Correlates of mental health among Pakistani adolescents: an exploration of the interrelationship between attachment, parental bonding, social support, emotion regulation and cultural orientation using Structural Equation Modelling
Background Mental health of the adolescents is an important global public health concern as a leading cause of illness and disability not only for the adolescents, but also their family, and the community. In recent years the broader definition of mental health suggests an overall improved well-being as well as absence of illness. Despite the global recognition of the significance of adolescents’ mental health it remains a seriously neglected area in research and policy in Pakistan. This thesis attempts to understand the epidemiology of mental health among Pakistani adolescents by drawing from developmentally informed framework. This thesis proposes that perceptions of relationship with parents and attachment underlie the adolescents’ successful ability to regulate emotions and perceive social support. It also attempts to understand the role of cultural orientation in the pathway of associations between the factors mentioned above. Objectives A quantitative cross sectional design was applied to investigate the state of mental health among Pakistani adolescents. The study also aimed at investigating the validity of constructs of attachment, parental bonding, emotion regulation, social support and cultural orientation in Pakistan and how these factors interrelate in relation to adolescents’ mental health. Methods A sample of eleven hundred and twenty four was recruited from eight secondary schools from the district of Rawalpindi, Pakistan after formal approval from concerned authorities. A battery of self-report measures was administered in class-room setting. Confirmatory factor analysis (CFA) and Structural equation modelling (SEM) were used to analyse the data. Results Prevalence of depression and anxiety among this sample was 17.2% and 21.4% respectively. Results from the CFA of the Urdu versions of the instruments used in the current study replicated the original factor structures in case of well-being, depression, anxiety, parental bonding, emotion regulation, and social support with minor modifications. However, a two factor model of cultural orientation is supported in the current study. In case of parental bonding, a second order factor was found for mother and father bonding showing that both form common factors of parental warmth, protectiveness and authoritarianism. Present study found support for the hypothesized structural equation model examining pathway of association between attachment, parental bonding, social support, emotion regulation and cultural orientation in understanding depression, anxiety and well-being among Pakistani adolescents. Discussion Findings of this study suggest that parental bonding, attachment, emotion regulation, social support and cultural orientation play a crucial role to further our understanding of adolescents’ depression, anxiety and well-being in Pakistani cultural context. Therefore, these are central constructs within a developmental framework and are important when considering long-term psychosocial functioning of individuals. Further implications are discussed regarding the recommendation of promoting and utilizing a developmentally informed approach when working with adolescent population. These findings may be used as base line information in making policy level decisions regarding evaluation, prevention and intervention and of mental health problems among Pakistani adolescents.