School factors causing Vietnamese adolescents’ anxiety in secondary schools

Anxiety is regarded as an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure, and it is a common phenomenon for people in general and adolescents in particular. The study aimed to determine the factors that cause anxiety among adolescents in Vietnam under the influence of gender and grade. A group of 749 Vietnamese secondary school students participated in the survey. Results showed that scores and exams caused the most anxiety for participants. Factors related to scores and exams created more anxiety for females than males. Factors related to communicating with friends, teachers, school/classroom facilities, and school safety caused more anxiety for students in grades 6, 7, and 8 than those in grade 9. Our study suggests that prevention and intervention programs should be promoted to minimize anxiety for adolescents from the pressure of scores, exams, and the impact of gender and grade.


INTRODUCTION
Adolescence is a crucial developmental stage in the life of every human being. This transition period from childhood to adult is marked with significant physiological and psychological changes (Grant, 2013). The development of the ego, the need for equal rights in adult relationships, and the expansion of social relations have made adolescents live in a mental world filled with emotions. It can be said that this is the stage with the most emotional and behavioral disorders (Silk et al., 2003). Emotions such as anger, boredom, and anxiety that persist in mild or severe forms can start at this age (Langelier, 2011). Anxiety is of of the most common phenomenon in teenagers' age (Dinh, 2014).
Anxiety is the painful feeling that we typically recognize as uneasiness, apprehension, or worry (Seligman et al., 2001). Spielberger et al. (1970) clarified two different statuses of anxiety: state anxiety and trait anxiety. State anxiety (A-State) reflects a "transitory emotional state or condition of the human organism that is characterized by subjective, consciously perceived feelings of tension and apprehension, and heightened autonomic nervous system activity" (Spielberger et al., 1970, p. 3). In contrast, trait anxiety denotes "relatively stable individual differences in anxiety proneness and refers to a general tendency to respond with anxiety to perceived threats in the environment" (Spielberger et al., 1970, p. 3).
Uncontrolled anxiety can result in anxiety disorders. In children and adolescents, anxiety is considered one of the most common psychological disorders (Costello et al., 2003). The rate of anxiety disorder among adolescents in the population ranged from 9 to 21% (Mardomingo, 2005). The prevalence of anxiety disorders among children and adolescents with chronic illness was about 20-50% (Cobham et al., 2019). Liu et al. (2018) conducted a study on 50,361 children and adolescents in rural areas of China from 2008 to 2015. Findings from this study revealed that seven percent of students were at risk for overall anxiety. However, over half of the students were at risk for at least one subcategory of anxiety. Students at higher risk for anxiety included students from poorer counties and families, female students, secondary school students, and students with lower academic performance levels. Another study from Deb et al. (2000) on 460 adolescents (220 boys and 240 girls), aged 13-17 years in India showed that anxiety was prevalent in the sample with 20.1% of boys and 17.9% of girls suffering from high anxiety.
A cross-cultural study was conducted by Essau et al. (2008) to compare the level of anxiety among adolescents in German and Hong Kong. A total of 1,022 adolescents (594 from Germany and 428 from Hong Kong) between the ages of 12 and 17 were investigated. Results showed that adolescents in Hong Kong reported significantly higher levels of anxiety symptoms than adolescents in Germany. Anxiety symptoms showed differences across cultures. Individually, academic motivational goals to compete to get good grades and be rewarded for their performance correlated significantly with anxiety symptoms in Hong Kong. In Germany, anxiety symptoms were markedly correlated with reinforcement received for anxiety-related problems (i.e., instrumental learning) and parental verbal transmission about the danger of anxiety (i.e., informational knowledge). The findings underscored the importance of cultural factors on adolescent's anxiety.
In Vietnam, the proportion of adolescents with anxiety disorders was reported relatively high. A study by Nguyen et  Evidence has shown that some groups of adolescents were at higher risk of having anxiety than other groups. For example, regarding gender, females were more anxious than males (Mendle et al., 2019;Shen et al., 2015). However, some other studies showed that males were at a higher level of anxiety than females (Deb et al., 2010). Xing (2008) found that older students and female students had higher rates of anxiety than younger and male students. Children in rural areas were more anxious than those in urban areas (Jin et al., 2014). Deb et al.
(2010) revealed that adolescents belonging to the middle socio-economic group suffered more anxiety than those from high or low socioeconomic groups. Adolescents with working mothers were found to be more anxious.
Some research results also showed that there were plenty of risk factors that led to anxiety among adolescents, such as physical or  (Pine et al., 1999). To develop intervention programs to reduce the risk of anxiety, it is essential to understand school factors that are believed to be the core environment that an adolescent interacts in everyday life, affecting anxiety among adolescents.
This study, therefore, aimed to answer the following two questions: 1. What school factors create anxiety feeling for adolescents at secondary schools in the two biggest cities in Vietnam? 2. How gender and grade-related factors create anxiety among those adolescents?

Study design
A cross-sectional study design was applied. All data were collected from March to April 2019.

Sampling and Participants
The sample was purposively selected from four secondary schools in Ha Noi capital city và Ho Chi Minh city, Vietnam, of which two schools are from each city. These two cities represent the Northern and Southern areas as the two biggest cities in Vietnam. Four selected secondary schools were public ones that were neither special nor schools in deprived areas. We randomly selected one class of each grade from grade six to grade nine, making up a total of 16 classes for the study. The convenience sampling method was used to recruit students who volunteered to help with the research and to administer the survey. The survey instrument was distributed to 780 Vietnamese students. Among these, 749 participants (response rate of 96.1%) completed and returned the questionnaire. All these data were included in the analysis. Table 1 shows the general characteristics of the study sample.

Tool for data collection
The self-completed questionnaire was used to collect data that included questions about the school's factors impact students' anxiety. These questions were developed from the results of a qualitative study among 90 students in Hanoi. Participants in this were asked to answer the question: "What factors at school make you feel anxious?". Data-driven codes were developed after repeated analysis of the raw information.
Using conventional coding, we collected six school factors from 186 answers that led to anxiety among students. The six factors were: Based on the results of the qualitative study, we developed an official survey questionnaire, which listed six above factors. Each factor has two options, in which "1" indicates the factor was the cause of anxiety while "0" did not.
Other demographic information was included, such as gender and grade.

Data analysis
We used SPSS 22.0 to analyze descriptive and inference statistics (Corp, 2012). Descriptive statistics with prevalence to describe school factors that caused anxiety among adolescents. Then, binary logistic regression modeling was carried out, in which six dependent variables were included. Factors related to scores and exams, relationship with friends in class, communication with teachers, school/class facilities, school safety, factors related to subjects were binary variables, and independent variables were gender (Boy -Girl) and grade (6-7-8-9). 95% confidence interval (CI) for statistics of interest were calculated. A significance level of .05 was used. least mentioned was school/class facilities, with one-third of the students. Prediction of gender and grade for factors causing anxiety among adolescents Table 3 reported outcomes from binary logistic regression models of gender and grade for six school-based factors caused anxiety for students. For each school factor, there were three models, in which models A (A1 to A6) and B (B1 to B6) described statistics of prediction of separate gender and grade tương ứng; models C (C1 to C6) included both variables as independent variables. Odds ratios (ORs) and 95% confidence interval (95% CI) for ORs were reported in this table.

Factors causing anxiety among adolescents
The model results showed that gender and grade associated with school factors cause anxiety for students according to the following trends.

Prediction of Gender
Results in A models (A1 to A6), where gender was as a single predictor for dependent variables, revealed that gender was statistically significantly associated with anxiety caused by scores and examinations (OR = .565, p = .022, 95% CI [.347-.920]) but was not statistically significantly correlated with the remaining five other factors (p > .2). The result inferred that males were more anxious about exams and scores than females. However, both sexes were at the same risk of having anxiety in relationship with classmates, communication with teachers, school/class facilities, school safety, and factors related to studying.

Prediction of Grade
The B models (B1 to B6), which examined the association of grade and anxiety, showed that students from grades 6 to 8 might have twice to three times more anxious in relationship with classmates than those in grade 9 (ORgrade6=2. 28

Prediction of both gender and grade
Adding the gender factor to the model, the C models (C1 to C6) showed that excepting factors related to studying, all other factors were significantly related to students' anxiety. However, in five models from C1 to C5, only one dependent factor was a predictor of independent factor. Model C1 revealed that gender was a predictor factor for anxiety (OR=.551, p = .018, 95% CI [. 336-.903]. This seemed to be consistent across all grades. After controlling sex, finding indicated that grade statistically significantly predicted anxiety in scores and exams, relationship with friends in class, communication with teachers, school/class facilities, school safety, factors related to studying. Specifically, the Odds of having anxiety caused by those factors for students in grades 6,7,8 were about 2-3 times higher than that of grade 9. The predictive role of gender and grade was controlled by other factors in multiple binary regression models (C models) that were consistent with its role in the models with the single independent variable (A and B models).

School factors of anxiety among adolescents
Scores and exams were the factors that caused the most anxiety among adolescents. In Vietnam, it is evident that scores and exams cause pressure for most of the students. The ultimate purpose of students at school is to pass the exams with as higher marks as possible. For junior students, the essential exam is the graduate junior school exam, which will decide which high school they are in while that for high school students is the university entrance exam.
In big cities like Hanoi and Ho Chi Minh, there is higher competition for a public school due to the limited number of high-quality public schools. Private schools are usually with high school fee that prevents many students from midle or lower income families. Therefore, parents typically put pressure on their children in studying and exams. A study of Dinh (2014) revealed that it was not the subjects at school, the stout curriculum, but the pressure from family created negative emotions for adolescents (including anxiety). Tran et al. (2014) và Nguyen (2018) revealed that studying was the core factor that created stress and anxiety among adolescents. In a study conducted by Do and Dinh (2020), scores played an essential meaning to students. The ranking was standard for students to compare themselves with other students. Therefore, low scores in academics meant shame to friends. Besides, students with low scores usually received word violence and physical punishment from parents and sometimes teachers (Do & Dinh, 2020).
Students were always in a high pressure of study harder and harder. However, the more parents put pressure on their children, the higher risk that students had anxiety, which negatively impacted their academic performance. The negative correlation between anxiety and academic achievement was confirmed in previous studies (Liu et al., 2018;Owens et al., 2008;Yousefi et al., 2010). It is necessary to reduce the pressure in scores and exams for adolescents in Vietnam.
The association between gender, grade and school factors of anxiety among adolescents in secondary schools (binary regression)

Scores and grades created more anxiety in females than in males
In this study, factors related to scores and grades created anxiety higher among female students than their counterparts. Some previous studies shared the same finding (Shen et al., 2015 Regarding the cultural aspect, Vietnam was under the influence of Confucianism, in which the role of females was limited in comparison to males. Hence, females were more likely to study harder to confirm their role in class and society. Data showed that females were more anxious than males in scores and exams. However, the data also showed that the correct prediction rates of all regression models and the relative amplitude of gender impact on this factor were quite small. Understandably, there were many other school factors that might caused the anxiety among adolescents.

Limitations
The study has several limitations. First, the primary evidence defects arise from the sampling process used. The random selection of participants alleviates this concern significantly but does not entirely remedy that shortcoming. Second, this is a cross-sectional study that cannot explain the causes and results associated with all school-related factors. Third, psychological and social factors specific to each gender and class were not included in this study. Fourth, participants were students in the two biggest cities in Vietnam. Therefore, it can not represent the adolescent samples in different geographical locations in Vietnam. Future studies should address these limitations.

CONCLUSION
The current research explored the anxiety of secondary school students in four secondary schools in Ha Noi Capital City and Ho Chi Minh City, Vietnam. It is amongst the first studies investigating the school factors causing anxiety for secondary school students related to their academic achievements in Ha Noi City and Ho Chi Minh City, Vietnam, to the best of authors' knowledge. According to the research results, scores and exams were the most important factors that cause anxiety among adolescents in Vietnam. Females were more likely to be anxious in scores and exams than males. Relationship with friends, communication with teachers, school/class facilities, and school safety caused more anxiety among students in lower grades. The results of this research are necessary for Vietnamese educational leaders and teachers to provide prevention and intervention programs to reduce anxiety among adolescents in Vietnamese secondary schools. Further research is recommended to identify the underlying reasons for no gender differences in self-control ability among secondary school students in Northern and Southern Vietnam. It is also suggested that research will be conducted involving students from more different areas in Vietnam so that the research results can be generalized.