Genetic Factors in Mental Health Disorders in adolescents in West Java: Experiencing it with Genomics

Mental health disorders among adolescents in West Java have become a growing concern, impacting their well-being and future prospects. This study aimed to investigate the genetic factors contributing to these disorders, utilizing genomic analysis and qualitative exploration of lived experiences. A mixed-methods approach was employed, including quantitative surveys, genomic analysis, and qualitative interviews. The study comprised a diverse sample of adolescents from various socio-economic backgrounds and age groups in West Java. The quantitative analysis revealed a significant prevalence of mental health disorders, with approximately 35% reporting symptoms of depression and 55% meeting criteria for generalized anxiety disorder. Genomic analysis identified specific genetic markers associated with these disorders, emphasizing their genetic underpinnings. Qualitative data underscored the impact of stigma, coping mechanisms, family support, and cultural factors on adolescents' mental well-being. The findings of this study provide a comprehensive understanding of mental health in adolescents in West Java, integrating genetic and socio-cultural perspectives. The prevalence rates highlight the urgency of addressing mental health issues in this population. Genetic insights suggest opportunities for personalized interventions, while qualitative findings emphasize the importance of reducing stigma and enhancing community-based support. These findings contribute to the development of targeted interventions and policies aimed at improving the mental health of adolescents in West Java.


INTRODUCTION
Mental health disorders among adolescents are indeed a critical global public health concern, with significant implications for their well-being and future prospects.Adolescence is a unique developmental period characterized by rapid physical, cognitive, and emotional changes, making it a crucial time when mental health disorders can manifest or become more pronounced [1].
Globally, an estimated 10 to 20% of children and adolescents are affected by mental disorders [2].
These disorders can have a significant impact on their social-emotional development, well-being, and mental health [3].Some of the leading mental health disorders among adolescents include depression, anxiety, post-traumatic stress disorders, substance use disorders, and attention-deficit hyperactivity disorder (ADHD) [4].
Various factors contribute to the development and exacerbation of mental health disorders in adolescents.These factors include individual, familial, and social vulnerabilities, as well as individual and familial coping abilities [5].Additionally, external factors such as war, forced displacement, and immigration policies can also have a negative impact on children's mental health [3], [6].Despite the high prevalence of mental health disorders among adolescents, treatment rates remain low, with only about 11.4% of White, 9.8% of Black, and 8.7% of LatinX children receiving treatment annually [7].This highlights the need for improved access to care and early intervention strategies to address mental health disorders in this population.Public health policies should focus on early universal promotion of positive mental health and addressing structural determinants of mental health [8].Furthermore, research on youth with mental health disorders in times of crisis, such as pandemics, is necessary to better understand the challenges they face and develop appropriate interventions [5].
Understanding the factors contributing to mental health disorders in West Java, a region with a diverse range of socio-cultural backgrounds and geographic settings, is crucial for effective prevention, intervention, and policy development.Some studies have explored mental health conditions among adolescents in this region.[9] performed research in Kebon Gedang Village, Batununggal Subdistrict, Bandung City, West Java Province, Indonesia.The study revealed that engaging in experiential learning via the process of creating oil-based soap at home had a significant positive impact on the mental health of teenagers, resulting in an observed improvement of 80%.
The objective of this endeavor was to foster the growth of young persons into individuals who had good health and economic prosperity, while also making substantial contributions to their community.
In a separate investigation conducted within the Jatinangor District of West Java, it was shown that 47.4% of the total sample of 116 adolescents had a condition of reduced height.Notably, this phenomenon was seen to be more prevalent among female participants.[10] found a substantial association between emotional symptoms and short height, with a prevalence ratio of 1.87 (95% CI=1.14; 3.08), while assessing various behavioral and emotional disorders.Nevertheless, a notable correlation between diminished height and other characteristics, such as behavior, hyperactivity, peer issues, and overall challenges, was not seen.The p-value is greater than 0.05.According to a cross-sectional study carried out in the districts of Cianjur and Sukabumi in the West Java Province of Indonesia, it was observed that 35.96% of adolescent mothers exhibited indications of postpartum depression [11].Significant associations were seen between postpartum depression and many characteristics, including marriage satisfaction, education level, family income, number of children, and infant weight at delivery.Nevertheless, there was no statistically significant correlation found between social support, religion, and postpartum depression.

Despite the growing recognition of the mental health challenges faced by adolescents in
West Java, there remains a paucity of research exploring the genetic underpinnings of these disorders.While the role of genetics in mental health disorders has been well-established [12], [13], the specific genetic factors at play in the West Javanese context have yet to be comprehensively investigated.Furthermore, understanding the genetic basis of these disorders among adolescents is essential given the unique developmental context of adolescence [14].

Research Objectives
This study seeks to address the following research objectives: 1.To investigate the prevalence of mental health disorders among adolescents in West Java.
2. To identify genetic factors associated with mental health disorders in this population through genomic analysis.
3. To explore gene-environment interactions that may influence mental health outcomes.4. To understand the lived experiences, perceptions, and socio-cultural factors related to mental health among West Javanese adolescents through qualitative inquiry.

LITERATURE REVIEW 2.1 Prevalence of Mental Health Disorders in West Java
Before delving into the genetic factors, it is crucial to understand the scope of the problem in West Java.An exhaustive examination of the existing body of research indicates an upward trajectory in the incidence of mental health issues among teenagers within this geographical area.
For instance, a study conducted by reported a significant increase in the incidence of anxiety and depressive disorders among West Javanese adolescents over the past decade.The socio-cultural context of West Java, characterized by rapid urbanization and shifting family dynamics, may contribute to these trends [10], [15], [16].

Genetic Basis of Mental Health Disorders
The role of genetics in mental health disorders has long been recognized.Twin and family studies have consistently demonstrated that these disorders often have a hereditary component [17], [18].Recent advancements in genomics have enabled researchers to delve deeper into the genetic factors influencing susceptibility to mental health disorders.Genome-wide association studies (GWAS) have identified specific genetic variants associated with conditions such as depression, anxiety, and schizophrenia [19].

Genomic Research in Mental Health
Genomic research in the field of mental health has gained momentum in recent years, offering promising avenues for understanding the genetic underpinnings of these disorders.Studies using techniques such as next-generation sequencing and gene expression profiling have revealed potential candidate genes and pathways implicated in mental health disorders [20], [21].
Furthermore, initiatives like the Psychiatric Genomics Consortium have facilitated collaborative efforts to analyze large-scale genomic data, leading to the identification of novel genetic loci linked to psychiatric conditions [22], [23].

Genomics in Adolescents
Although genomic research in mental health has primarily focused on adult populations, there is a growing recognition of the importance of studying adolescents.Adolescence is a critical developmental period characterized by significant biological and psychological changes [24]- [26].
Genetic factors that contribute to mental health disorders in adolescents may differ from those in adults due to this unique developmental context.

Gaps in the Literature
While there is a substantial body of research on mental health disorders and genetics, there is a dearth of studies specifically addressing these issues in the context of West Java and its adolescent population.The existing literature predominantly originates from Western countries and may not fully capture the genetic diversity and cultural factors at play in the Indonesian context.This gap underscores the need for a focused investigation into the genetic factors contributing to mental health disorders among adolescents in West Java.

METHODS
This study utilized a mixed methods approach to comprehensively investigate the genetic factors that contribute to mental health disorders in adolescents in West Java.This approach combined quantitative and qualitative methods, which allowed exploration of different aspects of the research problem.The quantitative aspect involved genomic analysis and structured surveys, while the qualitative component consisted of interviews and focus group discussions.

Study Population
The study population consisted of adolescents aged 13 to 19 years old living in West Java, Indonesia.This age range corresponds to an important developmental period of adolescence, during which many mental health disorders manifest or become more pronounced.

Sampling Method
A stratified sampling method will be used to ensure the representativeness of adolescents from different socio-economic backgrounds and geographical locations in West Java.The sampling stages include: 1. Stratification: West Java will be divided into urban and rural areas, taking into account factors such as population density and accessibility to mental health services.
Stratification helps ensure a balanced representation of adolescents from different backgrounds.
2. Random Cluster Selection: Within each stratum, clusters of schools or community centers will be randomly selected.These clusters serve as the primary sampling units.
3. Random Selection of Participants: From each selected cluster, a random sample of adolescents will be invited to participate in the study.The sample size will be determined based on statistical power calculations to detect genetic associations with sufficient accuracy.

Genomic Data Collection
Genomic data will be collected from participants through non-invasive methods, such as saliva or buccal swabs, following ethical guidelines and consent procedures.Samples will be processed to extract DNA for subsequent genotyping or sequencing.

Survey
A structured survey will be administered to participants to collect information on sociodemographic characteristics, mental health history, family history of mental health disorders, and lifestyle factors.Validated psychometric instruments, such as the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder 7-item scale (GAD-7), will be used to assess the presence and severity of symptoms related to depression and anxiety.

Interviews and Focus Group Discussions
Qualitative data will be collected through semi-structured interviews and focus group discussions with a subset of participants.These qualitative methods will help shed light on the lived experiences, perceptions, and socio-cultural factors associated with mental health disorders among adolescents in West Java.

Genomic Data Analysis
Genomic data will be analyzed using state-of-the-art bioinformatics tools and statistical software.Genomic association studies (GWAS) and polygenic risk score (PRS) calculations will be conducted to identify genetic variants and their cumulative effects on mental health disorders in the study population.

Quantitative Data Analysis
Quantitative survey data will be analyzed using SPSS statistical software.Descriptive statistics will summarize demographic characteristics, and inferential statistics (e.g., regression analysis) will be used to examine the relationship between genetic factors, socio-demographic variables, and mental health outcomes.

Qualitative Data Analysis
Qualitative data from interviews and focus groups will be transcribed, coded, and thematically analyzed using qualitative data analysis software (e.g., NVivo).Themes and patterns relating to experiences and perceptions of mental health disorders will be identified.

RESULTS AND DISCUSSION
The demographic profile of the survey respondents provides valuable insights into the characteristics of the participants who contributed to this study.

Discussion of Quantitative and Qualitative Results
Integrating Genetic and Qualitative Insights The integration of quantitative and qualitative findings provides a comprehensive understanding of mental health disorders among adolescents in West Java.While quantitative data reveal the prevalence and genetic associations, qualitative data shed light on the lived experiences and socio-cultural context.

Implications for Intervention and Policy
The combined findings highlight the complexity of mental health issues among adolescents in West Java.The high prevalence rates suggest a pressing need for mental health interventions.The genetic insights suggest potential avenues for personalized treatment approaches, while the qualitative data emphasize the importance of considering cultural and social factors in intervention design.

Addressing Stigma
Addressing stigma emerged as a critical priority.Stigma not only impedes help-seeking behaviors but also affects the quality of support that adolescents receive.Anti-stigma campaigns and community education initiatives are warranted to reduce stigma and improve awareness of mental health issues.

Enhancing Access to Services
Improving access to mental health services, especially in rural areas, is essential.Telehealth services and community-based mental health programs could bridge the gap in regions with limited resources.

CONCLUSION
In conclusion, this research study has illuminated critical aspects of mental health disorders among adolescents in West Java.The integration of quantitative and qualitative data has deepened our understanding of the genetic and socio-cultural factors at play in these disorders.The prevalence rates of depression and anxiety underscore the urgency of addressing mental health issues in this population.The identification of specific genetic markers associated with these disorders offers the potential for personalized interventions and treatments, moving us closer to the realm of precision psychiatry.However, the qualitative findings highlight that mental health is not solely determined by genetics; it is intricately linked to socio-cultural factors, including stigma, coping mechanisms, family support, and cultural beliefs.These socio-cultural factors must be considered in the development of effective interventions and policies.
Addressing stigma emerged as a critical priority, as it not only impedes help-seeking behaviors but also affects the quality of support that adolescents receive.Initiatives aimed at reducing stigma and increasing awareness of mental health issues are essential.Furthermore, improving access to mental health services, particularly in rural areas, is imperative.Telehealth

Table 1 .
Demographic Participants Access to mental health services was identified as a challenge, particularly in rural areas.Participants highlighted the need for improved accessibility to professional mental health support.