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ORIGINAL ARTICLE
Year : 2013  |  Volume : 26  |  Issue : 1  |  Page : 44-48

Prevalence of depression, anxiety, and obsessive–compulsive disorders among secondary school students in Menoufia Governorate, Egypt


1 Department of Public Health and Community Medicine, Faculty of Medicine, Menoufiya University, Menoufia Governorate, Egypt
2 Department of Neuro Psychiatry, Faculty of Medicine, Menoufiya University, Menoufia Governorate, Egypt

Date of Submission20-Feb-2013
Date of Acceptance17-Mar-2013
Date of Web Publication26-Jun-2014

Correspondence Address:
Reda A. Ibrahem
MSc, Department of Public Health and Community Medicine, Faulty of Medicine, Menoufia University, Al Awqaf Buildings, Gamal Abdel Nasser Street, Shebin El-Kom City, Menoufia Governorate
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.7123/01.MMJ.0000429483.48445.da

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  Abstract 

Objectives

The aim of this study was to estimate the prevalence of depression, anxiety, and obsessive–compulsive disorders among secondary school students and to assess the comorbidities of these disorders.

Background

Any type of mental illness can have a negative impact on cognitive development and learning and involves a very high cost to both the individual and society. Anxiety and depression can be considered reliable indicators for the assessment of mental illness in a community.

Participants and methods

From a total of 83 635 secondary school students in Menoufia Governorate during the academic year 2010–2011, using a multistage random sampling technique, a sample of 1373 students was selected and surveyed from March 2011 to April 2012 by means of the Beck Depression Inventory, 2nd ed., the Costello–Comrey Anxiety Scale, and the Obsessive–Compulsive Disorder Scale, all of which were answered by the participants. Those with scores higher than the cutoff values were interviewed by a psychiatrist for the final clinical diagnosis on the basis of the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. criteria.

Results

The prevalence of depressive symptoms was 21.5% for mild, 7.1% for moderate, and 0% for severe depression in this study group. The total prevalence of depressive symptoms was 28.6%, and the prevalence of depressive disorders was 11.3%. The prevalence of anxiety symptoms was 41.2% and that for anxiety disorders was 21%. The prevalence of obsessive–compulsive symptoms was 15.8% and that of obsessive–compulsive disorder was 2.7%. Comorbidities of mental disorders were common.

Conclusion

According to these findings, the high rate of mental disorders among adolescents in our community calls for more attention from the family and educational and health institutes. Comorbidities associated with mental disorders are common. In addition, assessment using screening is recommended.

Keywords: anxiety, depression, epidemiology, obsessive–compulsive disorder, secondary school students


How to cite this article:
Al Bahnasy RA, Abdel-Rasoul GM, Mohamed OA, Mohamed NR, Ibrahem RA. Prevalence of depression, anxiety, and obsessive–compulsive disorders among secondary school students in Menoufia Governorate, Egypt. Menoufia Med J 2013;26:44-8

How to cite this URL:
Al Bahnasy RA, Abdel-Rasoul GM, Mohamed OA, Mohamed NR, Ibrahem RA. Prevalence of depression, anxiety, and obsessive–compulsive disorders among secondary school students in Menoufia Governorate, Egypt. Menoufia Med J [serial online] 2013 [cited 2020 Feb 17];26:44-8. Available from: http://www.mmj.eg.net/text.asp?2013/26/1/44/135425


  Introduction Top


Mental health is defined as a state of well-being in which the individual realizes his/her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his/her community 1.

Many mental disorders manifest during childhood or adolescence. The National Health and Nutritional Examination Survey reported that 13% of children aged 8–15 had at least one mental disorder, a rate that is comparable to that of diabetes, asthma, and other diseases of childhood. Yet, mental disorders often go undiagnosed and untreated for years. NIMH’s research focuses on identifying symptoms early and finding effective treatments that can have a significant impact on how children develop and function as they grow 2.

Any type of mental illness can have a negative impact on cognitive development and learning, and involves a very high cost to both the individual and society 3. Depression is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem and loss of interest or pleasure in normally enjoyable activities 4.

Depression is a common disorder among children (<18 years). Approximately 5% of children at any particular time may suffer from serious depression. The incidence of depression increases with age, especially after the onset of puberty 5.

Anxiety is a general term for several disorders that cause nervousness, fear, apprehension, and worry. These disorders affect how we feel and behave and can manifest as physical symptoms. Anxiety disorders are very common in adolescents and are associated with considerable distress and impairment in adaptive functions 6.

Anxiety disorders affect one per eight children. Research has shown that if left untreated, children with anxiety disorders are at higher risk to perform poorly in school, miss out on important social experiences, and engage in substance abuse 7.

Anxiety and depression can be considered reliable indicators for the assessment of mental illness in a community 3.

An obsessive–compulsive disorder (OCD) is one of the most important psychiatric disorders which, as a rare disorder with poor response to treatment, have received much attention up to recent decades. The lifetime prevalence of OCD was estimated to be 2–3% 8.

Although no national epidemiological studies exist on the prevalence of mental disorders in Egypt, some smaller studies provide useful indications 9.

This study aimed to estimate the prevalence of depression, anxiety, and OCDs among secondary school students and to assess the comorbidities of these disorders.


  Participants and methods Top


Sample size calculation

We examined secondary school students in Shebin El Kom district, Menoufia, Egypt from March 2011 through April 2012. There were a total of 83 635 students studying in 17 secondary schools in Menoufia governorate in academic year 2010/2011.

On the basis of previous studies that document the prevalence rate of depression, anxiety and OCD as 7.7%, 25% and 1% respectively, we consider the lowest rate (1%) with 95% confidence interval (CI) for sample size calculation. The calculated sample size was 746 students.

Sampling technique

Using a multistage clustering sampling method, we selected 1373 students for our study as follows.

The first stage:

One district (Shebin El-Kom district) out of 10 ones consisting Menoufia governorate was chosen using simple random sampling technique.

The second stage:

Two out of seven general schools and three out of ten technical schools were chosen randomly.

The third stage:

Four classes were chosen randomly from each grade in the selected schools; hence, the total number of classes was 60, with total number of 2063 students, of whom 1687 were regularly attending school. Of those 1687 students, the response rate was 92.1% (1554 students).

After exclusion of 106 students on the basis of invalid questionnaire and 75 students on the basis of unsatisfactory preliminary tests, the total studied sample became 1373 students (770 students in general schools and 603 students in technical schools) which was approximately double the calculated sample size.

Methods

After attending a short training and explanatory course on the tools to be used, and coordinating with school deans, trained clinical psychologists referred to the predetermined schools and explained the needs for the participants (students), obtained informed consents, and recorded each student’s demographic data including age, gender, socioeconomic class, grade and educational field, as well as type of school (i.e. private or state).

After taking oral consent from each student, the participants were evaluated using the following three scales:

Beck Depression Inventory, 2nd ed.: this is a 21-item self-report instrument intended to assess the existence and severity of symptoms of depression as listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV, 1994). Diagnosis of significant depressive symptoms could be made for a minimum score of 26/63 for mild depression in females and 21/63 for mild depression in males, followed by a score of more than 38/63 for moderate depression in females and more than 33/63 for moderate depression in males and of more than 55/63 for severe depression in females and more than 48/63 for severe depression in males.

Costello–Comrey Anxiety Scale (Arabic version) (anxiety scale A, 2nd ed.): this is a nine-item self-report scale intended to assess the symptoms of anxiety. Diagnosis of significant anxiety symptoms could be made for a minimum score of 45/81.

Obsessive–Compulsive Disorder Scale: this is a 40-item self-report scale intended to assess the different symptoms of OCD, as derived from the following scales: the Yale–Brown Obsessive–Compulsive Scale, the National Institute of Mental Health Obsessive–Compulsive Rating Scale, the Self-Rated Scale for Obsessive–Compulsive Disorders, and the Arabic Scale for Obsessive–Compulsive Disorders. Diagnosis of significant obsessive–compulsive symptoms (OCS) could be made for a minimum score of 100/160.

The DSM-IV (Arabic version): participants with significantly high scores on the above-mentioned scales were subjected to psychiatric evaluation through the Structured Clinical Interview of DSM-IV (SCIDI) to diagnose anxiety, depression, and OCDs according to DSM-IV classification for final diagnosis.

Data processing and statistical analysis

Data were transferred to a personal computer, classified, and analyzed using SPSS (version 11, SPSS Inc., Illinois, Chicago, USA). The χ2-test was used to compare the categorical variables.


  Results Top


[Table 1] shows that 28.6% of participants had significant depressive symptoms, 41.2% had significant anxiety symptoms, and 15.8% had OCS. However, after clinical evaluation of the positive cases by means of the scales, the prevalence rate of different disorders was as follows: 11.3, 21.0, and 2.7% of participants had depression, anxiety, and OCDs, respectively.
Table 1: Prevalence of depression, anxiety, and obsessive–compulsive symptoms and disorders among the studied group using psychiatric scales and Diagnostic and Statistical Manual of Mental Disorders criteria, respectively

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[Figure 1] shows that 21.5% of participants are with mild depression symptoms and 7.1% of them are of moderate symptoms with no one suffer from severe symptoms. Participants with depression symptoms show coexisting anxiety and OC symptoms by rate of 71% and 32.1% respectively [Table 2].
Table 2: Coexistent symptoms of different studied disorders as diagnosed by psychiatric scales

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Depression disorder is associated with anxiety disorder in 58.1% and with OCD in 9.7% of participants [Table 3]. Depression and OC symptoms coexist with anxiety symptoms at rates of 49.4% and 30.1% respectively [Table 2]. However the rates of coexistent OCD with depression and anxiety disorders are of 31.3% and 8% respectively [Table 3]. Finally, the rates of occurrence of associated depression and anxiety symptoms with OC symptoms are 58.1% and 78.3% respectively [Table 2], and the rates of occurrence of associated disorders with OCD are 40.5% and 62.2% for depression and anxiety disorders respectively [Table 3].
Table 3: Distribution of comorbidities among the three studied disorders

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Figure 1: The prevalence of depressive symptoms among the studied group.

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  Discussion Top


Overall, the results from this study are well in line with those of previous studies.

Depression is a worldwide public health problem. We found that the prevalence of depressive symptoms was 28.6% and that of depressive disorders was 11.3%, which is in accordance with the results of Amir and El Gillany 10, who estimated the prevalence of depressive symptoms among 311 medical school students in Egypt and found that the prevalence of depression was 28.3%. Our results are also in concordance with those of Jafar et al. 11, who reported that the prevalence of depressive symptoms was 34% on using Beck’s self-administered standard questionnaire. However, our results are different from those of Sarkar et al. 12, who reported that 3.13% of their sample had depressive disorders. Our findings are also different from those of Adlina et al. 13, who revealed that 10.3% of their students had above-average scores on the depression scale (the children’s depression inventory). The disagreement may be attributed to the use of different tools for measurement of depression, different sample size, motivation of the student to respond, and the individual’s lifestyle.

In our study, the prevalence of anxiety symptoms among the study group was 41.2% and that of depressive disorders was 21.0%. This is in agreement with the results of Kadri et al. 14, who reported the prevalence of anxiety disorders as being 25.5%. Our results were also concordant with those of Raakhee and Aparna 15, who collected their data from 100 higher secondary students from different schools across Trivandrum District (Kerala, India) and reported that 56.8% of the students experienced anxiety symptoms. Our results, however, were different from those of Amir and El Gillany 10, whose study reported that 21.2% of their sample population had anxiety symptoms.

In our study, the prevalence of OCS among the studied population was 15.8% and that of OCD was 2.7% [Table 1]. This is in agreement with the results of Abay et al. 16, who collected their data from 3107 students in Edirne city center in Turkey and reported that the prevalence of OCD was 1.4%.

Moreover, our results are consistent with those of Mahmood et al. 17, whose study revealed that 18.4% of the study sample had OCS, as evaluated by the Arabic version of the Symptom Checklist Questionnaire (the portion that screens for OCS, the ‘OCS, portion of SCL-90’), and that 9.1% of individuals fulfilled the DSM-IV diagnostic criteria of OCD. Our results are also in accordance with those of Sultan and Abdel-Rahman 18, who reported that the prevalence of OCD among their study population was 1.2%, whereas that of OCS was 13.01%, as determined by the Leyton Obsessional Inventory-Child Version. However, Assarian et al. 8 reported that the prevalence of OCD among their study population was 8.87%. Moreover, our results are concordant with those of Shams et al. 19, who conducted a study on 909 randomly selected students and revealed that the prevalence of OCS was 11.2% for the total sample. Our results show a lower prevalence of OCS when compared with those of Okasha et al. 20, who conducted their study on a sample of students from the El Abasseya educational area in Cairo and reported that the prevalence of OCS was 43.1%.

Comorbid generalized anxiety disorder (GAD) and major depression (MD) diagnoses were searched for, and MD was detected as being the most prevalent. In contrast, the prevalence of comorbid GAD was found to be relatively low. However, according to Abay et al. 16, OCD is considered to have the highest comorbid diagnoses among anxiety disorders.

In our results, 58.1% of those showing significant depressive symptoms were also simultaneously suffering from anxiety symptoms ([Table 2]). This result is consistent with that of Regier et al. 21, who studied the co-occurrence of anxiety disorders with other mental, addictive, and physical disorders on 20 291 individuals from the Epidemiologic Catchment Area and found that nearly half (47.2%) of those meeting the lifetime criteria for major depression also meet the criteria for a comorbid anxiety disorder.

In our study group, 15.8% of students had OCS, of which 58.1 and 78.3% also suffered from comorbid depression and anxiety symptoms, respectively ([Table 3]). This result is in agreement with that of Shams et al. 19, who conducted their study on 909 randomly selected students and found that the most prevalent comorbid conditions were depression and anxiety, with prevalence rates of 91.2 and 78.4%, respectively. However, the study conducted by Abay et al. 16 revealed that the frequencies of comorbid MD and GAD in their study population were 47.5 and 5%, respectively, thus demonstrating the relatively low rate of comorbid anxiety; however, their study also reported that the most prevalent comorbid diagnoses were depression and anxiety disorders. In some studies, comorbid anxiety disorders were found to be most prevalent, whereas in others comorbid MD was found to be most prevalent.


  Conclusion Top


We conclude that there is a high prevalence rate of mental disorders (depression, anxiety, and OCD) among adolescents – a very sensitive age group. Therefore, it is important to increase the awareness of the public, especially parents and teachers, on the risk factors and manifestations of these problems in order to avoid their impact on the ongoing as well as future life of those affected. Integration of mental health services into primary healthcare will help reduce the stigma associated with these disorders.[21]

 
  References Top

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4..Diagnostic and statistical manual of mental disorders: DSM-II1968.Washington, DC:American Psychiatric Publishing Inc.[cited 2008-08-03]. Schizophrenia 36.  Back to cited text no. 4
    
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8.Assarian F, Biqam H, Asqarnejad A.An epidemiological study of obsessive compulsive disorders among high school students and its relationship with religious attitude.Arch Iran Med2006;9:104–107.  Back to cited text no. 8
    
9.Egyptian Initiative for Personal Rights. Mental Health Situation and Services in Egypt. Available at: http://eipr.org/en/report/2010/03/06/645/650 [Accessed 17 July 2010].  Back to cited text no. 9
    
10.Amir M, El Gillany A.Self-reported depression and anxiety by students at an Egyptian Medical School.J Pak Psychiatr Soc2010;7:71.  Back to cited text no. 10
    
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21.Regier DA, Rae DS, Narrow WE, Kaelber CT, Schatzberg AF.Prevalence of anxiety disorders and their comorbidity with mood and addictive disorders.Br J Psychiatry Suppl1998;34:24–28.  Back to cited text no. 21
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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