Introduction

Since 2004, in the 3 provinces of Southern Thailand; Patani, Yala, Narathiwat and some parts of Songkhla province, which have been dubbed by the Thai media as the Southern Border Providences (SBP) of Thailand, violence has continuingly worsened, generated by unidentified terrorists. Thailand’s insurgency is  part of a very critical political conflict; wherein, from the 1st of January, 2004 until the 28th of August, 2019; 20,226 violent situations were officially reported, with 6,956 people killed and another 13,549 being injured (Deep South Watch 2019). Thus, local people, including university students studying at the campus located in these areas, have had to live with these currently insecure environments and represent a generous acceleration in mental distresses, including burnout syndromes (Pitanupong & Jatchavala 2018).

However, most local people in the restive areas of the SBP have embodied that they have normal levels of stress. In addition, a study of widows, whose husbands died as a result of the violent situations in  South Thailand’s insurgency, represented steady stress management along with spiritual and physical strength (Udomlapsakul et al. 2011).

The notable question for any mental health study is ‘How do people continually live under such stressful circumstance?’. Particularly, students studying in higher education whose ages are in the categories of “adolescent” or “young people”, which is a population at risk of many mental illnesses. Worldwide WHO (2019) estimated 10-20% of adolescents are facing mental health difficulties, which are ongoing, underdiagnosed and undertreated.

According to the aim of mental health promotion and prevention, the researchers focused on the university students ‘resilience’, as this is “the process of adapting well in the face of adversity, trauma, tragedy, threats or even significant sources of stress” (American Psychological Association 2014). However, no Thai-version of resilience quotient could assess all processes of resilience. Within the context of Thailand, the Thai-version of resilience quotient was divided into three parts i.e. emotional stability, will power and coping skills, based on the concept of “I AM”, “I HAVE” and “I CAN” (Maneerat et al. 2011).

Previous studies revealed that culture, ethnicity, race and ethnic identity among youths of colour was not associated with resilience, whereas experiences of discrimination moderated the negative effects of it (Sellers al. 2003). Many researches pointed out that parent-family connectedness and support including, mentoring relationships assisted adolescents in overcoming mental adversities. Moreover, participation in extracurricular activities in their community settings promoted healthy psychological development (Zimmerman et al. 2013). Therefore, the main objectives of this study were to examine the levels of resilience and associated factors among university students in conflict areas, compared with those who studied in a nearby province; so as to promote mental health, and to prevent potential psychological difficulties in the population at risk.

Materials and methods

This was a cross-sectional survey, conducted amongst 897 Prince of Songkla university students in total. From this total, 443 students who studied at the Pattani campus, located in the restive areas, and 454 who studied at the Hatyai campus, were approached by research-assistants, from 8th August to 8th October, 2018. Randomization would be simple and convenient as the research assistants approached the participants at their lecture rooms, which are classified into three categories of the faculty i.e. health science, social science and pure/applied science. All of them completed the personal information and Thai resilience questionnaires (Thai-RQ) by themselves.

Measurement Instruments

The questionnaire was a self-report, divided into two parts. Socioeconomic and demographic characteristics were in the first part of the personal profile, with the other part consisting of the Thai Resilience Quotient screening test (20-items Thai RQ); which was developed by the Department of mental health, Ministry of Public health, Thailand, and used to assess personal resiliency, with the purpose of discovering strengths for individual development. The assessment of validity was moderate (0.749), and consisted of 3 domains; emotional stability, will power and coping skills. According to the Thai version’s internal consistency, Jannoppacun & Suppapitiporn (2015) revealed that Cronbach alpha was 0.838, with the range of normal resilience being between 55-69.

All statistical procedures were performed using the R software package. Descriptive statistics was presented as demographic characteristics of the samples in frequency, percentage, articulate mean and standard deviation. Correlation analysis was conducted by Chi-square and logistic regression.

Results

Of the 897 Prince of Songkla University students, who participated in this study, 443 students studied in the restive areas of  Southern Thailand’s insurgency. They were mostly (94.1%), Muslim (76.3%) female (80.3%) and lived in the SBP, as it was their hometown (55.7%). Their mean age was 20.2+1.3 years, without either physical or mental diseases (91.2% and 99.8%, respectively). Most of them reported high satisfaction towards their university teaching (63.4%), and most had never had an inclination of dropping out from their curriculums (44.6%) (Table 1).

Compared with 454 university students who studied in the non-restive area; race, religion, domicile, birth order and thoughts about dropping-out were shown to have statistically significant differences (p-value <0.001). At the Hatyai campus; only 0.4% of participants were Malays, whilst 5.9% of Malays students studied at the Pattani campus. The religions of those who studied in the non-restive area were mostly Buddhists (76.8%), and their hometowns were a variance from other provinces of Southern Thailand (46.8%). Even though most of them also stated that they had never thought of changing universities (64.2%) much the same as those who studied in the restive area, the latter reported more ideation of dropping-out (4.1%). Additionally, the ‘only child’ students were revealed to be higher in number than those who studied in the non-restive area (13.0%) (Table 1).

Level of Resilience 

Regarding Table 2; most of the university students who studied in the restive area were within the normal level of resilience (55.7%) and only 35.1% of them had lesser levels of resilience than that of the normal population. No significant differences of resiliency levels were found between the participants in either the restive or non-restive areas. 

Among the three domains of Resilience Quotient (Table 3); coping skill had the highest prevalence of normal to above average levels (75.9% in the restive area and 75.7 % in the non-restive area). The lowest prevalence was emotional stability; as 67.2% of those who studied in restive areas and 64.5% in non-restive areas were found to be either of normal to above average resiliency levels. Also, no statistically significant differences were found between those who studied in the two campuses.

Factors Associated to Resilience Quotient

According to Table 4 and 5, there was a significant difference satisfaction towards university teaching associated to the resilience between university students in both areas. Students who studied at the Hatyai campus and who considered themselves to have high satisfaction towards university teaching, were discovered to have resiliency levels 8.02 times higher than those whom had low satisfaction (95%CI=2.42, 26.64). Together with, those who studied at the Pattani campus, was shown to be 1.06 times higher (95%CI=0.20, 5.78).

Among the university students who studied in the restive areas, age, religion and birth order were discovered as factors associated with resilience quotient (p-value=0.036, p-value<0.001 and p-value=0.011, respectively). Additionally, they would have levels of resilience 1.21 times higher at an older age (95%CI=1.02, 1.43). Moreover, Buddhists and the youngest among siblings showed resiliency levels of 2.58 and 1.71 times higher than those who were not (95%CI=1.52,4.66 and 95%CI=1.44, 4.62, respectively). However, gender was reported as an associated factor among those who studied in non-restive areas (p-value=0.07). Female students at the Hatyai campus represented resiliency levels 1.89 times higher than their male counterparts (95%CI=1.13,3.16).

Discussion

Although this study was not the first study of resilience among young people in the restive areas of Southern  Thailand’s insurgency, research synthesis significantly assisted both health care providers and policy makers, for directions of basic mental remedies, and continuing support among this population (Prohmpetch & Songwathana 2018).  This research would contributes towards mental health promotion in community settings of Southern Thailand’s insurgency, especially in university campuses.

To compare with previous studies, Rattakul (2014) discovered that, 37.3% of adolescent students showed less levels of resilience than the normal population, which is similar to the prevalence found in both restive and non-restive areas in this study (35.1% and 33.1%). These prevalence rates seem to be much less than those which were reported in other studies, even among substance-related disorder patients in the SBP of Thailand (28.3%) (Jatchavala et al. 2018). However, the correlation between age and resilience were revealed in this study and supported by others. Wangsawat and co-authors (2011) ascribed that adults could face psychological difficulties better than adolescents. For these reasons young adolescents in the restive areas should be of more concern and surveillance should be undertaken of psychological adversities by mental health care providers and academic institutes; especially in regards to  emotional stabilization. 

Roles of universities on resilience and mental health promotion were remarkably mentioned from this study. Satisfaction toward university teaching had a significant impact on resilience quotient, in both the restive and non-restive areas. Hence, lecturers and instructors need to assess their own qualities of teaching and mentoring, as it may reflect upon the relationship and connectedness of their students, which in turn could help students build up their capacity to overcome mental adversities (Zimmerman et al. 2013). Moreover, the universities’ role is to eliminate any discrimination towards gender, religion, race and other identities. Since religion, gender and birth order were found as factors associated to resilience, Sellers and colleagues (2003) discussed that there was no direct effect of these identities on resilience and mental illnesses. However, experiences on discrimination according to gender, ethnic, religion and racial identity were. Thus, not only the quality of teaching, but other settings in the university should be emphasized to promote a mentally healthy environment.

Regarding the cross-sectional design of this study, we could not summarize which one was a cause or effect between resilience and socio-demographic profile; therefore, a cohort study is suggested to clarify this. Moreover, as this survey was a quantitative study, we could understand resilience as an individual trait, but not as a process of adapting to psychological distress. Thus, qualitative data is necessary to comprehend the paradigm of resilience among university students. The authors recommend further studies of resilience in this population to be of a mixed-method or qualitative, cohort studies for more considerable data; so as to emphasize mental health promotion in the restive areas of Southern Thailand’s insurgency.

Conclusion

Most university students, who were studying at the Prince of Songkla University, within the campus located in the areas of Southern Thailand’s insurgency, had a normal level of resilience. The domain of resilience with the highest prevalence was coping strategy, with the lowest one being emotional stability. There was no significant difference of resilience between the two campuses. Satisfaction towards university teaching, age, religion and birth order were associated to resilience among university students, who were studying in the restive areas of Southern Thailand’s insurgency. However, gender and satisfaction towards university teaching were found to correlate with resilience among those who studied in the non-restive area.

AcknowledgEment

This research was fully granted and endorsed by the ethics committee of the Faculty of Medicine, Prince of Songkla University, Thailand. (REC number: 61-071-3-1). It was also selected for poster presentation at the 5th European conference on integrated care and assertive outreach in Italy, September 5-7, 2019. The authors appreciate Mrs. Nisan Werachattawanand, Ms. Kruewan Jongborwanwiwat along with other research assistants for their help in data collection, analisation and administration.