INTRODUCTION:

Adolescent girls constitute one fifth of the female population in the world. Generally this group is considered healthy and has not been given adequate attention in health programmes.

The reason is age specific mortality is comparatively low in this age group as compared to others. In countries like India, adolescent girls face serious health problem due to socio-economic, environmental conditions and gender discrimination. These factors make them more vulnerable to health risks.

Globally adolescents account for 1/5^th of the population that is more than 1 billion. 4 out of 5 adolescents live in developing countries. According to Population Bureau in 1996, 30% of the total population was that of adolescents (284.02 million). Due to gradual decrease in the growth rate of the overall population, there is little increase in the number of adolescents in population projections till the year 2016 (Population projection 1996-2016) census of India.

The first menstrual period is called menarche. It usually starts between the ages 11 and 14. But it can happen as early as age 9 or as late as 15. Menarche is the sign of growing up. In the days before the periods start, the adolescent may feel tense or emotional, gain water weight and feel bloated, pain in the abdomen, back or legs that lasts few hours or more.

Premenstrual syndrome (PMS) is a common disorder of young and middle aged women characterized by cyclic occurrence in the luteal phase of the menstrual cycle of a combination of distressing physical, psychological and behavioral changes of sufficient severity to result in deterioration of interpersonal relationships and/or interference with normal activities, which remit upon onset or immediately after menstruation.

Prevalence of premenstrual symptoms sufficient to impair daily life and relationships are estimated to affect upto 40% of women of reproductive age with severe impairment occurring approximately three percent.

PMS is related to high suicide and accident rates, employment and school absentee rates, poor academic performance and acute psychiatric problems.

Pre-menstrual syndrome (PMS) is recurrent variable cluster of troublesome physical and emotional symptoms that develop 7–14 days before the onset of menstruation and subsides when menstruation occurs. The PMS consists of low backache, fatigue, breast heaviness, abdominal bloating, increased weight, headache, irritability, skin disorders, aggressiveness, depression, gastrointestinal symptoms and loss of appetite.

Premenstrual syndrome (PMS) is a set of physical, emotional, and behavioral symptoms that occur a week before menstruation in most cycles. The physical symptoms are: breast tenderness or swelling; weight gain due to fluid retention; abdominal bloating; fatigue; dizziness; nausea and vomiting; acne or worsening of an existing skin disorders; muscle aches; pelvic heaviness; appetite change; constipation; headache and backache. The emotional symptoms are: insomnia; sadness; irritability; tension; anxiety; restlessness; loneliness and food cravings. There are also behavioral symptoms such as: difficulty concentrating; forgetfulness and social avoidance.

Premenstrual syndrome is a psychophysiological stress induced disorder. Stress disturbs the balance of sympathetic and parasympathetic nervous system. Changes in heart rate and blood pressure are the most important physiological response following stress.^.

Women who had high stress before both cycles were 25 times more likely to experience physical and psychological PMS symptoms than those who reported low stress before both cycles.

Premenstrual symptoms have been associated with perceived stress, whereby perceived stress was the strongest predictor of Premenstrual Syndrome and had a significant positive correlation to all premenstrual symptom groups. Perceived stress in the college/university setting may take the form of academic stress. Negative health outcomes, including depression and physical illness have been associated with academic stress. In addition women may display greater behavioral and physiological reactions to academic stressors.

The stress that had an academic impact was identified by student respondents (n=20,507) as the leading impediment to academic performance for college students. The category stress (32.9%) out ranked other impediments to learning such as, sleep difficulties (25.4%), cold/flu/sore throat (24.8%), concern for friend or family (18.1%) and depression/anxiety disorders (15.5%) . 8.8 million women aged 18-23 years old (NCES, 2003) attending undergraduate colleges, 8- 10% will experience multiple premenstrual symptoms to a severe degree while 25-40% of women overall report mild to moderate perimenstrual symptoms. In addition it has been well established that approximately 60% of premenstrual syndrome occurs in women aged 15-30, lessoning thereafter.

Increased blood pressure due to premenstrual stress is due to increase in peripheral resistance and mediated by adrenocortical stimulation causing precapillary resistance. This could be due to increasing sympathetic activity or elevation of circulating catecholamine while other active harmone like rennin angiotensin aldosterone system also contribute. Rise in blood pressure due to stress leads to increased epinephrine secretion. Rise in blood pressure is important sympatho-adrenal response to physiological stressful experience caused by premenstrual stress.

Duester et al (1999) found that in a large population based sample, 874 women age 18-44; perceived stress (Cohen Perceives Stress Scale) was the strongest predictor of PMS after controlling for a variety of biological, social and behavioral factors.

Many women experience various premenstrual physical, emotional or behavioral changes, which at times reach such levels of severity that may have substantial social impact upon the woman herself, her associates and her work. So a correlation study to assess the perceived stress and premenstrual symptoms among adolescent girls in selected schools.

STATEMENT OF THE PROBLEM:

A correlation study on perceived stress and premenstrual symptoms among adolescent girls in selected school at Pallakkapalayam, Namakkal (Dt).

OBJECTIVES:

1. To correlate the perceived stress and premenstrual symptoms among adolescent girls

2. To find out the association between perceived stress and their demographic variables among adolescent girls.

3. To find out the association between premenstrual symptoms and their demographic variables among adolescent girls.

ASSUMPTION:

The study assume that,

§ Premenstrual symptoms are common among adolescent girls.

§ Premenstrual syndrome is a major cause of less academic performance and school absenteeism among students who suffer from the same.

DELIMITATIONS:

The study is limited to,

1. A study setting selected was Government schools in Namakkal District.

2. Adolescent girls who were present at the time of data collection.

3. Adolescent girls who were willingly participated in the study.

MATERIALS AND METHODS:

Research approach:

Research that explores the interrelationships among variables of interest without intervention on the part of the researcher is a correlation study. In the present study, the investigator intended to correlate the perceives stress and premenstrual symptoms

Research design:

The research design selected for the present study was descriptive design. The present study attempts to correlate the study perceived stress and premenstrual symptoms among adolescent girls. Therefore a correlational survey was found to be an appropriate research design.

Variables:

Dependent variable: Perceived stress and premenstrual symptoms

Associate variable: Selected background factors

Research setting:

The study was conducted in Government Higher secondary school, Pallakkapalyam, Namakkal District.

Population:

The population for the present study was all the adolescent girls between the age group of 14 – 18 years in selected school, Pallakkapalyam, Namakkal District.

Sample:

The sample consisted of 60 adolescent girls of Government Higher secondary school, Pallakkapalyam, Namakkal District.

Sampling technique:

Simple random sampling technique was used to select the sample for the study.

Development of tool:

A baseline Proforma, rating scale on common premenstrual symptoms and perceived stress was prepared with the help of review of literature, personal experience and discussion with experts.

Description of the tool:

Section A: Baseline Proforma of the samples

Section B: Rating scale on common premenstrual symptoms

Section C : Perceived stress scale

Tools are prepared in English.

Section A: Baseline Proforma: It contained items for obtaining information regarding age, age at menarche, duration of cycle, type of flow, family history of PMS, academic performance, school absenteeism, source of information and use of home remedies

Section B: Rating scale on common premenstrual symptoms: It consisted of 32 items in 3 different areas. They were 16 physical symptoms, 6 psychological symptoms and 10 behavioural symptoms. The subjects had to tick mark in the relevant column based on the No symptoms, Mild, Moderate and Severe symptoms. The maximum score was 128 and the minimum score was 32. The more severe the symptoms, the higher the score.

Section C: The Perceived Stress Scale (PSS) is the most widely used psychological instrument for measuring the perception of stress. The questions in the PSS ask about feelings and thoughts during the last month. In each case, respondents are asked how often they felt a certain way. This section seeks the information regarding the perceived stress on 4 point scale. It consisted of 10 items

0 = Never

1 = Almost Never

2 = Sometimes

3 = Fairly Often

4 = Very Often

Scoring:

PSS scores are obtained by reversing responses (e.g., 0 = 4, 1 = 3, 2 = 2, 3 = 1 and 4 = 0) to the four positively stated items (items 4, 5, 7, and 8) and then summing across all scale items. A short 4 item scale can be made from questions 2, 4, 5 and 10 of the PSS 10 item scale.

Data collection procedure:

The data on perceived stress and common premenstrual syndrome were collected from Government Higher secondary school adolescent girls. The data were collected for 4 weeks in the month of 5^th September to October 2012. Permission was sought and obtaining from school headmaster. The adolescent girls were selected using simple random sampling method among those who fulfilled the sample selection. Informed consent was obtained from the adolescent girls. The questionnaires were administered to the adolescent girls regarding perceived stress and common premenstrual symptoms separately. Confidentiality of the information shared was assured. The adolescent girls were co operative. On an average, it took 30 minutes to complete one sample.

Plan for data analysis:

The data were analysed by using both descriptive and inferential statistics

Ø Baseline proforma of the samples were described by frequency and percentage distribution

Ø Correlation of perceived stress and premenstrual symptoms among adolescent girls were analyzed by using mean, standard deviation and ‘r’ value

Ø The association between perceived stress and their demographic variables among adolescent girls were analyzed by using linear regression

Ø The association between premenstrual symptoms and their demographic variables among adolescent girls were analyzed by using linear regression

RESULTS:

Section A: Most (62%) of the adolescents girls were in the age group of 15 -16 years. However 82 % of the adolescents girls attained menarche at the age of above 13years, 75% of adolescents girls were in > 28 days cycle, Most (72%) of adolescents girls were 5-7 days flow, 67 % of them had family history of premenstrual syndrome, 53 % of adolescents girls had low academic performance 49% of adolescents girls were school absenteeism, 52% of them had source of information from peers and63% of the taking self treatment.

Section B: The findings revealed that the correlation between perceived stress and premenstrual symptoms among adolescent girls.

Mean, SD and “r” value regarding perceived stress and premenstrual symptoms

Adolescent girls	Max. Scores	Mean	SD	‘r’ value
Perceived stress	40	21.53	4.61	0. 56
Premenstrual symptoms	128	47.65	6.75	0. 56

The obtained co – efficient of correlation r = 0.56 was positive. There was significant correlation between perceived stress and premenstrual symptoms ( P < 0.05). Therefore null hypothesis was rejected.

Section C:

The findings shows “t” value regarding perceived stress and selected background factors of adolescent girls such as age at menarche t =1.25(p=0.22), duration of cycle t =0.141(p=0.89), type of flow t = 0.62 (p= 0.54), family history of PMS t =1. 09(p=0.28), academic performance t =1.14(p=0.26), school absenteeism t = 0.49 (p=0.63), and use of home remedies t = 0.045 (p=0.96).

Section D:

The findings shows “t” value regarding premenstrual symptoms and selected background factors of adolescent girls such as age at menarche t =1.46(p=0.15), duration of cycle t =0.13 (p=0.89), type of flow t = 0. 79 (p= 0.43), family history of PMS t =1. 11(p=0.27), academic performance t = 0.21(p=0.84), school absenteeism t = 0.16 (p=0.87), and use of home remedies t = 0.77 (p=0.44).

CONCLUSION:

é There was significant correlation between perceived stress and premenstrual symptoms. As the perceived stress increases the premenstrual symptoms among adolescent girls also increased.

é There was no significant association (P > 0.05) between the perceived stress and selected demographic variables.

é There was no significant association (P > 0.05) between the premenstrual symptoms and selected demographic variables.

RECOMMENDATIONS:

1. A study can be conducted with large samples to generalize the findings.

2. A comparative study can be done between urban and rural adolescent girls.

3. A comparative study can be done between married and unmarried women.

REFERENCES:

1. Parker M A, et. al. “The menstrual disorder of teenagers: determining typical menstrual patterns and menstrual disturbance in a large population based study of Australian teenagers, BJOG; 2010 Jan; 117(2):p185-92

2. Anil.k agarawal and Anju Agarwal. A study of dysmenorrehea during menstruation in adolescent girls. Indian journal community medicine.2010 January. 35(1).159-164.

3. Braverman PK. Premenstrual syndrome and premenstrual dysphoric disorder. J Pediatric Adolescent Gynecol. 2007 ; 20(1):3-12

4. Anandha Lakshmi et. al., Prevalence of Premenstrual Syndrome and Dysmenorrhoea among Female Medical Students and its Association with College Absenteeism. Int J Biol Med Res. 2011; 2(4): 1011 -1016

5. Mahin Delara.et.al., Health related quality of life among adolescents with premenstrual disorders: a cross sectional study. Health and Quality of Life Outcomes 2012, 10:1 doi:10.1186/1477-7525-10-1

6. M.V. Rode, P. Kamble, M.S. Phatak, P. Jadhao and P. Tayde Effect of premenstrual stress on autonomic function. Annals of Neurosciences, Volume 17, Number 3, July 2010.

Received on 25.10.2012 Modified on 10.11.2012

Asian J. Nur. Edu. and Research 3(1): Jan.-March 2013; Page 14-17