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Abstract
Adolescents depression was more common than previously thought, resembled adult depression, and was amenable to treatment. Moreover, It ‘s estimated that depression, will be the 1st cause of disability in 2030 & among adolescents it ‘s is a disabling condition that is associated with serious long-term morbidities and suicide. Therefore, research on depression during different life phases especially adolescence has attracted a growing interest during the last two decades.
Adolescents with unidentified mental disorders are in poorer physical health and engage in more risky behaviors than their peers, such as unsafe sexual activity, fighting and weapon carrying .Even though, Depression and other mental disorders often go undiagnosed in adolescence despite the availability of screening tools proven effective in identifying adolescent depression in the community ,but still adolescence mental health in the Eastern Mediterranean Region generally, and in Egypt specifically, is not a prime focus of policymakers, researchers and health providers, thus this study will be of great interest if it could be performed successfully as it would provide data to plan for prevention, early assessment and detection of cases .
Unfortunately, adolescents depression is particularly problematic in developing countries like Egypt, where data on the prevalence and scope of the disease as well as the resources to address it are sorely lacking & even the available resources do not often reach those who need them because of a number of overwhelming challenges in lack of facilities and trained mental health personnel ,in addition to questions about effective population-based screening, and the general stigma surrounding mental disorders.
Many schools of thought regarding depressive disorder in childhood and adolescence were distinguished. However, the predominant perspective assumed that depressive disorders in children and adolescents and those in adults are understood as the same phenomenological entities, which led to the( DSM-III ) ,(DSM-IV)& (ICD-10).
According to the (DSM IV TR), depressive disorders exist on a continuum, classified as Major depressive disorder (MDD), Dysthymic disorder (DD) and Depressive disorder Not otherwise specified (NOS). Even when diagnostic criteria are not met, subsyndromal depressive symptoms may indicate high levels of distress.
Epidemiological studies evaluating the burden of depression among adolescents report different prevalence rates ranging from 1% to 50%, such variations may result from differences in samples studied, in sample sizes, and diagnostic criteria applied, and the type of interviewing techniques used in addition to different factors affecting prevalence of adolescent depression including age, developmental Factors, sex differences, socioeconomic status ,ethnical and cultural Differences.
Extensive co morbidity is a manifest feature of depressive disorders in adolescence, which may result in poor adherence to treatment and lack of engagement in follow-up care. Moreover, depressed mood at younger ages carries risk for development of depressive disorder later in life.
Certain factors are to be considered in deciding the management of adolescence depression, e.g., the age of the patient, developmental stage, family conflict, academic problems, number of prior episodes, chronicity, subtype of depression , and co-morbidity .
Research clearly demonstrates that antidepressant medications, especially when combined with psychotherapy, can be very effective treatments for depressive disorders in adults.Similarly, The Treatment of Adolescents with Depression Study (TADS) indicated that combined treatment with CBT and Fluoxetine were superior to CBT or fluoxetine used alone or placebo.
• Hypothesis
o Depressive disorders are highly prevalent among male secondary school students.
o There are specific socio demographic factors related to depressive disorders as regards this age group.
• This thesis was designed aiming to cover the following areas in theoretical part:
o Review other literature that investigates the prevalence & epidemiology of adolescents depression , it’s diagnosis , classification & management.
• The practical part & discussion aimed to
o Estimate the prevalence of depressive disorders in Egyptian Secondary school male students.
o Evaluate the socio demographic factors related to depressive disorders in the study Population.
o Compare our results with other local & international studies.
The present study evaluated 774 secondary school male students in eastern Cairo Schools were selected from three educational district, each representing a certain socioeconomic class (upper, middle & lower), those districts are (Heliopolis, Ain shams & Al-salam city), from each 2 schools were chosen one private school and the other public school, from each school 3 classes were randomly selected (one class represents each secondary grade).
The tools were carefully selected to serve for the purpose of the study, which included:
o Designed Questionnaire to cover personal, past, family history.
o Fahmy and El Sherbiny Social Classification
o General Health Questionnaire (GHQ)
o Children Depression Inventory (CDI)
o Structured clinical Interview For DSM-IV Axis I Disorders (SCID I)[Clinical version]
o Hamilton Rating Scale for Depression (Ham- D)
All necessary approvals & permits and consents were completed before the start of the study.
The study proper was preceded by a pilot study, then the study proper was initiated in and completed during the educational year of 2007-2008 & 2008-2009.
The first group of results aimed at estimation of prevalence of depressive disorders among a sample of Egyptian secondary school adolescent males, this was done through screening for distress related to possible minor psychiatric morbidity using GHQ , those scoring 8 on (GHQ) were further subjected to CDI , if they scored 20 on CDI this is considered as confirmation that their distress is related to depression rather than other morbidity & was further considered as a depression group to be compared to the non depression group who scored < 20 on CDI, then clinical evaluation by SCID-I, for further confirmation & diagnosis of the specific category of depressive disorder as well as co morbidity ,then the confirmed cases are finally subjected to investigate severity of depression using HAM-D .
According to CDI : 28.03% of all students in the study had depressive disorders (CDI 20).
According (to SCID I ): About 18.6% of studied population proved to have depressive disorders as measured by SCIDI, distributed as ; 1.03% of them had major depressive disorder, 2.71 had dysthymic disorder & 14.86% had sub threshold depression.
It was found that 9.68% of the depressed students had social phobia being the most prevalent co morbidity , followed by generalized anxiety disorder & substance use disorder (According to SCID I ).
According to Hamilton rating scale: 43.32% of depressed students had mild depression while only 9.68 % of depressed male students were classified as having moderate depression.
Our results show that there is a very highly statistical significant relation regarding final preparatory score (P= <0.001), as 47.29% of the non depressed students had high final preparatory year total score above (85%) ,compared to only (30.88 %) of depressed students had such score .
Our study found a very highly significant statistical relation regarding type of school (P<0.001), in which 68.66% of depressed students were in public schools compared to (68 students) 31.34% were in private schools
It was found that there is a very highly statistical significant relation (P<0.001) regarding socioeconomic status with majority of non depressed students are of high socioeconomic status (70.76%).
Our results found very highly significant statistical relation regarding parental relation & home atmosphere (P<0.001) with 41.94% of depressed students reported quarrelsome home atmosphere compared to only 9.03% in non depressed students .Also, parental relation & home atmosphere was significantly related to severity of depression (P=0.002).
It was found that there’s a very highly significant statistical relation regarding family history of psychiatric disorder (P<0.001), in which 10.6% of depressed students in our study had family history of psychiatric disorder compared to only 3.25% of non depressed students who had .
Moreover, It was found that there is a very highly statistical significant relation (P= <0.001) regarding hospitalization for general medical with 11.06% of depressed students had past history of hospitalization for general medical condition compared to only 2.89 % for non depressed .
Our study demonstrated that there is a very highly statistical significant relation (P= <0.001) regarding past history of psychiatric disorder with 11.06% of depressed students had past history of psychiatric disorder, compared to 0.36% in the non depressed students.
Our results show that there’s a very highly significant statistical relation (P<0.001) regarding substance use, in which 9.22% of depressed male students reported illicit substance use compared to only 0.36 % of non depressed male students that reported it , with a very highly statistical significant relation regarding severity(P<0.001) & co morbidity of depression(P<0.001).
It was found that there is a highly statistical significance relation regarding past medical history (P= P=0.005) , where 22.58% of depressed students had past medical history compared to only 13 % in non depressed students.
Our study results demonstrate that there is a statistically significant relation regarding school grade (P=0.014) , with majority of depressed students were in second grade(43.32%).
It was found that there is a very significant statistical relation regarding smoking (P=0.021) , in which 7.37% of depressed students smoked cigarettes compared to only 2.89% for non depressed students who smoked.
Our study results show that there was no statistically significant relation regarding age (P=0.024), religion (being Moslem or Christian) (P=0.269), number of siblings (P=0.668), birth order (P=0.108)& having dead or alive fathers (P=0.770) or mother (P=0.259).
To sum up, our study found that there was:
o Very highly significant statistical relation regarding; academic performance, type of school, socioeconomic status, parental relation & home atmosphere, Family history of psychiatric disorder, medical history, history of psychiatric disorder & substance use.
o Highly significant statistical relation regarding medical history .
o Significant statistical relation regarding school grade, home atmosphere& cigarette smoking.
o Non significant statistical relation regarding age, religion, number of siblings, birth order & death of father or mother .
We concluded that depressive disorders are highly prevalent among male secondary school students & is related to specific socio demographic factors. Further studies should be encouraged to continue this issue.
We hope that this study will result in more effort to provide accurate data about the prevalence of depressive disorders in this age group & different age groups & provide awareness of the parents & teachers with providing effective mental health service with proper prevention & comprehensive intervention.
Based on our findings we recommend:
o Replication of our findings with larger sample size with further studies on different group representing different geographical areas, cultures, both males & females & types of schools.
o Unifying a protocol for screening & applying longitudinal designs & collecting data from parents & teachers
o Further studies are needed to refine the tools.
o Further research is needed to discover the precise genetic & Environmental factors underlying adolescents depressive disorders.
o Collaboration between health care professionals, school mental health team together with parents aiming at increasing awareness about depressive disorders
o We are also hopeful to increase training of school general practitioners for earlier diagnosis & referral to decrease suffering of adolescents with depressive disorders