Prevalence of anxiety and depression in ecuadorian adolescents

Objective: To determine the prevalence and incidence of anxiety disorders and depression with loneliness in a sample of adolescents.

Material and methodology: Quantitative, correlational, cross-sectional study including 330 Ecuadorian adolescents selected by non-probabilistic purposive sampling. The Ad Hoc Questionnaire, the Depression, Anxiety, and Stress Scale (DASS-21), and the UCLA Loneliness Scale were used for data collection.

Results: Of the 330 adolescents, 65.5% were male, and the mean age was 16.8 years. Sixty, 60% are in their third year of high school and 39.4% are in their second year. Most of them live in the province of Pichincha 36.1%. In anxiety they present an average of 6.4 and in depression of 5.7; they have an average of 42 in loneliness. There is a positive correlation between anxiety, depression and loneliness. Finally, females have higher levels of depression.

Conclusion: Adolescents do not present anxiety or depression disorders, however, they present high levels of loneliness. There is a positive correlation between anxiety, depression, and loneliness, that is, the higher the levels of loneliness, the higher the probability that adolescents present anxiety or depression. Likewise, there is evidence of higher levels of depression in females.

Introduction

Adolescents constitute an important population group given the physical, cognitive and psychosocial changes that occur at this stage, therefore, it is a stage of significant developmental transitions, the same that comes with new opportunities, however, also with risks such as accidents, violence, family problems, delinquency, risky sexual behaviors, drug use, pregnancies [1,2], and mental disorders (impulse control and behavioral, developmental, depressive, personality, stress and anxiety disorders) [3-6]. In the adolescent development process, peer rejection and the belief in a bad social situation within the group influence feelings of loneliness [7].

For its part, anxiety is a physiological and innate reaction characterized by feelings of tension and thoughts of worry, generating nervousness, restlessness, muscle tension, cautious or avoidant behaviors, headaches, tremors, sweating, tachycardia, epigastric discomfort, vertigo, dry mouth [8,9], in addition, high levels can decrease academic performance and professionalism [10]; added to this, it can become pathology and derive in mental health problems, such as low self-esteem and depression [11,12]. In other words, it is associated with a poor quality of life that affects overall health (physical, mental, social, and functional health) [13].

In addition, depression is a mood disorder of multifactorial origin, characterized by pathological sadness, feelings of unhappiness, negative perceptions about the future, helplessness in the face of life, and guilt, in addition, it may be accompanied by anxiety, generating physical, psychological and cognitive symptoms [8,14]. Likewise, it is related to high levels of distress [15], and suicidal ideation [16]. Similarly, it affects the ability to perform tasks, work, family, and social relationships, although, the greatest risk is suicide [17,18].

Coupled with the situation, anxiety, and depression are significantly correlated with socioeconomic status, gender, and age in adolescence [19,20]. They have high comorbidity with substance abuse [21] with behavioral, neurodevelopmental, mood, and psychotic disorders; likewise, they are related to anti-academic behaviors, feelings of loneliness and reduced empathy and ethics, generating negative and lasting impact, leading to cognitive, behavioral and social conditions [10-12,22].

Similarly, anxiety and depression are a leading cause of illness and disability among adolescents, approximately 3.6% of adolescents aged 10 to 14 years and 4.6% aged 15 to 19 years suffer from some anxiety disorder; similarly, about 1.1% of adolescents aged 10 to 14 years and 2.8% aged 15 to 19 years suffer from depression; moreover, in the age group 15 to 29 years, suicide is the fourth leading cause of death [23,24]. However, depression and anxiety affect women more than men [3,10,25-30]. Finally, they are linked to elevated levels of loneliness, i.e., the higher the levels of loneliness the higher the levels of anxiety and depression [31].

In this regard, loneliness is characterized by subjective feelings of lacking a social network of peers [32], and that, being categorized as a negative emotion can lead to different psychological disorders (depression, anxiety, stress) and behavioral problems [33-35]. In adolescence, loneliness is associated with high levels of depression, anxiety, and stress [31,36-38], and with risk of hospitalization for self-harm [39]. The aim of this study was to determine the prevalence and incidence of anxiety disorders and depression with loneliness in a sample of adolescents.

Methodology and material

A quantitative, correlational, cross-sectional study involving Ecuadorian adolescents. An Ad Hoc Questionnaire was used to collect sociodemographic data. Anxiety and depression levels were measured through the Depression, Anxiety, and Stress Scale (DASS-21)-Chilean version, with scores ranging from 0 to 21 points [40,41]. Finally, for loneliness, the UCLA Loneliness Scale - Spanish version was used, the score ranges from 20 to 80, where a higher score is related to a higher degree of loneliness [42,43].

Likewise, the research had ethical aspects, such as voluntary participation, confidentiality, informed consent and assent, and responsible and anonymous handling of data. For the selection of the sample, inclusion criteria were used: signing the informed consent and/or assent, age between 15 and 18 years, being enrolled in an educational institution and attending it in the morning; and exclusion criteria: not accepting participation in this study, age lower or higher than requested, not having signed the informed consent and/or assent, not having filled out the instrument in its entirety, not being in the institution (illness), being enrolled in the evening.

For the participant recruitment process, an invitation was sent through the educational institutions describing the objectives. Subsequently, with the authorization of the institutions, a meeting was held with the parents to explain the scope of the research and to request informed consent, and then, it was socialized with the students and free and voluntary participation was required. The STROBE guidelines were not followed in this study, since the research protocol was used under the regulations established by the internal research committee and the Helsinki Declaration.

The sample was selected by non-probabilistic purposive accessibility-accidental sampling; that is, according to the objectives and characteristics of the research. It consisted of 330 adolescents, 216 (65.5%) were males and 114 (34.5%) were females, the mean age was 16.8 years. As for the year of education, 60.6% were in their third year of high school and 39.4% in their second year. Most of the participants live in the province of Pichincha 36.1%, followed by Guayas at 11.2%, and a lower percentage in other provinces.

Statistical analysis

The Statistical Package for Social Sciences (SPSS) version 24 was used for data analysis. A descriptive and correlational analysis was performed between the variables, which are represented as Mean ± SD. In addition, means of central tendency and Pearson's correlation were used for bivariate statistics.

Results

Tables (1-5)

When analyzing the relationship between gender and mental health, men had a mean stress score of 6.8 (SD = 4.3) and women 7.7 (SD = 4.9), finding statistically significant differences t (-2.03) p = 0.042. As for depression, men obtained a mean of 5.4 (SD = 4.5) and women 5.9 (SD = 4.7), showing significant differences t (-1.14) p = 0.015. However, in anxiety, men obtained a mean of 5.7 (SD= 4.4) and women 6.7 (SD= 4.9), indicating that there were no significant differences t (-2.44) p = 0.512.

Discussion

In adolescence, depression and anxiety are one of the main disorders that interfere with physical and mental development; likewise, loneliness, being a negative feeling, is associated with anxiety and depression; therefore, it is important to identify the relationship between these variables, in order to implement effective interventions; taking into account that suicide is one of the main causes of death in adolescence [23,24,31].

The mean for anxiety was 6.4 and for depression 5.7, which is below the normal threshold, that is, indicating absence of disorder, results similar to those found by Coker, et al. [44]; Ediz, et al. [45]; Fawzy and Hamed [46]; Gaibor-González and Moreta-Herrera [47]; Le, et al. [48], where the means for anxiety and depression fluctuate between 3 and 9, indicating absence of disorder. In itself, low scores are associated with good family relationship, since maintaining healthy family relationships are a protective factor against adversities [49]. In addition, adolescents with age-characteristic problems are able to find solutions to them because they possess adequate functioning in relationships with others and in internal attitudes such as mastery and personal growth [50,51].

Regarding the loneliness variable, a significant score of 42 is evident, that is, values above the normal mean, something similar occurs in the studies of Bajaj and Kaur [52]; Eriş and Barut [53]; Fauziyyah and Ampuni [54]; Gao, et al. [55]; Kilinç, et al. [56]; Kundu, et al. [37]; Mamun, et al. [57]; Varghese and Pistole [58] where the means are between 40 and 49. The period of adolescence presents continuous changes in roles, relationships, and social expectations that can sometimes give way to a negative or low perception of social support, which translates to feelings of loneliness [38,59].

Concerning the relationship between anxiety, depression, and perception of loneliness, there is a significant positive correlation, therefore, the higher the levels of loneliness, the higher the levels of anxiety and depression; that is, loneliness represents a predictor that can aggravate or induce symptoms of anxiety and/or depression [27,37]; Majd, et al. [59]; Matthews, et al. [60]; Moeller and Seehuus [61].

In relation to gender and mental health in adolescents, significant differences have been found, with females having higher depression scores, the same is true in the research of Bermudez [3]; Ediz, et al. [45]; Fawzy and Hamed [46]; Hamaideh [62]; Kumar and Akoijam (2017); Kumar, et al. [63]; Le, et al. [48]; Sandalia, et al. [64], where it is evident that women are the most affected. However, in the levels of anxiety, no significant differences were found between men and women, these results are in relation to those found by Cheung, et al. [65]; Damásio, et al. [66]; Fawaz and Samaha [67]; Sánchez-Aguilar, et al. [68]; Van Zyl, et al. [69]; Yadav, et al. [70].

Conclusion

65.5% are male, the mean age is 16.8, and most of them are living in the province of Pichincha. The students score below the normal threshold for anxiety and depression, which indicates the absence of these disorders, therefore, they have good mental health, however, they have a score of 42 in loneliness, that is, a high level. The correlation between anxiety, depression, and loneliness is positive, that is, the higher the levels of loneliness, the higher the levels of anxiety and depression. Finally, women had higher depression scores than men; however, no significant differences were found in the levels of anxiety.

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