Influence of Menstrual Health Management on Mental Health of Adolescents in Thrissur District

Abstract

Menarche is a critical developmental milestone for adolescent girls, yet in India, menstruation remains shrouded in silence and stigma. Inadequate menstrual health management (MHM) can transform a normal biological process into a source of anxiety, shame and disruption, potentially affecting mental wellbeing. This study investigates the influence of menstrual health management on the mental health of adolescent girls in Thrissur district, Kerala. A cross-sectional descriptive research design was employed among 660 adolescent girls aged 13–18 years enrolled in secondary and higher secondary schools across Thrissur district. Schools were selected from both urban and rural areas, representing government, private and aided institutions. Data were collected using a structured, validated questionnaire translated into Malayalam, with Cronbach's alpha coefficients ranging from 0.78 to 0.89. Analysis employed descriptive statistics, Chi-square tests, ANOVA, Pearson's correlation and structural equation modeling using SPSS version 26.0. Menstrual problems (97.5%) and health issues (94.0%) were the primary reasons for school absenteeism, with 43.3% reporting irregular attendance. Nearly half (49.3%) of adolescents experienced high mental health impact due to reproductive health concerns, including emotional distress (48.5%), anxiety and stress (45.3%), self-esteem issues (45.2%) and social isolation (42.3%). Significant associations emerged between mental health impact and type of school (χ²=13.286, p<0.05), parent-child communication (χ²=23.303, p<0.01) and age (F=6.826, p<0.01). Path analysis revealed that while mental health impact does not directly influence reproductive health knowledge, attitudes and practices (KAP) (β=-0.009, p=0.875), it strongly predicts social stigma (β=1.344, p<0.001), academic participation (β=0.932, p<0.001) and social participation (β=0.796, p<0.001). Standardized coefficients confirmed the strongest effect on social participation (β=0.817). Correlations revealed that KAP protects against stigma (r=-0.165, p<0.001) and that academic and social participation are closely interconnected (r=0.527, p<0.001). Menstrual health significantly influences adolescent mental health in Thrissur district, with stigma and disrupted participation as critical pathways. Integrated, school-specific interventions combining comprehensive education, accessible counselling, infrastructure improvements, parental engagement and policy support are urgently needed to reduce psychological distress and promote holistic adolescent development.