ISA World Congress of Sociology
29th June, 2023
RC49:688.4

The Association between Mental Health and Overall Health,
Safety Behavior, and Social Relationships Among
University Students in Cambodia
Marie UENO1)2), Yuka MASUKO2), Kalyan LY2), Sokheng THAY2) and Somaly SAY2)
1)Tokyo Gakugei University, Japan, 2)School Health for All Cambodian Children Project, Cambodia

Introduction• Mental health is one aspect of overall health and well-being, and it is important tomaintain and promote mental health for healthy adolescent development. (WHO,2021)• Mental illness in adolescence has been associated with an increased risk ofmental disorders in later adulthood. (Johnson, et al., 2018)

2Introduction• In Cambodia, after the civil war of the late 20th century, people
developed mental disorders, affecting even younger generations
that did not directly experience the civil war. (Mak, et al., 2021)• A previous study reported some Cambodian university students have experienced
moderate depression, anxiety, and stress symptoms. (Pan, 2017)• Currently, Cambodia lacks adequate mental health care services for mental healthproblems. (Jegannathan, et al., 2015)
It is important to clarify the factors associated with mental healthproblems in the Cambodian context to support mental health among
university students.

3Introduction
Previous research shows• Key factors associated with depressive symptoms among Cambodian university
students (Ngin et al., 2018)
Low socio-economic
background

Poor academic
accomplishment

Consumption ofunhealthy foodPhysical violence, psychologicalabuse during childhood• Key factors associated with a reduced likelihood of depression(Seidler et al., 2017), (Fujiwara & Kawachi, 2008), (Fahmil et al., 2019).
High-quality social connection
with friends and family memberssocial trust(trust of neighbors)

How do university students perceive social support and trust around them?
Is that related to their mental health?
Lack of research on the association between mental health and social support and trust in Cambodia
4

Objectives
1. To clarify the association between mental health and socioeconomic status, health and safety behaviors, social support, andtrust among university students in Cambodia
1. To obtain insights into mental health support in university

5Method
Study design: cross-sectional study
Self-administered questionnaire survey
Sample

4th year university students in Phnom Penh and Battambang

Date

May to June 2022
・Socio-demographic status（Age, Gender, Marital status, Living situation, Hometown,Self-assessment of the economic situation)
・Mental health: Thinking too much, Self-rated mental health

Items

・Health behaviors: Consumption of fast food, Having breakfast, Physical activity habits, etc.
・Safety behaviors: Drinking alcohol, Smoking
・Self-rated academic performance・Social support and trust: Close people, Generalized trust, Warm and trusting relationship*Questionnaire was translated to Khmer language.
6Method
Statistical analyses

1）Descriptive statistics
2）Multiple regression analysis◆Dependent variable-Thinking too much, Self-rated Mental Health

Each question is scored on a scale of 1 to 5.
Higher scale has bad mental health status.

◆Independent variable-Socio-demographic status-Health behaviors-Safety behaviors-Self-rated academic performance*IBM SPSS Statistics, Version 29*The significance level was set at 5%*Ethical Approval of this study was obtained from Tokyo Gakugei University (registered number: 555)
7

Results
1. Characteristics of the study population
Variables

Age

Sex
Marital status
Living situation
Hometown

Self-assessment ofeconomic situation

Categoryn%

20
21
22
23
24
25 or older
MaleFemale
SingleMarried/Cohabiting
Alone
Not alone
Urban
Rural
Quite poor
Not very well-off
Moderate
Well-off
Very well-off
Non-response

746
99
52
35
51
102
188
272
185285
163
127
27

2.4
15.9
34.1
17.9
12.1
17.6
35.2
64.8
93.8
6.2
1.7
98.3
56.2
43.8
9.3

84
166
1201

29.0
57.2
4.1
0.0
0.3

⮚Data from 290 participants (95.1%) wereobtained.
⮚98.3% of students live together withothers (parents, friends, siblings, etc.).
⮚38.3% of students evaluated theireconomic situation as “Quite poor” or”Not very well-off”.

82. Mental health
1) Thinking too much

2) Self-rated Mental HealthIn the past 30 days, how often have you been
"Thinking too much" or "Thinking a lot“ ?

6.6

0%

15.5

10%

20%

Never

44.5

30%

Rarely

40%

50%

30.3

60%

Sometimes

70%

80%

Often

90%

How would you rate your overall mental health?

3.1

2.4

100%0%Always⮚33.4% of students were “often” or“always” thinking too much in the past
30 days.

40.3

10%

20%

Excellent

44.8

30%

40%

Good50%

Fair

60%

70%

Poor

10.71.7

80%

90%

100%

Very poor⮚12.4% of students evaluated theirmental health as “poor” or “very poor”.

94. Safety behaviors

3. Health behaviors
variables

category%variables

Never or less than once in
16.6
the past 30 days

Fast food consumption
in the past 30 days

Healthbehaviors

Having breakfast
in the past 30 days

Physical activity days
(a total of more than
60minutes per day)in the past 7days

1-3 days a month
1 day per week
2 days per week
3 days per week
4 days per week
5 days per week
6 days per week
EverydayNeverLess than once a week
Once a week
2-4 days a week
5-6 days a week
EverydayNon-response
0 day
1 day
2 days3 days4 days
5 days6 days7 days

29.7
7.9
11.0
11.7
7.9
5.9
2.8 23%
6.6
1.7
3.4
29%
2.1
21.7
24.8
45.9
0.3
6.2
16.6
12.4 51%
15.9
10.7
9.3
10.0
19.0

Drinking Alcoholin the past 30 days

Safetybehaviors
Smokingin the past 30 days

category%

Nondrinker
0 day
1-2 days per week
3-5 days per week
6-7 days per week
0 day
1-2 days
3-5 days
6-9 days
10-19 days
20-29 days
All 30 days
Non-response

60.3
27.6
10.0
1.4
0.7
98.6
0.3
0.3
0.0
0.0
0.0
0.0
0.7

88%

5. Self-rated academic performancevariables

category%

self-rated academic performance

Very poor
Poor
FairGood
Excellent

0.3
2.8
52.1
42.4
2.4

3%

106. Social Support and Trust2) Warm and trusting relationship1) Number of close people
How many people are so close to you that you can counton them if you have great personal problems?

11.0

58.6

18.6

In the past 30 days, how often did you feel that you had
a warm and trusting relationship with others?

13.1

11.7
0%

0%

10%

20%

None

30%

40%

1-2 people

50%

60%

3-5 people

70%

80%

90%

100%

5 or more people

3) Generalized trust
Do you agree that most people can be trusted?

21.7
0%

10%

56.9
20%

Strongly disagree

30%

Disagree40%

50%

13.4 7.2 0.7
60%

70%Neither agree nor disagree

80%

90%

100%Agree

Strongly agree

10%

24.1
20%

30%

18.6
40%

50%

24.1
60%

70%

16.2 3.8
80%

90%

NeverOnce or twice a month

About once a week

About 2 or 3 times a week

Almost everyday

Every day100%

⮚37.2% of students have a warm andtrusting relationship “never” or “less thanonce or twice a month”.
⮚78.6% of students disagree that mostpeople can be trusted.
11

7. Factors associated with Mental Health
1) Health behaviors
independent variables
Fast food consumption
Having breakfast
Physical activity days

Thinking too much1)

B

95% CI

0.07
-0.12
0.01

0.02
-0.21
-0.04

0.11
-0.03
0.05

Self-rated mental health

P value

B

<0.01
0.01
0.69

0.03
-0.05
0.00

95% CI
-0.01
-0.12
-0.04

P value
0.06
0.03
0.04

0.14
0.230.941)Omnibus test X2=35.447, df=11, p<0.0012) Safety behaviors (Drinking Alcohol, Smoking)-Non significant relationships

3) Self-rated academic performance
independent variables

Self-rated academic
performance

B-0.07

Thinking too much
95% CI

P valueB-0.24

0.42

-0.47

0.10

Self-rated mental health1)
95% CI
-0.60

-0.34

P value<.0011)Omnibus test X2=56.226, df=9, p<0.001*Control variables: Age, Sex, Hometown, Financial Status127. Factors associated with Mental Health4) Social support and trust
Self-rated mental health1)

Thinking too much
independent variables
B

95% CI

P valueB

95% CI

P value

Close people

-0.04

-0.18

0.10

0.57

-0.07

-0.19

0.04

0.22

Warm and trusting
relationship

-0.02

-0.10

0.06

0.62

-0.09

-0.16

-0.03

0.01

Generalized trust

0.08

-0.05

0.21

0.21

0.04

-0.69

0.140.501)Omnibus test X2=24.193, df=11, p=0.012*Control variables: Age, Sex, Hometown, Financial Status13

7. Factors associated with Mental Health (in the final model)
Factors associated with "Thinking too much"
Variables

B

95% CI

Factors associated with "Self-rated mental health"
P values

Variables

B

95% CI

P values

AgeAge
20

0.30

-0.38

0.99

0.39

21

0.46

0.10

0.81

0.01

22

0.22

-0.08

0.53

0.15

23

0.13

-0.21

0.480.45

240.11

-0.26

0.49

0.56

25 years old or older

Reference

Sex
Male

-0.13

FemaleReference

-0.35

0.09

0.24

Hometown
Urban

0.17

RuralReference

-0.04

0.38

0.11

Financial status

-0.23

-0.38

-0.08

<0.01

Fast food consumption

0.06

0.02

0.11

<0.01

-0.12
-0.20
Omnibus test X2=35.287, df=10, p<0.001

-0.03

0.01

Having breakfast

20
0.56
21
0.32
220.16230.10
240.5325 years old or older Reference
Sex
Male0.03
FemaleReference
Hometown
Urban
0.08
RuralReference
Financial status-0.12
Self-rated academic
performance-0.45
Warm and trusting
relationship
-0.08

0.02
0.04
-0.08
-0.17
0.23

1.11
0.60
0.41
0.36
0.82

0.04
0.03
0.19
0.48
<.001

-0.14

0.20

0.72

-0.09

0.24

0.35

-0.24

-0.004

0.04

-0.58

-0.32

<.001

-0.14

-0.02

0.01

Omnibus test X2=63.519, df=10, p<0.001

14Discussion⮚Factors associated with mental health problems(thinking too much, self-rated mental health)Low financialstatus

Low academic
performance

Unhealthy
dietary behaviors

Less warm andtrusting relationships

Same as the previous research⮚70% of students say they have less than 2 people who are so close to them. The 2
universities in this research do not have a lot of leisure activities such as sports and culture
clubs for students.
⮚This may make students have less opportunities to develop relationships with others.
Feeling lonely is associated with an increased risk of certain mental health problems.

⮚It is important to support-building a foundation for daily life (adequate financial situation, healthy dietary habits)-for students with poor grade-making an opportunity for students to have social interaction each other15Discussion⮚7.9% of students agree that most people can be trusted.
Previous research shows median of 53% of adults (18 to 29) generally believe most people
can be trusted in 14 developed countries (Pew research center, 2020).

Trust in other people among Cambodian university students is relatively low.
⮚Negative effect of the civil war-People were constantly spied day and night.
-It was necessary to hidden one’s own identity

to survive.

-Current education from the family: not to share the personal things to others.
⮚Further studies are needed to explore the factors regarding social support and trust in orderto think about how to promote mental health care services in the school.
16

Limitations⮚Sampling bias
Sample: 4th-year students from two universities⮚Limited variables
Mental health: thinking too much, self-rated mental healthSocial support and trust:Generalized trust, excluding the trust by category such as parents, friends, etc.

17

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systematic review. Depression and Anxiety. 2018 Aug;35(8):700-716.
• Chansophal Mak, Denise C. Lewis, and Desiree M. Intergenerational Transmission of Traumatic Stress andResilience Among Cambodian Immigrant Families Along Coastal Alabama: Family Narratives. Health Equity.
2021; 5(1): 431–438.
• Pan, Alexandria. The Mental Health and Well-Being of College Students in Cambodia. 2017 California State
University, Long Beach ProQuest Dissertations Publishing.

• Bhoomikumar Jegannathan, Gunnar Kullgren, Parameshvara Deva. Mental health services in Cambodia,
challenges and opportunities in a post-conflict setting. Asian Journal of Psychiatry. 2015 Feb;13:75-80.
• Chanrith Ngin, Khuondyla Pal, Sovannary Tuot, et al. Social and behavioural factors associated with depressive
symptoms among university students in Cambodia: a cross-sectional study. BMJ Open. 2018; 8(9): e019918.

• Aliza Werner-Seidler, Mohammad H Afzali, Cath Chapman, et al. The relationship between social support
networks and depression in the 2007 National Survey of Mental Health and Well-being. Soc Psychiatry
Psychiatr Epidemiol. 2017 Dec;52(12):1463-1473.
• Fujiwara, Kawachi. A Prospective Study of Individual-Level Social Capital and Major Depression in the UnitedStates.” Journal of Epidemiology & Community Health 62 (7):627–33.
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