Mental Health Disorders And Its Related Factors In Banyumas Regency

Background : The increase in mental health problems in the community needs to have more attention in research. The purpose of this research was to analyze the factors related to mental health disorders in RSUD Banyumas Methods : This research was analytic research using a case-control approach. The case population in this research was mental disorders inpatients of RSUD Banyumas on June 2018 – May 2019 while the control population was the neighbors of the cases. The samples were 100 respondents (50 cases using consecutive sampling and 50 controls using accidental sampling). The research instruments were a structured questionnaire and a Personal Style Inventory questionnaire. The data were analyzed by univariate, bivariate, and multivariate Results : The variables related to mental health disorders were educational status (0,032), economic status (0,020), bereavement (0,00), and personality type (0,00). The most caused variable was personality type. The variables that did not relate to mental health disorders were work status Conclusions : The most influential was personality type and the other variables that caused mental disorder are educational status, economic status, and bereavement.


INTRODUCTION
Many professionals view mental health symptoms as a public health concern, and they are commonly impacted by factors related to occupation, job opportunities, and economic concerns 1 . Compared to the general population, those with mental problems have a life expectancy that is 10-15 years less. [2][3][4] . Promotion of mental health, prevention, and early treatment of mental disorders before or at their onset improved outcomes 5 .
According to GBD 2019, there has been no evidence of a global burden reduction since 1990, and mental diseases continue to rank among the top 10 leading causes of burden globally 6 . The results of the 2018 Basic Health Research show that the prevalence of mental disorders in Indonesia is 7%, while Central Java Province has a prevalence of 9% or number 5 in Indonesia 7 . The number of visits by mental patients to hospital health facilities throughout Banyumas Regency in 2017 reached 41,809 with the highest visits at the Banyumas Regional General Hospital (RSUD) of 87.15% (36,437 visits). 8 According to Sulistyorini (2013), adverse effects affect family members as well as patients, beginning with attitudes of rejection, denial, and being ignored 9 . Significant mental illness reduces patient productivity, which raises costs that can affect families, communities, and the government. 13% of all illnesses and injuries result in Disability Adjusted Life Years (DALY) that are related to mental disorders 10 .
Mental health problems can be minimized by knowing what factors influence them. Factors that may cause mental disorders include organobiological factors (genetics, drug abuse), psychological factors (personality type, bereavement, social relationship problems), socio-cultural factors (economic factors), and socio-demographic factors (age, gender, employment status, and educational status). [11][12][13] The structural equation modeling revealed a strong correlation between financial threat and symptoms of mental illness 1 .
In this study, researchers conducted an analytical study by integrating factors that might influence mental disorders such as organobiological factors, psychological https://doi.org/10.20884/1.iphj.2022.3.1.9359 factors, sociocultural factors, and socio-demographic factors. The study was conducted using a sampling of patients with mental disorders who had been hospitalized at Banyumas Hospital. This is because inpatients with mental disorders have signs and symptoms that are more extensive, causing difficulties in their ability to function properly in everyday life. Therefore, hospitalized patients tend to fall into the category of severe mental disorders (psychosis).

METHODS
This research is an analytical research with a case control approach. The case population in this study were all mental patients who had been hospitalized at the Banyumas Hospital in the period June 2018 -May 2019 while the control population was all neighbors of the cases. The case samples in this study were mental patients who had been hospitalized at the Banyumas Hospital in the period June 2018 -May 2019 while the case samples were neighbors of cases adjusted for age and sex. The sampling technique used for cases is Consecutive Sampling while for controls is Accidental Sampling. The total sample in this study was 100 with a 1: 1 ratio of cases and controls, namely 50 cases and 50 controls.

RESULTS
100 people were involved in this study with the characteristics summarized in table 1. All respondents in this study were of productive age and most were women (65%). For the characteristics of the research subjects, most of them were of productive age (92%) and male (54%).  Table 2 shows that there were more research subjects in the case group who did not work (56%) while in the control group there were more who worked (56%). The percentage of educational status in the case and control groups had more secondary education than primary education where there were 60% in the case group and 84% in the control group. All study subjects (100%) between the case group and the control group had no genetic history related to mental disorders and had never abused drugs.
In the personality type variable, most of the research subjects in the case group (68%) had introverted personality types while in the control group most (86%) had extroverted personality types. Most of the research subjects in the case group (62%) had experienced loss, while in the control group most (88%) had never experienced loss. In addition, there were more research subjects in the case group and control group who had a high economy with a percentage of 78% for the case group and 92% for the control group.

DISCUSSION
Based on multivariate analysis, introverted personality type influences the incidence of mental disorders with a value of p = 0.00 (OR = 14.951; 95% CI = 4.203 -53.184). Someone who has an introverted personality type is at risk of 14,951 times getting mental disorders. Someone who has a mental disorder with an introverted personality type tends to be closed to family members and rarely talks about the life problems they are experiencing. Most of them need more time to be alone and tend to be quiet. This confirms that introverted personalities focus on their own thoughts and experiences 14 . People who have introverted personalities tend to close themselves off from outside life, think a lot, have little activity, prefer solitude and are reluctant to establish relationships with other people. The promotion of personality strengths may be of value in preventing suicidal behaviour and helping pro-social change in those with personality disturbance 15 .
Educational status is closely related to employment and economic status. Someone who has low education will find it more difficult to get a job than someone of the same age who has higher education 16 . If someone does not have a job, the income earned is low so that the economic status is also in the low category 17 . In addition, Ilhamdani's research (2017) explains that economic status can affect the ability to access health services. Someone who is able to access health services will get better information about health so that if there is a physical or mental disorder, it can be treated earlier 18 . Thus, the higher a person's education, the smaller the risk of developing a disorder (especially mental disorders) 19 .
The results of the study show that economic factors are one of the factors that influence the occurrence of mental disorders. This influence is possible because there are demands to meet the daily needs of the family that are not proportional to the income earned, causing stress in life. This supports the results of a study by Hawari (2012) which states that inadequate economic conditions can stress a person's mental resilience so that if they cannot withstand it they will be at risk of developing mental disorders. Negative effects could be even worse by low socioeconomic status 20 . Poor socioeconomic circumstances limited people's ability to study at home and obtain mental health care, widening already-existing social and academic disparities 21-23 .
Losing something will cause grief that can cause stress in a person. All people experience grief when they face change and loss in their lives, and this grieving process is frequently one of the most painful and challenging things in human life. The results of this study are also relevant to his explanation that the most devastating loss is the loss of someone you love, such as a child, parent, partner or closest person. Prolonged mourning reactions are likely to experience psychological problems such as depression, suicide, and substance abuse 24 . In addition, depression due to bereavement is less likely to recover than depression caused by other than bereavement 25 . The loss of a family member or friend amplifies psychological distress 26 . The loss of a family member increase the possibility of psychological and behavioral issues 27,28 . Loss of a parent is a significant stressful event that has been demonstrated to raise the likelihood of mental health issues in children 29 .
This study reports that work status has no effect on the incidence of mental disorders. This is different from previous research that someone who is not working can experience stress, depression, and a weakened mental condition 30 . In addition, the positive effect of work can reduce stress and is closely related to high social support, while people who do not work have low social support to respond to stressors related to unemployment problems 31 Many previous studies have reported that mental suffering (i.e., depression, anxiety disorders, stress, hopelessness, panic attacks, etc.) are associated with underemployment and unemployment (due to factors such as increased competition, joblessness, job insecurity, low wages, lack of scopes in practicing acquired skills etc.) [32][33][34]

CONCLUSION
Most of the respondents are of productive age, male, have secondary education, do not have a genetic history related to mental disorders and do not abuse drugs. Research subjects who have introverted personality types and experience loss in the case group are higher than the control group and most have high economic status. There is no relationship between age, gender, employment status, genetic factors, drug abuse and economic status with the incidence of mental disorders in inpatients with mental disorders at Banyumas Hospital. There is a relationship between educational status, personality type and loss factors with the incidence of mental disorders in inpatients with mental disorders at Banyumas Hospital. The variable that has the most influence on the incidence of mental disorders in inpatients with mental disorders at Banyumas General Hospital is personality type.
Communities are expected to carry out positive activities to avoid pressures that cause stress in life such as exercising regularly, participating in religious activities, actively participating in organizations in the community, and participating in health programs organized by policy makers. In addition, policy makers are expected to plan programs that are more effective and efficient in order to minimize the occurrence of mental disorders in the community