https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/567 Mon, 26 May 2025 10:57:44 +0000 Abstract Background and objectives: Increasing psychosocial dysfunction (PD) is a major mental health issue globally. Deviation from normal mental health in early childhood leads to severe sequelae in adulthood, jeopardizing not only the individual affected but also his family, community and the entire society as a whole. Social crimes indicate mental health disorders of society. Early detection and intervention of behavioral disorders are expected to prevent such an increasing trend. The study aims to measure the prevalence of psychosocial dysfunction in secondary school- going children and to determine its biological risk variables. Materials and methods: Three secondary high schools in rural communities were purposively selected. Students aged 11 – 18 years from classes six to ten were selected randomly. Having purposively selected 3 schools, the student participants were randomly selected based on class roll numbers 5, 15, 25, 35, 45, 55, 65 - --- 95; ten from each class for the girls (10 X 5 = 50). Likewise, for the boys, 20 from each class according to Class Roll No: 5, 10, 15, 20, 25 ---- 100. PSC35 was used for scoring psychosocial behavior. The class teachers filled out the questionnaire in consultation with parents or caretakers. Investigations included: a) anthropometry (height, weight, waist- and hip-girth), blood pressure; b) biochemistry profile (blood glucose, dopamine, serotonin, cortisol and oxytocin). PSC35 ≥23 was taken as the cut-off for PD. Results: A total of 250 students (boys / girls = 165/85) participated. The prevalence of PD was found to be 36.4% (boys / girls = 25.6 / 10.8%; p=0.332). Compared with the girls, the boys had significantly higher central obesity (WHR, p=0.018; WHtR, p<0.001) than girls, whereas the girls had higher FBG (p<0.001), cortisol (p = 0.009) and OT (p<0.001). Comparisons between those with PD (PSC35 ≥23) and without PD (PSC35<23) showed that PD group had significantly lower OT (p=0.015). Pearson’s correlation estimated that OT had negative correlations (r = - 0.159, p = 0.016) with PSC35. Multiple comparisons of risk variables based on PSC35-tertiles by ANOVA (Scheffe) showed the higher tertile had significantly lower OT (p = 0.008). Logistic regression (binary) also proved lower OT was significantly associated with PD. Conclusions: This cross-sectional study revealed a higher prevalence of PD among the school students. It investigated major biological risk variables (obesity, blood pressure, blood glucose and neurotransmitters), and whether these variables contribute to PD. Of the investigated variables, lower OT level was found to be significantly associated with PD and proved to be an important risk. Further study may be initiated to confirm our study findings. Acronyms – BMI – body mass index (weight in kg/height in met sq.), DBP – diastolic blood pressure, FBG – fasting blood glucose, MAP –mean arterial pressure [(MAP = DBP + 1/3 (SBP – DBP)], SD- standard deviation, WHR – waist-to-hip ratio, WHtR- waist-to-height ratio, SBP – systolic blood pressure; PSC35 – pediatric symptom checklist 35. PD- Psychological dysfunction: [ADHD – attention deficiency hyperactive disorders, CD – conduct disorders, ODD – oppositional defiant disorders]. July 2025; Vol. 19(2):002.  DOI: https://doi.org/10.55010/imcjms.19.011 *Correspondence: M Abu Sayeed, Department of Community Medicine and Public Health, Ibrahim Medical College, 1/A, Ibrahim Sarani, Segunbagicha, Dhaka 1000, Bangladesh. Email: sayeed1950@gmail.com © 2025 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License(CC BY 4.0).   Introduction Bangladesh is the most densely populated country in the world (total 172 million; 1329/sq km). According to the Bangladesh bureau of statistics (BBS), almost half of the population is below age 30y. A total of 33 million students are enrolled in 1.6 million primary educational institutes. Despite all efforts, Bangladesh experiences a sizeable dropout rate of about 18% at the primary level (‘Primary enrolment rate 98%’, 2020), which increases to 50% at the secondary level (Ministry of Education, 2011; Sarker et al., 2019). The factors causing such an alarming dropout rate are unknown. May be worthy to note – this population age-group is most important considering young energetic productive force, future development and dynamic strength of the country. It may also be noted that there is an increasing rate of social crimes indicating a deterioration of healthy attitude and behavior, inflicting mental health and crimes. Increasing rate of Juvenile delinquency may contribute to these crimes. According to UNICEF “there are 36 million teenagers in Bangladesh. Since 2012, the police headquarters has had records of juvenile crime. In 2012, 751 children and teenagers were accused in 484 cases. In the first six months of 2020, 1191 were arrested in 821 cases. Sources in the social welfare directorate said that most of these teenagers were arrested under the case of drug, murder, and rape and sent to the correctional centers. The above-mentioned findings suggest that the young and most potential population is at risk of dropping out of school, thus increasing the rate of juvenile delinquency. From Bangladesh’s perspective, it has been reported that poverty, broken families, social and economic inequalities and discrepancies are the causes of such juvenile delinquencies [1]. A very recent study in China on ‘Antisocial Behavior and Antisocial Personality Disorder (ASPD) among Youth’ showed that ASPD affects all youth irrespective of class and ethnicity [2,3]. An extensive review by Perrotta G et al. on Behavior and Conduct Disorder in Childhood, highlights the main predictive elements in preadolescents and adolescents that can be correlated with the symptoms of distinctive disorders in deviant and criminal conduct. Early detection and intervention in all forms, including therapeutic measures, can encourage behavioral improvement of those who are still not adults [3]. Regarding neurophysiology, some neurotransmitters (chemical messengers) play an important role in the brain by influencing mood and behavior like dopamine, serotonin, oxytocin, cortisol, norepinephrine, and endorphins [2,4]. Abnormalities (quality or quantity) of these chemical messengers may relate to behavioral disorders. Of them, oxytocin (OT) has been studied in relation to social bonding and has been termed as ‘love hormone’, ‘cuddling chemical’ and ‘hormone of sociostasis’ [4-6]. John Tully et al.opined oxytocin as a master regulator of social affiliation, social connection, and adaptive reproductive behaviors [7]. OT plays a very vital role in maintaining ‘Love and longevity’ [8]. The effect of OT on empathy and socialization was also reported from Argentina [9]. Based on the above findings – a) an alarming number of dropouts from schools, b) increasing involvement of youth in anti-social behavior, c) deteriorating mental and social health, eventually leading to juvenile crimes, this study aims to screen PD among secondary school children aged 11 – 18 years. Additionally, the study addresses some important metabolic (obesity, blood pressure, blood glucose) and neurotransmitters (dopamine, serotonin, oxytocin and cortisol) risks.   Material and methods The study protocol was duly approved by the Ibrahim Medical College Institutional Review Board (IMC IRB). Three secondary schools were selected purposively –two in Kharua, Nandal upazila (one boys’ school and one girls’) under Mymensingh. The third school having co-education, was selected in Vulbaria, Santhia under Pabna. For each selected school, local social leaders, parents and schoolteachers including the headmasters, were communicated with. They were informed about the objectives and the procedural details of the study. The selection of three secondary schools was purposive. Having purposively selected 3 schools the student participants were randomly selected based on class roll no: 5, 15, 25, 35, 45, 55, 65 - --- 95; ten from each class for the girls (10 X 5 = 50). Likewise, for the boys 20 from each class according to class roll no: 5, 10, 15, 20, 25 ---- 100. The eligibility criteria of the participants are based on class roll no. and willingness (assessed by class teacher) to volunteer for the investigation that needs blood sample. The schoolteachers kindly volunteered to fill out questionnaires on Pediatric Symptom Checklist-35 (PSC35) [10]. The parents / guardians of each student were interviewed by his / her respective class teachers. Having completed the questionnaires (PSC35), the data collected was computerized. The eligibility lists of the participants were prepared and printed. The investigation date and site at school were announced following consultation with teachers. The eligible participants were advised to attend the investigation site in the morning with an overnight fast. The teachers maintained a disciplined queue of the participants during investigations. At first, a brief clinical history (present illness, medications) was taken from each participant. Anthropometry (height, weight, waist- and hip-girth) and blood pressure were taken. Fasting blood samples were collected, centrifuged and serum samples were refrigerated and transported to Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrinology and Metabolic Disorders (BIRDEM). Cold chain was strictly maintained while transporting. The Lab investigations included fasting blood glucose (mmol/L), neurotransmitters [dopamine (pg/ml), serotonin (ng/ml), cortisol (ng/ml) and oxytocin (pg/ml)]. These were assayed in BIRDEM Endocrine Labusinga commercially competitive ELISA-based kit (DRG, USA). Diagnostic cut-off: Psychological dysfunctions (PD /behavioral disorders – ADHD, CD, ODD) were diagnosed based on PSC35 ≥23 [10,11]. Statistical analysis: The prevalence of PD was presented in percentages. All quantitative variables were expressed in mean with SD and 95% CI. The biophysical characteristics were compared between boys and girls using an independent t-test and so were the comparisons between students with and without PD. ANOVA compare the quantitative variables among the PSC35-tertiles. SPSS version 20.0 was used for all statistical analyses and p<0.05 was accepted as the level of significance. Logistic regression analysis estimated the biophysical variables as the independent and the PD (PSC35 ≥23) as the dependent variable. For the regression analysis, the quantitative variables were dichotomized into qualitative based on median– WHtR2 (<0.42 v ≥0.42), FBG2 (<6.0 v ≥6.0 mmol/l), Dopamine2 (<32.4 v ≥32.4 pg/ml), serotonin2 (<141.2 v ≥141.2ng/ml), cortisol2 (96.14 v ≥ 96.14ng/ml) and oxytocin2 (<109.5 v ≥109.5 pg/ml). For PD tertiles, the values are lower, middle and upper, <22, 22-28 and >28, respectively.   Results A total of 250 (boys / girls = 165/85) students took part in the study. The prevalence of PD was 36.4% (boys / girls = 25.6 / 10.8%, p=0.332; Table-1).   Table-1: Prevalence of psychosocial dysfunction by sex (boys / girls = 165 / 85)     The mean (SD) values and 95% CI of investigated variables were showing in Table-2. The biophysical variables included anthropometry (BMI, WHR, and WHtR), blood pressure, dopamine, serotonin, cortisol  and  OT.  Comparisons  between  boys  and girls of the variables are shown in Table-3. The boys had significantly higher central obesity (WHR, p=0.018; WHtR, p<0.001) than girls, whereas the girls had higher FBG (p<0.001), cortisol (p = 0.009) and OT (p<0.001).   Table-2: Biophysical characteristics of the participants (boys and girls: n =250: mean (SD) and 95% CI     Table-3: Comparison of biophysical characteristics (N= boys /girls = 165/85)     Correlations among the variables controlling for age and sex were displayed in Table-4. OT had significant positive correlation with dopamine (p=0.001), cortisol (p<0.001), serotonin (p=0.004), but significant negative correlation with PSC35 (p=0.016). No other neurotransmitters showed such association with PSC35.   Table-4: Correlations among biophysical variables controlling sex and class/age     As the 95% CI of PSC35 of all participants was found (20.8 – 22.6) in Table-2, the cut-off for PD was taken ≥23. Thus, a table was constructed based on this cut-off (PSC35: <23 vs. ≥23, Table-5) for comparisons of the investigated variables. None of the neurotransmitters differed except OT, which was found significantly lower in the PSC35 ≥23 group than those with PSC35 <23 (p=0.015).   Table-5: Students with normal PSC35 compared with those with higher PSC35 <23 vs. ≥23)     Figure-1A showed a declining trend of OT with the increasing PSC quartiles. At PSC<16, OT level was found 177 pg/ml, which came down to 126 pg/ml at PSC >26, though not significant. The other neurotransmitters showed no change with PSC35 level. Again, in Figure-1B obesity variables (BMI, WHtR), FBG and MAP did not show any change with varying PSC35 levels.     Figure-1A: Mean values of Dopamine, Cortisol, Serotonin and Oxytocin by quartiles (Q1 = <16, Q2 = 17-21, Q3 = 22-26, Q4 = >26) of PSC35. Oxytocin showed declining as PSC35 rising, though not significant. Other neurotransmitters showed no change.     Figure-1B: Mean values of WHtR, BMI, FBG and MAP by quartiles (quartiles (Q1 = <16, Q2 = 17-21, Q3 = 22-26, Q4 = >26) of PSC35) of PSC35.   Multiple comparisons of biophysical variables, based on PSC –tertiles, were estimated by ANOVA (Post-hoc, Scheffe) in Tables-6a and 6b. Of all four neurotransmitters, only OT was found to be associated with higher PSC (182.6 pg/ ml in the first tertile vs. 124.3 pg/ ml in third tertile; p = 0.008). This   finding   indicates   that   PD   was   significantly associated with lower OT level.   Table-6a: ANOVA: multiple comparisons of biophysical variables by post hoc (Scheffe) based on PSC35 Tertiles of Pediatric symptoms Checklist 35 as dependent     Table-6b: ANOVA: multiple comparisons of biophysical variables by post hoc (Scheffe) based on PSC35 tertiles of Pediatric symptom Checklist 35 as dependent     Furthermore, the studied risk variables were estimated by binary logistic regression taking PSC35 ≥23 as the dependent variables (Table-7). The analysis also proved low OT (<110 pg/ ml) was a significant predictor of psychological dysfunction.   Table-7: Binary logistic regression estimated the risks for psychological dysfunctions taking PSC35 ≥23 as the dependent and others as independent variables. Method – Backward stepwise, conditional     Discussions The study is the first of its kind with regard to – a) screening of behavior and conduct disorder in childhood and adolescence in a Bangladeshi population; b) addressing some major biological risks (neurotransmitters) related to PD (ADHD, CD, ODD). The importance of the study is focused on identifying risks in early life, which may help prevent juvenile crimes, eventually preventing serious adult delinquencies. Therefore, the future impact of this study is enormous, expecting acrime-free healthy society. There have been a substantial number of studies related to “mental health disorders” conducted in Bangladesh [1,13-16]. Most studies addressed prevalence, causes and / or risks of juvenile delinquencies in Bangladesh. All these study conclusions were mostly limited to incriminating – family disharmony, inequality, illiteracy, migration, poverty and social environment. None of them addressed biologic risks like nutritional abnormalities (malnutrition, obesity), metabolic abnormalities (blood pressure, blood glucose) and those related to neurotransmitters (dopamine, serotonin, cortisol, OT). In this regard, this study explored a new horizon to delve into. Many studies justify future research on the role of OT in psychological development and maintenance [3,5,6–10]. More and more studies are emphasizing neurotransmitters’ (chemical messengers) role in modulating behavior, personality, empathy, emotion, socializing aptitude and so on [17–22]. This study encompassed some biologic variables to determine whether any of them had an association with PD. The collected data was presented in eight tables and two figures. The baseline information on these variables related to mental health dysfunction could not be compared due to the scarcity of such studies among the secondary school children. The study findings may be taken as future reference for this age group population. All the presented data (Table-4, 5, 6a, 6b and figure-1A) indicated lower OT was significantly associated with psychological dysfunction. Additionally, binary logistic regression (Table-7), of all the investigated variables unequivocally proved, low OT to be an important predictor of this disorder. The risk association of this study is consistent with all the above cited literature. It is not overemphasized that this study attempted to create public awareness regarding the starting point of juvenile delinquencies, as varying psychosocial disorders among childhood originate very insidiously. Neither the children nor their parents, teachers, caretakers are aware of the effect of neurotransmitters on psychosocial abnormalities. These OT deficient children are usually traumatized by their family members, neighbors, teachers, friends and peers. These innocent and underdog children born with OT deficiency, lacking social bonding ability, behave unfriendly, receiving unkindness in return, are often traumatized. Thus, this creates a vicious cycle. This is an unfortunate condition, exposed to an unfavorable society with no love, no affection and no empathy leading them only to despair–likely to commit crimes. Some literature had extensive reviews explaining OT regarding diverse mechanisms, physiological effects, Nature’s’ medicine and therapeutic promise [5,8,9,10]. Its multifaceted physiological effects invite the attention of mental health professionals for psychiatric, developmental, and neurodegenerative disorders. Denoting our limitations, we could not analyze the association between OT deficiency and metabolic syndrome, though central obesity had a significant negative correlation with OT (r= -0.212, p<0.01). Endorphin and encephalin, the other neurotransmitters could not be included. Finally, the history of parenting, socio-economic status, dietary habits, sleep, physical activities and cultural practices, which influence mental health, could not be assessed.   Conclusions The study estimated the prevalence of PD among the school students. Additionally, it investigated the biological variables influencing mental health problems. It studied neurotransmitters along with obesity, blood pressure and blood glucose for the association with psychosocial abnormalities. Low OT level was proved to be an important risk. Further study may be initiated to confirm or establish the study findings.   Acknowledgements We are grateful to the Endocrine Lab of BIRDEM for assaying biochemical samples. We are also thankful to the teachers and students of Kharua high school and Ashefa Girls High School in Nandail, Mymensingh. 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IMC J Med Sci. 2025; 19(2):002. DOI: https://doi.org/10.55010/imcjms.19.011 2026 Ibrahim Medical College. All rights reserved.