Rajiv Gandhi University of Health Sciences



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE

SYNOPSIS PROFORMA FOR THE REGISTRATION

OF SUBJECT FOR DISSERTATION

|1. |NAME OF THE CANDIDATE AND ADDRESS |: Mr. NAZEERSAB .G. BALAGAR |

| | |: 1ST YEAR M.SC. NURSING, |

| | |GOVERNMENT COLLEGE OF |

| | |NURSING, FORT, BENGALURU-02. |

|2. |NAME OF THE INSTITUTION |: GOVERNMENT COLLEGE OF |

| | |NURSING, FORT, BENGALURU-02. |

|3. |COURSE OF STUDY AND SUBJECT |: 1ST YEAR M.SC. NURSING, |

| | |PSYCHIATRIC NURSING. |

| | | |

|4. |DATE OF ADMISSION TO COURSE |: 25-07-2011 |

| | | |

|5. |TITLE OF THE TOPIC. |“A COMPARATIVE STUDY TO ASSESS THE LEVEL OF SOCIAL PHOBIA AMONG ADOLESCENTS IN |

| | |SELECTED URBAN AND RURAL HIGHER SECONDARY SCHOOLS AT BENGALURU, WITH A VIEW TO |

| | |DEVELOP AN INFORMATION GUIDE SHEET”. |

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“A life lived in fear, is a life half lived”.

Feeling of anxiety is so common in our society that they are almost considered universal. Low levels of anxiety are adaptive and can provide the motivation required for survival. Anxiety becomes problematic when the individuals are unable to prevent the anxiety from escalating to a level that interferes with the ability to meet basic needs.1

Anxiety disorders are mental conditions whose most prominent feature is anxiety that impairs one’s ability to function. Social phobia is a specific form of anxiety, may be defined as discomfort and /or inhibition in social situations where the person may be the focus of attention or evaluation. In its clinical form, social anxiety is manifested as a phobia of situations calling for performing an action, interacting socially, and other situations in which the person may be exposed to the real or perceived scrutiny of others.2

Researchers believe that a combination of genetic and environmental influences results in the emergence and maintenance of social phobia. Biological theories suggest that some children are born with a genetic predisposition for shyness or an inhibited temperament, which is translated into social phobia when stressful life situations occur. In addition, certain family patterns, child rearing practices and school experiences also play a part. Some research has found that parents of socially phobic children and adolescents tend to be socially anxious themselves, less sociable and overly concerned with the opinions of others.2

Social anxiety may take different forms at different ages. Very young children who are socially anxious may appear excessively timid in social situations, cling to a familiar person, refuse to participate in group play and speak rarely. Classic social phobia typically has an onset in early adolescence (age 12-13) yet many youngsters report a history of social inhibition or shyness much earlier. With increasing age, adolescents develop more sophisticated social cognitive skills which unable them to compare themselves with others and to examine and interpret situations from another’s perspective. Peer relationships and peer groups approval become prominent; positive experiences such as inclusion in groups, invitations to p[arties, and negative experiences, such as teasing, rejection, or other humiliation take on intense meaning.2

Social phobia is a common and serious disorder, the good is that it is highly treatable and in a relatively short time. Most children and adolescents respond well to cognitive behavioral group therapy- sometimes in conjunction with medication. For some youths, medication is necessary to assist with lowering the overall level of anxiety and allowing the child to enter and access the benefits of cognitive behavioral therapy. The benefits of effective treatment for social phobia are evident in the changes made by the youth completing these programs. New friendship are formed, social skis are improved, loneliness decreases, and participation in academic, social, and volunteer activities increases.2

Social phobia in childhood not only causes internal distress, but it frequently the harbinger of later disorders. Children and adolescents with social phobia are at risk for major depression, suicide attempts and substance abused disorders. In fact, social phobia has been identified as a direct link to the development of alcohol abuse by late adolescents. Social phobia also takes a toll on an individual’s social, academic and occupational functioning. It is associated with failure to attain educational goals, resulting in reduced career and vocational options, financial security and the Develop and maintenance of healthy lifestyle. The nurse should take measure to improve the self esteem and social skills training in group therapy, role playing or modeling are techniques are used to rule out the social phobia in adolescents.1

6.1 NEED FOR THE STUDY

Anxiety is an emotional response i.e. apprehension, tension, uneasiness to anticipation of danger, the source of which is largely unknown or unrecognized. Anxiety may be regarded as pathologic when it interferes with effectiveness in living, achievement of desired goals or satisfaction or reasonable emotional comfort. A phobia is an unreasonable fear of a specific object, activity or situation. This irrational fear is characterized by various features. In phobic anxiety disorders, the individual experiences intermittent anxiety which arises in particular circumstances, i.e. in response to the phobic object or situation.3

Social phobia is a persistent and irrational fear of situations that may involve scrutiny or judgment by others, such as parties and other social events. People with social phobia fear and avoid situations in which they may be subject to the scrutiny of others. It may begin in adolescence and may be associated with over protective parents or limited social opportunities. Males and females are affected equally with this disorder.1

People with social phobia become overwhelmingly anxious and self-conscious in everyday social situations. They have an intense, persistent and chronic fear of being watched and judged by others, and of doing things that will embarrass them. They can worry for days or weeks before a dreaded situation. Social phobia is different from shyness. Shy people are able to participate in social functions. People with social are constrained by other condition to the point that it affects their ability to function in work and relationships.4

Social phobia is the most common anxiety disorder and the third most common psychiatric disorder, after major depressive disorder and alcohol dependence. Lifetime prevalence estimates for social phobia vary greatly and range from 0.4 to 20.4 % in different studies. Among the more well know epidemiological studies, the Epidemiological Catchment Area Survey in 1991 suggests a lifetime prevalence of social phobia at 2.73%. Also, estimates of more than 8,000 individuals from the National Co morbidity Survey in 1994, suggests the lifetime prevalence of social phobia at 13.3%.5

A cross-sectional survey of students at the University of Ibadan (Nigeria) using the Composite International Diagnostic Interview (CIDI) revealed a prevalence of social phobia at 8.5%. Another study of 523 Swedish University students with the Social Phobia Screening Questionnaire (SPSQ) reported prevalence to be as high as 16.1%. Izgic et al. from Turkey found the prevalence of social phobia at 7.9% among a stratified random sample of 1,003 university students. In India, there has been study conducted on social phobia (among high school adolescents) which mentions a prevalence of 12.8% and also an association with impairment in academic functioning.5

On the other hand, studies on mental health in general and anxiety disorders in particular, often neglect a person’s perception of his or her quality of life. Judging the impact of a mental disorder based on symptomatic distress, while ignoring one’s overall quality of life, is incomplete. Thus, as a humanistic and holistic approach to health and health care, mental health studies should consider measures of the impact of disease and impairment on daily activities and behavior, perceived health measures and disability/functional status measures.5

A cross -sectional study was conducted on Prevalence and characteristics of significant social anxiety in children aged 8-13 years: a Norwegian cross-sectional population study. The sample consisted of 14,497 parents and their 3rd-7th grade children (8-13 years old) who participated in a health profile study, including questions covering DSM-IV criteria A-D for social anxiety disorder (SAD). The study reveals that Parents described 2.3% of all children as significantly socially anxious and 0.9% feared at least three social situations. The study concluded that increased awareness of different aspects of social anxiety is needed to identify children who are at risk and to devise appropriate interventions to improve the immediate and long-term outcome.6

The study was conducted on social anxiety in adolescents, in India. 421 adolescents in one high-school were screened for SAD and depression and associated factors with academic impairment. 54 (12.8%) had SAD. The most common manifestation of SAD was avoiding giving speeches. SAD was equally common among both genders, was associated with difficulty in coping with studies. In conclusion, SAD is a common adolescent disorder, with major depression as co morbidity and associated with impairment in academic functioning. All adolescents especially with depression consulting medical professionals should be interviewed for SAD and treated.7

Above studies revealed that the social phobia is more common in adolescents, the investigator felt that there is need for study the adolescents who suffers from social phobia.

6.2 REVIEW OF LITERATURE

Review of literature is a written summary of the state of existing knowledge on a research problem. The task of reviewing literature in this research involves the identification, selection, critical analysis and written description of existing information on topic.

A study was conducted on social phobia and its impact in Indian university students. A stratified sample of 380 undergraduate university students was assessed to identify the extent of social phobia. The study reveals that social phobia was found 19.5%of participants, in varied degree of severity. The study concluded that High Prevalence and marked impact on life demands stringent efforts to recognize and treat social phobia.8

A study was conducted on social anxiety disorder in the west and in the east, cape down, South Africa. The study reveals that social anxiety is a prevalent symptom in many parts of the world. Fluvoxamine is more effective than placebo in randomized controlled trials of Social anxiety disorder in the West and the East. The study concluded that Patients suffering from Social anxiety disorders in different parts of the world share many features in common, and certain SSRIs are an effective treatment for this condition globally.9

A cross sectional study was conducted on the level of self reported social anxiety in a community sample of Turkish adolescents. This study was a school based study on 1,713 students in grades 6-8 i.e. age 10- 16 from twelve schools in kucaelo/turkey. Were screened by the social anxiety scale for Adolescents (SAS-S). The study reveals that phobic symptoms among Turkish adolescents were more severe in boys. Some factors such as low socio economic level and going to rural; school had impact on the sas-s scores. The study concluded that professionals and teachers need to recognize school anxiety in adolescents, so that help can be affected to overcome the difficulties social phobia causes.10

A study was conducted on screening abilities of Chinese (Taiwan) version of the social phobia inventory (SPIN) for evaluating social phobia in an adolescent. The community sample of 3,393 students by using questionnaire. The study reveals that the mean social phobia inventory total score of all subjects was higher in girls than boys. i.e.14.7+/- 9.4 vs 13.7+/- 9.1. The study concluded that the Chinese social phobia inventory has good screening abilities.11

A study was conducted on a new proposal for the subtypes of social phobia in a sample of Spanish adolescents. The test was conducted on 971 Spanish adolescents ranged between 14 and 18 years attending 59 high schools in rural and urban areas of south east of Spain. Principle component and cluster analysis were conducted. Results indicated that the principle components analysis revealed two factors, which could be categorized as interaction and performance anxiety, where as cluster analysis delimited four subtypes; specific social phobia mild, moderate and severe generalized social phobia. The study establishes preliminary support for a new proposal of subdivision of social phobia in adolescence.12

A study was conducted on Age and gender differences in social anxiety symptoms during adolescence. A large general population sample of 5252 Finnish adolescents aged 12-16 years by using social phobia inventory (SPIN) as a measure. The study reveals that girls scored higher than boys on the SPIN full scale and three subscales across the whole age range. Eighth graders (14- to 15-year-olds) scored higher than seventh and ninth graders on the full scale, for boys the differences were significant. The study concluded that symptoms of social phobia may increase in mid-adolescence. The SPIN appears to be a reliable self-report instrument among adolescents.13

A randomized controlled study was conducted on universal based prevention of syndromal and subsyndromal social anxiety among a population. A sample of 1,748 older children and young adolescents from two countries were cluster randomized to either an intervention or a central condition. The results indicate that NUPP-SA had a significant specific intervention effect for reducing social anxiety in the total samples as well as among syndromal subjects.14

A study was conducted on mediators and moderators of outcome in the behavioral treatment of childhood social phobia. There were 88 youths participating in one of two randomized controlled treatment trials of social effectiveness therapy for children. The study reveals that loneliness scores and social effectiveness during a role- play task predicted changes in social anxiety and over all functioning at post treatment. Changes in social anxiety were mediated by child- reported loneliness. The study concluded that role of loneliness as an important mechanism of change during treatment for childhood social phobia.15

A study was conducted on correlates and consequences of early appearing social anxiety in young children. 178 elementary school children in grade 2 (aged 7-8 years).Children were individually administered the Social Anxiety Scale for Children-Revised (SASC-R), as well as measures of socio-emotional adjustment. The study reveals that social anxiety was positively associated with self-reported loneliness, school avoidance, and internalizing coping, and negatively related to school liking. Findings are discussed in terms of use of the SASC-R for this type of population and reasons for the disparity between child and teacher reports of adjustment outcomes.16

A study was conducted on social fears during adolescence to assess there an increase in distress and avoidance. A community sample of 260 adolescents with 9-17 year olds completed a questionnaire derived from the Anxiety Disorders Interview Schedule for Children (ADIS-C). The study reveals that an age related increase for formal speaking and interaction situations in both avoidance and distress, with a stronger increase in avoidance than in distress. The same pattern was found for girls for situations regarding observation by others. No effects were observed for informal speaking and interaction situations.17

STATEMENT OF PROBLEM

“A COMPARATIVE STUDY TO ASSESS THE LEVEL OF SOCIAL PHOBIA AMONG ADOLESCENTS IN SELECTED URBAN AND RURAL HIGHER SECONDARY SCHOOLS AT BENGALURU, WITH A VIEW TO DEVELOP AN INFORMATION GUIDE SHEET”.

6.3 Objectives of study

1. To assess the level of social phobia among adolescents in selected urban and rural higher secondary schools.

2. To compare the level of social phobia between adolescents of urban and rural higher secondary schools.

3. To find the association between level of social phobia among adolescents of urban and rural higher secondary schools with selected socio demographic variables.

1. Assumptions

1. The adolescents may have social phobia.

2. There is difference between the level of social phobia among urban and rural adolescents.

6.3.2 Operational definitions

a) Assess: It is to measure the social phobia among adolescents.

b) Social phobia: It is an excessive fear of situations in which a person might do something embarrassing or be evaluated negatively by others.

c) Adolescents: It refers to boys and girls of age group of 13-16 years in selected urban and rural higher secondary schools, Bengaluru.

d) Higher secondary school: It is an educational institution where 8th , 9th and 10th standard students are studying.

e) Information guide sheet: It is a written material containing information regarding management of social phobia.

6.3.3 Variables

It includes all demographic variables such as age, sex, education of family, family income, place of study and any other psychiatric illnesses.

7 MATERIAL AND METHODS

| | | |

|7.1 Source of data |: |Data will be collected from adolescents of 13-16 years in selected urban|

| | |and rural higher secondary schools, Bengaluru. |

| 7.2 Method of data | | |

|collection | | |

| | | |

|7.2.1 Definition of the |: |Adolescents of 13-16 years studying in selected urban and rural higher |

|study subjects | |secondary schools, Bengaluru. |

|7.2.2 Inclusion criteria and Exclusion criteria |

| a)Inclusion criteria | |1. Adolescent boys and girls with age group 13-16 years. |

| | | |

| | |3. Adolescents who are willing to participate in the study. |

| | | |

|b)Exclusion criteria | |1. Adolescents who are sick and ill. |

| | | |

| | |2. Adolescents who are absent at the time of data collection. |

| | | |

|7.2.3 Research approach |: |Non-experimental approach. |

| | | |

|7.2.4 Research design |: |Comparative Descriptive research design. |

| | | |

|7.2.5 Setting |: |The study will be conducted in selected urban and rural higher secondary|

| | |schools Bengaluru. |

| | | |

|7.2.6 Sampling |: |The investigator will use stratified random sampling technique. |

|technique | | |

| | | |

|7.2.6 (a) Sample size |: |120 samples. |

| | |60 urban adolescents. |

| | |60 rural adolescents. |

| | | |

|7.2.7(b)Duration of the | | |

| |: |30 days |

|study: | | |

| | | |

| | | |

| | | |

|7.2.8 Tools of research | | |

| |: |Social phobia will be assessed under |

| | |Two parts. |

| | |Part 1) demographic data |

| | |Part 2) Modified version of social anxiety scale will be used by the |

| | |investigator to assess the level of social phobia. |

| | | |

|7.2.9 Collection of data |: |After obtaining consent from the concerned authority and subjects. The |

| | |investigator will collect the data by Administering modified version of |

| | |social anxiety scale to assess the level of social phobia among |

| | |adolescents of age 13-16 years in selected urban and rural higher |

| | |secondary schools, Bengaluru. |

| | | |

|7.2.10 Method of data |: |1] Investigator will use descriptive Statistical techniques such as |

|Analysis and | |mean, mode, median, standard deviation and inferential statistics like |

|presentation | |chi square test, and other relevant statistics are used. |

| | | |

| | |2] The analyzed data will be presented in the form of tables, diagrams |

| | |and graphs. |

| |

| |

|7.3 Does the study require any investigation to be conducted on patients or other human or animals? If so please describe briefly?|

| |

|Yes, with prior consent from samples the study will be conducted in urban and rural higher secondary schools regarding assessment |

|of level of social phobia. |

| |

| |

| |

| |

| |

|7.4 Has ethical clearance has been obtained from your institution in |

|case of 7.3. |

|a). Yes, permission will be obtained from the concerned person and authority of the institution before conducting the study. |

|b). Privacy, confidentiality and anonymity will be guarded. |

|c). Scientific objectivity will be maintained with honesty and impartiality. |

8. REFERENCES

1. Townsend MC .Psychiatric mental health nursing: concepts of care in evidenced based practice. 5th ed. New Delhi: Jaypee brothers; 2007.Pp 17-18.

2. A journal of child study center, volume 4.number 3; January/February 2010. . http;//files/articles/jan_feb_4.pdf

3. Sreevani. R. A guide to mental health and psychiatric nursing, 3rd edition, New Delhi: Jaypee brothers; 2010.Pp 172.

4. Stein MB, stein DJ. Social anxiety disorder. Lancet.2008; 371: 1115-1125. (pubmed)

5. P S. Shah and L. kataria: social phobia and its impact in Indian university students. The internet journal of mental health. 2010 volume 6 number 2.

6. Van Roy B, Kristiansen H, Groholt B, Clench-Aas J. Prevalence and characteristics of significant social anxiety in children aged 8-13 years: Soc Psychiatry Epidemiol. 2009 May;44(5):407-15.available from: .

7. Khyati Mehtalia, G.K. Vankar. Social anxiety In Adolescents. Indian Journal of Psychiatry [serial online]. 2004; (cited on 2011 Nov 26); 46(3) 221-227. Available from .

8. P.s.shah and kataria: social phobia and its impact in Indian university students. The internet Journal of Mental Health.2010 volume 6 number 2.

9. Stein DJ. Social anxiety disorder in the West and in the East. Ann Clin Psychiatry.2009Apr-Jun;21(2):109-17.available from

10. Cakin Memik N, Sismanlar SG, Yildiz O, Karakaya I, Isik C, Agaoglu B. Social anxiety level in Turkish adolescents. Eur Child Adolesc Psychiatry. 2010 Oct;19(10):765-72.Epub 2010 Jul8.available from:

11. Tsai CF, Wang SJ, Juang KD, Fuh JL. Use of the Chinese (Taiwan) version of the Social Phobia Inventory (SPIN) among early adolescents in rural areas: . J Chin Med Assoc. 2009 Aug;72(8):422-9.available from: .

12. Piqueras JA, Olivares J, López-Pina JA. A new proposal for the subtypes of social phobia in a sample of Spanish adolescents. J Anxiety Disord. 2008;22(1):67-77.Epub 2007 Feb3. available from:

13. Ranta K, Kaltiala-Heino R, Koivisto AM, Tuomisto MT, Pelkonen M, Marttunen M. Age and gender differences in social anxiety symptoms during adolescence: Psychiatry Res. 2007 Dec 3;153(3):261-70. Epub 2007 Aug 16. available from:

14. Aune T, Stiles TC. Universal-based prevention of syndromal and subsyndromal social anxiety: J Consult Clin Psychol. 2009 Oct;77(5):867-79. available from: .

15. Alfano CA, Pina AA, Villalta IK, Beidel DC, Ammerman RT, Crosby LE. Mediators and moderators of outcome in the behavioral treatment of childhood social phobia. J Am Acad Child Adolesc Psychiatry. 2009 Sep;48(9):945-53. available from:

16. Weeks M, Coplan RJ, Kingsbury A. The correlates and consequences of early appearing social anxiety in young children. J Anxiety Disord. 2009 Oct;23(7):965-72. Epub 2009 Jun 21. Available from: .

17. Sumter SR, Bokhorst CL, Westenberg PM. Social fears during adolescence: J Anxiety Disord. 2009 Oct;23(7):897-903. Epub 2009 Jun 6. available from: .

18. Basavantappa BT. Nursing research. 2nd ed. New Delhi: Jaypee Brothers; 2009. p. 168-188.

19. Polit DF, Beck CT. Nursing research. 8th ed. Newyork: Lippincott Williams and Wilkins; 2010.P.132-6

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|9 |SIGNATURE OF THE CANDIDATE |: |NAZEERSAB. G. B |

|10 |REMARKS OF THE GUIDE |: |The research topic selected by the candidate is relevant, emphasized on |

| | | |assessing the level of social phobia among adolescent students and |

| | | |information guide sheet may help to modify their social phobia. |

| | | | |

|11 |NAME AND DESIGNATION OF | | |

| | | | |

| |11.1 GUIDE |: |Mr. GANGADHAR. K. R LECTURER |

| | | |DEPARTMENT OF PSYCHIATRIC NURSING GOVERNMENT COLLEGE OF NURSING, FORT, |

| | | |BENGALURU-02. |

| |11.2 SIGNATURE |: | |

| | | | |

| | | | |

| |11.3 CO-GUIDE (IF ANY) |: |Prof. H .H. DASEGOWDA BA LLB M.Sc (N) |

| | | |HOD OF PSYCHIATRIC NURSING GOVERNMENT COLLEGE OF NURSING, FORT, |

| | | |BENGALURU-02. |

| |11.4 SIGNATURE |: | |

| | | | |

| | | | |

| |11.5 HEAD OF THE DEPARTMENT |: |Prof. H .H. DASEGOWDA BA LLB M.Sc (N) |

| | | |GOVERNMENT COLLEGE OF NURSING, FORT, BENGALURU-02. |

| |11.6 SIGNATURE |: | |

| | | | |

| | | | |

|12 |12.1 REMARKS OF THE PRINCIPAL |: |The statement is good and appropriate for the nursing research study, in|

| | | |current Scenario. |

| | | | |

| | | | |

| |12.2 SIGNATURE |: | |

| | | | |

ETHICAL COMMITTEE CLEARANCE

|1 |TITLE OF DISSERTATION | |“A COMPARATIVE STUDY TO ASSESS THE LEVEL OF SOCIAL PHOBIA AMONG |

| | |: |ADOLESCENTS IN SELECTED URBAN AND RURAL HIGHER SECONDARY SCHOOLS AT |

| | | |BENGALURU, WITH A VIEW TO DEVELOP AN INFORMATION GUIDE SHEET”. |

|2 |NAME OF THE CANDIDATE AND ADDRESS |: |Mr. NAZEERSAB .G.B |

| | | |M.Sc (N) 1st Year |

| | | |Government College of Nursing, Fort, |

| | | |Bengaluru -02 |

|3 |SUBJECT |: |PSYCHIATRIC NURSING |

| | | | |

|4 |NAME OF THE GUIDE |: |Mr. GANGADHAR.K.R |

| | | |Lecturer Department of Psychiatric Nursing, |

| | | |Government College of Nursing, Fort, |

| | | |Bengaluru -02 |

|5 |APPROVED / NOT APPROVED | | |

| |(If not approved, suggestion) | | |

| | | | |

| |Prof. H.H. DASEGOWDA | |Dr. SUVARNA. B. TALAWAR |

| |Head of the Department of Psychiatric Nursing, | |Head of the Department of Obstetrics and Gynecological Nursing, |

| |Government College of Nursing, Fort, Bengaluru -02 | |Government College of Nursing, Fort, |

| | | |Bengaluru -02 |

| |Smt. RENUKA.N | |Mr. H .B. PRAKASH |

| |Head of the Department of | |Head of the Department of |

| |Pediatric Nursing, | |Community Health Nursing, |

| |Government College of Nursing, Fort, Bengaluru -02 | |Government College of Nursing, Fort, |

| | | |Bengaluru -02 |

| |Mr. BASAVARAJU. G | | |

| |Head of the Department of | | |

| |Medical surgical Nursing, | | |

| |Government College of Nursing, Fort, | | |

| |Bengaluru -02 | |Smt. HEMAVATHY.S |

| | | |Principal, |

| | | |Government College of Nursing, |

| | | |Fort, Bengaluru -02 |

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