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ADad 3: The Epidemiology of Anxiety Disorders Among Adolescents in a Rural Community Population in India
Abstract
Despite being the most common mental health concern, there is paucity of literature on the epidemiology of anxiety disorders among the adolescent population in India. This study aimed to estimate the period prevalence of Anxiety Disorders (AD) among 11 to 19 y old adolescents in India.
A representative sample of adolescents (N = 500) from a rural community in Southern India was assessed for the period prevalence of all and specific Anxiety Disorders using Screen for Child Anxiety Related Emotional Disorders (SCARED), and confirmed in a subsequent interview with Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL).
The prevalence for all AD using the international, Indian SCARED cut-offs and DSM-IV-TR criteria was 8.6 % (boys = 2 %; girls = 6.6 %), 25.8 % (boys = 6.6 %; girls = 19.2 %) and 14.4 % (boys = 4.8 %; girls = 9.6 %) respectively. There were significant gender differences in the prevalence for all Anxiety Disorders (χ (2) = 3.61, df = 1; P < 0.05), Separation Anxiety Disorder (χ (2) = 22.27, df = 1; P < 0.001) and Social Anxiety Disorder (χ (2) = 4.29, df = 1; P < 0.03). Significant age difference in the prevalence of Panic Disorder (χ (2) = 10.32; df = 1; P = 0.00) and Generalized Anxiety Disorder (χ (2) = 5.87; df = 1; P = 0.05) was noted.
The prevalence of Anxiety Disorders in South Indian adolescents was higher than found in the western literature. Prevalence of specific AD was age and gender specific. Adolescent and mental health policies must integrate anxiety disorder of public health significance.
... The DASS-42 is a validated questionnaire available in both English and Hindi, containing a specific subset of questions focused on anxiety. The DASS-42 anxiety subscale comprises 14 items, each scored from 0 ("did not apply to me at all") to 3 ("applied to me very much or most of the time"), for a total score range of 0-42; scores are interpreted as normal (0-7), mild (8)(9), moderate (10)(11)(12)(13)(14), severe (15)(16)(17)(18)(19), and extremely severe (≥20), and assess symptoms such as nervousness, worry, and physiological arousal [9]. ...
... The study included 1,500 participants; however, 88 were excluded due to incomplete data, resulting in a final analysis of 1,412 participants. For context, anxiety severity was classified using the DASS-42 anxiety subscale cut-offs: normal (0-7), mild (8)(9), moderate (10)(11)(12)(13)(14), severe (15)(16)(17)(18)(19), and extremely severe (≥20). The mean age of the study participants was 16.46 ± 1.22 years. ...
... The current study aimed to assess the prevalence of anxiety among school-going adolescents and found that 53% of the participants experienced some level of anxiety. This is consistent with other Indian studies, which reported a wide range of anxiety prevalence, from 14% to 57% [11][12][13]. The broad variation across studies may be due to the use of different screening tools, such as the DASS-42, which was used in our study, as well as the timing of data collection. ...
... The DASS-42 is a validated questionnaire available in both English and Hindi, containing a specific subset of questions focused on anxiety. The DASS-42 anxiety subscale comprises 14 items, each scored from 0 ("did not apply to me at all") to 3 ("applied to me very much or most of the time"), for a total score range of 0-42; scores are interpreted as normal (0-7), mild (8)(9), moderate (10)(11)(12)(13)(14), severe (15)(16)(17)(18)(19), and extremely severe (≥20), and assess symptoms such as nervousness, worry, and physiological arousal [9]. ...
... The study included 1,500 participants; however, 88 were excluded due to incomplete data, resulting in a final analysis of 1,412 participants. For context, anxiety severity was classified using the DASS-42 anxiety subscale cut-offs: normal (0-7), mild (8)(9), moderate (10)(11)(12)(13)(14), severe (15)(16)(17)(18)(19), and extremely severe (≥20). The mean age of the study participants was 16.46 ± 1.22 years. ...
... The current study aimed to assess the prevalence of anxiety among school-going adolescents and found that 53% of the participants experienced some level of anxiety. This is consistent with other Indian studies, which reported a wide range of anxiety prevalence, from 14% to 57% [11][12][13]. The broad variation across studies may be due to the use of different screening tools, such as the DASS-42, which was used in our study, as well as the timing of data collection. ...
... The pooled prevalence of anxiety disorders was found to be 26% (95% CI: 16-37%, I 2 = 97.82%). The prevalence of anxiety disorders ranged from 12.4% to 60% across the nine studies 20,22,26,35,50,51,56,67,72 . ...
... Four studies reported the prevalence of the panic disorder, which ranged from 6.6% to 55.2% across the studies 51,56,67,72 . The pooled prevalence of panic disorder could be seen as 20% (95% CI: 6-41%, I 2 = 98.99%). ...
... Four studies reported the prevalence of separation anxiety disorder, which ranged from 2.1% to 74% across the studies 51,56,67,72 . The pooled prevalence of separation anxiety was found to be 18% (95% CI: 1-47%, I 2 = 99.50%). ...
Adolescent mental health problems have been recognised as a major issue in low‑income
countries including India. Through a meta‑analytic approach, the present review delineate the overall prevalence of each of the most discussed mental health problems among rural adolescents in India, comprising depression, anxiety disorders, generalised anxiety disorder, panic disorder, separation anxiety, social anxiety disorder, suicidality, hyperactivity, emotional problems, conduct problems and peer problems. The review also presents the potential determinants of such mental health problems.
Using PRISMA guidelines, a total of thirty‑five studies were finalized from databases such as PubMed, Science Direct, JSTOR, Web of Science, Google Scholar and ProQuest. From the findings, it is observed that male and female adolescents does not differ significantly in the prevalence of most mental health problems. However, social anxiety was found to be more prevalent among females when compared to males. In meta‑regression, factors like tools used (screening tools vs diagnostic interviews), sample size, setting (school‑based vs community‑based), sampling technique and year of publication were
found to influence the prevalence rates of certain mental health problems, reported in the studies.
Major determinants influencing the prevalence of mental health problems in rural adolescents were age, socio‑economic status, academic and family environment. Individual factors such as social media usage, physical activity, and substance use also contribute to mental health problems. As India accounts for one‑fifth of the world’s adolescent population, the findings of this review can have global implications
... The prevalence of anxiety disorders, and specifically separation anxiety disorder, has been studied and evaluated in various studies [6]. This prevalence varies according to the survey method and type of instrument used. ...
... Also, some assays have reported a different prevalence of anxiety disorders among boys and girls, while some studies have reported no difference in the prevalence among the two groups [6,8]. ...
... They reported the overall prevalence of this disorder in boys and girls 6% and 23%, respectively based on international cut-off scores and 1% and 2.8% based on DSM-IV-TR diagnosis of anxiety disorders as assessed with K-SADS-PL, emphasized the similar prevalence of disorder in different age groups of adolescents. [6] The apparent difference between the prevalence of this disorder between the two gender in this study and our study can be due to cultural differences between the two populations under study and its effect on the formulation of a different pattern of disorder distribution between two gender. ...
Separation Anxiety Disorder(SAD) is one of the earliest anxiety disorders. The effect of this disorder on the performance of children and adolescents reveals the need for awareness of the prevalence and comorbidity of this disorder in each region. This study is a cross-sectional analytical study implemented in all provinces of Iran. The instrument used in this study is the Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version(K-SADA-PL) questionnaire. The total number of participants was 29,699. The overall prevalence of SAD was 5.3%. The comorbidity rate of 65.3% was found between SAD and other psychiatric disorders. Specific phobia and oppositional defiant disorder had the highest comorbidity with this disorder in the studied population. The more prevalence of separation anxiety disorder in the age range of 6–9 years old highlights the need for early detection of this disorder and targeting screening programs in childhood and adolescence.
... Assuming the prevalence of anxiety disorders among adolescents as 14.5%, [6] alpha value of 0.05, power of 80%, relative precision of 20%, non-response rate 20%, 679 unmarried adolescents were minimum required within the study. The Health Management Information System (HMIS) maintained at CRHSP, Ballabgarh, has information on all persons residing in the field practice area. ...
... A total cutoff of ≤20 with any of the category positive suggested the presence of one or more of the anxiety disorders. [6] The individual cut-off for subscales used for identifying the type of specific anxiety disorder was as follows: social anxiety disorder (≥8), separation anxiety disorder (≥8), separation anxiety disorder (≥8), generalized anxiety disorder (≥7), panic disorder (≥5), and significant school avoidance (≥3) respectively. The SCARED tool wasadministered to study adolescents by a single investigator who was trained in psychiatry department for 1 month under the supervision of senior psychiatrist. ...
... [12] A study done in Kerala found out prevalence of anxiety disorders using the same tool SCARED as 14.5%; however, this study included a nonrandom sample of adolescents through Anganwadi centers; and thus, the estimate was stated to be biased. [6] Another study done among Tibetan adolescent refugees living in Northern India reported almost similar prevalence of anxiety disorders (21%). [13] A study conducted in Northern China reported much lower prevalence of anxiety disorders (6.1%) among adolescents. ...
Background: Anxiety disorders are the most frequent mental disorders encountered in childhood and adolescent years. The number of
epidemiological studies done in this area within India is limited. Objectives: We determined the prevalence of anxiety disorders among
adolescents in a rural community of Ballabgarh block, district Faridabad, Haryana. Secondarily, we also assessed socio demographic and
other factors associated with anxiety disorders among adolescents. Materials and Methods: This community‑based cross‑sectional study
was conducted among 729 adolescents (10–19 years). Screen for Child Anxiety‑Related Emotional Disorders tool was used for assessing
prevalence and type of anxiety disorders. Sociodemographic and personal factors were included in the logistic regression multivariable model
to establish associations. Adjusted odds ratios (AOR) along with 95% confidence intervals (CI) are computed. Results: The prevalence of
anxiety disorders among adolescents was (22.7%; 95% CI: 19.7–26.0). Girls (27.6%) had higher prevalence than boys (18.3%) (P < 0.01).
Social anxiety disorder (14.3%; 95% CI: 11.7–16.9) was the most common form of anxiety disorder. Female sex (AOR 1.8; 95% CI 1.2–2.6;
P < 0.01), lower‑middle socioeconomic status (AOR 1.96; 95% CI 1.2–3.1; P < 0.01), and presence of stressful event within the past 1‑year
(AOR 2.48; 95% CI: 1.12–5.06; P = 0.01) were found to be associated with the presence of anxiety disorders. Conclusions: Anxiety disorders
are common among adolescents in rural settings of India. Tackling them will require appropriate health systems response. Adequate interventions
should be incorporated at primary care level to address the mental health concerns of adolescents.
... Sample size was calculated based on a study by Nair et al among adolescents in Alappuzha District, Kerala which showed the prevalence of anxiety as 25.8%. 8 Taking 95% level of confidence and a relative precision of 5%, the sample size required for the study was 294. Since sampling method adopted was cluster sampling, a design effect of 2 was applied and the final sample size was 294×2=588~590. ...
... In this study the prevalence of anxiety among adolescents (10-19 years age group) was 21.4% (95% CI is 18. 8,[13][14][15][16][17][18][19] Female preponderance in anxiety disorders is seen in most studies irrespective of the geographic settings and the tools used. This may be due to difference in brain chemistry or frequent hormone fluctuations to which the women are exposed. ...
Background: Adolescents (10 -19 years) constitute 1.3 billion in the world today. According to WHO mental health issues constitute 13% of the global burden of disease in adolescents of which anxiety disorders are the most common. Objective was to estimate the prevalence of anxiety disorders among adolescents using SCARED tool, to find the association of selected factors with anxiety disorders. Methods: A cross sectional study was conducted among 590 adolescents in Arpookara Panchayat. A semi-structured pretested questionnaire was used for collecting sociodemographic details. Anxiety disorder was assessed using Screen for Child Anxiety Related Emotional Disorder (SCARED) tool. Data was coded and entered in Microsoft excel and analysed using IBM SPSS software version 20 Results: The mean age of the study participants was 15.04 with SD ±3.013. Prevalence of anxiety disorders using SCARED tool was found to be 21.4%. Factors found to have statistically significant association with anxiety on univariate analysis were female gender (p=0.001), mother’s education more than high school level (p=0.036), time spent with father (p=0.001), time spent with mother(p=0.001), inadequate sleep (p=0.001) and family history of mental illness(p=0.043). On binary logistic regression following factors with p<0.05 were found to be independent predictors of anxiety-female gender (OR=2.037), mother’s education more than high school level (OR=1.469) adequate time spent with father (OR=0.713), inadequate sleep (OR=14.726), family history of mental illness (OR=3.521) Conclusions: More than one fifth of adolescents are having anxiety disorders. There should be efforts for early diagnosis and prompt treatment of anxiety disorders among adolescents.
... This prevalence rate is higher than the study conducted in Haryana and Uttarpradesh 16,20 Whereas a study conducted in Mumbai slums only 10.8% had overall anxiety symptoms 21 . This can be accounted for the fact that data was elicited using SCAS scale, other study in Uttarpradesh used Revised Children's Manifest Anxiety Scale (RCMAS) 20, A study conducted in Karnataka and Kerala, South India reported to have 54.7% and 14.5% of anxiety disorders among respondents using SCARED tool 5,7 . SCARED tool is a contemporary instrument than others tools like RCMAS and SCAS, diagnoses is precise when comparing with others in adolescents. ...
... In the present study, higher age group, female sex, and higher grades were declared determinants of anxiety disorders using multivariate logistic regression. Many studies associated gender, socio-economic status with anxiety disorders 5,7 . A systematic review by Stirling etal., depicted multifactorial causation to develop anxiety disorder which also included environmental factors 24 Anxiety disorders usually remain undiagnosed in school students, which lead to poor academic performances, school avoiding behavior eventually early school leaving. ...
Background: Anxiety disorders are the most frequent mental disorders encountered in childhood and adolescent years. If left untreated, adolescents with anxiety consequence with poor academic performance, irrational parental relationships, poor vocal adjustments and ultimately to psychiatric illness in adult life. Thus, our study aimed to estimate the prevalence of anxiety disorders among school going adolescents using screen for child anxiety related disorder (SCARED) tool and explore the determinants among adolescents. Methodology: This is a school-based cross-sectional study conducted in suburban region of Tamilnadu among adolescents (15-19 years) in three government schools. Total sample size required was 250, recruited using purposive sampling method. SCARED tool with 5 subscales of anxiety disorder was used to collect data. Frequencies and proportions were used to describe data and multivariate analysis was used to elicit determinants. Results:Out of 250, 79 (31.6%) students were screened positive for anxiety disorders (95% CI: 29.6-37.8). Panic disorder (44.3%) followed by general anxiety disorder (34.1%) were two utmost common type of anxiety. Girls are significantly being affected more [OR:2.24, (1.23-7.89)] compared to boys. Others higher age, higher grades are significant determinants of anxiety disorders using Logistic regression. Conclusion:Anxiety disorders are common among adolescents in suburban regions of India. Appropriate health system response will be required to tackle this immense problem. Screening anxiety disorder among adolescent school going children is the need of the hour.
... We estimate the prevalence of generalized Social Anxiety Disorder to be 7.8%, and that of specific social phobia to be 23.1% in our study population of urban undergraduate students. Previously, an Indian study in a single school established a 12.8% prevalence of SAD in high-school students (Mehtalia and Vankar, 2004), another study in an urban public school estimated a prevalence of 10.3% and also found social phobia more frequent in females (Chhabra et al., 2009); while a study in a rural community found 4.8% adolescents had social phobia (Nair et al., 2013). ...
... The significant prevalence (7.8%) of SAD estimated in our study and in other Indian studies till date (Mehtalia and Vankar, 2004;Chhabra et al., 2009;Nair et al., 2013), informs to the need to generate awareness in the community about this chronic and debilitating illness, enabling patients to seek treatment for the same. Public health policies and programs should recognize SAD as a significant mental health illness in India. ...
Background:
Social Anxiety Disorder (SAD) is a globally prevalent, chronic, debilitating psychiatric disorder affecting youth. With comorbidities including major depression, substance abuse, lower educational and work attainment, and increased suicide risk, it has a significant public health burden. The objective of this study was to estimate the prevalence of SAD in urban Indian undergraduate students and to study their Facebook (FB) usage patterns.
Methods:
In this exploratory cross-sectional study, 316 undergraduate students were screened for social anxiety using validated instruments, Social Interaction Anxiety Scale (SIAS) and Social Phobia Scale (SPS), and divided into two groups based on scores obtained. The groups were then compared with regards to behaviors and attitudes toward Facebook, obtained from a self-report questionnaire.
Results:
SAD was estimated to be a significant, prevalent (7.8%) disorder in otherwise productive youth, and showed female preponderance. Higher specific social phobia scores were associated with the inability to reduce Facebook use, urges toward increasing use, spending more time thinking about Facebook, negative reactions to restricting use, and using it to forget one's problems.
Conclusions:
SAD was estimated to have a prevalence of 7.8% in our study, and was associated with stronger FB usage attitudes and patterns. We recommend that the relationship between social anxiety and Internet use be explored further, to study the possibility of Internet-based screening and intervention strategies having wider reach and appeal in socially anxious individuals.
... Comparably, in India, a meta-analysis of 13 psychiatric epidemiological studies (N=33,572) conducted in urban and rural India across all age groups yielded an estimated prevalence rate of 5.8% for GAD [4]. Similarly, Nair et al [5] found a 6.6% prevalence of GAD among adolescents in India. In Indian universities, in particular, Sahoo and Khess [6] found a 19% prevalence of GAD in 405 young male university students. ...
... These studies suggest that anxiety is a major public health concern, particularly in Indian students. Given that the global average age of onset of GAD is in adolescence and in early adulthood [1,5,7,8], university students are a vulnerable population. ...
Background:
Generalized anxiety disorder (GAD) is one of the most common mental disorders among university students; however, many students go untreated due to treatment costs, stigma concerns, and limited access to trained mental health professionals. These barriers are heightened in universities in India, where there are scant mental health care services and severe stigma surrounding help seeking.
Objective:
To evaluate the feasibility, acceptability, and efficacy of Internet-based, or "online," cognitive behavioral therapy (CBT)-based unguided and guided self-help interventions (using the programs GAD Online and Lantern, respectively) to reduce GAD symptoms in students with clinical and subthreshold GAD and, ultimately, reduce the prevalence and incidence of GAD among the student population.
Methods:
Students will be recruited via 3 colleges in Hyderabad, India, and referred for a campus-wide online screening. Self-report data will be collected entirely online. A total of 300 qualifying students will be randomized in a 1:1:1 ratio to receive GAD Online, Lantern, or to be in a wait-list control condition, stratified by clinical and subthreshold GAD symptomatology. Students will complete a postintervention assessment after 3 months and a follow-up assessment 6 months later, at which point students in the wait-list control condition will receive one of the programs. The primary outcome is GAD symptom severity at 3 months postintervention. Secondary outcomes include GAD caseness at 9 months, other anxiety and depression symptoms, self-efficacy, and functional measures (eg, sleep, social functioning) at 3 and 9 months, respectively. Primary analyses will be differences between each of the intervention groups and the wait-list control group, analyzed on an intention-to-treat (ITT) basis using mixed-design ANOVA.
Results:
The study commenced in February 2015. The sample was recruited over a 3-week period at each college. The trial is expected to end in December 2015.
Conclusions:
This trial will be the first to evaluate the use of Internet-based CBT programs compared with a wait-list control group for the treatment of GAD among students in Indian universities. If effective, these programs have the potential to reduce the mental health care treatment gap by providing readily accessible, private, and cost-effective evidence-based care to students with GAD who do not currently receive the treatment they need.
Trial registration:
ClinicalTrials.gov NCT02410265 http://clinicaltrials.gov/ct2/show/NCT02410265 (Archived by WebCite at http://www.webcitation.org/6ddqH6Rbt).
... [31] Similar findings from earlier studies revealed that the pooled prevalence of anxiety ranged from 23% to 41%. [44] Eastern Uttar Pradesh (15%), [41] Ballabhgarh, Northern India (22.7%), [45] Kerala (25.8%), [46] Union Territory of India (36%), [47] Tiruchirappalli, South India (51%), [48] Mangaluru, south India (54.7%), [27] Maharashtra (60%), [49] Delhi, north India (65.3%), [28] and multicenter study at schools of six India states (66%) [50] are studies that reported higher prevalence of anxiety than (13.70%) in the present study. The prevalence of depression and anxiety across all these studies varies due to various reasons. ...
A BSTRACT
Introduction
According to UNICEF, among adolescents’ mental disorders, depression and anxiety account for 42.9% of cases. As per the National Mental Health Survey (NMHS) (2015-2016) of India; the Prevalence of Depressive Episodes and Recurrent Depressive Disorder and Phobic anxiety disorder among adolescents is 2.6% and 1.3%, respectively. The well-being and development of adolescents are directly related to the quality of their environment and early experiences of life. To understand the current mental health of adolescents the present study was initiated.
Methods
A cross-sectional survey was conducted among 679 students aged 10-19 years at selected schools in South Delhi, India. Initially after the written informed consent procedure, a self-reported questionnaire was administered to collect data on socio-demographic variables and the Patient Health Questionnaire (PHQ-4). Descriptive statistics, Chi-square, univariate, and multivariate logistic regression were used to examine associations between variables under examination with anxiety and depression.
Results
In the present survey, the mean age of study participants was 13.43 years, 386 (56.85%) participants were male. The overall prevalence of depression and anxiety among adolescents was found to be 25.92% and 13.70% respectively. The prevalence of depression was significantly higher among students who do not have sleep satisfaction (35.9% vs. 23.0%, P = 0.001) and among those who experience anxiety (58.1% vs. 20.8%, P = 0.000) than others. Similarly, the prevalence of anxiety was found significantly higher with increasing age (χ2, P = 0.001), increasing education levels (χ2, P = 0.001), sleep quality (χ2, P = 0.009), sleep satisfaction (χ2, P = 0.000), relationship status (χ2, P = 0.032) and depression status (30.7% vs. 7.8%, P = 0.000). Based on Multivariate analyses, higher education level (AOR: 1.53, 95%CI: 1.06–2.20) and anxiety (AOR: 4.88, 95%CI: 3.07–7.76) were associated with depression. Anxiety was associated with increasing age (16–19 years) (AOR: 3.35, 95%CI: 1.59–7.06) and depression (AOR: 5.18, 95%CI: 3.26–8.25).
Conclusion
The present study suggests that the prevalence of depression and anxiety among school-going adolescents is 25.92% and 13.70%, respectively. The most common associated risk factors are increasing education level, sleep satisfaction, and anxiety and depression. The information may contribute to the development of preventive and control strategies for mental health conditions among adolescents for their welfare and well-being.
... 19 The results of a rural community-based study conducted by Nair et al in Kerala were comparable. 20 Another study by Dharmalingam et al in rural Tamil Nadu found the prevalence of anxiety to be 43.5% among school going adolescents. 21 Variations in prevalence estimates may be due to a variety of factors, including cross-cultural variation, utilization of different survey instruments, variations in the age range of adolescents under study, and variations in sampling techniques. ...
Background: Adolescence is a unique phase of human growth, marked by rapid cognitive, psycho-social, and physical development. Despite being a period of resilience, mental illnesses often begin during this stage. This study aimed to determine the prevalence of anxiety disorders among high school students in rural Tamil Nadu. Methodology: A community-based cross-sectional study was conducted in high schools in the rural areas of Chengalpattu district, Tamil Nadu. High school students aged 12 to 15 years of both genders were included using a systematic random sampling method. A total of 234 students were interviewed using the Spence Children’s Anxiety Scale (SCAS-Child) questionnaire to assess anxiety levels. Qualitative variables were described using mean and standard deviation, and ANOVA was applied to explore associations between anxiety and determining factors. Results: Panic/agoraphobia emerged as the most common anxiety disorder. Obsessive-compulsive disorder and social phobia were higher in girls, while panic/agoraphobia, fear of physical injury, general, and separation anxiety were more prevalent in boys. Children with fathers in white-collar jobs showed higher panic/agoraphobia and general anxiety (Mean±SD: 12.13±4.5, p < 0.02), while those from lower socioeconomic classes had more separation anxiety (Mean±SD: 6.86±2.7, p < 0.02). Anxiety disorders were higher among children from joint or three-generation families. Conclusion: There is a significant prevalence of anxiety among adolescents, with clear correlations to sociodemographic factors. Enhancing protective factors and addressing modifiable risks at the school level is crucial to improving adolescent mental health services.
... Three of the studies used the Screen for Child Anxiety Related Disorders (SCARD) tool [10][11][12]. DSM-5 and DSM-5 Text Revision (DSM-5 TR) were used in five studies [13][14][15][16][17]. The Depression, Anxiety and Stress Scale -21 (DASS-21), Westside Test Anxiety Scale, and Test Anxiety inventory were the other tools used in the studies [18][19][20][21] (Table 1). ...
Anxiety is one of the most common mental disorders in the adolescent age group due to both physiological and psychological changes along with substance use in this age group. Generalized anxiety disorder, obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), and social phobia (or social anxiety disorder) constitute anxiety disorders as per the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) criteria. In India, the National Mental Health Survey was conducted to estimate the burden of different mental health disorders, but the adolescent age group was not included in that survey.
A comprehensive search strategy was used to find out articles from PubMed and ProQuest, along with a risk of bias assessment using two components of the Quality in Prognosis Studies (QUIPS) tool.
The 13 articles included in the meta-analysis were divided into two groups depending on sampling strategy and outcome measurement. Due to more than 99% heterogeneity, the random effect model is used to find the pooled estimate. The pooled prevalence of anxiety disorder among adolescents in India is found to be 0.41 (CI: 0.14-0.96) for studies with more than low risk and 0.29 (CI: 0.11-0.46) for studies with low risk. The Begg and Mazumdar rank correlation test revealed no publication bias in the included studies. One study was found to be an outlier using the Baujat test, but pooled estimate and heterogeneity did not change significantly after its removal from analysis. The weight of individual studies calculated using the random effect model did not show any gross difference.
A significant burden of anxiety was found in adolescents in India. Effective intervention should be planned to reduce this burden.
... 7 Results of previous studies indicate that anxiety is a major public health issue, especially in Saudi students. 8,9 Given that the worldwide average age affected with GAD is in young and in early adulthood, [10][11][12] university students are susceptible to develop GAD. Previous studies reported high prevalence of anxiety and depression among university medical students in Saudi Arabia. ...
Background
Various screening tools have been designed and developed to identify individuals with generalized anxiety disorder (GAD). The current study aimed to assess the psychometric validation of the GAD-7 in Saudi university male students.
Methods
Healthy university male students (n= 192) participated in this cross-sectional study. All the participants were informed about the study details. Participants were asked to complete the GAD-7, the Sleep Hygiene Index (SHI), Perceived Stress Scale (PSS), and demographic details.
Results
In general, the range of the GAD total score was 0–21. There was no issue of the ceiling or floor effects as only 12.5% of participants reported the minimum score of 0, and none of the participants reported the maximum score of 21. The internal consistency score of the GAD-7 was found to be good (Cronbach’s alpha = 0.83). The internal homogeneity between item scores was 0.22–0.57 as indicated by the “Spearman correlation coefficient (r)”. The total scores and individual item scores of the GAD-7 were statistically associated with the PSS total score (correlation coefficient r = 0.21–0.37), and scores of the 8th and 13th item of the SHI (correlation coefficient r = 0.17–0.26, and 0.21–0.40, respectively). The exploratory factor and confirmatory factor loadings of the GAD-7 items were ranged from 0.60 to 0.81 and 0.51 to 0.80, respectively.
Conclusion
This study supported the use of the GAD-7 to assess the anxiety level among Saudi university students.
... [3] The anxiety disorders among adolescents study had reported the prevalence of anxiety disorder to be 14.4% (4.8% in boys and 9.6% in girls) as per Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM IV-TR). [4] This study documented the prevalence, pattern, comorbidities, and relationship with depression, associated suicidal phenomenon, and school phobia. [5] The prevalence of anxiety disorder among children in the clinic population at a tertiary care center was reported to be 20%. ...
Background
Anxiety spectrum disorders are the most prevalent psychopathology among children and adolescents. Qualitative research in childhood anxiety disorders can provide valuable insights regarding interventions. The objectives of this study were to examine the child's perspectives on the subjective experience of concerns, the impact of the symptoms on socioacademic functioning, and the process of recovery with interventions.
Methods
Children and adolescents aged 6–16 years, presenting with any subtype of anxiety spectrum disorder as per International Classification of Diseases and Related Health problems, 10th Revision (ICD-10) Diagnostic Criteria for Research, were included. Convenience sampling was used, and 30 children fulfilling inclusion and exclusion criteria were selected. An interview guide with simple questions to facilitate response was used, at the baseline and 12th week of follow-up, to generate a written narrative account of the experience of concerns, the impact of symptoms, and the treatment process. Children received treatment as usual, which included a workbook-based cognitive behavioral intervention.
Results
Content analysis was done using 30 baseline and 20 follow-up narratives. Clustering of themes were done. Themes related to the recovery process reflected perceived improvement in academic performance and competence, apart from the improvement in symptoms. There were more themes in favor of cognitive interventions.
Conclusion
Children's narratives highlight the importance of cognitive interventions for anxiety disorders.
... Epidemiological studies across the world have reported the prevalence of anxiety disorder ranging from 2 to 24% with the median prevalence rate of 8% [3][4][5]. Epidemiological studies from India report a prevalence ranging from 4 to 14.4% [6,7]. ...
Background
Although anxiety disorders are the most prevalent psychiatric disorders among children and adolescents, there is a paucity of research on the course and outcome of anxiety spectrum disorders in low and middle-income countries.
Methods
60 children and adolescents aged 6–16 years with anxiety spectrum disorders attending the child and adolescent psychiatry department in a tertiary care center from India were included after taking written informed consent and assent in this prospective study conducted between April 2012 to May 2014. Assessments were done at baseline, 12 weeks and 24 weeks using pediatric anxiety rating scale, clinical global impression-severity, clinical global assessment scale and pediatric quality of life scale; MINI-KID (version 6.0) was used to examine remission status.
Results
Mean age of children was 12.68 years and mean duration of illness was 34.52 months. Follow-up rate at 24 weeks was 80% with a remission rate of 64.6%. Socio-demographic factors did not affect the baseline severity or course and outcome measures. Children with greater baseline severity and social phobia had a less favorable outcome at 24 weeks. Improvements made in the initial 12 weeks were maintained at 24 weeks follow up. These findings are in line with earlier studies from high-income countries.
Limitations
Small sample size, attrition, rater bias.
Conclusion
The study has shown a favorable outcome in children and adolescents with anxiety spectrum disorders receiving treatment-as-usual in a tertiary care setting. Adolescents who present with greater severity, comorbid with other anxiety disorders and depression at baseline require intensive intervention, and long-term follow up. There is a need for interventional research with specific focus on universal preventive programs for anxiety spectrum disorders that are feasible for delivery in low and middle-income countries.
... [2] The prevalence was higher among females than males in this study which is similar to the findings of the other studies with a range of 9.6-16.5%. [1,4,7] The incidence of social anxiety in the sample of the population of school going children under the age group 14-17 years to be 10.3% by liebowitz social anxiety scale. [4] The age distribution clearly showed that the level of social anxiety was higher in children in their early teens, standing at 11.9% in 14 years old, 17.0% in 15 years, 6.4% in 16 years, and 0% ...
Background: The social phobia or social anxiety disorder (SAD) is likely to play adversely on their adulthood if it is not detected and treated during adolescence period. The problem of SAD is varying in rural and urban population based on multiple issues. Objective: The objective of the study is to estimate the prevalence and determinants of SAD (social phobia) among school children aged 11-16 years in rural population of Ramnagara district, Karnataka. Materials and Methods: A community-based, cross-sectional, and descriptive study was conducted in the six schools in Ramnagara district of Karnataka during the month of August 2016. The pretested, semi-open ended questionnaire was used to interview school children aged between 11 and 16 years in the school premises. Data were collected from each child separately by investigators after taking the consent from the Principal. The information was collected on social phobia inventory (SPIN) scale and sociodemographic factors. The SPIN is a 17-item self-rating scale with minimum score as “0” and maximum
score as “68” and adolescents were categorized as having SAD with cutoff score of more than 20. The data were analyzed in SPSS version 18.0. Results: Out of 446 students, 232 were males and 214 were female adolescents. The prevalence of SAD was 39.7%. The mild, moderate, and severe SAD accounted for 24.1%, 13.9%, and 1.6%, respectively. It was more in the female adolescents (47.7%) and age group of 11-13 years (43.4%). The mean score was 18.23 (±10.7) and it was higher for female adolescents. Number of siblings, family type, active physical activity, sports, yoga, and meditation had influence on the prevalence of SAD on males and females as assessed by odd’s ratio and many factors were found to be statistically not significant. Conclusion: The prevalence of SAD was two out of five adolescents, and one-fourth of the adolescents had
mild grade SAD. The important determinants of SAD were age, type of family, and yoga.
... Depression affects around 350 million people in the world leading to a significant contribution to global burden of disease [1]. The lifetime prevalence of MDD in India is estimated to be 9% [2] and of anxiety disorders to be 14.4% [3]. Anxiety leads to depression and they coexist in nearly half of depressed patients [4]. ...
Aim
This study aimed to examine the efficacy of the Coping Cat program, a CBT intervention, for Indian children (11–13 years) with high anxiety.
Methodology
A total of 240 children were screened, and 120 children with high anxiety were randomly assigned to either a treatment group ( n = 60) or a control group ( n = 60). The Spence Children’s Anxiety Scale (SCAS), Strength and Difficulties Questionnaire (SDQ), and Child Anxiety Impact Scale (CAIS) were used to assess anxiety symptoms and related outcomes. Systematic random sampling was employed to select participants.
Intervention
The therapeutic process consisted of a modified CBT protocol, comprising 16 sessions of 40–45 minutes each. The Coping Cat program was specifically designed to address anxiety symptoms in children.
Data Analysis
A linear mixed-effects model was used to analyze the data, accounting for both fixed effects (e.g., time and intervention) and random effects (e.g., individual differences). This approach was particularly suited for the repeated-measures design. A follow-up study was conducted one year after the intervention to assess its long-term effects.
Results
Significant differences were observed between the treatment and control groups, indicating the efficacy of the Coping Cat program in reducing anxiety symptoms. Notably, treatment gains were maintained at the one-year follow-up. Conclusion: The findings suggest that the Coping Cat program is an effective CBT-based intervention for reducing anxiety symptoms in highly anxious children.
Conclusion
The results indicated the efficacy of Coping Cat CBT in highly anxious young children.
Purpose
Adolescence is a stage where genetic and environmental vulnerabilities can emerge as behavioural and emotional disorders. Early detection and seeking professional help are critical for these groups. This study aims to explore how mental health literacy (MHL) and other demographic variables impact help-seeking behaviour among adolescents in India.
Design/methodology/approach
This quantitative study used a structured questionnaire comprising demographic variables and standardized measurement tools to assess MHL, and help-seeking behaviour among adolescent pupils. Two hundred students aged 14 and above were randomly selected, with informed consent of themselves and their parents, from selected public and private schools in Ernakulam district, Kerala, India.
Findings
The mean age of the sample was 14.5 and 67% belonged to nuclear families with the majority being male (64%). The help-seeking attitude was negatively associated with the ability to recognize disorders among male students and positively associated with attitudes that promote recognition or appropriate help-seeking behaviour among female students. Additionally, hailing from extended families was associated with help-seeking behaviour among adolescent boys, but this relationship was not significant for girls.
Originality/value
The current study has identified that targeted interventions for male adolescents should focus on enhancing disorder recognition and leveraging family support, while those for female adolescents, the programs should promote positive attitudes towards recognizing mental health issues and help-seeking behaviours, integrating families and schools in the process.
Anxiety is a state of psychological, physiological, and behavioral
distress which interferes with normal life. Disorganised lifestyles,
hectic schedules, social and occupational impairment make lives
more prone to these mental problems. Among all these mental
disorders anxiety disorder is the most prevalent one affecting
approximately 10- 30% of the general population. When the
anxiety lasts far beyond the presence of the threat, then this may
impair normal functioning and become an anxiety disorder.
Individuals with anxiety disorders develop cardiovascular,
cerebrovascular, gastrointestinal, and respiratory disorders at a
significantly higher rate than the general population. An anxiety
state is associated with multiple regions of the brain and abnormal
function in several neurotransmitter systems, including
norepnephrine (NE), GABA, dopamine and serotonin. In the
market there are so many of anti-anxiety drugs but all of them
possess many side- effects. Therefore, ayurveda is the alternate for
that. Ayurveda have many medicinal plants and herbs possessing
anti-anxiety activity and the side-effects are nil. We can cerebrate it
as blessing of nature for human kinds. Thus, in this review article
we tried to summarize the plants and herbs evidencing anti-anxiety
activities.
Social anxiety disorder is a prevalent mental health condition that significantly impairs social interactions, academic performance, and professional functioning in children, adolescents, and youth. This study aimed to investigate the global prevalence of social anxiety disorder across these developmental stages. Six electronic databases (PubMed, Scopus, Web of Science, Embase, ScienceDirect and Google Scholar) were systematically searched for studies related to the prevalence of social anxiety disorder in children, adolescents and youth. Random-effects models were employed for data analysis and Comprehensive Meta-Analysis Version 2.0. Heterogeneity was assessed using the I² index. A total of 38 studies were included in the final analysis. The global prevalence of social anxiety disorder was estimated to be 4.7% in children, 8.3% in adolescents, and 17% in youth. These findings suggest a progressive increase in the prevalence of SAD across these developmental stages. Considering the prevalence of social anxiety disorder in this study, policymakers can use the findings of this study to inform and develop effective prevention strategies for individuals and communities most susceptible to this disorder.
Coping Cat‐cognitive behavior therapy (CBT) is a 16‐week program, which has been used widely and has proven its efficacy in helping children in overcoming anxiety disorders. This research study intends to explore its efficacy on Indian school children with high anxiety in Delhi. The study aims at qualitative assessment of the experience of children with anxiety after intervention with Coping Cat‐CBT. After the Coping Cat‐CBT intervention, semistructured interviews were conducted with the children. Participants: Children aged 11–13 years exhibiting the symptoms of high anxiety were enrolled in the study. They were asked to write down their experience after the Coping Cat‐CBT intervention. Data were analyzed using the inductive approach of qualitative content analysis. Participants expressed that the intervention was beneficial in terms of their ability to combat anxiety experienced in day‐to‐day life, and reported improvements in various domains of life such as scholastic performance, interpersonal relationships, and successful use of coping skills in handling fearful situations and relaxation techniques in overcoming anxiety. The data provided empirical evidence that Indian children with anxiety‐related problems could benefit from the therapy. Coping Cat‐CBT was efficacious in reducing their symptoms of anxiety.
Background
Anxiety disorders are common in children and contribute to adverse developmental outcomes. Although etiological models of child anxiety have identified various environmental factors, very few studies in India have examined these factors in children presenting with anxiety disorders. Therefore, the present study was designed to examine parenting styles, parental personality, and child temperament in children with anxiety disorders in an Indian outpatient setting.
Methods
In total, 42 children with anxiety disorders and 42 typically developing children, matched on age and gender, were screened using Child Behavior Checklist, Color Progressive Matrices, and Screen for Child Anxiety Related Emotional Disorders Parent version. Their parents were screened using Mini International Neuropsychiatric Interview 5.0, following which they filled the questionnaires for parenting styles, parent personality, and child temperament.
Results
There were significant differences between the two groups on parenting style, parent personality, and child temperament. Anxiety disorder was positively associated with the father’s permissiveness and negatively with the mother’s authoritativeness and child’s sociability. A combination of parenting styles and child temperament explained 69% of the variances in child anxiety disorders. There were significant associations between parental personality, child temperament, and parenting style. Parent and child characteristics explained 14%–46% of the variances in parenting styles.
Conclusion
Results of this study are generally consistent with Western studies outlining the influence of child temperament and parenting styles on child outcome and have important implications for clinical management of anxiety disorders.
A significant number of adolescents have difficulty in this period of student life and results in anxiety disorders that are mostly undetected and untreated. The lack of data exists in this arena in India. This study aimed to assess anxiety disorders among adolescents studying in urban and rural areas and compared the differences between these two locations.
A cross-sectional, comparative study was carried out among 462 adolescents studying in rural and urban Government schools using stratified cluster random sampling. Data collected on a pre-designed proforma on demographic parameters and used the Screen for Child Anxiety Related Emotional Disorders (SCARED) scale for detecting anxiety disorders.
Out of 462 subjects, females outnumbered males (n = 237, 51.3%). The mean age of the sample was 15.85+/-0.7 (years); 167 (36%) subjects had anxiety disorders. All specific anxiety disorders except ‘school avoidance’ were significantly more in urban school students than in rural students (66.5% vs. 33.5 %). In a binary logistic regression model, gender (female > male), and locality (Urban student > rural student) were significant predictors of the presence of anxiety disorder in this adolescent sample.
Adolescent students from the urban area had a higher prevalence of any anxiety disorder, as well as for sub-types than the students from the rural area.
Background:
Social anxiety disorder (SAD) is a common mental health disorder affecting adolescents often associated with comorbidities like depression, suicide ideation and substance abuse. The objective of this study was to estimate the prevalence of social anxiety in adolescents and to explore its correlation with internet usage.
Methods:
An exploratory cross-sectional study was conducted among 307 undergraduate students to screen for social anxiety and social phobia using a validated instrument, social interaction anxiety scale (SIAS). Young's internet addiction scale was used for measuring internet addiction. Respondents were categorised according to the scores obtained and later compared with their internet addiction behaviours.
Results:
Internet addiction was seen in 93.8% of respondents. The prevalence of SAD was estimated to be 15.3%. Internet addiction was positively correlated with social anxiety score (Pearson correlation = 0.994, P < 0.001).
Conclusion:
More than 90% of participants had internet addiction, the majority had mild-moderate internet addiction. Social anxiety was present in more than one-third of the participants. SAD was found to be associated with internet addiction.
Background: Anxiety disorders are the most frequent mental disorders in children and contribute to the development of secondary complications such as later risks of anxiety disorders, major depression, and other adverse developmental outcomes. However, very few studies in India have examined childhood anxiety disorders.
Aim: This study aimed to understand sociodemographic correlates of childhood anxiety disorders.
Method: A total of 84 children aged 8-12, 42 in the anxiety group, and 42 healthy control group were evaluated. Anxiety group consisted of children who met the DSM-5 diagnostic criteria for anxiety disorders. The Control group consisted of typically growing children matched on age and gender.
Results: The study sample consisted of a large proportion of children coming from a nuclear family, with at least one sibling, parents with graduate education, fathers with skilled jobs, and mothers who were housewives. Anxious children were not characterized by family type, siblings, parental education, or occupation. However, anxious children had a higher proportion of marital discord between parents, parental anxiety, and family history of mental illness. These variables explained 34% of the variance in anxiety disorders. 50% of fathers and 52% of mothers of children with anxiety disorders had anxiety symptoms themselves. Children whose parents had marital discord were 3.4 times more likely to develop anxiety disorders. Children with a family history of
mental illness were 6.8 times more likely to develop anxiety disorders.
Conclusion: The results highlight the importance of screening and addressing dysfunctional relationships between parents and/or parental anxiety when children present with anxiety disorders.
Keywords: Anxiety disorders, Marital discord, Socio-demographic characteristics, Parent anxiety
Background:
Despite global recognition of the significance of adolescents' mental health it remains a neglected area in research and health policy in Pakistan.
Aim:
To examine the rates of depression and anxiety and to assess the level of well-being among Pakistani adolescents.
Methods:
A cross-sectional sample of 1124 adolescents (age 11-18 years) was recruited from schools in Rawalpindi, Pakistan.
Results:
17.2% and 21.4% participants were identified to be probable cases of depression and anxiety, respectively. The mean well-being score of the participants was 65.79 (S.D = 12.84). Girls were more anxious than boys. Depressive symptoms and well-being were significantly associated with age. Poor economic status, lower level of education and more negative life events were significantly associated with higher levels of depression and anxiety symptoms and poor well-being.
Conclusion:
To our knowledge, this is the first school-based observational research exploring the rates of symptoms of depression and anxiety as well as well-being among 11-18 years old in Pakistan. This study concludes that mental health of Pakistani adolescents is an important area of public health concern and provides information for making policy level decisions regarding evaluation, prevention and intervention of mental health problems among adolescents in Pakistan.
Background:
Low and middle income countries (LMICs) not only have the majority of the world's population but also the largest proportion of youth. Poverty, civil conflict and environmental stressors tend to be endemic in these countries and contribute to significant psychiatric morbidity, including depression, anxiety and post-traumatic stress disorder (PTSD). However, mental health data from LMICs is scarce, particularly data on youth. Evaluation of such information is crucial for planning services and reducing the burden of disability. This paper reviews the published data on the prevalence and randomized trials of interventions for depression, anxiety and PTSD in youth in LMICs.
Methods:
PubMed and Google Scholar were searched for articles published in English up to January 2017, using the keywords: Low/middle income country, depression, anxiety, post-traumatic stress disorder, child, youth, adolescent, prevalence, treatment, intervention, and outcomes.
Results:
The few prevalence studies in LMICs reported rates of up to 28% for significant symptoms of depression or anxiety among youth, and up to 87% for symptoms of PTSD among youth exposed to traumatic experienences, though these rates varied widely depending on several factors, including the assessments tools used. Most rigorous interventions employed some form or variation of CBT, with mixed results. Studies using other forms of psychosocial interventions appear to be heterogeneous and less rigorous.
Conclusions:
The mental health burden due to depression and anxiety disorders in youth is substantial in LMICs, with high needs but inadequate services. Youth specific services for early detection and cost-effective interventions are needed.
This article is our life time experience in conceptualizing and systematically developing Child Development Centre (CDC) Kerala in the last 25 years, from a research project to a national training centre in child and adolescent development and premarital counseling. CDC Kerala's major contribution was in creating a 'conceptual framework' of a valid link between childhood disability, low birth weight, adolescent girls' nutrition and fetal onset adult lifestyle diseases. It all started with a randomized controlled trial (RCT) proving beyond doubt that early stimulation is effective in improving the neurodevelopmental status of high risk babies at one and two years and the same cohort was followed-up in detail at 5, 13, 16, 19 and 24 completed years. The process of establishing CDC Kerala is being presented under (i) clinical child development, (ii) adolescent care counseling, (iii) young adults and premarital counseling and (iv) institution building.
Background: In Latin America, there is limited research on the prevalence of mental disorders in children and adolescents. This Chilean survey is the first national representative survey in the Latin American region to examine the prevalence of Diagnostic and Statistical Manual-IV (DSM-IV) psychiatric disorders in the region in children and adolescents.
Methods: Subjects aged 4–18 were selected using a stratified multistage design. The Diagnostic Interview Schedule for Children version IV (DISC-IV) was used to obtain 12-month DSM-IV diagnoses of affective, anxiety, conduct and substance use disorders, and supplemented with questionnaires examining family risk factors, family income, and service utilization. The parent or the primary caretaker was interviewed for children, aged 4–11, using the DISC-IV; however, adolescents, aged 12–18, were directly interviewed.
Results: A sample of 1558 children and adolescents was evaluated. Using the most stringent DISC-IV impairment algorithm, the prevalence rate for any psychiatric disorders was 22.5% (19.3% for boys and 25.8% for girls). The prevalence rate was higher among the children, aged 4–11, in comparison with adolescents, aged 12–18 (27.8% and 16.5%, respectively). Less than half of the subjects in need of services sought some form of assistance. Nearly a quarter of those using services did not present with a psychiatric diagnosis in the past year. Comorbidity was found in 24.8% of those with a disorder, but only 6.3% had three or more diagnoses.
Conclusions: The prevalence of psychiatric disorders in Chile is high among children and adolescents. This study highlights the increasing need to reevaluate mental health services provided to children and adolescents in Latin America.
Gender differences in anxiety were examined in a large sample of adolescents that included 1,079 who had never met criteria for any disorder, 95 who had recovered from an anxiety disorder, and 47 who had a current anxiety disorder. Participants were examined on a wide array of psychosocial measures. There was a preponderance of females among current and recovered anxiety disorder cases, but not among those who had never experienced an anxiety disorder. The female preponderance emerges early in life, and retrospective data indicate that at age 6, females are already twice as likely to have experienced an anxiety disorder than are males. Psychosocial variables that were correlated with both anxiety and gender were identified. Statistically controlling for these variables did not eliminate the gender differences in prevalence or anxiety symptom means.
The present study describes the psychometric properties of the Portuguese version of the Mental Health Inventory-5 for use with young adolescents. A sample of 367 Portuguese students (aged 10-15 years) completed the Portuguese-language versions of Mental Health Inventory-5 (MHI-5; Berwick et al., 1991), Children's Hope Scale (CHS; Snyder et al., 1997), Students' Life Satisfaction Scale (SLSS; Huebner, 1991a), and Global Self-Worth Sub-scale (Harter, 1985). Analysis of readability, reliability (internal consistency and 1-year stability), factor structure, and criterion-related validity suggested that the MHI-5 can be appropriately used in this age group. Implications of the findings are discussed.
Social Anxiety Disorder (SAD) is a chronic, disabling and treatable disorder with common onset in adolescence. Virtually there are no Indian studies on SAD. The study was conducted to find out frequency, demographic and phenomenological characteristics of SAD, family related risk factors, academic impairment and comorbidity of depression among adolescents. 421 adolescents in one high-school were screened for SAD and depression and associated factors with academic impairment. 54 (12.8%) had SAD. The most common manifestation of SAD was avoiding giving speeches. SAD was equally common among both genders, was associated with difficulty in coping with studies, concern about weight, having less friends, lack of intimacy with parents, and being treated differently from siblings. In conclusion, SAD is a common adolescent disorder, with major depression as a comorbidity and associated with impairment in academic functioning. All adolescents especially with depression consulting medical professionals should be interviewed for SAD and treated.
The Great Smoky Mountains Study of youth focuses on the relationship between the development of psychiatric disorder and the need for and use of mental health services.
A multistage, overlapping cohorts design was used, in which 4500 of the 11758 children aged 9, 11, and 13 years in an 11-county area of the southeastern United States were randomly selected for screening for psychiatric symptoms. Children who scored in the top 25% on the screening questionnaire, together with a 1 in 10 random sample of the rest, were recruited for 4 waves of intensive, annual interviews (n = 1015 at wave 1). In a parallel study, all American Indian children aged 9, 11, and 13 years were recruited (N = 323 at wave 1).
The 3-month prevalence (+/-SE) of any DSM-III-R axis I disorder in the main sample, weighted to reflect population prevalence rates, was 20.3% +/- 1.7%. The most common diagnoses were anxiety disorders (5.7% +/- 1.0%), enuresis (5.1% +/- 1.0%), tic disorders (4.2% +/- 0.9%), conduct disorder (3.3% +/- 0.6%), oppositional defiant disorder (2.7% +/- 0.4%), and hyperactivity (1.9% +/- 0.4%).
The prevalence of psychiatric disorder in this rural sample was similar to rates reported in other recent studies. Poverty was the strongest demographic correlate of diagnosis, in both urban and rural children.
The frequency, comorbidity, and psychosocial impairment of anxiety disorders among German adolescents was estimated from a survey of 1,035 students aged 12-17 years. The adolescents were randomly selected from 36 schools in the province of Bremen, Germany. Anxiety disorders and other psychiatric disorders were coded based on criteria from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, using the computerized Munich version of the Composite International Diagnostic Interview. Anxiety disorders occurred frequently in our sample of adolescents, with a rate of 18.6%. When considering the subtypes of anxiety disorders, phobia was the most common. Posttraumatic stress disorder and obsessive-compulsive disorder occurred less frequently with rates below 2%. Panic disorder and generalized anxiety disorder were the least common, with rates well below 1%. Anxiety disorders were significantly higher in girls than in boys, and that the rates increased with age. Comorbidity occurs quite frequently, both within the anxiety disorders and also with other psychiatric disorders. The most common pattern of comorbidity was that of anxiety and depressive disorders. Although a high number of anxiety cases were psychosocially impaired, at least during the worst episode of their disorders, only a few of them sought treatment for their problems. We conclude by discussing some research priorities in the area of anxiety disorders in children and adolescents.
Panic disorder (PD) in children and adolescents is a disabling and chronic condition, which is accompanied by psychosocial and academic difficulties both during adolescence and into adulthood. In this article, the prevalence, clinical characteristics, risk factors, comorbid states, differential diagnosis, and treatment of PD are reviewed. Although PD was thought to be rare in children and adolescents, the prevalence of PD in community samples ranges between 0.5% and 5.0, and in pediatric psychiatric clinics from 0.2% to 10%. Panic attacks are reported to be equally prevalent in males and females. Clinical studies have shown that the majority of the PD pediatric patients receiving consultation in clinics are older adolescents, Caucasian, female, and middle class. Up to 90% of children and adolescents with PD have other anxiety disorders (generalized anxiety disorder/overanxious disorder, separation anxiety disorder, social phobia or agoraphobia), or mood disorders (major depressive disorder or bipolar disorder). PD patients can be misdiagnosed or having neurologic, cardiovascular, pulmonary, or gastrointestinal illness. Psychoeducation and psychosocial treatments are recommended, and it appears that selective serotonin reuptake inhibitors (SSRIs) are a safe and promising treatment for children and adolescents with PD. The clinical characteristics, long-term course, and treatment of PD in children and adolescents needs to be further assessed by well-designed studies.
Background:
The frequently reported decline in the overall frequency and intensity of fears during late childhood and adolescence may mask different developmental patterns for two broad subclasses of fears: fears concerning physical danger and fears concerning social evaluation. It was investigated if physical fears decrease between late childhood and mid-adolescence, while social-evaluative fears increase during this period. It was also studied if changes in both sets of fears are more strongly related to socio-cognitive maturity than to age, which itself is only a proxy measure of maturity.
Methods:
A non-clinical sample of 882 children and adolescents (ages 8-18) was recruited for study. Fears were assessed using the Ollendick Fear Survey Schedule for Children-Revised (FSSC-R). A Principal Components Analysis (PCA) was conducted to study the factor structure of the Failure and Criticism subscale of the FSSC-R. Level of development was assessed using the Sentence Completion Test for Youth (SCT-Y), a measure of socio-cognitive maturity that is based on Loevinger's model, and measure, of ego development.
Results:
The PCA of the Failure and Criticism subscale revealed three factors: Social Evaluation, Achievement Evaluation, and Punishment. As predicted, the significant decrease of overall fearfulness obscured two contradictory developmental patterns: (a) fears of physical danger and punishment decreased with age, whereas (b) fears of social and achievement evaluation increased with age. Hierarchical regression analyses showed that the age effect for social-evaluative fears was explained entirely on the basis of developmental differences in socio-cognitive maturity (controlling for verbal ability). In contrast, age was a better predictor of the decrease of physical and punishment fears (although socio-cognitive maturity still added to the predictive value of age).
Conclusion:
The expression of social evaluation fears during adolescence appears not atypical and might be a corollary of socio-cognitive maturation. At the same time, the natural presence of those fears during adolescence appears to constitute a vulnerability for developing a social anxiety disorder.
Despite its inclusion in DSM-IV, little is known about the prevalence or correlates of adult separation anxiety disorder or its relationship to the childhood disorder. Results of the first epidemiological study of adult separation anxiety disorder, to the authors' knowledge, and its relationship to childhood separation anxiety disorder are presented.
Data were from the National Comorbidity Survey Replication (NCS-R), a nationally representative survey of U.S. households. A fully structured, lay-administered diagnostic interview assessed a wide range of DSM-IV disorders, including separation anxiety disorder. No independent clinical validation was obtained of the assessment.
Lifetime prevalence estimates of childhood and adult separation anxiety disorders were 4.1% and 6.6%, respectively. Approximately one-third of the respondents who were classified as childhood cases (36.1%) had an illness that persisted into adulthood, although the majority classified as adult cases (77.5%) had first onset in adulthood. The assessment of separation anxiety disorder in the NCS-R was comorbid with other NCS-R or DSM-IV disorders and associated with severe role impairment in roughly half of the comorbid cases and one-fourth of the pure cases. The majority of people with estimated adult separation anxiety disorder are untreated, even though many obtain treatment for comorbid conditions.
Criteria for adult separation anxiety disorder should be refined in future editions of DSM because the disorder is likely to be much more common in adults than previously recognized. Research is needed to develop and evaluate treatments that take into consideration its high comorbidity with other DSM-IV disorders.
Gender differences in anxiety were examined in a large sample of adolescents that included 1,079 who had never met criteria for any disorder, 95 who had recovered from an anxiety disorder, and 47 who had a current anxiety disorder. Participants were examined on a wide array of psychosocial measures. There was a preponderance of females among current and recovered anxiety disorder cases, but not among those who had never experienced an anxiety disorder. The female preponderance emerges early in life, and retrospective data indicate that at age 6, females are already twice as likely to have experienced an anxiety disorder than are males. Psychosocial variables that were correlated with both anxiety and gender were identified. Statistically controlling for these variables did not eliminate the gender differences in prevalence or anxiety symptom means. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Screen for Child Anxiety Related Emotional Disorders (SCARED), a measure found useful in different settings and cultures has not been validated in the subcontinent. This study validated this measure for identifying Anxiety Disorder (AD) among adolescents in an Indian community context.
Five hundred adolescents were assessed with SCARED and DSM-IV-TR reference standard for diagnosis of AD. The interviewers were experienced raters who were further trained to interview participants using Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL). Sensitivity, specificity, likelihood ratios and predictive values for various SCARED cut-off scores were calculated. Test-retest reliability and inter-rater reliability of SCARED were examined. The dichotomized SCARED score was correlated with the DSM-IV-TR clinical diagnosis of AD to establish the criterion validity of SCARED as a measure of AD.
A SCARED total score of ≥21(Sn = 84.62 %, Sp = 87.36 %; AUC = 90 %) is suggested for diagnostic use in Indian population. Specific threshold scores were identified for the Panic Disorder, Generalized Anxiety Disorder, Separation Anxiety Disorder and Social Anxiety Disorder subscales. The inter-rater reliability (ICC = 0.87) and test-retest reliability (ICC = 0.90) for SCARED is good. Besides the adequate face and content validity, SCARED demonstrates good internal consistency (Cronbach's α = 0.89) and item-total correlation. There is a high concordance rate with the reference standard, DSM-IV-TR diagnosis [81 %; Cohen's κ = 0.42 (95 % CI = 0.31 to 0.52); P = 0.001] in classifying AD.
SCARED has adequate psychometric properties and is now available for clinical and research work in India.
The Anxiety Disorders among adolescents (ADad) study aimed to document the prevalence, clinical pattern, co-morbidities, predictive factors, relationship with depression, associated suicidal phenomenon and school phobia of Anxiety Disorders in a rural community population in India. This paper reviews the rationale and study design used as well as discusses the strengths and limitations of the survey.
The ADad was a cross-sectional study that recruited 537 adolescents, with anganwadi workers, representative of the population aged 11-19 y. Trained raters independently administered the Screen for Child Anxiety Related Emotional Disorders (SCARED), Beck Depression Inventory (BDI), SAD PERSONS scale and Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL). Appropriate bivariate and multivariate statistical analyses were done.
Five hundred adolescents opted to participate and completed the study. About 37 % of boys and 63.4 % of girls responded to the measures, almost comparable with the gender distribution in the panchayat.
The ADad study creates a comprehensive database on validation of measure, the prevalence, clinical pattern, co-morbidities, predictive factors, relationship with depression, associated outcomes of suicidal phenomenon, school phobia, impairment associated with Anxiety Disorders and policy recommendations in a community population of adolescents in India. These data will enable policy makers to rationally plan clinical services and prevention programs for the target population.
Objective:
To replicate and extend work on the psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED), a child and parent self-report instrument used to screen for children with anxiety disorders.
Method:
The 41-item version of the SCARED was administered to a new sample of 190 outpatient children and adolescents and 166 parents. The internal consistency, discriminant, and convergent validity were assessed. In addition, using discriminant function analysis, a briefer version of the SCARED was developed.
Results:
Using item analyses and factor analyses on the 41-item version, 5 factors were obtained: panic/somatic, generalized anxiety, separation anxiety, social phobia, and school phobia. In general, the total score and each of the 5 factors for both the child and parent SCARED demonstrated good internal consistency and discriminant validity (both between anxiety and depressive and disruptive disorders and within anxiety disorders). A reduced version of the SCARED yielded 5 items and showed similar psychometrics to the full SCARED.
Conclusions:
In a new sample, the authors replicated their initial psychometric findings that the SCARED is a reliable and valid instrument to screen for childhood anxiety disorders in clinical settings. Furthermore, pending future research, the 5-item SCARED appears to be a promising brief screening inventory for anxiety disorders in epidemiological studies.
A recent paper by Nelles and Barlow (1988; Clinical Psychology Review, 8, 359–372) provided the rationale for an investigation of panic attacks in adolescents. A panic attack questionnaire and the Revised Children's Manifest Anxiety Scale were administered to an unselected sample of Australian adolescents. Of 534 adolescents, 42.9% reported having at least one panic attack. Other data are reported on the characteristics of panic attacks, life interference and avoidance behaviour. Panickers reported significantly higher anxiety levels than nonpanickers. Differences between the findings of Australian and American samples were noted and directions for future research were identified. Several methodological issues were also discussed including the reliability and validity of self-report data on panic attacks.
This review summarizes findings on the epidemiology and etiology of anxiety disorders among children and adolescents including separation anxiety disorder, specific phobia, social phobia, agoraphobia, panic disorder, and generalized anxiety disorder, also highlighting critical aspects of diagnosis, assessment, and treatment. Childhood and adolescence is the core risk phase for the development of anxiety symptoms and syndromes, ranging from transient mild symptoms to full-blown anxiety disorders. This article critically reviews epidemiological evidence covering prevalence, incidence, course, and risk factors. The core challenge in this age span is the derivation of developmentally more sensitive assessment methods. Identification of characteristics that could serve as solid predictors for onset, course, and outcome will require prospective designs that assess a wide range of putative vulnerability and risk factors. This type of information is important for improved early recognition and differential diagnosis as well as prevention and treatment in this age span.
Few studies directly compare amygdala function in depressive and anxiety disorders. Data from longitudinal research emphasize the need for such studies in adolescents.
To compare amygdala response to varying attention and emotion conditions among adolescents with major depressive disorder (MDD) or anxiety disorders, relative to adolescents with no psychopathology.
Case-control study.
Government clinical research institute.
Eighty-seven adolescents matched on age, sex, intelligence, and social class: 26 with MDD (14 with and 12 without anxiety disorders), 16 with anxiety disorders but no depression, and 45 without psychopathology.
Blood oxygen level-dependent signal in the amygdala, measured by means of event-related functional magnetic resonance imaging. During imaging, participants viewed facial expressions (neutral, fearful, angry, and happy) while attention was constrained (afraid, hostility, and nose-width ratings) or unconstrained (passive viewing).
Left and right amygdala activation differed as a function of diagnosis, facial expression, and attention condition both when patients with comorbid MDD and anxiety were included and when they were excluded (group x emotion x attention interactions, P < or = .03). Focusing on fearful face-viewing events, patients with anxiety and those with MDD both differed in amygdala responses from healthy participants and from each other during passive viewing. However, both MDD and anxiety groups, relative to healthy participants, exhibited similar signs of amygdala hyperactivation to fearful faces when subjectively experienced fear was rated.
Adolescent MDD and anxiety disorders exhibit common and distinct functional neural correlates during face processing. Attention modulates the degree to which common or distinct amygdala perturbations manifest in these patient groups, relative to healthy peers.
The relatively recent adoption of modern statistical analysis methods, such as latent growth modelling (lgm), makes it possible to study differences in the individual trajectories of development over time.
To examine prospectively the developmental trajectories of anxiety disorder symptoms in a large sample of adolescents (N = 1,318) from the general population over a period of five years.
The adolescents were divided into two cohorts: early adolescents (average age 12 at the first measurement) and middle adolescents (average age 16 at the first measurement). Age and gender differences in the developmental trajectories of adolescent anxiety disorder symptoms over time were examined by means of lgm. results Over the course of five years there was a slight decrease in panic disorder, school anxiety and separation anxiety disorder symptoms for all adolescents, with the exception of social phobia symptoms, which remained fairly stable over time. Adolescent girls showed a slight increase in generalised anxiety disorder symptoms over time, whereas these symptoms decreased among adolescent boys.
The use of individual trajectory-based analyses, enabled us to study advance our understanding of age and gender differences in the development of adolescent anxiety symptoms.
The authors used an epidemiologic approach to investigate rates, symptoms, and behavioral concomitants of anxiety across the child and adolescent age span. They drew 210 children aged 8, 12, and 17 in equal numbers from a community sample and evaluated them with structured diagnostic assessments. They found anxiety to be the most frequently reported type of psychopathology across all three age groups. Although the prevalence of any anxiety symptom remained constant, specific types of anxiety varied with age. Age differences in nonanxiety behavior were found between subjects with and without anxiety, particularly with regard to interpersonal dysfunction.
The prevalence of DSM-III disorders was studied in 943 adolescents aged 15 years from a general population. Prevalence rates of disorder of 25.9% for girls and 18.2% for boys were found. The most prevalent disorders were overanxious disorder, nonaggressive conduct disorder, and simple phobia. Marked differences were noted among the disorders in terms of associated social competence, with multiple disorders and primarily "externalizing" disorders being related to poorer competence. A model of parental confirmation of disorder was developed suggesting that confirmation was more likely where the mother was depressed, the family low in social support, and the adolescent less socially competent.
The one-year prevalence and correlates of selected DSM-III-R disorders were determined in a sample of 930 18-year-olds. Using both diagnostic and impairment criteria 340 individuals (36.6%) were considered to have disorder. The most prevalent disorders were major depressive episode (16.7%), alcohol dependence (10.4%) and social phobia (11.1%). There was a high degree of co-morbidity among disorders; 46% of those with disorder had two or more. The prevalence of disorders was greater for females, with the exception of conduct disorder and alcohol or marijuana dependence. A variety of characteristics were associated with disorder, including poor social competence, disadvantage and self-rated health status. A third of those with disorder had their problems recognised by a "significant-other". The results are presented within the context of a perceived need for research in the area of adolescent and early adult mental health in order to minimise the toll of mental disorder in later life.
To describe the NIMH Diagnostic Interview Schedule for Children (DISC) Version 2.3 and to provide data on its performance characteristics in the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study.
Data were collected on the DISC-2.3 at four sites on 1,285 randomly selected children, aged 9 through 17 years, and their parents. Two hundred forty-seven of these child-parent pairs were reassessed on the DISC-2.3 by a clinician interviewer, 1 to 3 weeks later.
Administration time was approximately 1 hour and the interview was acceptable to more than 90% of subjects. The reliability of questions to parents assessing impairment and age of onset was generally good to acceptable for most diagnoses but was less satisfactory for the child interview. Using information from parent and child, the prevalence for any diagnosis ranged from 50.6 if no impairment criteria were required to 5.4 if a Global Assessment Scale score of 50 or less was necessary. The prevalence of anxiety disorders and enuresis was markedly reduced by requiring attributable impairment.
The DISC-2 is a reliable and economical tool for assessing child psychopathology. Reliability of the DISC-P-2.3 is superior to that of the child DISC for most diagnoses but is least good for anxiety disorders. The 2.3 version of the instrument provides a significant improvement over earlier versions.
This report examines the clinical features and correlates of juvenile panic disorder in referred children and adolescents to test specific hypotheses about its relationship with adult panic disorder.
The sample consisted of consecutively referred children and adolescents (N = 472) comprehensively evaluated with structured diagnostic interviews, cognitive tests, and psychosocial assessments.
Panic disorder was identified in 6% and agoraphobia in 15% of psychiatrically referred children and adolescents. Children meeting criteria for panic disorder also frequently met criteria for agoraphobia. The latter disorder was more prevalent and had an earlier age at onset than panic disorder. Children with panic disorder and those with agoraphobia had similar correlates with frequent comorbidity with other anxiety and mood disorders. A high level of comorbidity with disruptive disorders was also identified.
These results support the hypothesis of continuity between the juvenile and the adult form of panic disorder. However, the high level of comorbidity with disruptive behavior disorders also suggests developmentally specific discontinuities between juveniles and adults with panic disorder.
The Quebec Child Mental Health Survey (QCMHS) was conducted in 1992 on a representative sample of 2400 children and adolescents aged 6 to 14 years from throughout Quebec. Prevalences of nine Axis-I DSM-III-R (American Psychiatric Association, 1987) mental health disorders were calculated based on each informant (for 6-11-year-olds: child, parent, and teacher; for 12-14-year-olds: child and parent). Informant parallelism allows the classification of results of the demographic variables associated with disorders in the logistic regression models. This strategy applies to group variables (correlates of disorders) whereas informant agreement applies to individual diagnoses. Informant parallelism implies that results for two informants or more are in the same direction and significant. In the QCMHS, informant parallelism exists for disruptive disorders, i.e. in two ADHD regression models (child and parent) higher rates among boys and young children, and in three oppositional/conduct disorders regression models (child, parent, and teacher) higher rates among boys. No informant parallelism is observed in the logistic regression models for internalizing disorders, i.e. the patterns of association of demographic variables with anxiety and depressive disorders vary across informants. Urban-rural residence does not emerge as a significant variable in any of the logistic regression models. The overall 6-month prevalences reach 19.9% according to the parent and 15.8% according to the child. The implications of the results for policy makers and clinicians are discussed.
The paper describes prevalence, impairments, patterns of co-morbidity and other correlates of DSM-IV social phobia in adolescents and young adults, separating generalized and non-generalized social phobics.
Data are derived from the baseline investigation of the Early Developmental Stages of Psychopathology Study (EDSP), a prospective longitudinal community study of 3021 subjects, aged 14-24. Diagnoses were based on the DSM-IV algorithms of an expanded version of the Composite International Diagnostic Interview.
Lifetime prevalence of DSM-IV/CIDI social phobia was 9.5% in females and 4.9% in males, with about one-third being classified as generalized social phobics. Twelve-month prevalence was only slightly lower, indicating considerable persistence. Respondents with generalized social phobia reported an earlier age of onset, higher symptom persistence, more co-morbidity, more severe impairments, higher treatment rates and indicated more frequently a parental history of mental disorders than respondents with non-generalized social phobia.
History of DSM-IV social phobia was found to be quite prevalent in 14-24 year-olds. The generalized subtype of social phobia was found to have different correlates and to be considerably more persistent, impairing and co-morbid than non-generalized social phobia. Although generalized social phobics are more likely than non-generalized social phobics to receive mental health treatments, the treatment rate in this sample was low despite the fact that mental health services are free in Germany.
The article reviews the literature on anxiety disorders in children and adolescents. Anxiety disorders represent one of the most common disorders in children and adolescents, with a life-time prevalence of about 10%. In most studies, significantly more females than males met the diagnosis of anxiety disorders. Some factors that have been commonly found to be associated with anxiety disorders include parental psychopathology, familial dysfunction, negative life events, and behavioral inhibition. Anxiety co-occurs frequently with other disorders; it has a chronic course and most of the anxiety cases are psychosocially impaired in various areas of life. The article ends by giving an overview of various types of intervention strategies commonly used to treat children and adolescents with anxiety disorders.
To investigate the possibility of rationalizing the management of sore throat in the doctor's office with the aid of appropriate guidelines.
Part 1 was designed as a retrospective study involving two comparative groups: A1 under the care of general practitioner (GP) A, and B1 under the care of GP B. Part 2 was designed as a randomized prospective study involving two comparative groups and intervention: A2 under the care of GP A with no intervention, and B2 treated by GP B with intervention. The study was conducted in the group practice of the two GPs, located in a middle-sized town. Guidelines for the differential management of sore throat was developed. An overall total of 1010 patients with sore throat were divided into 4 groups, and their epidemiological data, care criteria (throat swabs, antibiotics) and effectiveness criteria (success rate, relapses) evaluated statistically using the Instat Guide program to identify guideline-influenced effects.
No significant differences were to be seen between the three groups receiving routine care. In the guideline-oriented group, however, significant changes were observed (P < 0.01): more frequent identification of viral pharyngitis in comparison with other underlying clinical causes, a decrease in the frequency of throat swabs from 32% to 7%, and a decrease in the use of antibiotics from 51% to 31%, with the success and relapse rates remaining virtually unchanged.
The implementation of the guidelines results in the avoidance of unnecessary diagnostic measures and the overuse of antibiotics, while ensuring high-quality care and a high level of feasibility in the day-to-day work of the doctor's office.
The present study examined psychiatric functioning in a community sample of adolescents aged 14 to 17 years (average age of 15 years). We administered the Diagnostic Interview Schedule for Children-2.25 (DISC-2.25) to 1,201 adolescents and their mothers to obtain prevalence estimates of DSM-III-R disorders and the amount of perceived impairment associated with these disorders. While adolescent females reported a significantly higher prevalence of psychiatric disorders than males (15.5% vs. 8.5%), mothers indicated no sex difference. Compared with adolescent males, females had significantly higher rates of internalizing, anxiety. and depressive disorders. In contrast, the prevalence of externalizing disorders was significantly higher among adolescent males. The inclusion of an impairment criterion had a significant impact in reducing the prevalence rates of overall psychiatric disorders. This reduction occurred mainly through impairment's effects on internalizing disorders, specifically anxiety-based disorders (i.e., simple and social phobia). Given the limited research on the effect of impairment on the prevalence of adolescent psychiatric disorders, future work in this area seems warranted.
This study examined associations between the extent of anxiety disorder in adolescence (14-16 years) and young people's later risks of a range of mental health, educational, and social role outcomes (16-21 years).
Data were gathered over the course of a 21-year longitudinal study of a birth cohort of 1,265 New Zealand children. Measures collected included (1) an assessment of DSM-III-R anxiety disorders between the ages of 14 and 16 years; (2) assessments of mental health, educational achievement, and social functioning between the ages of 16 and 21 years; and (3) measures of potentially confounding social, family, and individual factors.
Significant linear associations were found between the number of anxiety disorders reported in adolescence and later risks of anxiety disorder; major depression; nicotine, alcohol, and illicit drug dependence; suicidal behavior; educational underachievement; and early parenthood. Associations between the extent of adolescent anxiety disorder and later risks of anxiety disorder, depression, illicit drug dependence, and failure to attend university were shown to persist after statistical control for the confounding effects of sociofamilial and individual factors.
Findings suggest that adolescents with anxiety disorders are at an increased risk of subsequent anxiety, depression, illicit drug dependence, and educational underachievement as young adults. Clinical and research implications are considered.
Treatment outcome data for childhood social anxiety are scant. Studies that do exist support the efficacy of both pharmacological and psychotherapeutic interventions. Aside from case reports, studies assessing the efficacy of combined treatment approaches are even more limited. In the current study, we present preliminary findings from a combined psychoeducational and pharmacological treatment program for children and adolescents (ages 8-17 years) with generalized social anxiety disorder. Twelve participants received 12 weeks of citalopram treatment (maximum dose 40 mg/day) and eight brief counseling sessions (15 minutes each). Counseling sessions included education about social anxiety, skills coaching, and behavioral exercises; parents were included in these sessions. Based on clinician global ratings of change, 10 of 12 (83.3%) youths reported improvement: 41.7% (n = 5) of the participants were very much improved, and 41.7% (n = 5) were much improved. Significant changes were also found on self-report ratings of social anxiety, depression, and parents' perceptions of children's social skills during the course of treatment. Findings support the need for double-blind, placebo-controlled studies of combined treatments for youth with generalized social anxiety disorder.
This study investigated the prevalence of nonclinical panic attacks and associated psychopathology in 576 older adolescents. Nonclinical panic attacks are defined as panic occurring in individuals not seeking treatment. In this study, recent panickers (those reporting at least one nonclinical panic attack in the past month) comprised 12.2% of the sample. Nonpanickers and past panickers comprised 71.4 and 16.5% of the sample, respectively. Recent panickers evidenced significantly higher levels of trait anxiety, state anxiety, and depression, with a trend toward higher levels of anxiety sensitivity and internal negative attributions. This group also reported lower life experiences ratings suggesting higher levels of negative life stress. Finally, 46 recent panickers were administered a structured diagnostic interview, and 31 received a clinical diagnosis. The most common diagnoses were generalized anxiety disorder, social phobia, and specific phobia. Comorbidity rates were high in this sample: 24 of the 31 who received a diagnosis were comorbid with at least one other disorder. Implications of these findings for assessment and treatment are discussed.
Parents' concerns typically determine the focus of a primary care visit. This study examined which information is lost if child reports are excluded from screening for anxiety. It also explores the use in primary care of the Screen for Child Anxiety Related Emotional Disorders (SCARED) and the Pediatric Symptom Checklist (PSC-17).
Two hundred thirty-six children (8-12 years 11 months) and their parents completed SCARED and PSC-17 before a primary care visit occurring during discrete periods between June 1999 and March 2001.
Child reports yielded higher SCARED scores than parent reports (mean=18.12, SD=12.14 versus 14.43, SD=10.34, p <.001). Somatic/panic and separation anxiety accounted for 73.8% of the excess score from children's reports. The level of parent-reported symptoms did not vary with demographics. Female gender and younger age predicted greater excess reporting by children. Parent and child scores were moderately to highly correlated (R=0.55 total score; 0.40-0.58 subfactors).
There are discrete anxiety domains in which children's reports are likely to yield more information than that of parents. This phenomenon is almost entirely attributable to variations in the level of symptoms reported by children. Studies are needed to design brief screening procedures that integrate parent and child reports and carry age- and gender-adjusted thresholds.
To estimate the prevalence and severity of anxiety, mood, substance and eating disorders in New Zealand, and associated disability and treatment.
A nationwide face-to-face household survey of residents aged 16 years and over was undertaken between 2003 and 2004. Lay interviewers administered a computerized fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. Oversampling doubled the number of Māori and quadrupled the number of Pacific people. The outcomes reported are demographics, period prevalences, 12 month severity and correlates of disorder, and contact with the health sector, within the past 12 months.
The response rate was 73.3%. There were 12,992 participants (2,595 Māori and 2,236 Pacific people). Period prevalences were as follows: 39.5% had met criteria for a DSM-IV mental disorder at any time in their life before interview, 20.7% had experienced disorder within the past 12 months and 11.6% within the past month. In the past 12 months, 4.7% of the population experienced serious disorder, 9.4% moderate disorder and 6.6% mild disorder. A visit for mental health problems was made to the health-care sector in the past 12 months by 58.0% of those with serious disorder, 36.5% with moderate disorder, 18.5% with mild disorder and 5.7% of those not diagnosed with a disorder. The prevalence of disorder and of serious disorder was higher for younger people and people with less education or lower household income. In contrast, these correlates had little relationship to treatment contact, after adjustment for severity. Compared with the composite Others group, Māori and Pacific people had higher prevalences of disorder, unadjusted for sociodemographic correlates, and were less likely to make treatment contact, in relation to need.
Mental disorder is common in New Zealand. Many people with current disorder are not receiving treatment, even among those with serious disorder.
We present prevalence data for adolescents in a large metropolitan area in the US and the association of DSM-IV diagnoses to functional impairment and selected demographic correlates. We sampled 4175 youths aged 11-17 years from households enrolled in large health maintenance organizations. Data were collected using questionnaires and the Diagnostic Interview Schedule for Children, Version IV (DISC-IV). Impairment was measured using the Child Global Assessment Scale and diagnostic specific impairment in the DISC-IV. 17.1% of the sample met DSM-IV criteria for one or more disorders in the past year; 11% when only DISC impairment was considered and 5.3% only using the CGAS. The most prevalent disorders were anxiety (6.9%), disruptive (6.5%), and substance use (5.3%) disorders. The most prevalent specific disorders were agoraphobia, conduct and marijuana abuse/dependence, then alcohol use and oppositional defiant disorder. Younger youths and females had lower odds for any disorder, as did youths from two parent homes. There was increased odds associated with lower family income. Females had greater odds of mood and anxiety disorders, males of disruptive and substance use disorders. There were greater odds of mood and disruptive disorders for older youths. Prevalences were highly comparable to recent studies using similar methods in diverse non-metropolitan populations. We found associations with age, gender, and to a lesser extent, socioeconomic status reported in previous studies. The inclusion of both diagnosis-specific impairment and global impairment reduced prevalence rates significantly. Our results suggest commonality of prevalences and associated factors in diverse study settings, including urban and rural areas.
Few longitudinal studies of child and adolescent psychopathology have examined the links between specific childhood anxiety disorders and adolescent psychiatric disorder. In this paper we test the predictive specificity of separation anxiety disorder (SAD), overanxious disorder (OAD), generalized anxiety disorder (GAD), and social phobia.
Data come from the Great Smoky Mountains Study (GSMS). A representative population sample of children--ages 9, 11, and 13 years at intake--was followed to age 19. Diagnoses of both childhood (before age 13 years) and adolescent psychiatric disorders (age 13 to 19 years) were available from 906 participants.
Childhood SAD predicted adolescent SAD, whereas OAD was associated with later OAD, panic attacks, depression and conduct disorder (CD). GAD was related only to CD. Social phobia in childhood was associated with adolescent OAD, social phobia, and attention-deficit/hyperactivity disorder (ADHD).
Anxiety disorders in childhood are predictors of a range of psychiatric disorders in adolescence. It appears that children meriting a well-defined diagnosis are missed by the current rules for the diagnosis of GAD. Future studies should examine whether OAD deserves reconsideration as a nosological entity.
ADad 1: Rationale and study design for anxiety disorders among adolescents in a rural community population in India
- Pss Russell
- Mkc Nair
Russell PSS, Nair MKC. ADad 1: Rationale and study design for
anxiety disorders among adolescents in a rural community population in India. Indian J Pediatr. 2013; doi:10.1007/s12098-0131206-5.
The great smoky mountains study of youth. Goals, design, methods, and the prevalence of DSM-III-R disorders
- E J Costello
- A Angold
- B J Burns
- D K Stangl
- D L Tweed
- A Erkanli
- EJ Costello