Objective: This study aims to review scientific literature about Mental Health Problems (MHP) in Indonesian population, especially children and important findings of the studies.

Materials & methods: Two methods of searching were conducted; English peer-reviewed literature from Pub Med and MEDLINE and the keywords included Mental Health Problems, children, Indonesia. Specifically, mood disorder, schizophrenia, anxiety, phobia, insomnia, ADHD and OCD were also included. Several related studies published in Bahasa (Indonesian Language) were searched in Indonesian version of Google with “masalahkesehatanjiwa” and “anak” as the keywords.

Results & discussion: At least, there are eight studies conducted in Indonesia related to MHP in children both in national and international publications. The studies applied various instruments and revealed different results. The majority of the studies found that Indonesian children had risk for MHP, some factors such as academic competence, family relationship, and maternal parenting stress related to MHP, andsome intervention-based researches reported to have effective result in this population, such as atypical antipsychotic in adolescents with schizophrenia, Stroop test in children with ADHD and Triple P-Positive Parenting Program in children with emotional and behavioral problems. More studies should be conducted to investigate factors related to MHP based on Indonesian population as well as interventions to minimize the impact of MHP in children in Indonesia.

Saputra F (2017) Mental Health Problems in Indonesian Children: A Review Study. Ann Psychiatry Ment Health 5(4): 1105.

•    Mental Health Problems
•    Children
•    Indonesia
•    Review study

MHP: Mental Health Problems

MHP in Indonesian children population is not a new phenomenal issue, but related clinical and epidemiological studies are rarely to be conducted in Indonesia. In fact, the prevalence gradually increases every year, although the numbers cannot be properly specified. Unfortunately, many reports revealed that Indonesian children may be affected by MHP in various forms, both as abusers and victims [1,2]. Some studies found that MHP in children expose them to early criminal behaviors such as smoking, drug use and pornography, and psychiatric diseases, such as bipolar disorder and suicide [3-5]. Unlike MHP in adults, MHP in children is more difficult to detect because their inner world has not well developed yet. Therefore, it is important to conduct early detection of MHP in Indonesian children, so the number of MHP in adults can be reduced and avoided, because MHP in children predicted MHP in adult [6].

Even the impacts of MHP in children seem to be serious, but the literature about MHP in children population in Indonesia is still limited. This paper purposed to review scientific literatures about MHP in Indonesian children population that were published nationally and internationally, including related factors as well as any intervention to minimize the impact of MHP in children

There were two methods of searching conducted in this paper; English peer-reviewed literatures from Pub Med and MEDLINE and Indonesian literatures from Indonesian version of Google. The keywords for English publication included Mental Health Problem, children, Indonesia. Specifically, mood disorder, schizophrenia, anxiety, phobia, insomnia, ADHD and OCD were also included. Meanwhile, “masalahkesehatanjiwa” and “anak” were the keywords included to search several related studies published in Bahasa (Indonesian Language). Any related articles including titles, abstracts and full articles were evaluated and reviewed

English Publication studies

In Pub Med publication, I found five studies that focus on MHP in Indonesian children population. The first study revealed that, mostly Acehnese (one of provinces in Indonesia) children at school had emotional symptoms (37.8%) higher than any other MHP, such as peer problems, conduct problem, and hyperactivity. The study also found that three factors such as academic competence, family relationship, and maternal parenting stress related to MHP in school-aged children (r = -0.177, -0.176 and 0.173 p<0.05 respectively). Furthermore, age related to peer problems negatively (r = -0.162 p<0.05), and maternal parenting behavior had negative relationship with emotional symptoms (r = -0.287 p<0.05) and positive relationship to both conduct problems and hyperactivity (r = 0.162, 0.143, p<0.05 respectively). Maternal depression was also found to be related to emotional symptoms and hyperactivity (r = 0.236 and -0.158, p<0.05 respectively). The second study discussed that medication adherence of some children with schizophrenia is affected by parental relationship (24.4%). This study suggested parents to improve their relationship with schizophrenic children in order to increase medication adherence and avoid relapse [7,8].

In addition, the other three studies are intervention-based study. First study found that adolescents with schizophrenia who had atypical antipsychotic medication showed higher executive function. The adolescents were treated with rispiridone, aripipripazole, olanzapine and clozapine for one to 36 months. Compared to controlled group, the adolescents showed higher for BRIEF T score such as on emotional state, initiate scale, monitor scale, and behavior regulation index (detail in Table 1). The study suggested taking atypical antipsychotic medication for adolescents with schizophrenia in order to maintain and improve their executive function [9]. The second study revealed that age may influence the result of Stroop test in children with ADHD. Compared to young school-aged children (children aged 6-9 years old), older school-aged children (children aged 10-13 years old) showed significantly delayed completion time for the CST and IST compared with controls of the same age. This study suggested that Stroop test may differentiate ADHD in older school-aged children or preadolescent children [10]. The third study discussed that the Triple P-Positive Parenting Program Seminar Series was effective to help parents of children with behavioral problems. The study involved 143 parents of children aged 2-12 years. It was reported that intervention group had a greater decrease in child behavioral problems (d = 0.45), dysfunctional parenting practices (d = 0.69), parental stress (d = 0.44), and a greater increase in parenting confidence (d = 0.45). It is suggested that the program was effective to improve parenting skill and control behavioral problems of children [11].Unfortunately, no closely related articles were suggested in MEDLINE publication with the same key words.

Bahasa publication studies

Finding bahasa published studies; the author searched the related papers by using Indonesian version of Google. There were three studies published in Indonesian journal with concerned issue. First study focused on school-aged children (6 – 12 years old) and suggested to conduct initial assessment of MHP. The study found that 74% of children have lower risk for MHP and they were not referred to have further examination, but the other 26% have higher risk for MHP and suggested to have other examination [12]. Of 1000 children aged 5 – 14 years old in the second study, 10.2% children suffered from MHP. This study also found that there were no differences of MHP in gender, provinces or rural and urban area [13]. But, the weakness of the above studies is, no specific MHP is discuss because they only focus on initial screening of MHP, so other study was suggested to investigate the type of MHP in order to specify appropriate interventions. The last study stated specific MHP clearly. This hospital based study found that 42.2% of school-aged children have emotional symptoms and the other majority of children (54.81%) exhibited peer problems [14]. The detailed information about reviewed studies as mentioned in Table (1).

The implication of the studies

Both of English and bahasa publication studies revealed that children in Indonesia are suffering from MHP, but the number of related studies is still limited. Two studies conducted at school and hospital found the similar finding, that school-aged children in Indonesia have emotional symptoms more than other problems. Children with emotional problems tend to have higher risk for depression. Later on, if the depressed children are not treated appropriately, they will have higher risk for suicide [4]. The other interesting findings of the studies revealed that, some family factors should increase the risk of MHP in children, the factors such as family relationship, maternal parenting stress, maternal parenting behavior and maternal depression is important to note in order to minimize the risk for MHP in children. In addition, some intervention-based studies found different facts such as atypical antipsychotic medications are effective to maintain executive function of adolescents with schizophrenia, Stroop test is effective to separate ADHD in preadolescent children and Triple P intervention is a helpful program for parents of children with behavioral problems in Indonesia

Table 1: English and Bahasa published articles related to MHP in Indonesian children population.

MHP have many consequences in later life of the children. Once when children become adults, undetected and untreated MHP increase the severity of MHP. Considering the serious impacts of MHP in children population in Indonesia, further researches are needed to fulfill the gap of knowledge of the related issue, because the study about MHP in Indonesian children population is still limited. The other researches are expected to focus more on interventions, especially family based intervention because some investigated factors of children with MHP related to family.

1. Erlinda. UpayaPeningkatanAnak Dari BahayaKekerasan, Pelecehan, Dan Eksploitasi. 2014.

2. Ministry of woman empowerment and child protection of Indonesia. Kebijakan Penanganan Anak Berke butuhan Khusus. No. 10.Tahun 2011. Kementerian PP and PA Republic Indonesia, Jakarta. 2011.

3. Aebi M, Giger J, Plattner B, Metzke CW, Steinhausen HS. Problem coping skills, psychological adversities and mental health problems in children and adolescents as predictors of criminal outcomes in young adulthood. Eur. Child Adolesc. Psychiatry. 2014; 23: 283-293.

4. Consoli A, Peyre H, Speranza M, Hassler C, Falissard B, Touchette E, et al. Suicidal behaviors in depressed adolescents: role of perceived relationship in the family. Child Adolesc. Psychiatry Mental Health. 2013; 7: 1-12.

5. King SM, Iacono, WG, McGue M. Childhood externalizing and internalizing psychopathology in the prediction of early substance use. Addiction. 2004; 99: 1548-1559.

6. Copeland WE, Shanahan L, Costello EJ, Angold A. Which childhood and adolescent psychiatric disorders predict which young adult disorders? Arch. Gen. Psychiatry.2009; 66: 764-772.

7. Saputra F,Yunibhand J, Sukratul S. Relationship between personal, maternal, and familial factors with mental health problems in school-aged children in Aceh province, Indonesia. Asian Journal of Psychiatry. 2017; 25: 207-212.

8. Wiguna T, Ismail RI, Noorhana SR, Kaligis F, Aji AN, Belfer ML, et al. Family responses to a child with schizophrenia: An Indonesian experience. Asian J Psychiatr. 2015; 18: 66-69.

9. Wiguna T, Guerrero AP, Honjo S, Ismail I, Wr NS, Kaligis F, et al., Executive Dysfunction among Children with Antipsychotic Treated Schizophrenia. Clinical Psychopharmacology and Neuroscience. 2014; 12: 203-208.

10. Thursina C, Ar Rochmah M, Nurputra DK, Harahap IS, et al. Attention Deficit/Hyperactivity Disorder (ADHD): age related change of completion time and error rates of Stroop test. Kobe J Med Sci. 2015; 61: 19-26.

11. Sumargi A, Sofronoff K, Morawska A. A randomized-controlled trial of the Triple P-Positive Parenting Program Seminar Series with Indonesian parents. 2014. Child Psychiatry Hum Dev. 2015; 46: 749- 761.

12. Warastuti W, Otomo AS. Deteksidinikesehatanjiwaanak yang mengalami penurunan prestasi belajar. Jurnal Keperawatan. 2013; 4: 160-165.

13. Isfandari S, Suhardi S. Gejalagangguan mental emosionalpadaanak. Bul. Penelit, Kesehat. 1997; 25: 53-60.

14. Wiguna T, Manengkei PSK, Pamela C, Rheza AM, Hapsari, WA. Masalah emosi dan perilaku pada anak dan remaja di poliklinikji waanakdan remaja RSUPN dr Ciptomangunkusumo (RSCM). Jakarta. Sari Pediatr. 2010;12: 270-277