Self-esteem and other risk factors for depressive symptoms among adolescents in United Arab Emirates

Determinants of adolescents' depression, anxiety, and somatic symptoms in Northwest Ethiopia: A non-recursive structural equation modeling

INTRODUCTION

In low and middle-income countries, adolescent mental health is not only a major public health challenge but also a development concern. Depression and anxiety are the most common mental health disorders and somatic symptoms often co-exist with them. Adolescents with common mental health problems are associated with an increased risk of suicide, future unemployment, and poor quality of life. However, little is known about the mental health of adolescents in Ethiopia. Thus, this study aimed to assess the determinants of depression, anxiety, and somatic symptoms among adolescents in Northwest Ethiopia, in 2022.

METHODS

An institution-based cross-sectional study was conducted from June 8 to 24, 2022. Two-stage stratified random sampling was used to select 1407 adolescents in Northwest Ethiopia. Structured and standardized self-administered questionnaires were used to collect the data. Non-recursive structural equation modeling was employed to assess the direct, indirect, and total effects of predictors. Adjusted regression coefficients and corresponding 95% confidence intervals were used to interpret the strength of the association.

RESULTS

The prevalence of depression, anxiety, and somatic symptoms were 28.21% (95% CI: 25.8, 31%), 25.05% (95%CI: 22.8, 27.5), and 25.24(95% CI: 23, 27.6%) respectively. Alcohol use had a significant positive effect on depression [β = 0.14, 95% CI: 0.073, 0.201], anxiety [β = 0.11, 95% CI: 0.041, 0.188], and somatic symptoms [β = 0.12, 95% CI: 0.062, 0.211]. Stress had a significant positive effect on depression [β = 0.76, 95% CI: 0.642, 0.900], anxiety [β = 1.10, 95% CI: 0.955, 1.264], and somatic symptoms [β = 086, 95% C: 0.700, 1.025]. Depression had a direct positive effect on anxiety [β = 0.74, 95% CI: 0.508, 1.010].

CONCLUSION

In this study, the prevalence of depression, anxiety, and somatic symptoms was moderate. Alcohol use and stress were significantly related to depression, anxiety, and somatic symptoms. The bidirectional relationship between anxiety and depression was significant. Therefore, public health interventions should focus on the bidirectional relationship between depression and anxiety, as well as on identified factors to reduce the burden of mental illness in adolescents.

Development and Validation of the Multidimensional Psychosocial Risk Screen (MPRS): An Approach towards Primary Prevention

Background:

The prevalence of mental health problems in adolescents has been identified as a global concern. Early screening and identification can offer benefits in terms of primary prevention and reduced healthcare costs. This study aimed to develop a tool to assess the risk of developing mental health problems in adolescents.

Methods:

The study followed an exploratory sequential design and was divided into five phases. The Multidimensional Psychosocial Risk Screen (MPRS) is a newly developed self-report measure. The various steps in its development and validation have been elaborated. The MPRS was evaluated with a sample of 934 adolescents aged 12-18, spread across the 8th-12th grade.

Results:

Exploratory and confirmatory factor analyses revealed a robust factor structure. The extracted five factors were named as Parent–Child Relationship (PCR), Self-Concept (SC), Teacher–Student Dynamics (TSD), Social Media Use (SMU), and Peer Interaction (PI). The reliability of the subscales ranged from 0.60 to 0.80. The overall reliability of the scale was good (a = 0.87). Convergent validity of the scale was established using standard measures of risk factors and emotional and behavioural problems.

Conclusions:

The MPRS can be considered an effective tool with an adequate factor structure and good psychometric properties. It can be beneficial in the early detection of vulnerabilities to mental health problems in adolescents and, therefore, seen as a key element in primary prevention and fostering individualized interventions.

Child maltreatment and protection in the Arab Gulf Cooperation Council countries: A scoping review

BACKGROUND

Research on child maltreatment and protection in the Arab Gulf Cooperation Council countries-Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates (UAE)-is limited but growing, as is child protection as a sector.

OBJECTIVES

We aimed to identify themes and gaps in existing research on child maltreatment and protection, identify opportunities for building capacity in research and practice.

PARTICIPANTS AND SETTING

N/A.

METHODS

We conducted a scoping review of empirical studies published in peer-reviewed journals in English and Arabic and reported methods and findings according to the PRISMA-ScR reporting protocol. Articles were coded by country, topic of research, and type of abuse studied, if any.

RESULTS

Our database search returned 6109 articles and 160 articles were included in our review. Themes included (1) prevalence, incidence, and characteristics of maltreatment, (2) outcomes associated with maltreatment, (3) attitudes, awareness, and reporting, (4) accidental injury and death potentially associated with neglect, (5) policy and practice. Eighty-seven articles studied Saudi Arabia, while 28 studied the UAE, 21 Kuwait, 13 Qatar, 12 Oman, and 11 Bahrain. Physical abuse was studied in 77 articles, followed by sexual abuse in 54 articles and emotional abuse in 54.

CONCLUSION

Although the medical community produces an encouraging volume of child maltreatment research, gaps remain. Intervention research is lacking, and further inquiry into family dynamics, culture, and spirituality could inform the development of effective interventions. Cross-sectoral collaboration among education, social work, law enforcement, and healthcare is also needed to safeguard children's rights in the GCC.

Geographic, Socio-Demographic and School Type Variation in Adolescent Wellbeing and Mental Health and Links with Academic Competence in the United Arab Emirates

Interest in adolescents' wellbeing and mental health is growing worldwide, but little research in this area has been conducted in certain world regions and countries such as the United Arab Emirates (UAE). Geographic, socio-demographic and school type differences in adolescent wellbeing and mental health are commonly observed in the field, and the UAE is a diverse country where these types of differences have been found for other outcomes (notably, academic). Yet, no prior national study has explored these differences in terms of wellbeing and mental health in the nation. We address this gap by investigating differences across emirates, gender, socio-economic status, immigrant status, school sector and school curriculum for overall life satisfaction, positive affect, negative affect, meaning and purpose in life, and internalizing difficulties. We use linear regression to analyse cross-sectional data from the Programme for International Student Assessment (PISA) study from 2015 and 2018. We find substantial geographic, socio-demographic and school type differences in levels (2018) of wellbeing and mental health -which vary across distinct domains- and declines (2015-2018) of wellbeing. Better wellbeing and mental health are observed in the northern emirates and among boys. Better wellbeing and poorer mental health are observed among nationals (compared to expatriates) and in public schools (compared to private schools). Despite presenting the best academic outcomes, British schools present the worst wellbeing and mental health outcomes. However, results show the absence of a trade-off between academic competence and wellbeing and mental health, with evidence of a small positive association with wellbeing.

The effects of cyberbullying victimization on depression and suicidal ideation among adolescents and young adults: a three year cohort study from India

BACKGROUND

Cyberbullying victimisation is considered a global public health issue concerning the psychological development of adolescents that oftentimes persists into adulthood. The current study explored the longitudinal relationship between cyberbullying victimisation and depression and suicidal ideation among adolescents and young adults, given the scarcity of such studies in poor-resource settings like India.

METHODS

Data were drawn from the "Understanding the Lives of Adolescents and Young Adults" (UDAYA- 2015-16 and 2018-19) surveys conducted in two most-populated Indian states of Uttar Pradesh and Bihar. Bivariate and logistic regression analysis was conducted to fulfil the objectives of the study using a sample of 4428 and 11,864 adolescent (aged 10-19 years) male and female cohorts, respectively.

RESULTS

The prevalence of cyberbullying victimization increased from 3.8% to 6.4% among female respondents and 1.9% to 5.6% among male respondents over three years. About 33% of females and 16.6% of males had depressive symptoms in their young adulthood. Nearly 7.5% females compared to 2.3% of males, reported that they have seriously considered attempting suicide in the past one year. Adolscents who experienced cyberbullying victimization were 2.07 times more likely to have depressive symptoms comapared to those who did not experience cyberbullying victimization. Similarly, adolescents who experienced cyberbullying victimization were 2.50 times more likely to have suicidal ideation than their counterparts with no experience of cyberbullying victimization.

CONCLUSION

The findings suggest that cyberbullying victims are at higher risk of depressive symptoms and suicidal thoughts and these adverse effects persist for longer period. Therefore, cyberbullying and related mental health problems need to be addressed with more efficient strategies such as increased awareness of nuances of online harassments among adolescent and young adult population.

Hypertension Prevalence, Awareness, and Control Among Parents of School-Aged Children in the United Arab Emirates

BACKGROUND

Increased blood pressure (BP) is a major cardiovascular disease risk factor. The study aimed to determine the prevalence and predictors of hypertension and its awareness and control among parents of school-aged children in the United Arab Emirates (UAE).

METHODS

A total of 605 parents participated in this cross-sectional study. Information on socio-demographics, lifestyle factors, and history of chronic disease were collected through an adapted version of the World Health Organization STEPS questionnaire. Fasting blood glucose samples, BP measurements, body mass index (BMI), and waist and hip circumference were obtained using standard measurement protocols. Prevalence of hypertension was identified in the cohorts by defining hypertension using the 2017 American College of Cardiology (ACC) and the American Heart Association (AHA) guidelines (BP≥130/80 mmHg) and the World Health Organization-International Society of Hypertension Guidelines Orchid (BP≥140/90 mmHg) in association with antihypertensive medication use.

RESULTS

The mean age of participants was 42.9±7.9 years. The prevalence of hypertension was 37.2% (95% CI: 33.5-41.2) and 18.0% (95% CI: 15.2-21.3), using the 2017 and the previous WHO definitions, respectively. Little over half of the sample (51.5%) who were aware of having hypertension reported using antihypertensive medications. Of those reporting the use of antihypertensive medications in the past two days, 13 of 33 patients (39.4%) had their hypertension under control (<140/90 mmHg). The independent correlates of hypertension included age [(adjusted odds ratio (AOR): 1.09 (1.05-1.13], male sex [AOR: 2.48 (1.41-4.34], college or higher education [AOR: 0.22 (0.09-0.56)], family history of hypertension [AOR: 2.03 (1.17-3.53)], obesity [AOR: 3.15 (1.24-7.12)], and moderate or vigorous physical activity [AOR: 0.50 (0.26-0.98)].

CONCLUSION

Hypertension is prevalent among parents of school-going children. Improving lifestyle, health literacy, and introducing innovative models to raise awareness and education about hypertension are essential to achieve sustainable development goals (SDGs).

Depression Among Adolescents in a Rural Area of Haryana, India: A Community-Based Study Using Patient Health Questionnaire-9

Introduction: The estimates of prevalence of depression among adolescents in the Indian community are limited; most studies are institution-based. Early identification and management of depression can provide significant health dividends to the affected adolescents, and better health consequences in their adulthood.

Objectives: To determine the prevalence of depression among 10- to 19-year-old residents in a rural area of Haryana, India, and to assess factors associated with adolescent depression.

Methods: A sample of 630 adolescents (between 10 to 19 years of age) residing in the selected area of Ballabgarh (Haryana) were selected using simple random sampling technique. Home visits were made, in which participants were administered the Patient Health Questionnaire (PHQ)-9 to screen for depression. The prevalence and 95%CI were estimated. In addition, a semi-structured interview schedule was administered to identify sociodemographic variables and other factors associated with adolescent depression. Unadjusted and adjusted OR were reported with p-value, using multivariable logistic regression analysis.

Results: The age-adjusted prevalence of depression among adolescents was 20.6% (95% CI: 16.9-24.2). The prevalence in late and early adolescence was 11.7% and 8.9%, respectively. It was higher in girls (22.3%) as compared with boys (19.2%). Mild depression was the most common type identified. On multivariable logistic regression, depression was associated with birth order of four or more (Adjusted OR (AOR)=3.0 (95%CI: 1.4-6.3), p<0.01), presence of long-standing illness in the past three months (AOR=3.0 (95%CI: 1.4-6.1), p<0.01), impaired self-perceived body image (AOR=2.9 (95%CI: 1.8-4.6), p<0.01), and perceived stressful event(s) in the past six months (AOR=4.9 (95%CI: 2.8-8.6), p<0.01).

Conclusion: One in five adolescents was screened positive for depression, necessitating focus on screening and early identification of depressive symptoms, especially at the primary care level.

Prevalence of diabetes distress and depression and their association with glycemic control in adolescents with type 1 diabetes in Dubai, United Arab Emirates

OBJECTIVE

Diabetes distress and depression have been shown to be prevalent among adolescents with type 1 diabetes and screening for these parameters should be a routine part of diabetes care. To assess the prevalence of diabetes distress and depression and their association with glycemic control in a sample of adolescents with type 1 diabetes attending a diabetes center in Dubai, United Arab Emirates. All adolescents aged 13 to 18 years with type 1 diabetes that were seeking treatment at the Dubai Diabetes Center from the period of September 1, 2018 to May 1, 2019. A total of 72 participants completed the study.

RESEARCH DESIGN AND METHODS

Adolescents were asked to fill in questionnaires assessing diabetes distress and depression. Multivariate linear regression analysis was used to assess the relationships between the subsets of socio-demographic and clinical characteristics, and the scores of the questionnaires.

RESULTS

The mean HbA1c of the study sample was 9.61% [82 mmol/mol] with higher levels found in females as compared with males (p<0.05). Females showed significantly greater levels of distress as compared with males. Although adolescents with HbA1c≥7.5% scored higher for diabetes distress and depression, the difference was not statistically significant to those with an HbA1c of <7.5%. Higher levels of diabetes distress were highly correlated with depressive symptoms, with distress and depression both being significant predictors of one another.

CONCLUSIONS

Our results highlight the importance of implementing and sustaining psycho-educational interventions to aid in alleviating diabetes distress and depression in this subgroup of the population.

Child maltreatment and neglect in the United Arab Emirates and relationship with low self-esteem and symptoms of depression

OBJECTIVES

To our knowledge, this study is the first in the United Arab Emirates (UAE) to investigate the prevalence of child maltreatment in relation to depressive symptoms and self-esteem.

STUDY DESIGN

Exposure to physical maltreatment, emotional abuse and neglect was evaluated in 518 adolescents (86% response rate) randomly selected from schools in Al Ain in the Emirate of Abu Dhabi. The Rosenberg self-esteem scale and the Beck Depression Inventory were used to measure self-esteem and depressive symptoms by using multivariate logistic regression analyses.

RESULTS

The mean age of study participants was 14.3 years. Emotional abuse was the most frequent form of maltreatment (33.9%), physical abuse (12.6%) and neglect (12.1%) followed. Male sex was a positive predictor of physical abuse (OR = 2.12; 95% CI 1.18-3.77), whilst higher maternal level of education was protective (OR = 0.40; 95% CI 0.19-0.86). Daily screen time (OR = 2.77; 95% CI 1.17-6.56) and tobacco smoking (OR = 1.86; 95% CI 1.09-3.18) positively predicted emotional abuse. Emotionally maltreated and neglected participants were less likely to report high level of self-esteem and more likely to report symptoms of depression.

CONCLUSIONS

Child maltreatment in the UAE is of a similar magnitude to what reported in other countries around the world and significantly associated with low self-esteem and depressive symptoms.

Characterizing individuals accessing mental health services in the UAE: a focus on youth living in Dubai

Background

Most mental health issues develop during adolescence, therefore identifying youth mental health needs and pathways to care is critical to improve prevention. To date, studies have typically focused on Western samples, while the impact of cultural diversity on perception of health and illness, and pathways to care, remain poorly understood. To address the shortage of studies conducted in the Arab world, and particularly in the United Arab Emirates (UAE), the present investigation aims to identify the characteristics of youth accessing mental health services in Dubai.

Methods

Data was collected retrospectively from patients’ records at Rashid Hospital Child Psychiatry Service. Information collected included demographics, life stressors, symptoms duration, main diagnosis, and presence/absence of psychotic features in patients’ symptomatology. The relationship between demographic and clinical variables was explored using Chi-square tests and negative binomial regression models.

Results

The sample included 99 treatment-seeking young patients (mean age 15.3; SD = 1.7); 47.5 % were Emirati (UAE national) and 52.5 % were non-Emirati patients. In our treatment-seeking youth sample Depressive disorders represented the most frequent diagnosis, followed by Bipolar and related disorders, Anxiety and stress related disorders, and Schizophrenia and psychotic disorders. Compared to Emirati patients, non-Emirati patients were more likely to report relationships with friends as a source of stress. Female help-seekers, compared to males, were more likely to report stressful relationships with family members, and to receive a diagnosis of Depressive disorders. The duration of symptoms before seeking help was significantly predicted by family stress, gender, self-harm behavior, a symptomatology with psychotic features, and a diagnosis of Anxiety disorders.

Conclusions

The present study contributes to characterizing youth accessing mental health services at Rashid Hospital’s Child Psychiatry service in Dubai. An overall prevalence of poor family functioning among help-seeking youth, and the importance of peer support for expatriate youth were highlighted. Gender differences in perceived stressors, diagnoses and help-seeking behavior suggest the need to promote help-seeking among young boys. While presentation with psychotic features seems to lead to quicker access to medical care, self-harm and anxiety appear to delay help-seeking. The potential implications of our results for promoting youth wellbeing in the region are discussed.

Depression among adolescents in a rural community of north India: A cross-sectional study

Background:

There is a paucity of literature on depression among adolescents in the north Indian community.

Objectives:

The aim of this study was to estimate the prevalence of depression among adolescents residing in a rural community of north India, and to determine associated factors, psychiatric comorbidities, and functional impairment.

Methods:

A simple random sample of 630 adolescents aged 10-19 years was drawn. Participants were enrolled in house-to-house visits, and screened for depression using the nine-item version of Patient Health Questionnaire (PHQ-9). Diagnostic confirmation and assessment of psychiatric comorbidities was done using Mini International Neuropsychiatric Interview for Children and Adolescents (MINI Kid) for 10-17-year-old adolescents, and MINI for 18 year olds. Prevalence was reported with 95% confidence interval. Multivariable logistic regression analysis was done to determine the association of depression with socio-demographic and other factors. Children's Global Assessment Scale (CGAS) was used to assess functional impairment.

Results:

The prevalence of depression was 3.7% (95% CI: 2.3–5.2) (n = 583), comparable in both sexes. Over half the participants with depression had psychiatric comorbidities; the most common were conduct disorder, oppositional defiant disorder, and attention deficit hyperactivity disorder; nearly two-fifth had suicidal ideas/attempt. About two-third of participants with depression had functional impairment. Depression was associated with perceived frequent conflicts at home [adjusted odds ratio (aOR) = 4.0 (95% CI: 1.0-16.0), P = 0.049], and perceived stressful event (s) in past six months [aOR = 7.0 (95% CI: 2.4-20.3), P < 0.01], which were predominantly related to academics.

Conclusion:

Study results indicate the need to strengthen diagnostic and therapeutic/rehabilitative mental health services in adolescent age group. Low-stress lifestyle could be a promising approach to sidestep depressive symptoms.

Suicidal Ideation Among Adolescents-The Role of Sexual Abuse, Depression, and Impulsive Behavior

Suicide is the second leading cause of death among adolescents. With every fifth Indian to be an adolescent, the cost of an adolescent dying by suicide is enormous. This necessitates an understanding of the potential risk factors of suicidal ideation among adolescents. Secondary data analysis is performed on cross-sectional survey data obtained from Understanding the Lives of Adolescents and Young Adults. The survey was conducted in two Indian states of Bihar and Uttar Pradesh. Descriptive statistics, bivariate analysis and logistic regression are done to examine the results. Adolescent girls reported more suicidal ideation than boys. The odds of suicidal ideation are significantly higher among adolescents whose mother faced physical abuse and adolescents who themselves experienced sexual abuse. Adolescent boys and girls who have moderate depressive symptoms and impulsive behavior are significantly more likely to report suicidal ideation. The results help in identifying the adolescents who are at a particular risk for suicidal ideation while planning for intervention program for prevention of suicide.

Trends in the prevalence of twenty health indicators among adolescents in United Arab Emirates: cross-sectional national school surveys from 2005, 2010 and 2016

BACKGROUND

The aim of this study was to assess the trends in the prevalence of various health indicators among adolescents in United Arab Emirates (UAE).

METHODS

Nationally representative data were analysed from 24,220 in-school adolescents (median age = 14 years) that took part in three cross-sectional surveys (2005, 2010 and 2016) of the "UAE Global School-Based Student Health Survey (GSHS)".

RESULTS

Significant improvements were identified among both girls and boys in the reduction of being physically attacked, inadequate fruit intake, inadequate vegetable consumption, loneliness, and among girls only poor oral hygiene (< 2 times tooth brushing/day) and among boys only, experiencing hunger and in physical fight. Significant rises were identified among both girls and boys in the prevalence of bullying victimization, overweight or obesity, leisure-time sedentary behaviour, injury and inconsistent washing hands prior to eating, and among boys only obesity and among girls only inadequate physical activity, and school truancy.

CONCLUSIONS

Several reductions but even more increases of poor health indicators were identified over three cross-sectional surveys during a period of 11 years emphasizing the need for enhanced health promotion activities in this adolescent school population.

Efficacy of a fasting-mimicking diet in functional therapy for depression: A randomised controlled pilot trial

OBJECTIVE

This randomized controlled trial examined the efficacy of adding a fasting-mimicking diet to a structured psychotherapy protocol for treating depression.

DESIGN

Of 20 patients with depression, 10 were randomly assigned to psychotherapy and dieting (i.e., experimental group) and the other 10 to psychotherapy only (i.e., control group). Patients in both groups received 20 individual sessions of functional therapy along with nutrition consultation. Patients in the control group were instructed to maintain their usual daily diets.

RESULTS

Both treatments were effective in reducing depression as well as increasing self-esteem and quality of life. The experimental group showed improved self-esteem and psychological quality of life as well as a reduction in their mean body mass index, in comparison to the control group.

CONCLUSIONS

The study revealed initial evidence of the efficacy of combining psychotherapy with a fasting-mimicking diet to treat depression and its correlates.