Factors that Affect Mental Health in Elementary School Children: Scoping Review

Background: Children's mental health is a condition of harmoniously adapting to themselves, their peers, and their environment. Children can control emotions when playing with their peers and have positive and negative attitudes toward themselves. Children's mental health can affect growth and development in adolescence and adulthood, so it can be instilled early. This study aims to identify the factors influencing mental health in school-age children. Methods: The article search uses articles from the last ten years, from 2013-2022. Search articles using the EBSCO, ProQuest, Google Scholar, and ScienceDirect databases according to the inclusion and exclusion criteria that have been determined. The article identification process uses the PRISMA chart and keywords used to identify relevant studies in this review such as “ cause ” , “ child mental health ” , and “ primary school ” . Results: The results obtained from the search for articles were 41377, with the results of as many as 16 articles that matched the inclusion criteria. The results of the paper show that several factors affect the mental health of elementary school-aged children including peer relationships, bullying, violence by friends, attending physical lessons and exergames, student academies, and support from staff and teachers at school. The conclusion is that the scope of the school can influence the factors that affect mental health and mental health problems of children.


INTRODUCTION
The mental health of school-age children is a condition of a person who can adapt to himself and the surrounding environment in harmony and can face a problem in his life so that individuals can feel happy, peaceful, and happy (Fakhriyani, 2019), (Rozali et al., 2020). The mental health of school-age children is marked by the condition of children being able to think clearly, adapt to their peers and be able to control emotions while playing (Hasanah, 2016), (Saskara & Ulio, 2020). Mental health problems for school-age children are currently quite maximal. The National Institute of Mental Health (NIMH) states that the number of mental health problems in children is around 10-15% in the world (Subekti et al., 2020). WHO reports the prevalence of poor health in children under 15 years of age experiencing depression (WHO, 2017). In Indonesia, the number of children with mental disorders at the national level cannot be found, but with the existence of a government program that becomes the Minimum Service Standard (SPM) in the health screening conducted by the health office on students who have just entered school each year, namely in 2016 increased from the previous year, as much as 11.5% in 2015 and increased to 20.4% in 2016 (Prihatiningsih & Wijayanti, 2019). The number of basic education children in recent years will increase, in 2000 the number of students reached around 657 million. In 2019 the number of students reached 793 Million, but the highest number reached 742 Million in 2017 (UNESCO, 2021). In Indonesia, the number of school-age children ranks second, after toddlers with a total of 23.3 million people, and it can be predicted that this will increase by 2020 to 24 million people (Kusumawardani et al., 2020(Kusumawardani et al., ), (kemendikbud, 2021. Mental health problems for children aged 6-12 years can have an impact at school. The impact of mental health disorders on school-age children at school consists of social, physical, and psychological. The physical impact that occurs is that children are at risk of fighting with their peers which will cause physical disturbances (Oktaviani et al, 2018). The social impact in children's schools is mental health disorders where children cannot socialize with their peers, want to change schools, cry, and often play truant. The psychosocial impact at school is that children experience anxiety, feel afraid, cannot complete assigned tasks, deteriorate learning achievement, and decrease concentration (Setiawati Yunias, 2017), (Hasanah, 2016). Several factors that are important in the mental health of school-age children include family relationships, bullying, involvement with the school, and feelings about appearance (The Children's Society, 2018). Based on the important factors for students' mental health in school, the researcher focused on how school, schoolwork, teacher interaction, and student interaction are related to social-emotional health in elementary school students. A good school can provide support, security, to be active, as well as opportunities for social and emotional development (Wood & Foundation, 2018). The psychosocial development stage of school-age children is industry vs inferiority, at this stage, the child can produce work, interact with the surrounding environment and excel in learning. The development of normal school children can complete the given task, has a sense of competition, likes to be in groups with their peers, and plays a role in group activities (Livana & Anggraeni, 2018). The biological strength of the individual as well as the psychological and sociological forces can lead a person to the developmental tasks that must be carried out to become a successful individual. The developmental phase of elementary school children can be seen from several aspects of individual personality in children, including physical motoric, language, emotional, and social children (Lestari Puji, 2020), (Murni et al., 2019). The purpose of this study was to determine the factors that affect the mental health of elementary school children.

METHOD
The steps used in this scoping review are identifying research questions, determining keywords, determining inclusion and exclusion criteria, searching for articles using several databases, selecting studies, mapping data, collecting, and then summarizing the findings. Formulation of research questions using pico. The research question was developed using PICO. What are the factors that influence mental health in elementary school children?
The mental health of school children.
The keywords used are Boolean ("AND") such as "causes", AND "child mental health", AND "elementary school". Inclusion criteria literature of the last 10 years (2013-2022), research and original articles, open access and open archive, English, free full text, and elementary school. Exclusion criteria blogspot, opinion/discussion, dissertation, paid articles, inappropriate articles, Indonesian, and review articles. Strategy Search using predefined keywords, search articles using EBSCO, ProQuest, Google Scholar, and ScienceDirect. Search results for 5 articles on EBSCO, 3 on Google Scholar, 7 on ProQuest, and 1 on ScienceDirect. Searching for articles in the database uses the Boolean "AND" to make it easier to search and focus on the research question. Study selection process, an article searches across four databases found many articles. Inclusion and exclusion criteria help to select and filter the reports found. The inclusion criteria consisted of articles with a full text published from 2013 to 2022. The articles taken were articles that discussed factors that could affect the mental health of elementary school children. The exclusion criteria for the articles sought are reports, dissertations, and also inaccessible theses, manuscripts, and articles that have been reviewed. In addition, articles that do not discuss factors that affect children's mental health in primary schools, as well as articles published before 2013.  The results obtained indicate that maternal adolescent pregnancy, absence of a biological father, mental pathology in relatives, psychosocial dysfunction, and negative teacher perceptions of academic performance and student behavior predict the emergence of SM after three years in the school system.

DISCUSSION
Elementary school age is called the intellectual period or the period of school harmony in achieving industrial development where this stage is also a stage of growth and development tasks that are expected to be able to get things done productively in stages, but if this stage is not reached, inferiority (low self-esteem) will occur (Potter Patricia A., 2013). School-age children are a period for the formation of self-concept in children, moral, social, and emotional formation so that if the child's growth and development are not achieved, the child's emotions cannot be controlled. Psychosocial growth and development of children, namely being able to complete the tasks that have been given, have a sense of competition and enjoy being in groups with peers. Psychosocial growth and development are not appropriate, namely, the child will withdraw, likes to disturb his friends, cannot concentrate, and is easily offended (Khasanah et al., 2019), (Malfasari et al., 2020). The process of psychological growth and development of children affects the mental health of children in the future. Several factors that are important in the mental health of school-age children include family relationships, bullying, involvement with the school, and feelings about appearance (The Children's Society, 2018).

Academic
Elementary school children are children aged 6 to 12 years who enter the elementary school education level. Elementary school children often experience many developments including social and emotional, this development can be influenced by friends and the school environment (Pluit & Raya, 2022). Children with behavioral and emotional problems will experience low learning motivation and children will be lazy to engage in school activities, as well as children often miss school and low academic achievement (Zendarski et al., 2019) high academic stress when students prepare and take exams, rank competitions classes, and mastering a large number of syllabuses in a relatively small amount of time". Recognizing that academic stress is a stressor that occurs for various reasons such as too many assignments, competition with other students, failure, and poor relationships with other students or teachers (Worley & Subramani, 2017). ] Student academic stress and parental stress and psychiatric problems are positively correlated in the context of India. Examination-related anxiety has a significant positive relationship with psychiatric problems among students. It is emphasized by this study that academic stress is a serious problem (Deb et al., 2015). good for school children will make children's academics improve t (Ana et al., 2015).

Bullying
Bullying in schools is a problem that affects children all over the world. School is part of a microsystem for children after home which has an important role in their social and emotional development. Children's experiences at school can interfere with the learning process and future life (Husky et al., 2020). Bullying is an act of verbal violence that can make others feel hurt or uncomfortable (Sukmawati et al., 2021). Bullying can affect the future of children who are victims, of either physical violence or verbal abuse (Eriksen et al., 2014). The impact of bullying on school children is that children feel lonely, have difficulty adjusting, feel insecure, have low selfesteem, depression, and most children will commit suicide (Aulia, 2016). Bullying in children also affects the academic value of elementary school children, often bullying will cause the child's academic value not to concentrate on lessons at school (Oliveira et al., 2018). Children who change schools will be faced with new social challenges and have to renegotiate their social identity; with these conditions the period of bullying occurs (Williford et al., 2016). School children who often change schools are often called out by their friends because of language barriers, economic factors, and not being accepted by school staff (Shea et al., 2016). School children who experience physical violence and bullying experience mental health problems, and support from the school is important to know the occurrence of violence and bullying (Thumann et al., 2016).

Teachers and Staff at School
An effective classroom is determined by the presence of supportive teacher-student interactions (instructional, emotional, and behavioral) which together create a classroom environment that is conducive to academic and socio-emotional development. Proximal interactions are behavioral and verbal exchanges that communicate warmth and respect (eg, the teacher provides comfort and assistance), positive and clear expectations (eg, the teacher establishes clear rules and reinforcement), and interesting learning opportunities (Cappella et al., 2012). Preventive health services in the education system help detect physical and mental health problems of students and further have an impact on improving students' health and cognitive quality (Lee et al., 2018). Support from the school to improve mental health is by providing information by providing health promotion as prevention of mental health in children. Health promotion is very important as a strategy that changes from an individual mental health treatment to an organizational approach, thus the effectiveness and sustainability of schoolbased health promotion programs can be increased (Karyani, 2016). Schools will form healthy living habits and can improve mental health which consists of having knowledge, attitudes, and skills to improve health. physically, mentally, socially, and environmentally healthy, and the last one has life skills and the ability to fight against bad influences (Bezem et al., 2017).

Peers Relationship
Peer relationship support affects the mental health of school-age children, for children sources of social support other than parents, teachers, peers, and other figures can help children to influence mental health (WHO, 2017), (Marilyn J. Hockenberry, PhD, RN-CS, PNP, FAAN and David Wilson, MS, RN, 2015), (Camara et al., 2017). Peer relations are considered very important in children's relationships, this provides an opportunity to get acquainted with social norms. School-age children who have good peer relationships will have positive mental health (Shin et al., 2016). The child's relationship with the environment, especially good peers, is an important factor that can affect a child's academics. Peer relationships have positive and negative factors on academics, positive relationships will make children learn in learning, while in negative terms children do not face and are lazy to learn (Parwata et al., 2019). Social support from peers can increase self-esteem in the school environment and the home environment (Iwahori et al., 2022).

Physical Activity at School
Physical activity or physical education in schools has the potential to improve the social and emotional well-being of schoolchildren. Physical activity and sports have a positive effect on mood and anxiety. Physical inactivity can also be associated with the development of mental disorders such as anxiety and depression (Kliziene et al., 2021). Children who participate in sports both inside and outside of school show a reduced incidence of metabolic disease later in life, besides that physical activity can make children feel confident, not feel anxious, and are less prone to stress (Cocca et al., 2020). Physical activity in school is very important for the future of elementary school children on physical and mental health, physical activity can improve the self-esteem and mood of children (Andrade et al., 2020b). School children who do not have a healthy lifestyle and do not do physical activity will be at risk of mental health problems (Aoki et al., 2022) Mental health factors in school-age children apart from school environment factors, parenting patterns are also a factor in children's mental health. Parenting can affect children's mental health by providing warmth to children, protection, good communication, and providing good supervision (Sim et al., 2022). Parents with low education will affect children's health, parents don't teach how to deal with stress, can't control bad emotions (Jin et al., 2022). A father's relationship can affect a child's emotional development in the future, a good father and son relationship is a protective factor that prevents children from experiencing depression in academics, careers, and romantic relationships (Fakhrunnisak & Patria, 2022) CONCLUSION The mental health of school-age children can socialize well, can control emotions, and how influence positive thinking, and can handle stress. Mental health problems can also affect elementary school children, which can affect low self-esteem and anxiety. The school environment is a factor that can affect mental health and mental health problems in elementary school children. The school environment is very supportive to improve children's mental health with schoolbased interventions.