Depression, anxiety, and post-traumatic stress disorder among youth in low and middle income countries: A review of prevalence and treatment interventions

Prevalence of anxiety and depressive symptoms and their association with multimorbidity and demographic factors: a community-based, cross-sectional survey in Karachi, Pakistan

OBJECTIVE

This study aimed to estimate the prevalence of anxiety and depressive symptoms and their association with multimorbidity and the demographic characteristics of adults aged 30 years and above in Karachi, Pakistan.

DESIGN

Observational cross-sectional study.

STUDY SETTING AND PARTICIPANTS

The study was carried out among a general population aged 30 years and above residing in the Gulshan-e-Iqbal town of Karachi, Pakistan. The study participants were recruited using the systematic random sampling approach based on the inclusion criteria. The data collected from 2867 participants were analysed.

MAIN OUTCOME MEASURES

The primary outcome of the study was the prevalence of anxiety and depressive symptoms, measured with the Aga Khan University Anxiety Depression Scale. The secondary outcome was the association of anxiety and depressive symptoms with multimorbidity as well as with the sociodemographic characteristics of the participants, using binary logistic regression.

RESULTS

Out of 2867 individuals, 27.4% reported having anxiety and depressive symptoms. The multivariate logistic regression model revealed that the presence of multimorbidity (adjusted OR (AOR)=1.33, 95% CI 1.11 to 1.58), female gender (AOR=2.40, 95% CI 2.01 to 2.87), illiteracy (AOR=1.51, 95% CI 1.09 to 2.07), more children (AOR=0.74, 95% CI 0.59 to 0.93) and visiting a faith healer (AOR=2.29, 95% CI 1.82 to 2.88) were the significant factors associated with anxiety and depressive symptoms.

CONCLUSION

This study revealed a moderately high prevalence of anxiety and depressive symptoms among adults aged 30 years and above in Karachi, Pakistan. The key variables associated with anxiety and depressive symptoms were multimorbidity, female gender, lower level of education, more children and visiting faith healers.

Correlates of leisure-time sedentary behavior among 181,793 adolescents aged 12-15 years from 66 low- and middle-income countries

BACKGROUND

Sedentary behavior is a growing public health concern in young adolescents from low- and middle-income countries (LMICs). However, a paucity of multinational studies, particularly in LMICs, have investigated correlates of leisure-time sedentary behavior (LTSB) in young adolescents. In the current study, we assessed socio-demographic, socio-economic, socio-cultural and health behavior related correlates of LTSB among adolescents aged 12-15 years who participated in the Global school-based Student Health Survey (GSHS).

METHODS

Self-reported LTSB, which was a composite variable assessing time spent sitting and watching television, playing computer games, talking with friends during a typical day excluding the hours spent sitting at school and doing homework, was analyzed in 181,793 adolescents from 66 LMICs [mean (SD) age 13.8 (1.0) years; 49% girls). Multivariable logistic regression was used to assess the potential LTSB correlates.

RESULTS

The overall prevalence of ≥3 hours/day of LTSB was 26.4% (95%CI = 25.6%-27.2%). Increasing age (OR = 1.14; 95%CI = 1.11-1.17), past 30-day smoking (OR = 1.85; 95%CI = 1.69-2.03), alcohol consumption (OR = 2.01; 95%CI = 1.85-2.18), and bullying victimization (OR = 1.39; 95%CI = 1.31-1.48) were positively associated with increased LTSB across the entire sample of 181,793 adolescents. Food insecurity (OR = 0.93; 95%CI = 0.89-0.97) and low parental support/monitoring (OR = 0.91; 95%CI = 0.85-0.98) were negatively associated with LTSB. There were some variations in the correlates between countries.

CONCLUSIONS

Our data indicate that in adolescents aged 12 to 15 years living in LMICs, LTSB is a complex and multi-dimensional behavior determined by socio-demograhic, sociocultural, socio-economic, and health behavior related factors. Future longitudinal data are required to confirm/refute these findings, and to inform interventions which aim to reduce sedentary levels in adolescents living in LMICs.

Correlates of physical activity among 142,118 adolescents aged 12-15 years from 48 low- and middle-income countries

Physical inactivity is a serious public health concern in adolescents from low- and middle-income countries (LMICs). Despite this, only a few multinational studies has investigated correlates of physical activity (PA) in young adolescents in this part of the world. In this study, we identified physical activity correlates using data from the Global school-based Student Health Survey. In total, 142,118 adolescents from 48 LMICs (age 13.8 ± 1.0 years; 49% girls) were included in the analyses. PA was assessed by the PACE+ Adolescent Physical Activity Measure and participants were dichotomised into those who do (60 min of moderate-vigorous PA every day of the week) and do not comply with the World Health Organization recommendations. We used multivariable logistic regression in order to assess the correlates. The prevalence of low PA was 15.3% (95%CI = 14.5%-16.1%). Boys (OR = 1.64; 95%CI = 1.47-1.83) and those who participated in physical education for ≥5 days/week (OR = 1.12; 95%CI = 1.10-1.15) were more likely to meet PA guidelines, while adolescents with food insecurity (OR = 0.85; 95%CI = 0.80-0.90), low fruit and vegetable intake (OR = 0.68; 95%CI = 0.63-0.74), low parental support/monitoring (OR = 0.68; 95%CI = 0.62-0.74), no friends (OR = 0.80; 95%CI = 0.72-0.88), and who experienced bullying (OR = 0.93; 95%CI = 0.86-0.99) were less likely to have adequate levels of PA. There were a few variations in the correlates depending on country-income level. Our data indicate that in adolescents aged 12 to 15 years living in LMICs physical activity participation is a complex and multi-dimensional behavior determined by sociocultural, socio-economic, and policy-related factors. Longitudinal research is needed to confirm/refute the present findings.

Which HIV-infected youth are at risk of developing depression and what treatments help? A systematic review focusing on Southern Africa

Background Depression is common in people with HIV and is associated with lower quality of life, reduced medication adherence, worse disease progression and higher risk of transmission to others. While the majority of HIV-infected youth live in Southern Africa, research has largely focused on adults from Western countries, with limited generalisability across these populations. This review sought to identify and synthesise research on the risk factors for depression in HIV-infected youth in Southern Africa, and to summarise the available evidence on psychosocial interventions to reduce depression. Method A systematic review was conducted of studies using a validated measure of depression in HIV-infected youth (aged ≤19) in Southern Africa. Eligible studies included either analysis of variables associated with depression, or evaluation of the impact of psychosocial interventions on depression in this population. Results Twelve studies met inclusion criteria for assessing risk factors, based on nine independent samples, constituting 3573 HIV-infected youth (aged 9-19 years). Study quality varied, with heterogeneous methodology limiting comparability and conclusions. There is some evidence that female gender, older age, food insecurity, exposure to abuse and internalised stigma are risk factors for depression, while disclosure of HIV status, satisfaction with relationships and social support are protective. Only one study met inclusion criteria for assessing psychosocial interventions (n = 65; aged 10-13 years). The intervention study did not successfully reduce depression, demonstrating a need for low-cost, large scale interventions to be developed and trialled. Conclusion This review has highlighted the dearth of research into depression in HIV-infected youth in Southern Africa. Disclosing HIV status could be an important protective factor.

Sedentary behavior and anxiety-induced sleep disturbance among 181,093 adolescents from 67 countries: a global perspective

OBJECTIVES

Sleep problems are burdensome in adolescents. Understanding modifiable environmental risk factors is essential. There is evidence that physical activity is protective against sleep problems in adolescents. However, the association between sedentary behavior (SB) and anxiety-induced sleep disturbance has not been investigated.

METHODS

Using cross-sectional data from the Global school-based Student Health Survey, we explored the association between SB and anxiety-induced sleep disturbance in 181,093 adolescents [mean (standard deviation, SD) age 13.7 (1.0) years; 48.4% girls] from 67 countries, controlling for confounders (including physical activity). Adolescents reported anxiety-induced sleep disturbance during the past 12 months, and SB, which was a composite variable assessing time spent sitting and watching television, playing computer games, talking with friends during a typical day excluding the hours spent sitting at school and doing homework. Multivariable logistic regression analysis was conducted and a countrywide meta-analysis undertaken.

RESULTS

Overall, 7.8% of adolescents had anxiety-induced sleep disturbance. The prevalence of SB was: <1 h/day 39.9%; 1-2 h/day 33.8%; 3-4 h/day 15.4%; 5-8 h/day 7.4%; and >8 h/day 3.6%. Compared to <1 h/day of SB, >8 h/day was associated with a 2.27 [95% confidence interval (CI) = 1.98-2.62] times higher odds for anxiety-induced sleep disturbance. The association was similar among both sexes. The pooled odds ratio for anxiety-induced sleep disturbance when being sedentary ≥3 h/day was 1.42 (95% CI = 1.36-1.48) with only a small degree of between-country heterogeneity (I² = 41.4%).

CONCLUSIONS

Future longitudinal data are required to confirm/refute the findings to inform public interventions which aim to reduce anxiety and sleep disturbance in adolescents.

Sedentary behavior and depressive symptoms among 67,077 adolescents aged 12-15 years from 30 low- and middle-income countries

BACKGROUND

Depression is common and burdensome in adolescents. Understanding modifiable environmental risk factors is essential. There is evidence that physical activity is protective of depression. However, the impact of sedentary behavior (SB) on depression is relatively under-researched especially in low- and middle-income countries (LMICs). In this cross-sectional study, we explored the association between SB and depressive symptoms in adolescents from 30 LMICs, controlling for confounders including physical activity.

METHOD

Data from the Global school-based Student Health Survey were analyzed in 67,077 adolescents [mean (SD) age 13.8 (0.9) years; 50.6% girls). Self-report measures assessed depressive symptoms during the past 12 months, and SB, which was a composite variable assessing time spent sitting and watching television, playing computer games, talking with friends during a typical day excluding the hours spent sitting at school and doing homework. Multivariable logistic regression analysis was conducted and a countrywide meta-analysis undertaken.

RESULTS

The prevalence of depressive symptoms and ≥ 3 h/day of SB were 28.7 and 30.6%, respectively. There was a linear increase in the prevalence of depressive symptoms with increasing sedentary time beyond ≥3 h/day (vs. < 1 h/day). Among boys, 1-2 h/day of SB was associated with lower odds for depression (vs. < 1 h/day). Countrywide meta-analysis demonstrated that spending ≥3 h/day versus < 3 h/day was associated with a 20% increased odds for depressive symptoms (OR = 1.20; 95% CI = 1.16-1.24) with low between-country heterogeneity (I2 = 27.6%).

CONCLUSION

Our data indicate that being sedentary for ≥3 h/day is associated with increased odds for depressive symptoms in adolescence. Future longitudinal data are required to confirm/refute the findings to inform public interventions which aim to limit the time spent being sedentary in adolescents.