Epidemiological studies show that 5–10% of children and adolescents suffer from emotional and behavioral problems, which are among the most common psychiatric disorders for this age group . Emotional and behavioral problems are associated with suffering and disturbances in the daily life of the affected person, his/her family, and among the relatives. These problems were associated with an increased risk of substance abuse, depression, and impaired social and emotional functioning during adolescence and early adulthood [18,19,20,21]. Therefore, emotional and behavioral problems in childhood should be identified and treated as soon as possible.
The standard deviation and mean of the total score of the questionnaire’s strengths and difficulties in the sample were 15.61 ± 5.89. The value was reported as 5.5 in Muris et al.’s (2003) study in the Netherlands, 5.1 in the study by Klasem et al. (2000) in Germany, 10.85 in Smedje et al.’s (1999) study in Sweden, 11.4 in Goodman et al.’s (1998) study in England, and 10.05 in Tehranidoust et al.’s (2008) study in Tehran (17, 22, 25). The reason mentioned for the difference in the total score of the strengths and difficulties is the difference in the real prevalence of problems in different countries and probably different mean ages of the study subjects . Therefore, in this study group, the age group of 9–18 years old, the highest mean score was in the range of 17–18 years old with an average of 16.69.
Nasiri et al. carried out a study to determine the prevalence of mental health disorders in primary school children in Boushehr city (2006–2007). A total of 2350 SDQ questionnaires were distributed randomly in urban and rural primary schools. In this study, 946 (49.3%) subjects had an abnormal score similar to that of the present study in which 960 (48%) subjects had an abnormal score .
A comparison of the indicators obtained from the SDQ questionnaire in the present study showed that the highest mean was related to the dimension of appropriate social behaviors; this is consistent with the studies of Tehranidoust et al. and Arabgol et al. The lowest mean was related to the dimension of problems with peers, while in Tehranidoust and Arabgol’s studies, the lowest mean was related to behavioral problems [17, 23].
Latif Nezhad et al. conducted a study with the aim of comparing emotional and behavioral problems and depression in two groups of girls before and after menarche in Mashhad city. In this case-control study, 320 healthy high school children aged 11 to 15 years old (140 girls in the pre-menarche period and 140 in the post-menarche period) who did not have emotional and behavioral problems were selected through multistage sampling from 18 high schools in Mashhad. The results showed no significant difference in the behavioral and emotional problems of the girls in the post-menarche period in comparison with those in the pre-menarche period. However, in this study, the relationship between emotional and behavioral problems and menopause age was statistically significant. Most of them (638 subjects) (46%) had emotional and behavioral problems at the menarche age of 11–12 years . However, in Tehranidoust et al.’s study, the scores of the SDQ questionnaire score were not significantly correlated to age . Moreover, in another study by Sanders on Japanese families living in Australia (2007), 50 families were evaluated in two case and control groups. Then, a significant difference was observed in the dimensions of parenthood, parenting, and adolescent behavioral problems at the end of the intervention. However, there was no significant difference in anxiety, stress, and depression . Grant et al.’s (2003) study concluded that stressful events, such as the conflict in the family, have a significant role in the expansion of emotional and behavioral problems in children and adolescents .
Garnefski et al.’s study (2005) also investigated children and adolescents aged 12 to 18 years in the Netherlands among the general population. They found that the scores of people with emotional and behavioral problems were significantly higher than those of the control group and the group with conditions of behavioral problems in terms of cognitive coping strategies as self-blame and rumination . In a case-control study in Birjand, it was found that the mean of emotional and behavioral problems and aggression was significantly higher in divorce children than non-divorced children . Cognitive-behavioral therapy was strongly supported as an effective treatment for emotional and behavioral problems in children . However, the vast majority of children and adolescents with emotional and behavioral problems do not receive evidence-based psychological treatment [30, 31].
Turner et al. showed that adolescents who were in the warm, intimate, adaptive, communicative, and supportive environment of their family could control the negative effects of stress on their health . In adolescence, the role of parents and their ability to communicate positively and constructively with their adolescent is very critical. Studies showed that warm and protective family relationships were predictive of the positive correlation between children and adolescents and are considered as protective factors against emotional and behavioral problems in adolescence .
Van et al. (2012) investigated the impact of social skills training programs for children aged 7 to 13 years on emotional and behavioral problems. The results showed that social skills training caused positive changes in children’s emotional and behavioral problems . Chen (2006) and Spence’s (2003) study on students at risk of behavioral and emotional disturbances indicated that social skills training, which included modeling, feedback, and encouragement in case of proper performance and role-plays, led to an increase in their social adequacy [35, 36].
Senik showed that training social skills led to increased social interaction and interpersonal relationships followed by increased indicators of psychological well-being, income-earning, and consequently increased quality of their life . A meta-analysis study showed that two thirds of adolescents who were at risk of behavioral and emotional disorders but received social skills training were improved compared with the control group [38, 39].
Generally, the review of the studies conducted on social skills training shows that 25 years after the beginning of research in this field, the researchers make an attempt to train these skills in order to make people acquire, maintain, and publicize the skills to overcome or reduce their behavioral and emotional problems [38, 40].
It should be noted that mental disorders may activate the corticotropin-releasing hormone from the nervous system following an increase in cortisol and prolactin, which leads to menstrual symptoms [41, 42]. In addition to the effects of hormones released on the quality of life, these mental disorders may lead to suicide, addiction, early sexual experience, depression in adulthood, crimes, loss of education, low self-esteem, and its consequences, eventually leading to occupational, family, and social disorders [43, 44]. The prevalence of these mental disorders in the premenstrual period is rare. Gender differences show that during puberty, these disorders increase with a steep slope and are more common among the girls who are more vulnerable to various psychological factors so that the ratio of the girls’ psychological condition in these disorders compared to boys is 1/1/3 .
In explaining these results, it can be mentioned that life skills are like a behavior change-based approach that can make a balance between knowledge, attitude, and skills and can increase stress-coping skills, self-esteem, and individual control in different situations. The adolescence period is a critical stage in the course of which the foundation of adulthood can be set for a person . This period is associated with significant physical and mental changes, and the lack of awareness of adolescents in this period may lead to inaccurate performance and adverse outcomes. Training can reduce many of the problems and crises of that period. Therefore, since it is important to know how to enter the process of adolescence and how to overcome its ups and downs by adolescents, families should get acquainted with the time and trends of menarche and factors affecting it in order to provide their children with the right decisions in a timely manner . Training issues, especially support of the family, can reduce the stresses and menstrual disorders of the adolescent girls , given that the main aim of this project was to study the prevalence of menarche, early and late menarche. Therefore, the factors affecting adolescents’ psychological problems have not been fully evaluated. Other factors affecting psychological problems have been proposed as a design limitation in the article.
Another factor in the development of emotional and behavioral problems are socioeconomic status; a possible clue could be related to the type of school and area of residence. Further research is suggested to confirm the relationship between environmental factors and menarche onset age, development of secondary sexual characteristics, perception of puberty or physical maturity compared to peers, and the rate of puberty in different racial-ethnic groups so that the existing contradictions are resolved. Besides, interest in environmental factors that have influenced the onset of puberty has increased significantly over the past three decades. However, despite extensive studies, how environmental factors affect the first menstrual period is largely unclear.