Psychological Resilience and its Associated Factors among Hill Tribe Junior High School Students in Northern Thailand: A School-Based Cross-Sectional Study
Keywords:
Psychological resilience, Adolescent, Ethnic minority, Mental health literacy, Family supportAbstract
A school-based cross-sectional study was carried out to explore the psychological resilience and its associated factors among junior hill tribe high school students in Chiang Rai Province, Thailand. A multistage sampling method was used to randomly select participants from four secondary schools located in a hill tribe village across three districts in Chiang Rai Province. Data were collected using validated questionnaires, including the Resilience Inventory (RI-9), from December 2023 to March 2024. Data were analyzed using descriptive statistics and binary logistic regression, with a statistically significant p-value set at <0.05. A total of 396 participants were included in this study. Of these, 63.9% were female, with an average age of 14.16 years (SD = 0.98), 40.9% identified as Akha, and 23.0% identified as Hmong. The prevalence of low psychological resilience was 26.8%. Multivariable logistic regression analysis identified five factors significantly associated with low psychological resilience: female sex (aOR = 2.35, 95% CI: 1.38–3.99), smoking (aOR = 2.43, 95% CI: 1.08–5.47), negative life events (aOR = 2.92, 95% CI: 1.41–6.04), low family support (aOR = 2.68, 95% CI: 1.13–6.38), moderate family support (aOR = 1.90, 95% CI: 1.03–3.49), and inadequate-to-problematic mental health literacy (aOR = 2.05, 95% CI: 1.11–3.80). In conclusion, a considerable proportion of junior hill tribe high school students had low psychological resilience. Targeted public health interventions should be developed to promote psychological resilience, particularly among students who are female, smoke, have experienced negative life events, report low family support, or have limited mental health literacy.
References
World Health Organization. Adolescent and Young Adult Health. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescents-health-risks-and-solutions, accessed 28 September, 2025.
Yosson S, Boonchieng W, Kueausukon P. Mental health literacy among junior high school students in schools under municipal jurisdiction. Journal of Nursing and Health Research 2023; 24(1): 107-19. (In Thai)
World Health Organization. Mental health of adolescents. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health, accessed 18 August, 2025.
Centers for Disease Control and Prevention. Data and Statistics on Children's Mental Health. Available from: https://www.cdc.gov/children-mental-health/data-research/index.html, accessed 19 August, 2025.
Iorhen PT. Vulnerability: Types, causes, and coping mechanisms. International Journal of Science and Management Studies 2021;4(3):187-94. DOI: 10.51386/25815946/ijsms-v4i3p116
Ruanjai T, Siri S, Amyong N, Munsawaengsub C, Apidechkul T. Prevalence and Factors Associated with Depression among Hill-Tribe High School Students in Chiang Rai Province, Thailand: A Multilevel Cross-Sectional Study. Journal of the Medical Association of Thailand 2024; 107(9): 708-17. DOI: 10.35755/jmedassocthai.2024.9.708-717-792
Tamornpark R, Apidechkul T, Upala P, Chomchoei C, Yeemard F. Factors influencing early sexual initiation among hill tribe youths in Chiang Rai Province, Northern Thailand: A community-based cross-sectional study. PloS one 2025; 20(4): e0321083. DOI: 10.1371/journal.pone.0321083
Chomchoei C, Apidechkul T, Keawdounglek V, Wongfu C, Khunthason S, Kullawong N, et al. Prevalence of and factors associated with depression among hill tribe individuals aged 30 years and over in Thailand. Heliyon 2020; 6(6): e04273. DOI: 10.1016/j.heliyon.2020.e04273
Apidechkul T, Laingoen O, Suwannaporn S. Inequity in accessing health care service in Thailand in 2015: a case study of the hill tribe people in Mae Fah Luang district, Chiang Rai, Thailand. Journal of Health Research 2016; 30(1): 67-71. DOI: 10.14456/jhr.2016.10
Apidechkul T, Wongnuch P, Sittisarn S, Ruanjai T. Health situation of Akha hill tribe in Chiang Rai province, Thailand. Journal of Public Health and Development 2016; 14(1):77-9.
Srichan P, Apidechkul T, Tamornpark R, Mulikaburt T, Wongnuch P, Kitchanapaibul S, et al. Stigma experiences and adaptations in accessing healthcare services among hill tribes in Thailand: A qualitative study. PLoS One 2025; 20(5): e0321119. DOI: 10.1371/journal.pone.0321119
Bayram Özdemir S, Özdemir M, Kharel N. Experiences of cultural clashes at home and ethnic victimization in school:“I live between two cultures, and neither of them understands me”. New Directions for Child and Adolescent Development 2021; (177): 179-98. DOI: 10.1002/cad.20416
Valladares-Garrido MJ, Cueva-Cañola LE, Grados-Espinoza P, Aguilar-Manay LA, Santin Vásquez J, Valladares-Garrido D, et al. Prevalence and factors associated with resilience in Peruvian adolescent schoolchildren during the early post-pandemic context: A cross-sectional study. Frontiers in Psychiatry 2025; 16: 1609190. DOI: 10.3389/fpsyt.2025.1609190
Masten AS. Resilience theory and research on children and families: Past, present, and promise. Journal of Family Theory & Review 2018; 10(1): 12-31. DOI: 10.1111/jftr.12255
Li Y, Song C, Huang H. Rural resilience in China and key restriction factor detection. Sustainability 2021; 13(3): 1080. DOI: 10.3390/su13031080
Allan JF, McKenna J, Dominey S. Degrees of resilience: profiling psychological resilience and prospective academic achievement in university inductees. British Journal of Guidance & Counselling 2014; 42(1): 9-25. DOI: 10.1080/03069885.2013.793784
Fru-Ngongban AC. The impact of resilience on students’ academic achievement: case study of secondary school students. Journal Transnational Universal Studies 2023; 1(5): 206-13.
Kasiulevičius V, Šapoka V, Filipavičiūtė R. Sample size calculation in epidemiological studies. Gerontologija 2006; 7(4): 225-31.
Auttama N, Seangpraw K, Ong-Artborirak P, Tonchoy P. Factors associated with self-esteem, resilience, mental health, and psychological self-care among university students in Northern Thailand. Journal of Multidisciplinary Healthcare 2021: 1213-21. DOI: 10.2147/JMDH.S308076
Maybery D, Neale J, Arentz A, Jones-Ellis J. The Negative Event Scale: Measuring frequency and intensity of adult hassles. Anxiety, Stress, and Coping 2007; 20(2): 163-76. DOI: 10.1080/10615800701217654
Silpakit C, Silpakit O, Komoltri J, Chomchuen S.Validation of the Srithanya stress scale in adolescents. Journal of Mental Health of Thailand 2010; 18(1): 24-35. (In Thai)
Buhrmester D. Intimacy of friendship, interpersonal competence, and adjustment during preadolescence and adolescence. Child Development 1990; 61(4): 1101-11. DOI: 10.1111/j.1467-8624.1990.tb02844.x
Resnick MD, Bearman PS, Blum RW, Bauman KE, Harris KM, Jones J, et al. Protecting adolescents from harm: findings from the National Longitudinal Study on Adolescent Health. Jama 1997; 278(10): 823-32. DOI: 10.1001/jama.1997.03550100049038
Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International 2000; 15(3): 259-67.
Kaeodumkoeng K, Junhasobhaga J. A Development and Testing of Health Literacy on Disease Prevention and Control Assessment form for Public Health Officers. Romphruek Journal of the Humanities and Social Sciences 2021; 39(2): 193-220. (In Thai)
Sørensen K, Pelikan JM, Röthlin F, Ganahl K, Slonska Z, Doyle G, et al. Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). European Journal of Public Health 2015; 25(6): 1053-8. DOI: 10.1093/eurpub/ckv043
Wongpakaran T,Wongpakaran N. 9-item Resilience Inventory (RI-9). Available from: http://www.pakaranhome.com/images/sub_1593260902/Resilient%20Inventory%20RI-9.pdf, accessed 23 December, 2024.
Chua JH, Cheng CKT, Cheng LJ, Ang WHD, Lau Y. Global prevalence of resilience in higher education students: A systematic review, meta-analysis and meta-regression. Current Psychology 2023; 42(26): 22645-63. DOI: 10.1007/s12144-022-03366-7
Singh R, Mahato S, Singh B, Thapa J, Gartland D. Resilience in Nepalese adolescents: Socio-demographic factors associated with low resilience. Journal of Multidisciplinary Healthcare 2019: 893-902. DOI: 10.2147/JMDH.S226011
Inoura S, Chucharoen P, Thepthien B-o. Factors associated with resilient Thai students of international programs in Bangkok, Thailand. Journal of Public Health and Development 2017; 15(2): 1-13.
Dallas JC, Jullamate P, Vatanasin D, Moungkum S, Nadarajan S, Krungkraipetch N. Resilience and influencing factors among youths undergoing substance abuse treatment in Thailand: a cross-sectional study. SAGE Open Nursing 2023; 9:23779608231157986. DOI: 10.1177/23779608231157986
Namarak R, Jantham W, Buajaroen H. The relationship between mental health literacy, resilience, and depression among students at Nakhon Pathom Rajabhat University. Journal of Nursing and Public Health Research 2024; 4(2): 1-16. (In Thai)
Xiao X, Xiao J, Yao J, Chen Y, Saligan L, Reynolds NR, et al. The role of resilience and gender in relation to infectious-disease-specific health literacy and anxiety during the covid-19 pandemic. Neuropsychiatric Disease and Treatment 2020: 3011-21. DOI: 10.2147/NDT.S277231
Malek NA, Nordin N. The role of gender in resilience development among children: a systematic review of empirical evidence. Muallim Journal of Social Sciences and Humanities 2025; 9(1): 89-100. DOI: 10.33306/mjssh/334
Mayor-Silva LI, Moreno G, Meneses-Monroy A, Martín-Casas P, Hernández-Martín MM, Moreno-Pimentel AG, et al., editors. Influence of gender role on resilience and positive affect in female nursing students: a cross-sectional study. Healthcare 2025; 13(3): 336. DOI: 10.3390/healthcare13030336
Kennedy B, Chen R, Fang F, Valdimarsdottir U, Montgomery S, Larsson H, et al. Low stress resilience in late adolescence and risk of smoking, high alcohol consumption and drug use later in life. Journal of Epidemiology & Community Health 2019; 73(6): 496-501. DOI: 10.1136/jech-2018-211815
Tsourtos G, Ward PR, Miller ER, Hill K, Barton C, Wilson CJ, et al. Does resilience moderate the relationship between stress and smoking status?. Substance Use & Misuse 2019; 54 (3): 412-25. DOI: 10.1080/10826084.2018.150106
Nezhad MAS, Besharat MA. Relations of resilience and hardiness with sport achievement and mental health in a sample of athletes. Procedia-Social and Behavioral Sciences 2010; 5: 757-63. DOI: 10.1016/j.sbspro.2010.07.180
Ratanasiripong P, China T, Ratanasiripong NT, Toyama S. Resiliency and mental health of school teachers in Okinawa. Journal of Health Research 2021; 35(6): 470-81. DOI: 10.1108/JHR-11-2019-0248
Gonçalves AM, Cabral LdR, Ferreira MdC, Martins MdC, Duarte JC. Negative life events and resilience in higher education students. The European Journal of Social and Behavioural Sciences 2017; 19(2): 2381-92. DOI: 10.15405/ejsbs.211
Hosiri T, Jongjaroen A, Imaroonrak S, Sumalrot T, Phattharayuttawat S. Role of resilience in the relationship between adverse childhood experiences and behavior problems among Thai adolescents in a province of Southern Thailand: A school-based cross-sectional study. Siriraj Medical Journal 2024; 76(5): 282-92. DOI: 10.33192/smj.v76i5.267232
Panjaphothiwat N, Tamornpark R, Apidechkul T, Seeprasert P, Singkhorn O, Upala P, et al. Factors associated with domestic violence in the Lahu hill tribe of northern Thailand: A cross-sectional study. PloS one. 2021; 16(3): e0248587. DOI: 10.1371/journal.pone.0248587
Wongnuch P, Ruanjai T, Mee-inta A, Inta C, Apidechkul T, Tamornpark R, et al. Narratives of structural and cultural violence in the context of the stateless hill tribes living with HIV/AIDS in Chiang Rai, Thailand. Asia-Pacific Social Science Review. 2022; 22(1): 3. DOI: 10.59588/2350-8329.1432
Thompson NJ, Fiorillo D, Rothbaum BO, Ressler KJ, Michopoulos V. Coping strategies as mediators in relation to resilience and posttraumatic stress disorder. Journal of Affective Disorders 2018; 225: 153-9. DOI: 10.1016/j.jad.2017.08.049
Alves CP, Relva IC, Costa M, Mota CP. Family support, resilience, and life goals of young people in residential care. Behavioral Sciences 2024; 14(7): 581. DOI: 10.3390/bs14070581
Cheraghian H, Moradian K, Nouri T. Structural model of resilience based on parental support: the mediating role of hope and active coping. BMC Psychiatry 2023; 23(1): 260. DOI: 10.1186/s12888-023-04678-z
Guo X, Liu Q, Wang H, Huang K, Lei X, Zhang F, et al. Resilience and its influential factors in left-behind middle school students in Yunyang County of rural three gorges areas in China: a cross-sectional survey. Public Health 2015; 129(11): 1479-87. DOI: 10.1016/j.puhe.2015.07.018
Zhang X, Yue H, Hao X, Liu X, Bao H. Exploring the relationship between mental health literacy and psychological distress in adolescents: A moderated mediation model. Preventive Medicine Reports 2023; 33:102199. DOI: 10.1016/j.pmedr.2023.102199
Jorm AF, Korten AE, Jacomb PA, Christensen H, Rodgers B, Pollitt P. “Mental health literacy”: a survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Medical Journal of Australia 1997; 166(4): 182-6. DOI: 10.5694/j.1326-5377.1997.tb140071.x
Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health 2012; 12:1-13. DOI: 10.1186/1471-2458-12-80
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