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Original article / Araştırma
Gender differences according to psychological and behavioral variables among 10th grade students in Istanbul Cüneyt EVREN,1 Müge BOZKURT,1 Arzu ÇİFTÇİ DEMİRCİ,1 Bilge EVREN,2 Yeşim CAN,1 Gökhan UMUT1 _____________________________________________________________________________________________________
ABSTRACT Objective: Aim of this study was to determine the gender differences according to psychological and behavioral variables among 10th grade students in Istanbul/Turkey. Methods: Cross-sectional online self-report survey conducted in 45 schools from the 15 districts in Istanbul. The questionnaire included sections about demographic data and school life. Also depression, anxiety, anger, sensation seeking, assertivity and impulsivity subscales of Psychological Screening Test for Adolescents (PSTA) were used. The analyses were conducted based on the 4957 subjects. Results: Rate of males was 52.7% (n=2614). Mean age, sensation seeking and impulsivity scores were higher in males, whereas depression, anxiety, anger and lack of assertivity scores were higher in females. Rates of poor school success, disciplinary punishment, absenteeism, truancy before age of 13, physical harm from a friend, physical fight in last year, to bear arms and problem with the law were higher in males, whereas having suicidal ideation or attempt were higher in females. In logistic regression model, school related problems (poor school success, absenteeism and truancy before age of 13), delinquent behavior (physical fight in last year, to bear arms and physical harm from a friend), sensation seeking, and lower depression, anxiety, anger, impulsivity, lack of assertivity, and suicidal ideation differentiated males from females. Discussion: The findings suggest that females have higher psychological problems such as anger, depression and anxiety, which may also be related with suicidal thoughts, whereas males have higher school related and behavioral problems. (Anatolian Journal of Psychiatry 2015; 16(2):77-84) Key words: adolescence, behavioral problems, gender, online survey, psychological problems
İstanbul’daki 10. sınıf öğrencileri arasında psikolojik ve davranışsal değişkenlere göre cinsiyet farklılıkları ÖZET Amaç: Bu çalışmanın amacı İstanbul/Türkiye’deki 10. sınıf öğrencileri arasında psikolojik ve davranışsal özelliklere göre cinsiyet farklılıklarını belirlemekti. Yöntem: Özbildirime dayalı bu kesitsel ve online araştırma İstanbul’daki 15 ilçede yer alan 45 okulda yürütüldü. Soru formu demografik bilgileri ve okul yaşamını içeriyordu. Ayrıca Ergenler için Ruhsal Sorunlar Tarama Ölçeğinin depresyon, anksiyete, öfke, yenilik arayışı, asertiflik eksikliği ve dürtüsellik alt ölçekleri kullanıldı. Analizler 4957 hasta üzerinden yapıldı. Sonuçlar: Erkeklerin oranı %52.7’ydi (s=2614). Ortalama yaş, yenilik arayışı ve dürtüsellik puanları erkeklerde yüksekken; depresyon, anksiyete, öfke ve asertivite eksikliği kadınlarda yüksekti. Düşük okul başarısı, disiplin cezası, devamsızlık, 13 yaşından önce okuldan kaçma, _____________________________________________________________________________________________________ 1
MD, Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey MD, Baltalimani State Hospital for Muskuloskeletal Disorders, Department of Psychiatry, Istanbul, Turkey Correspondence address / Yazışma Adresi: Cüneyt Evren MD, İcadiye Cad. Menteş Sok. Selçuk Apt. No.1/17 Kuzguncuk 34674 Üsküdar, İstanbul, Turkey E-mails:
[email protected],
[email protected] Geliş tarihi: 15.02.2014, Kabul tarihi: 14.05.2014, doi: 10.5455/apd.160603 2
Anadolu Psikiyatri Derg 2015; 16:77-84
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Gender differences according to psychological and behavioral variables among 10th …
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bir arkadaştan fiziksel zarar görme, geçen sene içerisinde fiziksel bir kavgaya karışma, silah taşıma ve yasal sorunlar erkekler arasında daha fazlayken; intihar düşüncesi ve girişimi kadınlarda daha fazlaydı. Lojistik regresyon modelinde okulla ilişkili sorunlar (düşük okul başarısı, devamsızlık ve 13 yaşından önce okuldan kaçma), suça yönelik davranış (geçen sene içerisinde fiziksel bir kavgaya karışma, silah taşıma ve bir arkadaştan fiziksel zarar görme), yenilik arayışı ve düşük düzeyde depresyon, anksiyete, öfke, dürtüsellik, asertivite eksikliği ve intihar düşüncesi erkekleri kadınlardan ayırt eden özelliklerdi. Tartışma: Sonuçlar kadınlarda olasılıkla intihar düşüncesi ile de ilişkili olabilecek öfke, depresyon, anksiyete ve gibi psikolojik problemlerin daha fazla olduğunu; erkeklerde ise okulla ilişkili ve davranışsal sorunların daha yüksek düzeyde bulunduğunu göstermektedir. (Anadolu Psikiyatri Derg 2015; 16(2):77-84) Anahtar sözcükler: Ergenlik, davranışsal sorunlar, cinsiyet, online tarama, psikolojik sorunlar _____________________________________________________________________________________________________
INTRODUCTION Gender differences in psychiatric symptoms and diagnoses among adolescents are well documented.1 Several studies have documented that males and females differ in their rates of internalizing and externalizing psychopathology.2,3 Adolescent females’ internal responses cause them to be vulnerable to internalizing psychopathology, while adolescent males’ external responses increase their propensity for externalizing psychopathology.4,5 Typically, girls are more vulnerable to internalizing problems such as depression and anxiety.6,7 Thus, female adolescents experience depression8,9 and anxiety10 in higher rates than male adolescents. In contrast, males have an elevated risk of externalizing symptoms (e.g., aggression, delinquency, impulsivity and other risk behaviors) after exposure to these same types of stressors.5,11-13 During late adolescence and young adulthood, the gender gap in such externalizing behaviors as conduct disorder, delinquency, and aggression widens, with a male-to-female ratio greater than two to one.14 Previous studies found that sensation-seekers were more prone to get involved in some risktaking behaviors among late adolescents.15,16 Findings on the relationship between risk-taking and sensation-seeking appear to show similar characteristics in Turkey.17 Among Turkish adolescents, males were more likely to be high sensation-seekers than females, and authors claimed that gender roles and parental attitudes in Turkish culture might simplify the males’ sensation-seeking behavior.18 Thus, Turkish male sensation seekers might be more exposed to be risk-takers. Peer aggression is common in adolescents and previous research shows males are more likely to be the perpetrators and victim perpetrators of peer aggression.19-21 Gender differences were found among school-going adolescents in 20 countries22 and in Portuguese,23 with boys being more likely to report frequent fighting than girls. Anatolian Journal of Psychiatry 2015; 16:77-84
In the previous studies conducted with the adolescents, boys reported more physical bullying and victimization,24-26 more weapon carrying, and more injury.26 Furthermore, a study of over 160,000 students from 35 countries found that as many as 11% of adolescent girls and 22% of adolescent boys reported carrying guns.27 Research has established linkages between being armed with a weapon and subsequent violence, physical fighting, and injury physical and relational victimization.28-30 Nevertheless, changes in gender roles apparently have led adolescent girls to physically fight more frequently than in the past.31,32 Also, associations have been found between perpetration and depressive symptoms among girls,33 but less consistently among boys.34 Overall, 17.25% of adolescents in Guangzhou, China reported suicidal ideation, and 3.04% reported suicidal attempts during the past 12 months. The associations of health risk behaviors with suicidal ideation and attempts varied by gender, and physical fight was associated with suicidal attempts among adolescent males.35 We aimed to determine the gender differences according to psychological and behavioral variables among 10th grade students in Istanbul, Turkey. METHODS Settings and sample In Turkey, elementary education starts at 7 years of age. The first 8 years of elementary education is obligatory (primary school). Students may then attend secondary school. The duration of secondary school education may vary between 3 and 5 years, due to extra years of foreign language education. The sample size was determined as 5,000 taking into account earlier studies. Frequencies from 1% to 50% are within an acceptable range of accuracy with this sample size (90% power, the estimated accuracy limit of from 1% to 50%±5). Basing on the experience gained from previous
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studies, it was estimated that factors such as non-response, improper filling or less number of students than the expected amount would be around 15%, and the total sample size was computed as 5750. Multi-stage sampling was performed to select subjects. Multi-stage sample initially stratified according to the Istanbul’s 15 districts. Tenthgrade students in different geographical areas and different schools, which were selected from the districts and schools included in the previous researches’ in Istanbul,36 were enrolled into the study. The primary sampling units were schools, selected with a probability proportional to student enrollment numbers (45 schools from the 15 districts). Next, 1 or 2 classes within each participating school were selected systematically with equal probability sampling. All students in selected classes were included into the study sample. Five thousand three hundred eighty three students participated in the study and entered to the system from the Internet and filled the questionnaire. Although none of the patients refused to participate in the study, 410 students were excluded because they left some parts of the scales unfilled, 16 students were excluded because of the trap question. Thus, a representtative sample of 4957 students participated in the study. When we compared the students excluded from the study and included in the study, mean of age (16.69±6.44, 15.58±2.85 respectively, t=3.57, p
