Screening for Symptoms of Depression, Anxiety and Stress Among Third-Year Male Secondary School Students in Abha City
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Med. J. Cairo Univ., Vol. 80, No. 2, December: 47-51, 2012
www.medicaljournalofcairouniversity.com
Screening for Symptoms of Depression, Anxiety and Stress Among
Third-Year Male Secondary School Students in Abha City
ABDULLAH A. KHAWAJI, SBFM, CABFM and MOHAMMAD M. MOGBEL, SBFM, ABFM, JBFM
The Department of Family Medicine, Ministry of Health, KAS
Abstract Consequently, progress in the fields of prevention
and management of mental health remained rela-
Objective: To screen for negative emotional states (i.e.,
those related to depression, stress and anxiety) among third- tively slow [1] .
year secondary school male students.
Adolescence constitutes a forgotten age. Its
Subjects and Methods: The Arabic version of the Depres- problems are largely ignored in the noise for atten-
sion, Anxiety and Stress Scale (DASS) was used to screen
413 third-year secondary school male students in Abha City tion to competing societal concerns. Perhaps that
for symptoms of depression, anxiety and stress. is because adolescents enjoy relatively low mor-
tality rates and are so often perceived as troubled
Results: Symptoms of depression were experienced by kids or troublemakers, unlike younger children for
48.4% of students, 47.5% of students had symptoms of anxiety,
while 37% of students had symptoms of stress. Proportions whom it is easy to get a sympathetic hearing [2] .
of students with negative emotional states were significantly A worry to their parents and teachers, teenagers
different according to their age groups, the older the student, are often touchy, obsessed with the approval of
the higher the proportion. Proportions of symptoms for negative their peers, and seemingly indifferent, or even
emotional states were significantly higher among students
with bigger family size. Symptoms of negative emotional
hostile, to the views and values of adults [3] .
states were significantly lower among Saudi students than
non-Saudi students (46.9% vs. 80.9%, p=0.003; 45.8% vs. Adolescents, especially those aged between 14
80.9%, p=0.002; and 35.5% vs. 66.6%, p=0.003, for depression, and 18 years, face an "extremely vulnerable" time
anxiety and stress, respectively).
in the lives of young people. They desperately
Conclusions: Symptoms of negative emotional states are want the acceptance and approval of their friends,
highly prevalent among third-year secondary schools male and they will do dangerous and just plain dumb
students in Abha. These symptoms are significantly higher things to gain that status [4] . Violent behavior and
among older, non-Saudi students and those with bigger family
size. It is important that school health care providers should
emotional problems, such as depression, which
be trained to screen students for negative emotions, in order may be the precursor of a lifelong disability, may
to identify students at high risk, those who need appropriate worsen during this period as well. It may seem
care and those who need to be referred for specialist treatment. odd to think of adolescence as a major public health
School health care providers should teach and help students, issue, but that is exactly the truth [3] .
especially those who have risk factors for negative emotions,
to cope with stressors and adapt to stressful situations.
The mental health of adolescents has received
Key Words: Mental health – Screening – Depression– Anxiety increasing attention over the last two decades [4,5] .
– Stress – DASS – Adolescents.
A question raised by the existing research concerns
Introduction the extent to which the transition to university life
and its attendant pressures contribute to increased
MENTAL well-being has been very well recog- levels of student distress as has been claimed [6] .
nized by the World Health Organization as an
essential dimension of health. However, this com- Epidemiological studies have shown a substan-
ponent of health did not receive its due respect. tial growth in depressive disorders during adoles-
cence [7] . Concern is also raised because of evidence
Correspondence to: Dr. Abdullah A. Khaw aji, The Department of an augmentation in affective disorders in younger
of Family Medicine, Ministry of Health, KAS cohorts and findings indicating that young people
4748 Screening for Symptoms of Depression, Anxiety & Stress Among
who report more distress symptoms or depression The DASS comprises 42 questions whose rating
are at greater risk for psychiatric illness in adult- scale for responses extends from: Did not apply
hood [8] . to me at all (0); Applied to me to some degree, or
some of the time (1); Applied to me to a consider-
Confirmed views on the structure of negative able degree, or a good part of time (2); or Applied
emotion tend to reject the “bipartite model” for to me very much, or most of the time (3). Test-
anxiety and depression and proposed instead a retest reliability is likewise considered adequate
“tripartite model” for the three psychometrically with 0.71 for depression and 0.79 for anxiety.
distinct: Depression, Anxiety and Stress Scales. [11,12] .
Stress can be distinguished from depression and
All students who proved to have symptoms of
anxiety. The Stress scale has been shown to measure negative emotions were referred to the school
a distinct negative emotional state, rather than health physician.
nonspecific symptoms common to both depression
and anxiety. Therefore, there is a converging view Results
of the existence of three separate states [9] .
The age of 62.2% of students was 18-19 years,
Screening of students at high school for their 20.1% aged 20 years or more, while 17.7% aged
mental health status would give a clue on the less than 18 years. The great majority of students
psychological status of this vulnerable group. So, (94.9%) were Saudi. About half of students (50.8%)
this study aimed to screen for negative emotional had a family size of 6-10 members, as shown in
states (i.e., those related to depression, anxiety and Table (1). Table (2) shows that 48.4% of students
stress) among third-year secondary school male experienced symptoms of depression, 47.5% of
students had symptoms of anxiety, while 37% of
students.
students had symptoms of stress. Proportions of
students with negative emotional states were sig-
Material and Methods
nificantly different according to their age groups,
During April 2011, four secondary schools in the older the student, the higher the proportion, as
Abha City, the capital of Aseer Region, in the shown in Table (3). Proportions of symptoms for
southwestern part of Saudi Arabia, were selected, negative emotional states were significantly higher
following a simple random sampling. All third- among students with bigger family size, as shown
in Table (4). Symptoms of negative emotional
year male students (n=413) within the four selected
states were significantly lower among Saudi stu-
schools were included in the present study.
dents than non-Saudi students (46.9% vs. 80.9%,
The inclusion of third-year secondary school p=0.003; 45.8% vs. 80.9%, p=0.002; and 35.5%
vs. 66.6%, p=0.003, for depression, anxiety and
students is based on the fact that the results of
stress, respectively), as shown in Table (5).
secondary school students’ scholastic achievement
at the final year are important determinants for
Table (1): Sociodemographic characteristics of study sample
which college students will be admitted to. More- (n=413).
over, the choice of males only to be screened in
this study is due to the limitations of the strictly Variables No. %
conservative community at the southern part of
Age groups (in years):
Saudi Arabia, which forbid any male to meet orAbdullah A. Khawaji & Mohammad M. Mogbel 49
Table (2): Distribution of prevalence of symptoms of negative Table (3): Distribution of symptoms of negative emotional
emotional states among secondary school students states according to students’ age groups.
(n=413).
Age groups (in years)
Symptoms of negative emotional No. %
Depression: Negative50 Screening for Symptoms of Depression, Anxiety & Stress Among
other mental disorders, most commonly anxiety members suffer more symptoms of depression,
disruptive behavior, or substance abuse disorders anxiety and stress than those who belong to families
[21] . with less family members.
Abdel-Khalek and Al-Damaty [22] noted that This finding is in agreement with that reported
prevalence of anxiety among Saudi students were by Wiersma and Berg [26] , who concluded that the
significantly higher than those for American and family climate decides the psychological state of
Spanish students. Nair et al. [23] explained the high the members. They observed that the higher the
prevalence of negative emotional states among size of a family the more social and psychological
adolescents, by stating that adolescence is a stage problems among family members.
of emotional instability, being the transition period
from childhood to adulthood. Adolescents have Lyness [27] emphasized the role played by the
stress, as they get confusing message, have conflicts family and social environment. He noted that, for
with in family and school and have difficulties in some teens, a negative, stressful, or unhappy family
establishing self-identify and self-esteem. It is a atmosphere can affect their self-esteem and lead
time of increased thinking emotionality and empa- to depression. Social conditions like poverty can
thy. As a result it is also a time for mood swings make it more likely for people to become depressed.
ranging from depression to the height of elation.
The present study showed that symptoms of
Richardson and Katzenellenbogen [24] stated negative emotional states were significantly lower
that sources of psychological stressors are as varied among Saudis than non-Saudis.
as the people experiencing them, including stress
This finding has been explained by Gloster et
of a job or study. Stressors in the work or study
al. [28] , who enumerated several risk factors for
place can not be avoided, but when the number
negative emotional states, e.g., person’s housing
and types experienced exceed the individuals'
and neighborhood (whether the family members
ability to cope with them comfortably, a sort of
live alone or they know and mix with their neigh-
"occupational stress" occurs. Stressors can be either
bors); whether the area is safe; presence of any
negative or positive, creating distress or eustress,
geographic or occupational exposures, travel or
harm or energy in individuals.
residence in other countries.
The present study showed that prevalence rates
Burns et al. [29] stated that as the causes of
of symptoms of negative emotional states were
experiencing negative emotional states are complex,
significantly different according to age of students.
the identification of modifiable risk and protective
Older students suffered significantly higher prev-
factors, and understanding the processes through
alence of depression, anxiety and stress than young-
which they operate is crucial. A protective factor
er students. This finding may be due to the relatively
may affect risk, either directly by operating on the
lower scholastic performance of the older students
antecedent risk factor itself, or indirectly by affect-
than the younger ones as those who sustained
ing the strength of the relationship between the
repeated scholastic failures are usually older than
risk factor and the development of depression,
those who pass their scholastic year from the first
anxiety or stress.
time.
Irons and Gilbert [25] stated that, in general, Conclusions:
phobias, OCD and separation anxiety start early Symptoms of negative emotional states are
in childhood, followed by social phobia and panic highly prevalent among third-year secondary
disorder, which are often diagnosed during the teen schools male students in Abha City. Both symptoms
years. Almost one third of adolescents have some of depression and anxiety affect almost half of
anxiety disorder. Indeed, this may be an underes- students, while about one third of students have
timation, particularly since symptoms experienced symptoms of stress. Symptoms of negative emo-
in adolescence may differ from those in adults. If tional states are significantly higher among older
anxiety among adolescents is diagnosed early, they students, non-Saudi students and those with bigger
possibly could be treated to avoid later anxiety family size.
disorders.
It is important that school health care providers
Results of the present study indicated that should be trained to screen students for negative
prevalence of negative emotional states were sig- emotions, in order to identify students at high risk,
nificantly higher with higher family size, i.e., those who need appropriate care and those who
students that belong to families with more family need to be referred for specialist treatment. SchoolAbdullah A. Khawaji & Mohammad M. Mogbel 51
health care providers should teach and help stu- 14- NEVALA K., LEINONEN E., POKKINEN V., NIEMIN-
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15- SAWYER M.G., KOSKI R.J., GRAETZ B.W., et al.:
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