Teacher Nomination of School-aged Children for Mental Health Services in a Low and Middle Income Country

Figures & data

Table 1. Teacher demographics

Categorical variables	n		%
Gender Female Male	15 4		79.0 21.0
Scheduled caste/tribe^a Yes No	7 12		36.8 63.2
Language Nepali Bengali English Hindi Other	18 0 18 12 0		94.7 0 94.7 63.2 0
Formal training in education Yes No	4 15		21.0 79.0
Teaching certificate Yes No	3 16		15.8 84.2
Class levels taught^b Class I (kindergarten) Class II (1st grade) Class III (2nd grade) Class IV (3rd grade) Class V (4th grade) Class VI (5th grade) Class VII (6th grade)	9 14 14 16 15 12 6		47.4 73.7 73.7 84.2 79.0 63.2 31.6
Other employment No Yes Housework Selling things/running a shop Farming/agricultural Tutoring Tour guide	0 19 10 1 3 5 1		0 100 52.6 5.3 15.8 26.3 5.3
Continuous variables	Mean	Standard deviation	Range
Age	27.9	5.2	21–39
Years at current school	4.5	4.2	1–17
Years teaching	4.9	5.1	1–17

N = 21 teachers attending a 10-day training course. Two teachers did not participate further in the study due to changes in employment.

^aScheduled caste and scheduled tribe are standard terms used in Indian demographic surveys for officially recognised groups of historically disadvantaged peoples by the Government of India and State of West Bengal. A response of ‘yes’ indicates membership in a historically disadvantaged group.

^bSum is greater than 100% due to individuals teaching multiple grade levels.

Table 2. Student demographics (n = 272)

Categorical variables	Total n (%)	Not nominated n (%)	Nominated n (%)	P-value^a
Number of students	272	215 (79.1)	36 (13.2)
Sex Female Male	135 (49.6) 137 (50.4)	114 (53.0) 101 (46.9)	15 (41.7) 21 (58.3)	0.21
Grade Class I (1st grade) Class II (2nd grade) Class III (3rd grade) Class IV (4th grade	67 (24.6) 70 (25.7) 66 (24.3) 69 (25.4)	52 (24.2) 57 (26.5) 53 (24.7) 53 (25.7)	10 (27.8) 8 (22.2) 8 (22.2) 10 (27.8)
Age-grade mismatch^b 2 years advanced  1 year advanced Appropriate  1 year delayed 2 years delayed 3+ years delayed	1 (0.4) 16 (5.8) 243 (89.3) 5 (1.8) 6 (1.6) 1 (0.4)	1 (0.5) 14 (6.5) 4 (1.9) 0 (0) 1 (0.5)	0 (0) 0 (0) 1 (2.8) 5 (13.9) 0 (0)	<0.0001**
Mother’s education Some primary Primary Secondary Higher secondary Undergraduate or higher	47 (17.3) 15 (5.5) 172 (63.2) 17 (6.3) 12 (4.4)	39 (18.7) 12 (5.7) 132 (63.2) 15 (7.2) 11 (5.3)	8 (22.9) 3 (8.6) 23 (65.7) 1 (2.9) 0 (0)	0.49
Father’s education Some primary Primary Secondary Higher secondary Undergraduate or higher	37 (13.6) 11 (4.0) 163 (59.9) 36 (13.2) 13 (4.8)	31 (15.0) 8 (3.9) 124 (59.9) 32 (15.5) 12 (5.8)	3 (9.1) 2 (6.1) 25 (75.8) 3 (9.1) 0 (0)	0.30
Scheduled caste or tribe^c Yes No	91 (33.5) 181 (66.5)	71 (33.0) 144 (67.0)	11 (30.6) 25 (69.4)	0.77
Language Nepali Bengali English Hindi Other Monthly income category (USD)^d  0–99 (%)  100–199 (%)  200–299 (%) >299 (%)	268 (98.5) 1 (0.4) 249 (91.5) 13 (4.8) 0 (0) 151 (55.5) 68 (25.0) 23 (8.5) 27 (9.9)	213 (99.1) 1 (0.5) 196 (91.2) 12 (5.6) 0 (0) 122 (57.3) 55 (25.8) 19 (8.9) 17 (8.0)	36 (100) 0 (0) 36 (100) 0 (0) 0 (0) 18 (51.4) 9 (25.7) 3 (8.6) 5 (14.3)	0.67
Continuous variables	Total mean [range]	Not nominated mean [range]	Nominated mean [range]	P-value^a
Age	8.2 [5–13]	8.1 [5–13]	8.9 [6–13]	0.0062**
Household size^e Older generation Same generation Monthly income (USD)^d	4.4 [1–9] 2.7 [0–8] 0.7 [0–6] 133.27 [7.7–769.2]	4.4 [1–9] 2.7 [0–8] 0.7 [0–6] 125.5 [7.7–769.2]	4.4 [2–7] 2.6 [1–4] 0.8 [0–2] 151.32 [19.2–769.2]	0.81 0.52 0.63 0.34

Students that were nominated as alternates (n = 21), but not nominated for intervention, are not included in the nominated or the not-nominated groups.

^aCalculated using the independent sample t-test for continuous variables, Pearson χ² for categorical variables, or Spearman’s rank correlation for ordinal variables.

^bGrade outside the expected for age assuming first grade was begun at age 5 or 6 and student advanced 1 grade level each year. Grade-age-mismatch was applied to students that were either young for their grade (advanced) and had a lower mismatch value or old for their grade (delayed) and had a higher age-grade mismatch value.

^cScheduled caste and scheduled tribe are standard terms used in Indian demographic surveys for officially recognised groups of historically disadvantaged peoples by the Government of India and State of West Bengal.

^dMonthly income as reported by family in 2018. Presented in USD (1 USD = 65 INR).

^eTotal number in household including student.

*P < 0.05.

**P < 0.01.

Figure 1. Percent of nominated and not nominated children by BTST score

Figure 2. Percent of nominated and not nominated children by TRF total problem T-score

Table 3. Comparison of BTST and TRF total and subdomain scores

BTST	TRF	Spearman’s correlation coefficient
Overall ranking (fine vs. borderline or needs attention)	Total problem score (normal vs. borderline or clinical)	0.34^
BTST categories	TRF syndrome subdomains
Anxious	Anxious	0.25^
Disagreeable	Disagreeable	0.23^^
Withdrawn	Withdrawn	0.26^
BTST categories	TRF DSM-oriented subdomains
Anxious	Anxious	0.33^
Disagreeable	Disagreeable	0.24^
Withdrawn	Withdrawn	0.24^

^P < 0.0001.

^^P = 0.0002.

Figure 3. ROC curves for the BTST as compared with the TRF total problem score and any positive TRF score

Data availability statement

Due to the connectedness of the Darjeeling community and the relatively small sample size of children nominated for mental health intervention, participants of this study did not agree for their data to be shared publicly. Accordingly, supporting data is not available.