-Didn’t your child listen to Never 126 34.2
.000
rules? Sometimes 208 56.5 .75 .611 23.548
Often 34 9.2
11-Did your child fidgety, unable Never 44 12.0
.000
to sit still? Sometimes 241 65.5 1.11 .579 36.668
Often 83 22.6

Table 3.4: Assessment of parent’s awareness regarding the importance of seeking pediatric mental health
care services. (N=368)
Statement Frequency Percentage Mean SD t-value Sig

1-Did you go to the psychiatric Never 260 70.7

hospital if you see abnormal physical .660
.39 11.381 .000
and emotional signs in your child? Sometimes 72 19.6
Often 36 9.8
2- Have you ever visited a mental and Never 334 90.8
.000
psychiatric hospital to assess your Sometimes 29 7.9 .11 .350 5.814
child’s mental health? Often 5 1.4
3-Did you think your child needs to Never 305 82.9
.20 .455 8.252 .000
be examined by a mental and Sometimes 54 14.7
psychiatric doctor? Often 9 2.4
4- Did you think the children can help Never 95 25.8
26.664
themselves to manage their Sometimes 187 50.8 .98 .702 .000
mental health? Often 86 23.4

Table 3.5: Relationship among sociodemographic characters &parent awareness regarding child physical
symptom, emotional symptom, and the importance of seeking pediatric mental health services
Sociodemographic Awareness of physical Awareness of emotional Awareness of seeking psychiatric
characteristic symptoms symptoms health services
Pearson Sig Pearson Sig Pearson Correlation Sig
Correlation Correlation
Parents Sex .153** .003 .063 .230 .075 .151
Father education level -.250** .000 -.165** .001 .082 .116
Mother education level -.217** .000 -.121* .021 .108* .039
Father working -.140** .007 -.070 .178 .051 .333
Mother working -.055 .295 .018 .732 .104* .045
Marital status .001 .980 -.052 .316 -.026 .623
Child lives with -.007 .890 -.025 .627 .047 .368
Residence .045 .387 .096 .065 .028 .592

IV. Discussion
The results of sociodemographic variables, concerning parents' sex, in our study the majority were
mothers 76.6% and fathers 23.4%, similar study which was done by (Rochelle and Cheng, 2016) pointed that
mother 76% and fathers 24%. (29) In our study marital status 96.7% is married, it is higher than (Rochelle and
Cheng, 2016) study is (93.4 %%). (29) In our study child living with both parents were 97.8% compared to
(Mahsoon et al., 2020) (30) study was 78%, the difference may be due to sampling size which was 236 is lower
than our study 368. In our study employed parents was 85.6% higher than (Abera, Robbins, and Tesfaye, 2015)
study that was 49.8%, the difference may be due to study area, (Abera, Robbins and Tesfaye, 2015) study in
Ethiopia, and sample size 532 is higher than our sample size. (26)
The physical characteristics variables about children who complain about abdominal pain in the present
study was 9.7%, whereas it was 14.7% in the study carried out by (Abera, Robbin and Tesfaye 2015). It is

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 Assessment of Parents’ Awareness regarding their Children Mental Health Status in Eastern ..
noticeable that (Abera, Robbin and Tesfaye 2015)’s study has a higher percentage; this difference may be due to
the sample size. This is because Abera’s study had a higher sample size which included 532 individuals: besides
it had a different study area i.e., Abera’s study was carried out in a developing country. (26)
In response to the question: ‘Did your child suffer from migraine?’, in our study, the ratio of response
of the majority was 87% with a mean of 0.15% (NEVER). In a similar study by (Merikangas et al) 2015 it has
been mentioned that absence of migraine (rate =1). (31) In Merikangas study, when dealing with the physical
symptom endocrine/metabolic (child tires easily) the ratio was 6.1%. This ratio is higher than ours which
indicates that 3.3% of the children tire easily, sometimes with the mean 0.55. The difference here is due to the
sampling size (9014 versus 368). (31)
The results of emotional characteristic variables, concerning aggressive behavior in our study, was
lower 20.1%, compared to (Bottino et al., 2015) was 75%, the difference may be due to study design used, they
used a systematic review of two databases: PubMed and Virtual Health Library (BVS) and our study is a
descriptive. (32) In comparison to our study and (Abera, Robbins and Tesfaye, 2015), all emotional states in our
study is lower than (Abera, Robbins and Tesfaye, 2015), such as child unhappy was 9% versus 36.8%. A child
like to be alone, was 6.3% versus 25%. Child warry a lot was 2.7% versus 31%. A child absent from school was
0.8% versus 12%. Child sleep problems was 6% versus 64.5%. A child poor attention was 22.6% versus 40.8%.
A child can’t sit still (fidgety) was 22.6% versus 27.4%.(26) A child afraid from new situations was 11.4% versus
37.2%. Child refuses to share things was 3% versus 12.6%. Child conduct problems was 4.1% versus 43.3%.
Child doesn’t listen to rules was 9.2% versus 35.5%. Childless fun was1.4% versus 56%. Child daydreams was
12.8% versus 69.4%, the difference may be due to the sample size, Albera study is higher sample size 532 and
study area, Abera study done in Ethiopia is developing country.
Also compared to study done by (Ciechomski, Blashki, and Tonge, 2004) community samples in the
USA have found prevalence rates of anxiety was 4.6% is higher than our study 2.7%, school refusal may occur
in approximately 1–5%, is higher than our study absent from school was 0.8%, the difference may be due to
study period, (Ciechomski, Blashki and Tonge, 2004) is done during 6 months and our study is 3 months. (33)
Health care-seeking behavior is a particular aspect of help-seeking behavior. People differ in their
willingness to seek help from health care services. Some go readily for treatment others only when in great pain
and an advanced state of ill health. (34)
It can be challenging for some families to get mental health care for their children. Nearly 1 in 5
children have a mental, emotional, or behavioral disorder, such as anxiety or depression, attention-
deficit/hyperactivity disorder (ADHD), disruptive behavior disorder, and Tourette syndrome. Children with
these disorders benefit from early diagnosis and treatment. Unfortunately, only about 20% of children with
mental, emotional, or behavioral disorders receive care from a specialized mental health care provider. (34)
Some families cannot find mental health care because of the lack of providers in their area. Some
families may have to travel long distances or be placed on long waiting lists to receive care. Cost, insurance
coverage, and the time and effort involved make it harder for parents to get mental health care for their children.
CDC works to identify policies and practices that connect more families to mental health care. (35)
In our study, in response to a question “Have you ever visited a mental and psychiatric hospital to
assess your child’s mental health?” 90% were (never) compared to study done (Axelson, 2019), in the United
States, the rate of death by suicide in children aged 10% to 19, increased by 86% from 2007 to 2017 after that
pediatric emergency department visits for mental health conditions have risen steadily. (36) A recent report found
that 16.5% of youth (7.7 million) in the United States have an identifiable mental health condition. However,
only 49% of them were receiving treatment from any mental health professional, let alone a psychiatrist. The
difference is due to the study area, despite the services there is a higher suicidal rate.
Early involvement in mental health intervention is critical, although most the children with mental
health issues don't receive the necessary services (37), that could the child's mental disorder contribute to making
a load all over the world (Radez et al., 2021) (38), because most of the mental disorder that untreated in
childhood leads to permanent problems (World Health Organization, 2005) (1).
untreated disorders are related to those children who do not know the way to ask for help, so, it remains
the parents' responsibility to discover their child's mental health disorders. In general, if the child's behavior
continues for a few weeks or more, causing distress to the child or the child's family, then it is often a serious
problem that considers seeking help (26).
In our study, the results of relationship showed that there is a statistically significant relationship
between a sociodemographic characteristics and physical symptoms in sex, father education level, mother
education level, and father employed, and there are no statistically significant differences between the sample
members in the mother employed, marital status, the child lives with and the place of residence.
there is a statistically significant relationship between father and mother education level, and residence.
and there are no statistically significant differences between the sample members in sex, father employed,
mother employed, marital status, the child lives with whom.

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 Assessment of Parents’ Awareness regarding their Children Mental Health Status in Eastern ..
The relationship among sociodemographic characters &parent awareness regarding the importance of
seeking pediatric mental health services that there is a statistically significant relationship in mother education
level and mother employed, and there are no statistically significant differences between the sample members in
sex, father education level, father employed, marital status, the child lives with and the place of residence

V. Conclusion:
In sum, the present study showed that Eastern Region-KSA has unclear and consistent views of
children's mental health problems. Mental health specialists face challenges in gaining family participation.
Unless systematically addressed, the public's lack of knowledge, skepticism, and misinformed beliefs signal
continuing problems for providers, as well as for caregivers and children seeking treatment.
This study illustrates, most parents didn’t go to the psychiatric hospital when noticed abnormal
physical and emotional signs in their children, and never visited a mental and psychiatric hospital to assess their
child’s mental health, finally they think that their children didn’t need to be examined by a mental and
psychiatric doctor.

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