馬拉威小學教師對學生心理健康問題的覺察和感知

Abstract

背景 馬拉威年輕人自殺率上升以及憂鬱症的普遍存在，凸顯了面對心理健康挑戰的必要性。兒童時期的心理健康問題往往在成年後表現出來，許多個案未能得到適當處遇，造成長期的影響。本研究試圖填補馬拉威兒童和青少年心理健康研究的空白，將重點發在教師身上，因為他們在心理健康資源嚴重不足的國家中扮演關鍵角色。鑑於教師與學生相處時間長與對學生的影響力，因此了解教師對學生心理健康需求的知識水平是很重要的。

目標 本研究旨在探討馬拉威在職和職前教師對學生心理健康問題的覺察與感知，以及相關因素。本研究並調查了老師對兒童心理健康問題成因的認知，以及學校心理健康資源的可及性和重要性。

方法 本研究為橫斷性調查，於2024年5月至2024年6月在馬拉威對974名小學教師和教師學員進行紙筆問卷調查。問卷包括四個部分：社會人口學特徵、對立反抗症（ODD）和分離焦慮症（SAD）兒童的案例故事、兒童心理健康問題嚴重程度認知（使用改編的長處與困難問卷量表，SDQ），對兒童心理健康問題的歸因，與所感知的資源可及性和重要性。使用邏輯斯迴歸來分析覺察ODD和SAD的相關因素，兒童心理健康問題的歸因，以及將有兒童心理健康問題的學生轉介給非醫療服務提供者的情況。使用線性迴歸分析教師對兒童心理健康問題嚴重性感知的相關因素。

結果 雖然分別有81.7%和71.6%的教師報告曾接觸過患有心理疾病和障礙的個人和學生，但只有23.2%的教師報告曾接受過心理健康培訓。大多數教師認識到案例中的兒童有ODD（96.3%）和SAD（88.6%）的問題，這與之前接觸過他人心理障礙的經歷和教學經驗相關。教師對外化障礙的認知嚴重程度高於內化障礙，且認知嚴重程度與某些因素相關。遺傳（70.9%）和物質濫用（70.3%）最常被認為是兒童心理健康問題的原因。宗教和種族因素則與認為兒童心理健康問題是被附身或與靈性因素有關。多數教師認為應將兒童心理健康問題轉介給心理健康專業人士（79.4%）和心理諮商師（72.3%），少數教師則認為可轉介給教堂（29.1%）和傳統治療師（7.3%），後兩者與年齡和宗教相關。學校心理健康服務被大多數人認為重要，但一些服務被認為不常見，例如，只有29.6%的教師報告學校內有學生心理健康問題的篩檢服務。

結論 這些發現強調了加強心理健康培訓和資源的重要性，以支持馬拉威小學教師應對學生的心理健康問題。

Background The escalating youth suicide rates and prevalence of depression in Malawi underscore the imperative to address mental health challenges. Poor mental health during childhood often manifests in later life, with many cases going unaddressed, exacerbating long-term effects. This study addressed the research gap on child and adolescent mental health in Malawi, focusing on teachers—key figures in a country with severe mental health resource constraints. Recognizing teachers as the primary influencers due to their extensive time spent with students, it is important to better understand teachers’ literacy level regarding students’ mental health needs.

Objectives This study aimed to explore the recognition and perceptions of students’ mental health problems and the associated factors in in-service and pre-service teachers in Malawi. It also investigates perceived causes of child mental health problems and the availability and perceived importance of school mental health resources.

Methods The study employed a cross-sectional survey administered via pen-and-paper questionnaires in English to 974 primary school teachers and teacher trainees in Malawi from May 2024 to June 2024. The survey questionnaire, comprising four sections—socio-demographic inquiries, vignettes of children with Oppositional Defiant Disorder (ODD) and Separation Anxiety Disorder (SAD), perceived severity of child mental health problems (based on the adapted version of the Strengths and Difficulties Questionnaire Scale, SDQ), and perceived causes, resource accessibility and significance. Logistic regression was used to investigate the factors associated with problem recognition of ODD and SAD symptoms, and the attribution of causes of child mental health problems (CMHPs) and the referral of students with CMHPs to non-medical service providers. Linear regression was used to examine factors linked to teachers' perceptions of CMHP severity.

Results While 81.7% and 71.6% of teachers reported exposure to individuals and students with mental illness and disorders, respectively, only 23.2% reported ever receiving mental health training. The majority of teachers recognized children with ODD (96.3%) and SAD (88.6%) in the vignettes having a problem, and the recognition was associated with previous experience of exposure to others’ mental disorders and teaching experience. Teachers demonstrated greater perceived severity for externalizing disorders compared to internalizing ones, and perceived severity was associated with certain factors. Heredity (70.9%) and substance abuse (70.3%) were most commonly cited as the causes of child mental health issues. Religion and ethnicity were associated with the belief that CMHPs were caused by being possessed / spiritual factors. There was a strong preference for referral of CMHPs to mental health professionals (79.4%) and counselors (72.3%). Some considered referrals to churches (29.1%) and traditional healers (7.3%), and such preference was associated with age and religion. School mental health services were mostly recognized as important but some were perceived to be not commonly available, e.g., only 29.6% of teachers reported that school-wide screening of mental health problems in students was available in their schools.

Conclusion These findings underscore the critical need for enhanced mental health training and resources to support teachers in managing mental health challenges within the primary educational environment in Malawi.