(LUẬN văn THẠC sĩ) parental perceptions of child mental health symptoms, causes and responses among cambodian and its correlation with their children mental health

Background of the Study

The healthy development of children is a vital concern for families and societies globally, as a nurturing environment fosters their growth into successful, productive individuals Ensuring children are physically and mentally healthy necessitates significant effort and attentive care from parents or caregivers Mental health issues play a critical role in child development; thus, recognizing the symptoms and causes of these problems enables parents to effectively support their children, enhancing their cognitive, social, and emotional growth.

On World Mental Health Day in 2011, Ban Ki Moon emphasized that "there is no health without mental health," urging both public and private sectors to prioritize mental health care for all, especially children The World Health Organization (WHO) identifies improving mental health as a key priority, noting that approximately 20% of children and adolescents globally experience mental disorders, with variations influenced by cultural contexts Alarmingly, a global study revealed that 10% to 15% of children face mental health issues, with 3% to 4% experiencing significant developmental delays or mental retardation This aligns with findings from the Seven Nation Collaborative Study, which indicated that 16% of children in the Philippines suffer from mental disorders, highlighting the urgent need for early intervention in mental health care.

A recent study revealed that 12-13% of Vietnamese children aged 6-16 suffer from mental health issues, indicating that approximately 2.7 million children in Vietnam require access to mental health services Research by Weiss et al (2013) identified parental income and education as significant risk factors for behavioral and emotional problems in Vietnamese children Similarly, a study based on the Spanish National Health Survey found a strong correlation between parental education and the mental health of children aged 4 to 10, although this correlation was not observed in older children aged 12 to 15 This suggests that parental education is a more critical risk factor for child mental health than family income or social status.

Parenting behavior significantly influences the development of mental health disorders in children Research indicates that a positive parenting style, characterized by strong interpersonal relationships, is associated with fewer mental health issues in children (Bolghan-Abadi, Kimiaee & Amie, 2011) Additionally, family interventions that focus on specific parenting skills have proven to be the most effective approach for reducing behavioral problems in children (Hutching & Lane, 2005).

Research on child mental health reveals significant cultural differences in perceptions and reporting styles among parents A study of Vietnamese parents in Australia found that they associated psychotic symptoms, disorientation, and suicidal thoughts with their child's mental illness, attributing these issues to metaphysical causes, biological factors, and traumatic experiences (McKelvey et al., 1999) Similarly, a New Zealand study aimed to capture diverse parental perspectives on child mental health symptoms, resulting in the development of a culturally consistent parent-report measure (Shanley, 2008).

Problem Statement

Professionals and experts recognize that children's mental health issues arise from a complex interplay of biological, psychological, and social factors Research indicates that multiple pathways can lead to a single disorder, and conversely, one pathway may result in various outcomes The development of child psychopathology is often influenced by an increase in risk factors, particularly during critical developmental periods, which heightens the likelihood of mental health disorders Additionally, risk and protective factors are often nonlinear and can interact reciprocally, emphasizing that children and their environments are interconnected and continuously evolving.

Cambodian parents may struggle to fully grasp the complexities surrounding the causes and maintenance of children's mental health issues A pivotal study on mental health literacy in Australia highlighted that many individuals have difficulty accurately identifying psychiatric symptoms associated with disorders like depression and schizophrenia Additionally, evidence suggests that altering perceptions and beliefs about mental disorders can significantly impact behavior When it comes to understanding their children's mental health, parents are more inclined to adopt a disease model, which views maladaptive functioning as a syndrome that is either present or absent.

In 1997, it was highlighted that a parent perceiving their child's depression as simply present or absent tends to support the disease model This perspective overlooks the idea that mental health issues exist on a spectrum of severity, rather than as a binary condition.

Research indicates that misperceptions of child mental health symptoms and disagreements among parents significantly influence their willingness to seek help for their children's mental health issues (Shanley, 2008) While there is growing literature on mental health perceptions in Cambodia (See Chapter 2.2), a comprehensive review of child mental health disorders in the country is still lacking Therefore, it is essential to further investigate Cambodian parental perspectives on child mental disorders to enhance understanding and support for these issues.

Importance of the study and policy implications

It is expected that this empirical study will generate many significant scientific findings relevant to child mental health, family functioning and social development

This study aims to enhance our understanding of parents' perceptions of children's mental health issues across diverse demographics It will provide valuable insights for health and education professionals, such as child psychotherapists, school counselors, and organizations dedicated to child welfare Ultimately, the research seeks to bolster efforts in educating parents about mental health challenges and empower them to access suitable services for their children.

Purposes of the study / The Aim of Research (Research Questions)

The purpose of this study is to explore parental perceptions of child mental disorders This research will address the following three main questions:

1 What are the common Cambodian parental perceptions of common symptoms, causes and effective responses to child psychopathological problems?

2 What are the factors (education, socio-economic, demographic, family situation, etc) that influence the Cambodian parental perceptions of child mental health?

3 Is there any existing association between parental perceptions of child mental disorders and their child‘s mental health?

Objectives of the study

To specifically address the primary study research questions, the primary goals of the study are the following:

1 Understand the general Cambodian parents‘ perceptions of symptoms and causes of child‘s mental health problems and about howparents in Cambodia commonly respond to children with mental health problems

2 Explore the factors that may influence Cambodian parents‘ perceptions of child mental health

3 To explore significant differences between Cambodian parents from urban areas compared to parents from rural areas on their perceptions of child mental health

4 To explore how Cambodian parents‘ perceptions of child mental health problems may be associated with their own child‘s mental health symptoms.

Hypotheses for the study

In response to above objectives, the author has pre-determinedly provided the following hypotheses:

Hypothesis 1: A significant number of Cambodian parents will have inaccurate beliefs regardingthe common symptoms, causes and effective responses to common child psychopathological problems

Hypothesis 2: Cambodian parental socio-demographic factors, including age, education, andincome will be significantly correlated with their perceptions of child mental health symptoms, causes and appropriate parental responses

Hypothesis 3: There will be a significant difference between parents from urban areas inCambodia compared to parents from rural areas on perceptions of child mental health

Hypothesis 4: Cambodian parents‘ reported responses to common mental health problems andperception of causes of child mental health will be correlated with their own child‘s mental health

Hypothesis 5: High rates of mental health in children will be correlated withCambodianparental demographic information.

Scope and Limitation

This study focuses on Cambodian parents' perceptions of their school-aged children's mental health, specifically those with children in grades 1 and 2 It aims to explore the correlation between parents' understanding of mental health and their child's mental health status The research will involve parents from two urban schools in Phnom Penh and two rural schools in Kampong Speu province, approximately 80 kilometers from the capital.

LITERATURE REVIEW

Introduction to mental health and mental disorders

The World Health Organization (WHO) defines health as complete physical, mental, and social well-being, emphasizing that it goes beyond merely the absence of disease To achieve overall health, individuals require physical stability, social well-being, and mental well-being, which encompasses a wide range of factors that promote well-being, prevent mental disorders, and support the rehabilitation of those affected Mental health includes emotional, psychological, and social aspects, contributing to life satisfaction, self-confidence, a sense of purpose, and the ability to function daily.

Mental disorders are defined as syndromes that cause significant disturbances in cognition, emotion regulation, or behavior, reflecting dysfunction in psychological, biological, or developmental processes (DSM-V, APA, 2013) These disorders often lead to considerable distress or disability in various aspects of life, including social and occupational activities The diathesis-stress model explains that the causes of psychological disorders arise from a combination of genetic and environmental factors Symptoms can vary in severity, and untreated conditions can hinder individuals' ability to manage daily life effectively If left unaddressed, mental illnesses may progress into chronic and debilitating disorders Additionally, barriers such as inadequate services, economic pressures, and societal stigma contribute to lower rates of individuals seeking help.

2.1.1 Worldwide epidemiological research regarding prevalence of mental disorders

Studies conducted in the US and Europe indicate that the most common mental health disorders are anxiety, depression and substance abuse A study by

A study by Jordan et al (2004) revealed that among 1,837 Pentagon employees in the United States, the rates of PTSD, depression, panic attacks, generalized anxiety, and alcohol abuse were notably high, with prevalence rates of 7.9%, 17.7%, 23.1%, 26.9%, and 2.5% respectively Similarly, a national mental health survey in Australia and New Zealand (Slade et al., 2009) found that 45.5% of individuals experienced a lifetime mental disorder, while 20.0% reported a current disorder, predominantly anxiety disorders at 14.4% In Portugal, Rabasquinho and Pereira (2014) identified a 32.15% prevalence of mental disorders from 2000 to 2006, with mood disorders being the most common at 42.6% Additionally, the São Paulo Megacity Mental Health Survey indicated that mood, anxiety, impulse-control, and substance use disorders, along with suicide-related behaviors, were prevalent within the population (Viana et al., 2009).

Mental health issues are significant in Asia, with a study in China revealing that 6.1% of adults suffer from mood disorders, 5.6% from anxiety disorders, 5.9% from substance abuse disorders, and 1% from psychotic disorders Women and individuals aged 40 and older showed higher prevalence rates for mood and anxiety disorders, while alcohol use disorders were 48 times more common in men In India, research indicated a lifetime prevalence of mental disorders at 5.03%, with depression being the most common at 3.14%, followed by substance use disorder at 1.39% and panic disorder at 0.86% Current mental disorders affected 3.18% of the population, with depression again leading at 1.75% An epidemiological study in Nepal further underscores the regional mental health challenges.

2013) found that among 720 adults, 27.5 % met criteria for depression, 22.9 % for anxiety, and 9.6 % for PTSD

Variations in findings from different epidemiological studies, such as the high rates reported in Nepal compared to the lower rates in India, can be influenced by several factors Higher prevalence rates are often observed in low-resource countries or those facing stress and trauma For instance, the 2013 study in Nepal by Luitel et al shows that the rates of depression and anxiety in the sample are similar to or lower than those found in studies involving conflict-affected populations and refugees.

Globally, approximately 20% of children and adolescents experience mental disorders, with prevalence rates varying by culture Early psychological intervention and prevention are crucial, as nearly half of all lifetime mental disorders emerge before age 14 The 2009 World Mental Health Survey by the WHO estimated that 18.1-36.1% of children suffer from anxiety, mood, externalizing, and substance abuse disorders Mental illnesses are prevalent worldwide, often developing during childhood and adolescence, and can significantly hinder individuals' ability to transition into various life roles.

2.1.2 Impact of mental health problems

Mental health is crucial for overall success in life, influencing family dynamics, career achievements, and interpersonal relationships, as well as contributing to societal and national progress It affects various aspects of personal development, including thoughts, emotions, behaviors, and daily functioning Additionally, mental health plays a vital role in stress management, interpersonal relationships, and decision-making Its importance spans all life stages, from childhood and adolescence to adulthood.

Mental health issues significantly hinder learning abilities and educational outcomes A study by Aggarwal (2012) on college students in London identified mental health problems as a risk factor for poor academic performance and social discrimination Similarly, research conducted at Western Michigan University (Hysenbegasi, Hass & Rowland, 2005) revealed that depression correlated with a 0.49 point decrease in GPA, equating to nearly half a letter grade Additionally, students experiencing depression reported that their symptoms increasingly interfered with their academic performance.

Mental health issues can adversely affect parenting, potentially resulting in a dysfunctional family environment According to Rutherford (2004), parents experiencing high levels of anxiety may struggle to accurately assess situations and engage in behaviors that foster their children's self-confidence and sense of mastery Consequently, anxious parents display distinct behaviors compared to their non-anxious counterparts.

Mental health significantly impacts physical health and health-related behaviors, with research indicating that anxiety and depression can worsen asthma control and diminish quality of life for asthma patients (Urrutia et al., 2012) Additionally, mental health issues are linked to body weight and sleep patterns, both of which are crucial for physical well-being A study revealed a strong correlation between mental health, physical health, body weight, and sleep preferences during adolescence (Pabst et al., 2009) Furthermore, social anxiety has been associated with less successful smoking cessation outcomes, highlighting the interplay between mental and physical health problems (Buckner et al., 2014).

Mental health problems significantly affect society and national development, accounting for 3 to 4% of the GDP in developed countries In low-income nations, the costs are even higher due to financial strains on family caretakers and productivity losses, leading to widespread suffering globally In the United States alone, the total costs associated with mental health disorders are estimated at approximately $1.25 trillion annually Mental health is a crucial aspect of overall health, being one of the leading causes of disability and premature mortality It contributes to 13% of the global disease burden, highlighting its critical role in public health and the need for effective interventions.

In Nigeria, mental disorders impose a significant financial burden on both individuals and society, with the annual cost of serious mental illness estimated at US$463 per person and a total societal impact of approximately US$166.2 million (Esan, Kola & Gureje, 2012).

2.1.3 Common causes of mental health problems

Many factors contribute to mental health issues, including biological influences like genetics and brain chemistry, as well as life stressors such as trauma and abuse A family history of mental health problems can increase the likelihood of developing similar issues, as susceptibility may be inherited Life stressors, including death, divorce, and feelings of inadequacy, can trigger mental illness in those predisposed to it Negative life events and a passive coping style may heighten the risk of anxiety, while social support and active coping strategies can provide protection against anxiety symptoms Environmental factors such as trauma, personal relationship stress, and financial worries also play a role in anxiety disorders Additionally, medical conditions like anemia and asthma can be associated with anxiety.

Stress and trauma significantly contribute to the development of psychological disorders, with research highlighting a strong link between traumatic life events and the onset of depression Notably, a study revealed that a substantial portion of the connection between stress and depression stems from individuals predisposed to depression seeking out high-risk environments, such as toxic relationships Additionally, cognitive factors play a crucial role, as those who tend to blame themselves for negative events are at a higher risk of experiencing depression.

A study by Kosslyn (2011) indicates that college students who attribute negative events, such as poor grades, to personal shortcomings are more susceptible to depression compared to those who consider external factors Research by Metalsky et al (1993) supports this finding, highlighting the correlation between self-blame and increased risk of depressive symptoms in academic contexts.

Mental Health Literacy

2.2.1 What is mental health literacy?

Health literacy is crucial for individuals to effectively manage their health and understand the connections between symptoms, causes, and treatments of chronic diseases As defined by Kuras (2011), it encompasses a person's ability to comprehend and apply health-related information Mental health is equally vital, as emphasized by Ban Ki Moon on World Mental Health Day in 2011, stating, "There is no Health without Mental Health." This highlights the importance of integrating mental health care into public and private health initiatives, particularly for children Mental health literacy involves recognizing symptoms of mental illness and knowing how to manage and recommend appropriate interventions (Ganasen et al., 2008; Kuras).

Mental health literacy encompasses several key components, including the understanding of how to prevent mental disorders, recognizing the developmental processes of these disorders, and being aware of available help-seeking options and treatment services Additionally, it involves knowledge of effective self-help strategies for managing milder mental health issues.

(e) first aid skills to support others who are developing a mental disorder or are in a mentalhealth crisis

Previous research has shown that the public often struggles to accurately identify different types of mental disorders (Jorm, 1999) There is a notable gap between the beliefs of laypeople and mental health professionals regarding the causes and effective interventions for psychological disorders This misunderstanding is prevalent in both developing and developed countries, as highlighted by various studies (Van, 2011; Jorm, 2011; Kermode, 2010) that reveal a lack of mental health literacy among the public For instance, a study in Ethiopia identified four main causes of mental health issues: psychosocial stressors, supernatural retribution, biological defects, and socio-environmental factors, with the first two seen as the most significant Similarly, research on Chinese and Vietnamese American immigrants in the US (Nan Zang, Teraza, & Hao, 2007) uncovered diverse beliefs about mental health causes, including stressful life circumstances, genetic factors, personality traits, lifestyle choices, and karmic consequences from past lives.

However, there also are individuals who appropriately identify symptoms and causes of mental health A study of adult community members in Vietnam (Van,

A 2011 study revealed that the most prevalent symptoms of mental health issues included talking or laughing alone (90.5%), wandering (89.9%), memory loss (82.5%), and hallucinations (70.4%) The primary causes identified for these mental health problems were stress and pressure, excessive studying or thinking, environmental factors, brain injuries, and biological or genetic influences.

2.2.2 Mental health literacy regarding help-seeking behaviors

A nationwide study in China revealed that 24% of individuals with a diagnosable mental illness experienced moderate to severe disability due to their condition, yet only 8% had sought professional help, and a mere 5% had consulted a mental health professional This highlights a significant gap between the prevalence of mental illness and the rates of individuals seeking treatment.

In both the US and Europe, a significant treatment gap exists for mental health issues, with many patients opting for complementary and alternative medicine (CAM) and religious advisers rather than mental health professionals A European study, the Epidemiology of Mental Disorders (ESEMeD), revealed that among 2,928 respondents who sought help for psychological problems, 20% turned to CAM providers like chiropractors and herbalists (8.6%) or religious advisers such as ministers and priests (8.4%), while only 2.9% consulted mental health professionals This trend highlights the need for increased awareness and accessibility of mental health services in these regions.

2.2.3 Factors influencing mental health literacy and help-seeking behavior

Social-Cognitive Theory (SCT), developed by Bandura, posits that human behavior is shaped by the interplay of three key factors: environment, behavior, and cognition This theory prioritizes conscious thought over unconscious influences, highlighting the significant role of beliefs in shaping behavior Specifically, beliefs inform attitudes, which in turn lead to intentions that often dictate individual actions.

Research by Spicer (2006) indicates that social-cognitive factors significantly influence prisoners in New Zealand when it comes to seeking help for specific issues, particularly in relation to suicidal thoughts and support from prison psychologists The Theory of Planned Behavior suggests that those with previous interactions with prison psychologists are less likely to seek help for suicidal feelings compared to those without such experiences Additionally, a lack of social cognitive understanding can lead to internalizing problems in young children, highlighting the critical role of social cognition in shaping both positive and negative behavioral outcomes in early childhood Therefore, there is an urgent need for early interventions that focus on developing social cognitive skills during the preschool years (LaBounty, 2009).

Understanding mental health and the willingness to seek help are shaped by various factors, including knowledge of health issues, exposure to different health perspectives, education, and family income In some cultures, mental illness is viewed as possession by evil spirits as a consequence of wrongdoing, leading to varying attitudes towards seeking help A study focusing on depression among African American elders highlights these cultural differences in perceptions of mental health.

Research has shown that the stigma surrounding mental health issues significantly impacts individuals' willingness to seek help Negative perceptions of treatment can hinder help-seeking behaviors, as evidenced by Conner et al (2010), who found that unfavorable attitudes towards therapy correlate with reluctance to pursue treatment Additionally, Barksdale (2008) highlighted that African Americans are less likely to seek psychological assistance from formal sources like psychologists or psychiatrists, further emphasizing the need to address these stigma-related barriers to improve mental health support.

Cultural factors significantly influence help-seeking behaviors for mental health issues Research by Wynaden (2005) highlights that religion plays a crucial role in shaping health beliefs, with many individuals in Taiwanese culture seeking folk healing through Buddhism and Taoism Similarly, Wang (2011) indicates that cultural insights and stigmatization indirectly affect beliefs about seeking help, particularly for those with schizophrenia Aloud (2004) further emphasizes that Arab-Muslims' attitudes toward formal mental health services are shaped by cultural traditions, knowledge of available services, perceived societal stigma, and reliance on informal indigenous resources.

Cultural factors such as community, family, and peer norms significantly influence psychological help-seeking behaviors Socio-demographic variables, including age, education, and location, play a crucial role in shaping individuals' approaches to mental health service utilization (Knipscheer & Kleber, 2005) A study in Vietnam revealed that willingness to disclose, preference for professional resources, and prioritization of mental health concerns were key predictors of positive help-seeking attitudes, while stigma and traditional beliefs had less impact (Nguyen, 2000) Furthermore, Vietnamese individuals often favor medical treatment combined with family care, with perceptions of mental health being affected by limited knowledge and a blend of traditional and modern beliefs Barriers to effective help-seeking include a lack of understanding of mental disorders and stigmatizing attitudes (Jorm et al., 2005) Additionally, research on depression literacy in Malaysia indicated that urban residents were more likely to recognize depression as a disorder compared to their rural counterparts, with trauma and stress commonly identified as contributing factors (Loo & Furnham, 2013).

Parental influences on child mental health development and treatment

2.3.1 How parental factors put children at risk or help them recover from mental health problems

Child mental health is influenced by cultural differences in how mental health is perceived, including symptom presentation and parenting behaviors Parents play a crucial role in shaping their children's mental well-being, as studies show that parenting styles significantly impact the development of mental health disorders Research by Bolghan-Abadi, Kimiaee & Amie (2011) highlights that parents with strong relationships with their children tend to have kids with fewer mental health issues, with permissive and authoritative styles linked to better quality of life and mental health outcomes Conversely, authoritarian parenting is associated with lower quality of life Additionally, a study in Vietnam (Weiss, Dang, & Nguyen, 2013) reveals that parental income and education are key risk and protective factors for child behavioral and emotional problems, respectively Children living with married parents experience fewer mental health issues, and those whose parents engage in meaningful conversations also show lower rates of mental health problems.

Research indicates that children of stressed or mentally ill parents face a higher likelihood of developing their own mental health issues, emphasizing the significant influence of family dynamics on child development (Hoven et al, 2009; Tran, 2014; Hisle-Gorman et al, 2015) Specifically, children of depressed parents are about twice as prone to various mental health challenges compared to those whose parents do not suffer from depression (Olfson et al, 2003) Additionally, parental substance abuse poses both prenatal and postnatal risks, with children born to affected mothers at risk for developmental issues that can persist throughout early childhood (Moe et al, 2011).

Child-parent separation significantly affects a child's psychological development, with research indicating that left-behind children experience higher levels of depression and anxiety compared to their peers Pan and Liu (2010) found that these children struggle with less harmonious relationships with teachers, but maintaining contact with parents can alleviate some of these mental health issues Additionally, Lucas, Nicholson, and Erbas (2013) highlighted that children from separated families are more likely to face mental health challenges, primarily due to factors such as parental conflict, socioeconomic status, and parental mental health Among these, maternal parenting consistency emerges as the strongest predictor of mental well-being in children from separated families.

Research highlights that second-generation Cambodian refugee children in the United States face significant mental health challenges due to factors such as low socioeconomic status, poor educational adjustment, strained communication with parents, and the trauma inherited from their parents' experiences during the Khmer Rouge regime (Daley, 2006) Additionally, traditional parenting beliefs in Cambodia continue to influence child-rearing practices, with a notable 98% of mothers and grandmothers endorsing the idea that corporal punishment is acceptable for misbehavior (Laezer, 2014) This reliance on corporal punishment correlates with increased emotional and behavioral problems in children, including hyperactivity and peer issues Conversely, research indicates that family interventions utilizing positive parenting techniques, which avoid corporal punishment, are more effective in mitigating child behavioral problems (Hutching & Lane, 2005).

Child mental health is significantly impacted by parental academic achievement and family income, with research indicating that parental emotional well-being and parenting practices mediate the effects of low socioeconomic status on child mental health issues Specifically, family economic factors are linked to externalizing problems through these parental influences, while maternal education affects externalizing issues through negative disciplinary practices Internalizing problems are directly correlated with family economy and indirectly with parental emotional health A study highlighted a strong connection between parental education and reported child mental health among 4 to 11-year-olds, surpassing the influence of family income and social class Additionally, various factors such as male sex, immigrant status, activity limitations, and parental mental health contribute to reported child mental health problems across age groups Furthermore, the mental health histories of both parents and grandparents are crucial for the social and emotional well-being of children, with findings showing that children experience greater mental distress when either parent has a mental health issue In particular, for children aged 8-9, maternal and paternal mental health histories significantly influence grandchild outcomes, while for younger children aged 4-5, only paternal grandfather mental health history correlates with higher distress scores.

Parental factors play a crucial role in promoting recovery and protecting child mental health, as enhanced collaboration in mental health services leads to more effective treatment outcomes for both children and families Training parents in efficacy and providing system information fosters better parent-professional collaboration, as highlighted by Norton (1998) A study by Monsson (2011) found that parents of children with autism spectrum disorder experience significant positive correlations between their hope for their child and their overall satisfaction and positive affect regarding support Conversely, hope was negatively associated with autism severity, chronic sorrow, anxiety, and depression These findings underscore the importance of parental hope in fostering positive coping strategies for parents of children with autism.

2.3.2 How parental mental health literacy affects identification, help seeking, and recovery from childhood mental health problems

Parental knowledge of mental health plays a crucial role in shaping children's mental health outcomes, influencing both the development and recovery from internalizing and externalizing problems Effective parenting programs enhance the security of infant attachments and reduce childhood conduct issues, while also preventing abuse at a population level (Scott, 2012) Understanding how parents perceive child behavior problems and their help-seeking tendencies can address unmet mental health needs However, research indicates that many parents struggle to recognize specific mental disorders and often hold beliefs about their causes and effective interventions that differ from those of mental health professionals (Jorm, 1999) Public understanding of mental health is generally poor, with studies showing a significant gap between the prevalence of mental disorders and the rates of individuals seeking appropriate care (Van, 2011; Jorm, 2011; Kermode, 2010) Furthermore, parental stress and depression are linked to their perceptions of child behavior and their likelihood of seeking help, which in turn affects service utilization Parental resources and their perception of stressors are key predictors of involvement in mental health treatment, with parental characteristics influencing help-seeking decisions (Hankinson, 2011; Wilson, 2000).

Research indicates that educational levels and attitudes towards mental health significantly influence how parents perceive and address their children's mental health issues Macaluso (2006) found that positive attitudes toward mental health services enhance the identification of conditions such as Major Depressive Disorder (MDD) and ADHD, although they do not significantly impact perceptions of Oppositional Defiant Disorder (ODD) and Separation Anxiety Disorder (SAD) Additionally, higher education levels correlate with recognizing mental health issues across various disorders, except for MDD, yet do not necessarily lead to a preference for mental health specialists Pineda (2014) highlighted that while maternal acculturation does not affect disorder identification, it is linked to recognizing more symptoms of child internalizing and externalizing issues and influences the likelihood of seeking formal care for mental disorders Verhulst and van (1997) further identified that child problem behaviors, academic challenges, and family stress are key factors driving the need for and utilization of mental health services, while parental psychopathology and life events lower the threshold for perceiving a child's behavior as problematic without increasing referral rates.

The three key predictors for utilizing mental health services are the child's level of impairment, parental concern, and the child's challenges in schoolwork Notably, the distinction between mental health and school settings plays a crucial role in predicting diagnoses of disruptive disorders By assisting parents in connecting their child's impairments to the necessity for mental health care, we can potentially address and reduce the unmet mental health needs of children.

Research by Sayal et al (2010) highlights that mental health care appointment systems are significant barriers for parents, who often feel that brief appointments do not adequately address their child's issues Establishing continuity of care and building trusting relationships with general practitioners can encourage parents to seek help, as these factors validate their concerns However, barriers such as embarrassment, stigma surrounding mental health, and fears of being labeled or diagnosed hinder help-seeking behaviors Additionally, some parents worry about being perceived as inadequate caregivers, fearing that seeking assistance could lead to their child being removed from the family.

Selles et al (2015) highlight that positive mental health attitudes, characterized by low stigma and favorable help-seeking intentions, along with a preference for self-reliant treatment methods such as exercise and relaxation, can moderate challenges in accessing care While psychotherapy received favorable ratings, psychiatric medications and alternative strategies like alcohol use were viewed negatively The acceptance of psychotherapy was linked to previous experiences with such services, reduced stigma, and more positive attitudes towards seeking help.

Research shows that after children undergo clinical treatment for mental health issues, parents often report significant improvements in various aspects of the parent-child relationship, including support, satisfaction, involvement, positive communication, and limit setting Additionally, parents of preschoolers with behavioral problems are more inclined to seek mental health services compared to those with internalizing issues However, they also face greater perceived barriers to treatment, such as the belief that they can handle the problem independently, that it will resolve itself, or that other family members do not recognize the child's issues.

Parent-professional collaboration and the accessibility of information significantly influence parents' treatment outcome expectations in mental health services Increased collaboration enhances efficacy and mediates higher expected treatment outcomes for children and families Training parents in effective parenting practices and providing system information can improve collaboration and other systemic factors (Norton, 1998) Research by Mak (2011) indicates that the symptoms of child anxiety and parental efficacy are linked to the amount of information parents receive Developing materials and decision aids to facilitate informed decision-making will help service providers communicate more effectively with parents and families, thereby supporting informed choices and enhancing family-centered care.

Cambodian Mental Health Perceptions

2.4.1 Rates of child and adult mental health in Cambodia

Cambodia faces significant mental health challenges exacerbated by various psychosocial issues, including poverty, child abuse, and domestic violence (Somasundaram and van de Put, 1999; MoH, 2005) A study conducted in Kampong Cham province found that 42.4% of participants exhibited symptoms consistent with depression, while 53% reported high anxiety levels and 7.3% met the criteria for posttraumatic stress disorder (PTSD) Additionally, 47.8% experienced intrusive posttraumatic symptoms, and 45.4% showed signs of avoidance Comorbid conditions were prevalent, with 29.2% of individuals displaying both depression and anxiety symptoms, and 7.1% suffering from a combination of PTSD, depression, and anxiety Social functioning is notably impaired, as 25.3% of respondents reported social difficulties, particularly among those with comorbid symptoms, indicating a heightened risk for social impairment.

Additionally, the Cambodia Mental Health Survey in Cambodia (Shunert et al,

A study conducted in 2012 involving over 2,600 adults aged 21 and older in Cambodia revealed significant mental health challenges within the population The findings indicated that 27.4% of respondents reported experiencing anxiety, while 16.7% reported symptoms of depression Additionally, 2.7% of participants exhibited signs of post-traumatic stress disorder (PTSD), highlighting the urgent need for mental health support in this community.

Probable schizophrenic disorders affect approximately 0.6% of males and 0.2% of females Common depressive symptoms include excessive worrying, sleep difficulties, and low energy levels Despite these challenges, only 24.1% of individuals seek assistance for their mental health issues Among those who do, 62.3% visit health centers, 50.7% turn to family for support, and 34.1% consult local pharmacies Additionally, a significant portion, 47.7%, seeks help from traditional, spiritual, and Buddhist resources.

Despite the lack of nationwide epidemiological studies on child psychopathology in Cambodia, existing research highlights significant mental health concerns among children A door-to-door survey in Kandal province revealed that 13% of children were reported to have problems according to the SDQ-parent version, while the SDQ-teacher version indicated a higher prevalence of 20% Additionally, 21.8% of parents noted their children appeared "backward or slow to learn" compared to peers In 2013, consultations at Chey Chumneas Referral Hospital showed that neuropsychiatric issues, primarily epilepsy, constituted 11% of cases, with developmental disorders, including autism, making up 60% of consultations.

2.4.2 Cambodian mental health literacy and seeking-help behavior

Culture plays a crucial role in shaping the understanding and presentation of mental disorders among Cambodians, influenced by Khmer traditional beliefs These beliefs are founded on four key practices: Buddhist-Hindu principles, spiritual beliefs, the concept of luck through astrology and fortune tellers, and somatic and physiological views Cambodian Buddhism, which emphasizes the authority of spirits known as borameù, empowers spiritual healers to provide guidance and solutions for personal challenges, paralleling the role of psychotherapists in Western contexts Additionally, factors such as family cohesion, positive childhood experiences, a supportive recovery environment, and resilience fostered by Buddhist values contribute significantly to mental health The acceptance of suffering as fate, a core Buddhist tenet, helps individuals manage hardships with optimism and confidence.

In Cambodia, individuals typically begin their treatment journey by utilizing personal or family coping strategies, such as engaging in recreational activities, problem-solving, seeking support from loved ones, and employing traditional practices like drinking warm water, coining, cupping, and using herbal remedies If these methods fail to provide relief, many turn to monks, traditional healers (kru khmer), or mediums for assistance through meditative prayers and blessing ceremonies When traditional approaches prove ineffective, Western medicine becomes an option, with neighbors often sharing medications or consulting pharmacists and physicians Research indicates that pharmacological treatment can significantly improve PTSD symptoms in Cambodian refugees, as well as address culturally relevant somatic symptoms and syndromes.

Reports indicate that individuals with schizoaffective or schizophrenic disorders in rural Cambodia often face inhumane treatment, including being caged or chained for extended periods, sometimes lasting months or years (Stewart et al., 2010; Ministry of Health, 2003; Phnom Penh Post, 2014) A study has examined the help-seeking behavior of patients suffering from schizophrenia, highlighting the urgent need for improved mental health care and humane treatment options in these regions.

In Cambodia, traditional and religious medicine are often the first choices for mental healthcare when patients and caregivers seek help for psychotic symptoms (Coton et al., 2008) A significant barrier to help-seeking among schizophrenic patients is the lack of knowledge about mental health and available services Education plays a crucial role in influencing the help-seeking behavior of family members of these patients Among 104 families studied, 56.7% sought assistance from traditional medicine, 22.1% from Western medicine including psychiatry, and 20.2% from religious medicine Notably, 77.3% of individuals do not initially consult psychiatry due to unawareness that their symptoms indicate a mental health issue or a lack of knowledge about mental health services.

This research employed a mixed-methods design, integrating both qualitative and quantitative approaches The qualitative aspect involved open-ended questions based on brief vignettes, allowing parents to express their general perspectives on various issues Meanwhile, the quantitative component utilized closed-ended and Likert-scale questions to assess parental understanding of children's mental health concerns.

The study involved parents of children in grades 1 and 2 from four elementary schools in Cambodia, including two urban schools in Phnom Penh and two rural schools in Kampong Speu province A total of 208 participants were recruited, with 52 parents from each school, to voluntarily share their perceptions of children's mental health issues and report on their child's recent behaviors related to mental health.

A research study involving 200 parents achieved a participation rate of 96%, with 8 respondents unable to complete the questionnaires The sample consisted of 100 parents of first graders and 100 parents of second graders, equally divided between rural and urban areas Among the respondents, 32% were male and 68% were female The average age of mothers was 33.41 years, while fathers averaged 36.47 years Educational attainment showed that mothers had an average of 6.50 years of education, compared to 8.28 years for fathers On average, families had 2.69 children.

Convenience Sampling was used because of permission and access to the four elementary schools in the study.

Data Collection and Procedures

The researcher recruited participants from four schools by distributing information letters to parents of children in grades one and two Only parents of these early primary school students received the letters, following prior approval from each school's principal Interested parents were invited to the school to complete a questionnaire, which took approximately 60 to 80 minutes Those who could stay longer were also invited to join a focus group or participate in a brief interview.

Measurements (Scale)

The study utilized open-ended questions developed by the author and closed questions adapted from a parent-report measure by Dianne C Shanley and colleagues (Shanley, 2008) These questions were translated into Khmer by bilingual members of the psychology department at the Royal University of Phnom Penh and were pilot tested in Khmer twice prior to formal implementation Additionally, the questionnaire included the Strengths and Difficulties Questionnaire (SDQ) for assessing child mental health, which was received in both English and Khmer, having been previously utilized in research within Cambodia (Goodman, 2005).

English and Khmer assessmets are attached in Appendix A and B

Parents first filled out a questionnaire detailing socio-demographic information to provide insights into their family's living situation, including the ages and professions of both parents, family income, education levels, marital status, number of children, residential area, and religious beliefs The second section featured short vignettes illustrating typical child mental health symptoms, prompting parents to reflect on the reasons behind these behaviors and to consider appropriate responses for each scenario.

The third section of the questionnaire is based on Shanley's (2008) assessment of parents' perceptions regarding the causes of psychopathological disorders, featuring 58 items that encompass 12 factors such as biological, physical, motivational, emotional regulation, cognitive, social influences, stressful life events, trauma, parental factors, and community aspects Additionally, the fourth section utilizes the parent-reported Strengths and Difficulties Questionnaire (SDQ) by Goodman (2005), aimed at evaluating the mental health of children aged 4-10 years This measure includes 25 items, with 5 focusing on child strengths and 20 addressing mental health difficulties.

Statistical Data Analysis

The data for this research article were purely primary data which was directly collected by the researcher from actual 200 parents of children enrolled in 1 st and

In a study involving 2nd graders aged 4-12, the investigator utilized SPSS/IBM version 20 for statistical analysis, focusing on demographic data through descriptive statistics such as frequency, mean, variance, and standard deviations To explore significant differences in parental perceptions of child mental health based on factors like geographic location (rural vs urban), child gender, parental education, family income, number of children, and ages of both parents and children, Independent Sample t-tests and One-way ANOVA were employed The analysis aimed to determine how perceptions of child mental health vary by geographic area and to identify the influence of income and family size, as well as the critical role of parental education in predicting child mental health outcomes These statistical methods provided insights into how various predictive factors affect parents' perceptions of their children's mental health and the barriers they may face in seeking help for children exhibiting maladaptive behaviors.

Exploratory Factor Analysis was employed to streamline parental perception variables, while Bivariate Correlational Analysis (Pearson r) examined the relationships among various factors, including the direction and strength of associations between parents' perceptions of their child's mental health symptoms and causes, demographic profiles, and current child mental health status Additionally, the analysis utilized the SDQ parent-report, which is categorized into five subscales: hyperactivity, behavioral issues, emotional concerns, social difficulties, and peer problems The examination also incorporated statistical significance levels to enhance the analysis.

Ethical Considerations

To ensure ethical and responsible conduct in this project, the researcher initially sent an informative letter to parents through their children, outlining the project's purpose During the data collection session, parents received comprehensive details and were asked to provide voluntary consent for participation They were assured that participation was optional and that declining would not negatively affect them or their children Importantly, all data collected and participant identities were strictly used for the study's objectives and would remain confidential, with no disclosure to external parties.

RESULTS AND DISCUSSION

Descriptive Results

The analysis of participants' background characteristics revealed key factors including age, gender, number of children, marital status, education, occupation, landholding status, and economic status, categorized by residential location (urban or rural) Table 1 presents a comprehensive overview of these background characteristics, organized according to the participants' residential settings.

In a survey of 200 respondents, 68% were female, with a higher female proportion observed in both urban and rural locations The marital status breakdown revealed that 88.5% of participants were married, with 90% in urban areas compared to 87% in rural regions Additionally, 4.5% identified as widows or widowers, comprising 3% from urban and 6% from rural populations.

In a recent survey, 7% of both urban and rural respondents reported being divorced, while a significant 88.5% were married, with higher marriage rates observed in both locations Additionally, the findings indicated that a predominant majority of the respondents identified as Buddhist, comprising 97.5% of the urban sample and 100% of the rural sample.

Table1 Demographics by location (percentages reported for urban versus rural)

Level of Education of mother

Level of Education of father

The analysis of respondents' occupations reveals significant disparities between urban and rural areas In the rural sample, 42.5% of mothers identified as farmers, while no urban mothers held this occupation Conversely, 20.5% of respondents were housewives, with a higher prevalence in urban areas (32%) compared to rural settings (9%) Market sellers comprised 17% of female respondents, predominantly in urban areas (34%) with none in rural regions Additionally, 13% were professionals, such as civil servants, again more common in urban locales (26%) than in rural ones, where none were reported Unemployment was minimal, affecting only 1% of respondents, all from rural areas, while urban areas reported no unemployment among females Lastly, 6% of respondents fell into other occupational categories.

An analysis of father occupation data reveals significant disparities between urban and rural populations Among respondents, 42.5% identified as farmers, with none in urban areas compared to 85% in rural regions Professionals accounted for 26.5% of respondents, with 48% in urban settings versus only 5% in rural areas Market sellers represented 14.5% of the total, with 28% in urban locations and just 1% in rural Both urban and rural respondents equally reported 8% as laborers, while 8.5% fell into other occupational categories.

Table 1 illustrates the educational attainment of parents in urban versus rural areas, revealing notable disparities between genders Figures 1 and 2 highlight that women in rural areas have significantly lower education levels, with an average of 6.50 years of schooling (sd=4.86) Specifically, 39% of mothers completed primary school, with a stark contrast between urban (20%) and rural (58%) populations Furthermore, only 18% achieved high school completion, predominantly in urban areas (33% compared to 3% in rural) Secondary school completion rates were 17%, with urban (22%) outpacing rural (12%) Alarmingly, 15% of respondents did not attend school at all, with 27% in rural areas versus just 3% in urban Higher education figures are also concerning, as only 9% attained a bachelor’s degree (18% urban vs none rural), and a mere 2% achieved education beyond a bachelor’s degree (4% urban vs none rural).

Figure 1 Level of education completed by mothers by residential area

In urban areas, males generally have higher levels of education compared to their rural counterparts According to Figure 2, the average years of schooling for fathers is 8.28 years, with a standard deviation of 5.28 Notably, 26.5% of fathers completed primary school, with a significant disparity between urban (10%) and rural populations (43%) Additionally, 19.5% of fathers achieved high school completion, contrasting sharply with urban (32%) and rural (7%) figures.

In a recent survey, educational attainment varied significantly between urban and rural populations Only 23% of respondents completed secondary school, with 16% from urban areas compared to 30% from rural regions Alarmingly, 11% of respondents did not attend any grade, a stark contrast of 2% in urban settings versus 20% in rural areas Furthermore, 14% of respondents achieved a bachelor's degree, including 28% in urban locales, while none of the rural respondents reached this level Lastly, only 6% of participants completed a higher bachelor's degree, with 12% from urban areas and none from rural backgrounds.

Figure 2: Level of education for fathers

D Income of parents by area

The monthly income data for households reveals that the average income is 153.6 USD, with 42.5% earning less than 100 USD Notably, only 12% of households in Phnom Penh fall into this category, compared to 73% in Kampong Speu Additionally, 25% of households earn between 100 and 300 USD, with equal distribution in urban and rural areas A smaller segment, 11.5%, earns between 300 and 500 USD, with 22% in Phnom Penh versus just 1% in Kampong Speu In Phnom Penh, 17% of households earn between 500 and 700 USD, while no rural households reach this income level Furthermore, 9% of households in Phnom Penh earn between 700 and 900 USD, and 15% earn 900 USD or more, with no rural respondents in these higher income brackets.

Figure 3 Household’s income by location

Perceptions of the cause and consequences of specific child mental health

The responses to the vignettes were analyzed using descriptive statistics

Case 1: A child with Somatoform Disorder

A survey of 200 parents revealed several perceived causes of somatoform disorder in children, including trauma or stress in the child's life (18%), underlying mental health issues (14.4%), inadequate parenting styles (11.8%), and potential medical or physical health problems (10%) To address these concerns, parents suggested interventions such as promoting positive behaviors (20.9%), engaging in conversations to enhance understanding of their feelings (16.6%), encouraging emotional expression (15.5%), and providing desired comforts to improve well-being (12.8%) For detailed insights, refer to Table 2, which outlines the percentage of all responses.

Case 2: A child with Separation Anxiety Disorder

A study involving 200 parents identified key causes of Separation Anxiety Disorder in children, with 15.8% attributing it to a lack of social skills, 15.6% to trauma or stress, 13.9% to underlying mental health issues, 11.8% to insufficient motivation, and 11.4% to inadequate parenting styles Additionally, parents suggested effective interventions for managing Separation Anxiety Disorder, emphasizing the importance of focusing on positive behaviors (17.2%), encouraging emotional expression (16.6%), enhancing communication to foster understanding (16.4%), and improving parenting skills (11%).

Case 3 Child with Attention Deficit Hyperactive Disorder (ADHD)

A recent survey of 200 parents revealed their perceptions of the main causes of Attention Deficit Hyperactive Disorder (ADHD) in children, identifying factors such as inadequate parenting styles (17.7%), the belief that the child is inherently "bad" (13.4%), potential trauma or stress in the child's life (13%), lack of social skills (11.3%), and insufficient motivation (11.5%) In response to these challenges, parents suggested effective strategies to support children with ADHD, including focusing on positive behaviors (18.8%), encouraging emotional expression (14.2%), increasing communication to help children understand their feelings (11.4%), rewarding positive actions (11%), and teaching essential skills (10.7%).

Case 4: Child with Tic Disorder

A survey of 200 parents revealed several perceived causes of Tic Disorder in children, including mental health issues (13.1%), lack of social skills (13.1%), inadequate parenting styles (12%), cognitive or intellectual challenges (11.3%), and insufficient motivation (10.7%) To effectively support children with Tic Disorder, parents suggested strategies such as enhancing communication to help children understand their feelings (15.7%), promoting positive behaviors (15.2%), encouraging emotional expression (14.7%), acquiring new parenting skills (12%), and teaching children specific skills (10.9%).

Case 5: Child with aggressive behavior

A survey of 200 parents revealed key factors contributing to children's aggressive behavior, including inadequate parenting styles (16.1%), lack of motivation in the child (13.2%), deficiencies in social skills (12.2%), potential trauma or stress in the child's life (11.7%), and underlying mental health issues (8.7%).

Effective interventions for children include focusing on positive behaviors (16.7%), encouraging emotional expression (13.4%), facilitating conversations to enhance their understanding of feelings (13.7%), and teaching essential skills (10.8%) These strategies collectively promote emotional well-being and personal development in children.

Case 6: Child with Depressive Disorder

A survey of 200 parents identified several key factors contributing to depressive disorders in children, including mental health issues (15.5%), trauma or stress in the child's life (15.3%), a lack of social skills (12%), insufficient motivation (10.5%), and inadequate parenting practices or family dynamics (9.8%).

Effective interventions for children involve several strategies: encouraging emotional expression (16.4%), promoting positive behavior (16.4%), engaging in conversations to enhance their understanding of feelings (13.9%), teaching essential skills (9.9%), and providing desired items to improve their mood (9.4%).

Case 7: Child with Posttraumatic Stress Disorder/PTSD

A survey of 200 parents revealed that the primary perceived causes of Post-Traumatic Stress Disorder (PTSD) in children include mental health issues (18.3%), life trauma or stress (16.8%), deficiencies in social skills (10.6%), medical or physical health problems (9.6%), and lack of motivation (9.4%).

Effective interventions for children include encouraging emotional expression (17.8%), promoting positive behaviors (16.3%), engaging in conversations to enhance their understanding of feelings (14.4%), and teaching essential skills (9.1%).

Table of vignette case for types of child mental health:

Table 2 Responses to vignette of child with somatoform disorder a Why might this child be feeling and acting this way? Responses Percent of

1 The child is a bad child 35 7.0% 17.7%

2 This is part of a mental health problem 72 14.4% 36.4%

3 The parents are not raising the child correctly The problem is due to family's parenting style 59 11.8% 29.8%

5 This is part of a medical or physical health problem 50 10.0% 25.3%

6 The child has a cognitive or intellectual problem 38 7.6% 19.2%

7 The child was born this way It's genetic 16 3.2% 8.1%

8 The child lacks social skills 45 9.0% 22.7%

9 The child is not properly motivated 37 7.4% 18.7%

10.The child may have trauma or stress in his/her life 90 18.0% 45.5%

11 The neighborhood is unsafe or lacks resources to support families and children 34 6.8% 17.2%

Total 500 100.0% 252.5% b What is the best way a parent could respond to this? Responses Percent of

1 Punish the behaviors to make the child stop 17 3.3% 8.6%

2 Take away the child's privilege until they stop 25 4.8% 12.7%

3 Try to help the child focus on positive behaviors 120 22.9% 60.9%

4 Reward the child for positive behaviors 50 9.6% 25.4%

6 Give the child what they want to help them feel better 67 12.8% 34.0%

7 Talk with the child more to help them understand how they can feel better 87 16.6% 44.2%

8 Encourage the child to express their emotions more 81 15.5% 41.1%

9 Teach the child some skills 9 1.7% 4.6%

10 Learn new skills for parenting (or teaching) to know better how to help the child 18 3.4% 9.1%

Table 3 Responses to vignette of child with separation anxiety disorder a Why might this child be feeling and acting this way? Responses Percent of

3 The parents are not raising the child correctly

The problem is due to family's parenting style 65 11.4% 32.8%

Table 4.Responses to vignette of child with Attention Deficit Hyper-active

Disorder(ADHD) a Why might this child be feeling and acting this way? Responses Percent of Cases

Total 583 100.0% 293.0% b What is the best way a parent could respond to this?

Table 5 Responses to vignette of child with tic disorder a Why might this child be feeling and acting this way? Responses Percent of Cases

10.The child may have trauma or stress in his/her life 56 9.6% 28.1% 11.The neighborhood is unsafe or lacks resources to support families and children 40 6.9% 20.1%

Table 6 Responses to vignette of child with aggressive behavior a Why might this child be feeling and acting this way? Responses Percent of Cases

Total 598 100.0% 299.0% b What is the best way a parent could respond to this? Responses Percent of Cases

10.Learn new skills for parenting (or teaching) to know better how to help the child 68 10.6% 34.0%

Table 7 Responses to vignette of child with depressive disorder a Why might this child be feeling and acting this way? Responses Percent of

Table 8 Responses to vignette of child with Posttraumatic Stress Disorder

(PTSD) a Why might this child be feeling and acting this way? Responses Percent of Cases

3 The parents are not raising the child correctly The problem is due to family's parenting style

10.The child may have trauma or stress in his/her life 98 16.8% 49.0% 11.The neighborhood is unsafe or lacks resources to support families and children

10.Learn new skills for parenting (or teaching) to know better how to help the child 43 7.2% 21.7%

Health-seeking behavior for mental health issues in children

The analysis of parents' responses regarding treatment options revealed their perceptions of effectiveness, potential for improvement, and overall preference for various treatments Parents rated several treatment options, indicating their beliefs about each option's helpfulness and likelihood of resulting in positive outcomes The findings are illustrated in Figure 4, which presents the percentages of responses from the parents.

In a survey of 200 participants, 29% fully endorse the effectiveness of spiritual treatment, while 24.5% consider it unhelpful Additionally, another 24.5% find spiritual assistance to be moderately beneficial, and 17% believe it to be truly helpful Only 5% of respondents indicated that spiritual treatment is unhelpful These findings are illustrated in Figure 4.3.1A, which displays the distribution of opinions among all respondents.

In a survey of 200 participants, 31% fully agree that spiritual assistance leads to lasting improvement, while 23% find it moderately helpful Additionally, 20% believe it to be true, and 16% disagree with the notion that spiritual assistance offers permanent benefits Notably, 9.5% of respondents completely reject the idea that spiritual assistance is effective at all.

Figure 4.3.1.A I believe this treatment was helpful

Not True at allNot trueModerateTRUE completely true

Among 200 samples, 36% of respondents completely like spiritual treatment, 18% is moderately like it, 17.5% is truly like it, 17% is not like it and 11.5% think that it is not true at all

In a survey of 200 participants, 32% fully agree that traditional healers are beneficial, while 21% consider them moderately helpful Additionally, 20.5% believe traditional healers are genuinely effective, whereas 20% feel this is not the case Only 6.5% of respondents completely dismiss the efficacy of traditional healers.

Figure 4.3.1.B I believe this treatment was likely permanent improvement.

Not True at all Not true Moderate TRUE completely true

Figure 4.3.1.C Overall, I like this kind of treatment

Not True at allNot trueModerateTRUE

33.50% figure 4.3.2.B.I believe this treatment was likely permanent improvement

In a study involving 200 samples, 33.5% of participants believe that traditional healing offers a completely permanent improvement, while 24% consider it to provide a moderately permanent improvement Additionally, 22% of respondents feel that traditional healing results in truly permanent improvement, whereas 13.5% think it is not truly permanent Only 7% of those surveyed do not believe in the effectiveness of traditional healing at all.

Among 200 samples, 35% completely like traditional healer, 21.5% truly like, 19% moderately like it, 17 % don‘t like it and only 7.5% truly not like it

In a study involving 200 participants, 46% indicated that medication would be completely helpful, while 28.5% believed it to be very helpful Additionally, 13.5% rated it as moderately helpful, 10.5% found it not very helpful, and only 1.5% considered it not helpful at all.

In a study involving 200 samples, 52% of participants fully agree that medication can lead to permanent improvement Additionally, 20% believe this treatment is likely to result in lasting benefits, while 17.5% consider the improvement to be moderately permanent Conversely, 8.5% disagree with the notion, and only 2% completely reject the idea of permanent improvement through medication.

Figure 4.3.3.B I believe this treatment was likely permanent improvement

Among 200 samples, half of them (57.5%) completely like treatment by medication, 19% truly like it, 13.5% moderately like it, 8% is not like it and only 2% not like medication for treatment at all

Among 200 samples, 32.5% think that individual counseling with children is completely helpful, 26% moderately, 23% truly helpful, 17.5% Not true and only 1% think it is not true at all

Figure4.3.4A I believe this treatment would be helpful

In a study of 200 samples, 42% of respondents believe that individual counseling with children leads to permanent improvement, while 29% feel it results in true permanent improvement Additionally, 17.5% report moderate improvement, 10.5% do not believe the improvements are genuine, and only 1% assert that there is no improvement at all.

Among 200 samples, 44.5% completely like individual counseling with children, 24.5% truly like it, 18% moderately like it, 12% not truly like it and only 1% do not like it at all

4 Counseling for parent to help them learn some skill

In a study involving 200 samples, 33.5% of participants fully agreed that counseling for parents to acquire essential skills is entirely beneficial, while 26.5% found it to be genuinely helpful Additionally, 23.5% rated it as moderately helpful, 15% disagreed with its effectiveness, and only 1.5% believed it to be completely unhelpful This data is illustrated in the accompanying figure.

Figure 4.3.4B I believe this treatment was likely permanent improvement

Figure 4.3.4C Overall, I like this kind of treatment

Among 200 samples, (see Figure 8B) 38.5% think that it completely permanent improved, 27.5% think truly permanent, 24% moderately improved, 8.5% is not true and only 1.5% is not true at all

Among 200 samples, 40% completely like it, 27% truly like it, 17.5% is moderately like it, 13.5% is not truly like it and 2% is do not like it at all

Figure 4.3.5b I believe this treatment was likely permanent improvement

Figure 4.3.5A I believe this treatment was helpful

5 Counseling for parents and Child together/family therapy

In a survey of 200 participants, 44% of respondents indicated that counseling for parents and children together is completely helpful, while 32% found it to be truly helpful Additionally, 12.5% rated it as moderately helpful, 10.5% did not find it helpful, and only 1% believed it is not helpful at all.

Among 200 samples, 49% think that it is completely permanent improved, 27.5% think it is truly permanent improved, 17.5% moderately permanent improved and 6% think it is not true

Figure 4.3.5C Overall, I like this kind of treatment

Figure 4.3.6A I believe this treatment was helpful

Among 200 samples, 49.5% completely like it, 30.5% truly like it, 13.5% moderately like it, 6% not like it and 0.5% do not like it at all

7 Help from the child's school

Among 200 samples, 43.5% think that helping from child‘s school is completely helpful, 28% is truly helpful, 17% is moderately helpful, 11% is not truly helpful and 0.5% is not truly helpful at all

Figure 4.3.6C Overall, I like this kind of treatment.

Figure 4.3.7A I believe this treatment was helpful.

Among 200 samples, 47.5% believe that helping from child‘s school is completely permanent improved, 28.5% is truly improved, 18% is moderately, 5.5% is not true and 0.5% is not true at all

Among 200 samples, half of them (50.5%) completely like it, 29% truly like it, 15% is moderately like it and 5.5% think that it is not true.

Analysis of parental perceptions

Independent sample t-tests and analysis of variance were employed to evaluate significant differences in parental perceptions of child mental health based on various predictive factors, including geographic location (rural vs urban), child gender, parental education, family income, number of children, and the ages of both parents and children This analysis aimed to determine how perceptions of child mental health may vary depending on the geographic area in which families reside.

Figure 4.3.7C Overall, I like this kind of treatment.

Income and the number of children served as predictors in this study, while parental education was included as a grouping variable due to its significant impact on children's mental health ANOVA analyses were utilized to enhance the understanding of how these predictive factors shape parents' perceptions of their children's symptoms and identify barriers that may hinder parents from seeking help for maladaptive behaviors.

4.4.1 Parental perception of causes of child mental health by demographic profile

A study analyzed how socio-demographic factors influence parental perceptions of child mental health issues Results indicated that rural parents had a higher average perception score (2.24) compared to urban parents (2.20), with a significant difference of 0.04 (t-test= -3.33; p=0.001) Additionally, mothers identified as housewives or farmers had distinct views on the causes of child mental health compared to those in other professions (p0.05) Education of mother didn‘t attend school 2.30 0.602

(F-test= 0.956, P=0.446>0.05) Education of father didn‘t attend school 2.43 0.572

Occupation of Mother No occupation 2.81 0.268

(F-test=3.894, P=0.005

Tiêu đề	Parental Perceptions Of Child Mental Health: Symptoms, Causes And Responses Among Cambodian And Its Correlation With Their Children Mental Health
Tác giả	Phan Ratha
Người hướng dẫn	Dr. Amie Pollack, Dr. Dang Hoang Minh
Trường học	Vietnam National University Hanoi
Chuyên ngành	Psychology
Thể loại	Master’s Thesis
Năm xuất bản	2016
Thành phố	Hanoi

Định dạng
Số trang	126
Dung lượng	2,2 MB