The prevalence of depressive symptoms among Arab adolescents: Findings from Jordan

The mediation role of social support in the relationship between bullying and depressive symptoms among Jordanian adolescents

BACKGROUND

Bullying in school is a universal psychosocial issue that raises concerns about adolescents' safety and mental health and is positively associated with depressive symptoms. Social support could be a preventive factor that eases bullying and its psychological distress.

PURPOSE

The primary purpose of this study was to examine the mediating effect of social support in the relationship between bullying and depressive symptoms among adolescents in Jordan. Another aim was to investigate predictors of depression based on adolescents' sociodemographic factors.

METHODS

In this cross-sectional, non-experimental mediational study, a stratified and systematic sampling method was used to recruit 270 Jordanian adolescents.

RESULTS

Sociodemographic variables of being female, having divorced parents, having illiterate fathers, and being older in adolescence explained 12.2% of the variance in depressive symptoms. Family social support partially mediated the relationship between bullying and depressive symptoms.

CONCLUSION

Our findings showed that a notable proportion of adolescents experienced bullying victimization and depressive symptoms, and a positive relationship exists between these two variables. These results further highlight the role of family social support in buffering the negative impact of bullying on depressive symptoms.

IMPLICATIONS TO PRACTICE

The study's results emphasize the significance of developing and implementing family-centered social support initiatives by nurses to lessen adolescents' bullying experiences and depressive symptomatology.

Adolescent Depression Prevalence and Factors: A Jordanian Cross-Sectional Study

Objective There is a great deal of variation in the prevalence of adolescent depression among nations, but overall, it is a severe and common mental illness that is a major contributor to disability on a global scale. This study aimed to determine the prevalence of depression, the severity of its symptoms, and its characteristics among adolescents residing in Amman, Jordan, in 2023. Method A cross-sectional design was used to collect descriptive data from 784 adolescents from Jordan, aged between 14 and 17 years. Participants were administered the Patient Health Questionnaire-9 to assess the prevalence and severity of depression as well as measures of socio-demographics and health history. Significance was set at p ≤.05. Results The mean age was 15.56 +/- 1.077 with 55% female and 45% male participants, with a prevalence of moderate to severe depression of 32.4%. This study identified four significant predictors of depression: female sex, cigarette smoking, history of mental health problems, and family history of psychiatric disorders. Conclusion Our findings highlight the importance of directing prevention and intervention efforts toward adolescents, considering the projected increase in depression rates across the Arab region. This serves as a warning for policymakers and healthcare professionals to prioritize this demographic in their strategies.

The lived experience of Omani adolescents and young adults with mental illness: A qualitative study

There is currently limited knowledge about the firsthand experiences of adolescents and young adults with mental health problems and the meanings they ascribe to these experiences, particularly within Arab countries. This study, therefore, aimed to explore the lived experience of Omani adolescents and young adults with a mental health problem. A sample of 15 participants aged 13-22 diagnosed with a range of mental health problems took part in the study. A qualitative interview guide consisting of open-ended questions was used to allow participants to speak in-depth about their experiences. Using the thematic analysis approach to uncover patterns in the data, three major themes emerged: "living in darkness", "perilous journey" and "uncertain future". Results show that the progress of adolescents and young adults with mental health problems is characterized by several challenges; the most significant of which is having insufficient knowledge about their illness, leading to unnecessary delays in their treatment. These findings shed light on the breadth and depth of the experience of adolescents and young adults with mental health problems and lay the groundwork for further examinations. Implications lie in the development of approaches for preventing or mitigating difficulties faced by adolescents and young adults with mental health problems.

Validation of the Arabic version of the resilience scale for adolescents (READ)

INTRODUCTION

Adolescents react differently to challenging negative life events. Resilience, a dynamic characteristic of individuals, was studied to be a protective factor against such events. In order to study the resilience among Arabic-speaking adolescent populations, age-appropriate measures that are fully apprehended by younger respondents are needed. In this context, the present study aimed to examine the psychometric properties of an Arabic translation of the Resilience Scale for Adolescents (READ) in a community sample of native Arabic-speaking adolescents aged 13-18 years.

METHODS

A sample of 546 community Arabic-speaking adolescents from Lebanon was recruited (n = 328 females, with a mean age of 15.76 ± 1.65 years). Through an online questionnaire, participants were requested to complete the READ, Depression, Anxiety and Stress Scale (DASS-8) and the 13-item Children's Impact of Event Scale (CRIES-13).

RESULTS

Following the exploratory and confirmatory factor analysis (EFA-to-CFA) strategy, a unidimensional model of the Arabic version of the READ was met after 10 items were removed from the scale, and showed strong internal consistency (Cronbach's alpha of 0.943). Additionally, the one-factor solution of the Arabic version of the READ was identical across male and female adolescents at the three levels of invariance (Configural, Metric and Scalar). Finally, higher resilience scores were significantly correlated with lower levels of psychopathology, namely depression, anxiety, stress and PTSD, thus attesting to the concurrent validity of the Arabic READ.

CONCLUSION

Findings lend support to the psychometric reliability and validity of the Arabic version of the READ, and therefore its suitability for use among Arabic-speaking adolescents. The availability of this tool facilitates the implementation of interventions that foster resilience, especially in adolescents who have faced a number of negative life events.

Mental Health and Psychosocial Problems among Children and Adolescents in Jordan: A Scoping Review

Introduction: In Jordan, mental health morbidity among children and adolescents is on the rise. Several studies in Jordan have assessed mental health issues and their associated factors among adolescents; however, there remains a lack of a collation of data regarding such issues. Objectives: To review the prevalence rates of mental health problems among children and adolescents in Jordan to understand the evidence base concerning psychiatric morbidity. Methods: The PubMed database, Cochrane Library, Virtual Health Library (VHL) Lilac, and APA PsycArticles were searched for literature published between January 2010 and May 2023. Studies were included if they were conducted on children and adolescents (≤19 years), were observational studies that reported prevalence data regarding psychosocial problems, and were studies conducted in Jordan. Results: The search yielded 211 records, of which 33 studies were assessed for eligibility and 28 met the inclusion criteria. The sample age ranged from 6-19 years. The prevalence rates ranged from 7.1% to 73.8% for depression, 16.3% to 46.8% for anxiety, 13.0-40.6% for ADHD, 11.7-55.2% for overall emotional and behavioral difficulties, 16.2-65.1% for PTSD, and 12-40.4% for eating disorders. Conclusions: The findings highlight the magnitude of mental health problems among children and adolescents and the heterogeneity of the results. Further studies are needed to investigate the prevalence of eating disorders among refugees, as well as sleeping disorders and substance use disorders among all adolescents.

Lifetime prevalence and treatment of mental disorders in Saudi youth and adolescents

Previous global and regional studies indicate that adolescents and young adults (i.e., youth) are affected by various mental disorders with lifelong consequences. However, there are no national estimates of mental disorders prevalent among Saudi youth. Using data from the Saudi National Mental Health Survey (SNMHS), we examined the lifetime prevalence, treatment, and socio-demographic correlates of mental disorders among Saudi youth (aged 15-30). A total of 4004 interviews were conducted using the adapted Composite International Diagnostic Interview (CIDI 3.0). Cross tabulations and logistic regression were used to generate estimates for the SNMHS youth sample (n = 1881). The prevalence of a mental disorder among Saudi youth was 40.10%, where anxiety disorders affected 26.84% of the sample, followed by disruptive behavior disorders (15.44%), mood disorders (9.67%), substance use disorders (4%) and eating disorders (7.06%). Sex, education, parental education, income, marital status, region, and family history of disorders were significant correlates of various classes of mental disorders. Only 14.47% of Saudi youth with any mental disorder received treatment for a lifetime disorder. Age, parental education, and family history of disorders emerged as significant correlates of mental health treatment. Lifetime mental disorders are highly prevalent among Saudi youth. There is an unmet need for culturally sensitive and age-appropriate treatment of lifetime mental disorders among youth in Saudi Arabia.

Psychological and contextual risk factors for first-onset depression among adolescents and young people around the globe: A systematic review and meta-analysis

AIM

Identifying predictors for future onset of depression is crucial to effectively developing preventive interventions. We conducted a systematic review and meta-analysis to identify risk factors for first-onset depression among adolescents and young people.

METHODS

We searched MEDLINE (Ovid), PsycINFO, Cochrane Database, Web of Science, Lilacs, African Journals Online and Global Health (July 2009 to December 2020) for longitudinal studies assessing risk factors for first-onset depression among adolescents and young people aged 10-25 years. Meta-analyses generated summary odds ratio (OR) estimates.

REGISTRATION

PROSPERO CRD42018103973.

RESULTS

Nineteen studies representing 21 unique populations were included in the meta-analysis. Among studies reporting race/ethnicity, 79% of participants were of White/European descent. Seventeen studies were from high-income countries, with only two from an upper-middle-income country (China). Odds for first-onset depression were significantly greater for girls compared to boys (n = 13; OR = 1.78 [1.78, 2.28], p < 0.001) and for youth with other mental health problems at baseline (n = 4; OR = 3.20 [1.95, 5.23], p < 0.001). There were non-significant associations for negative family environment (n = 8; OR = 1.60 [0.82, 3.10], p = 0.16) and parental depression (n = 3; OR = 2.30 [0.73, 7.24], p = 0.16).

CONCLUSIONS

Most longitudinal studies do not report risk factors specifically for first-onset depression. Moreover, predictive data are limited to predominantly White populations in high-income countries. Future research must be more ethnically and geographically representative. Recommendations are provided for consistent and comprehensive reporting of study designs and analyses of risk factors for first-onset depression.

Psychosocial determinants of adolescent suicide: A national survey

BACKGROUND

Suicide is a global health problem with considerable variability across countries in its prevalence and correlates. The aims of this study were to: (a) explore the prevalence and psychosocial determinants of adolescent suicidal ideation, and (b) explore the perceived stigma of suicide among adolescents.

METHOD

A nationally representative electronic survey was utilized to collect data from school adolescents. The Joanna Briggs Institute critical appraisal checklist for studies reporting prevalence data was used to design the survey. The study collected data on adolescents' suicidal ideation, depression, self-esteem, stigma of suicide, family functioning, educational stress, and anxiety levels. A representative sample of 647 Jordanian school adolescents was included.

RESULTS

The prevalence of suicidal ideation among school adolescents was 11%. Suicidal ideation was significantly higher among respondents who were boys and enrolled in public schools, had a mental health problem, a family history of suicidal attempt, a lower self-esteem, and higher depressive symptoms. The majority of school adolescents agreed with the descriptions of people who take their own lives as being "lost" (70%), "coward" (53%), "stupid" (51%), and "lonely" (49%).

CONCLUSION

There is no typical suicide victim, and there are no specific characteristics that can point out those who are suicidal. Suicide remains a complex phenomenon that is embedded in its sociocultural context. Collaborative efforts from Jordanian policy makers, healthcare providers, researchers, and educators are needed to develop culturally appropriate screening and prevention approaches to address suicide among adolescents. Nurses have a significant role in helping adolescents experiencing suicidal ideation and their families restore, maintain, and/or promote their mental health and wellbeing.

Investigating the prevalence of and factors associated with depressive symptoms among urban and semi-urban school adolescents in Bangladesh: a pilot study

BACKGROUND

Adolescent depression is an alarming issue for Bangladesh since a large number of Bangladeshi adolescents suffer from depression but cannot get proper treatment. This study aimed to investigate the prevalence of depression and factors associated with this psychological health hazard among urban and semi-urban adolescents of the Dhaka region in Bangladesh.

METHODS

A cross-sectional pilot study was performed among 311 adolescents, grades 8-10, in Dhaka city and Savar Upazila, adjacent to the city, in 2018. Data were collected using a questionnaire consisting of items on sociodemographics, lifestyle information, screen-based sedentary behaviour (SBSB) and mental health.

RESULTS

A total of 36.6% of the adolescents reported depressive symptoms, with a greater prevalence among females (42.9%) than males (25.7%). Sociodemographic factors including being female, residence and grade in school were significantly associated with depression. Logistic regression analysis showed that SBSBs, such as the use of social media (odds ratio [OR] 2.06 [95% confidence interval {CI} 1.27-3.35]), high screen time (>120 min/day; OR 2.35 [95% CI 1.30-4.25]) and sleep disturbance (OR 3.93 [95% CI 2.37-6.50]) were significantly linked with depressive symptoms.

CONCLUSIONS

Depressive symptoms are prevalent among urban and semi-urban adolescents of Dhaka, Bangladesh. Therefore, urgent initiatives should be taken to curb the spread of depression among Bangladeshi adolescents.

The relationship between screen time exposure and the presence of anxiety-related disorders among adolescents during the COVID-19 pandemic: A cross-sectional study

Background

The Coronavirus Disease 2019 (COVID-19) pandemic prompted rules and laws such as lockdown, which contributed to staying at home and participating in sedentary activities such as using smartphones, tablets, televisions, gaming devices, and computers. As a result of the increased use of digital screen time, a worldwide issue has arisen among various age groups, especially adolescents, which may have affected their psychological well-being, increasing their susceptibility to anxiety-related disorders.

Objective

This study aimed to assess the relationship between screen time exposure and the presence of anxiety-related disorders among adolescents during the COVID-19 pandemic.

Methods

A quantitative descriptive cross-sectional design using convenience sampling was used in this study. The online self-administered questionnaire, including the Arabic-translated version of the Screen for Child Anxiety-related Disorders (SCARED-C), was distributed through social media using Google forms between February and April 2021. The Chi-Squared test was used for data analysis.

Results

Of 625 participants, majority were females (n = 527, 84.3%) than males (n = 98, 15.7%). A significant difference between screen time and the presence of an anxiety-related disorder among adolescents during the COVID-19 pandemic (p = .021) was noted. More than half of the participants (n = 410, 65.6%) scored above 25 in the SCARED-C test, indicating the presence of an anxiety-related disorder regardless of the type. Of those, more than a quarter (n = 176, 28.2%) used screens for more than 8 hours a day.

Conclusion

The results indicated a relationship between screen time exposure and the presence of anxiety-related disorders among adolescents during the pandemic. In particular, adolescents are more susceptible to the adverse effects of increased exposure to screen time, which is constantly on the rise. Therefore, nurses and other healthcare professionals can play a significant role in providing guidance and advice to parents, caregivers, and adolescents themselves on how to limit screen time exposure. The findings can also be useful for future studies to build on and develop screen time management interventions and guidelines.

Depression rates and health-seeking behavior in primary care: Andersen model of health- care utilization

Depression imposes a tremendous burden on the health-care systems. Many patients prefer informal (family & friends) over formal mental health services (MHS) provided by professionals. We aimed to investigate the prevalence of depression among primary care patients and to examine the factors predicting seeking MHS using the Andersen Health Care Utilization Model. We interviewed 300 primary care patients in Jordan. The mean age was 39.85 ± 14.45, and 80% were women. 35.7% had depression, and 28.7% had significant depression impairing daily function. The most commonly reported source of help was family members and less than one-third had the intention to seek formal MHS. The predisposing-factors domain was the only predictive of seeking MHS in depression and suicide, whereas the 'enabling' and 'need' domains were not. Knowledge, stigma and life satisfaction were predictive of seeking formal MHS. Raising awareness and empowering doctors to screen for depression is needed as less than a third would seek formal MHS.

The Relationship of Family and School Environments with Depression, Anxiety, and Stress Among Jordanian Students: A Cross-Sectional Study

INTRODUCTION

Depression, anxiety, and stress are highly prevalent among adolescents. The role of impaired family and school environments in adolescents' depression, anxiety, and stress in Jordan has yet to be established.

OBJECTIVE

The purpose of this study was to explore the association of family and school environments with the depression, anxiety, and stress of adolescents in Jordan.

METHODS

A cross-sectional correlational survey was used. A sample of 220 adolescents aged 12-18 years completed the study. Data were collected about family and school environments and adolescents' depression, anxiety, and stress.

RESULTS

School climate had a strong significant relationship with both general family functioning (r = .53, p < 0.01) and family process (r = .58, p < 0.01). General family functioning and school climate were uniquely associated with stress, anxiety, and depression (Β = -.280 or higher), p < 0.05, controlling for demographics.

CONCLUSION

The general family functioning and overall school climate were shown to play important role in adolescents' depression, anxiety, and stress. School nurses and psychiatric nurses may want to respond to the needs of adolescents with depression, anxiety, and stress through campaigns, lectures, and conferences and encourage them to access professional psychological counseling.

A Decade of Pharmacogenetic Studies in Jordan: A Systemic Review

The aim of this study was to perform a systematic overview of the pharmacogenetic studies conducted in Jordan. A structured search of Medline was conducted for articles over the last decade (January 2010-July 2020). Studies were classified by design, sample size, drug-gene combination, and the significance of the results. Thirty-two studies met the criteria for review. Most pharmacogenomic studies had a case-only design (n = 23). Only five studies included >500 participants. The total number of genetic variants in all studies was one hundred fifteen, which were found in forty genes, including dynamic (n = 27), and kinetic (n = 9) genes. The most commonly studied drugs were within the hematology and cardiology therapeutic areas and included statins, warfarin, aspirin, and clopidogrel. Most studies (n = 18) reported results with mixed p values [<0.05 and >0.05]. Pharmacogenomic research in Jordan is still in its infancy and is limited mainly to replication attempts. The need for standardization is imperative, especially in developing countries with scarce funding resources.

Depression and anxiety among school adolescent females: A national study from Jordan

Depression and anxiety are major mental health concerns among adolescent females within the school community and inflect many implications for psychological service providers in schools. The aims of this descriptive correlational study are to estimate the prevalence of anxiety and depression among high school adolescent females in Jordan, and to determine the contributing factors associated with depression and anxiety. Data were collected using self-report questionnaires from a clustered stratified sample of 405 high school females attending public schools in Jordan. Severe levels of depression and anxiety were reported by 25.7% and 21% of high school adolescent females, respectively. Education challenges and having a history of health problems contributed to having higher levels of depression and anxiety among the high school adolescent females. School mental health services regarding adolescent females mental health should be activated and supported through policies and legislation in Jordan.

Poor sleep quality among young adults: The role of anxiety, depression, musculoskeletal pain, and low dietary calcium intake

PURPOSE

This study examined the relationships between sleep quality, anxiety, depression, musculoskeletal pain (MSP), and calcium intake.

DESIGN AND METHODS

In this cross-sectional study (N = 1422), sleep was assessed using the Pittsburgh Sleep Quality Index, anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, and calcium intake and MSP were assessed by self-reporting.

FINDINGS

Poor sleep quality was reported by 62.66% of the participants. The participants with poor sleep quality reported lower calcium intake, higher anxiety and depression levels, more severe MSP, and multisite pain. Anxiety, depression, low calcium intake, and multisite pain were significant predictors of poor sleep quality. Anxiety was predicted by poor sleep quality, depression, multisite pain, and sex (ie, female). Depression was predicted by anxiety, poor sleep quality, and low calcium intake.

PRACTICAL IMPLICATIONS

The findings underscore the role of low calcium intake in the development of sleep problems, anxiety, depression, and MSP. Individuals with these conditions should be advised to increase their calcium intake.

Anxiety and depression and their relation to the use of electronic devices among secondary school students in Al-Khobar, Saudi Arabia, 2018-2019

BACKGROUND:

Adolescence is a critical transitional period for the development of mental illnesses such as depression or anxiety, and these days, adolescents spend less time playing outside than they do using electronic devices. The aim of this study was to examine the relationship between the use of electronic devices and anxiety and depression in female secondary school students in Al-Khobar City, KSA.

MATERIALS AND METHODS:

This cross-sectional study included 903 female students selected from the four educational districs (Al-Khobar, Al-Thuqbah, Al-Dhahran and Al-Rakah). Data was collected using a self-administered anonymous questionnaire that included questions related sociodemographics and the use of electronic devices, the Beck Depression Inventory, and the Generalized Anxiety Disorder 7-item scale. Data analysis included descriptive statistics frequencies and percentages for categorical variables, and mean and standard deviation for continuous variables. Chi-square test was performed to test for significance for association between categorical variable. Odds ratios were calculated for association of anxiety and depression with various independent variables including the use of electronic devices. A binary logistic regression model was used to determine factors associated with anxiety and depression. All test were performed at 5% significance level.

RESULTS:

The mean age of the participants was 16.29 years (SD=0.84). About 98% reported using electronic devices; 67.3% used electronic devices 2 or more hours daily, and 81.5% used them at bedtime. About 66% students had moderate-to-severe anxiey and 70/5% had mild-to-severe depression. The logistic regression model showed that users of electronic devices at bedtime were 1.524 more likely to have anxiety (P=0.026), while spending more than 2 hours on the devices at bedtime were significantly associated with depression.

CONCLUSION:

The high prevalence of anxiety and depression among female students is worrisome. Finding suggests that adolescents might benefit from a restricted use of electronic devices. It is necessary to develop age-specific guidelines regarding duration of the use of electronic devices and to integrate the development of psychosocial skills into the school curriculum.

Protocol for a systematic review of the development of depression among adolescents and young adults: psychological, biological, and contextual perspectives around the world

BACKGROUND

Depression is a leading contributor to disability-adjusted life-years because of early onset and chronicity throughout the lifecycle. It is crucial to identify early predictors of depression among adolescents and young people to effectively target prevention. A gap in the literature is a comprehensive systematic review of predictors of depression among adolescents around the globe, especially in low- and middle-income countries LMICs. This review aims to identify evidence for biological, psychological, and contextual risk factors for the development of depression among adolescents and young adults (10-24 years of age) in high-income countries (HICs) and LMICs, ultimately contributing to (a) identification of potential mechanisms underlying depression development, (b) selection of common risk and protective factors as targets for detection, and (c) refinement of risk models that can be evaluated through existing cohorts in HICs and LMICs.

METHODS

This review will follow the Population, Exposure, Comparison, Outcome (PI(E)CO) model and adheres to the PRISMA-P guidelines. A search strategy was developed by a multidisciplinary research consortium. Seven databases (MEDLINE via Ovid, PsycINFO, Cochrane Database of Systematic Reviews, Web of Science, Lilacs, African Journals Online, Global Health) will be searched to identify articles. Independent raters will screen and retrieve articles for inclusion, conduct quality ratings, and extract data. The Systematic Assessment of Quality in Observational Research adapted for Cultural Psychiatry Epidemiology (SAQOR-CPE) will be used to assess quality of observational studies. We will assess for publication bias using funnel plots and statistical methods. We will use narrative synthesis to present results, addressing the study's objectives following the Cochrane Handbook guidelines. Meta-analyses will be used to report summary statistics for association of risk factors with development of depression.

DISCUSSION

This systematic review will summarize evidence-based research that examines the psychological, biological, and contextual factors contributing to the onset of depression in adolescents across the globe. Results will support the development of a model that can be evaluated in existing cohorts around the world.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration CRD42018103973 .

Social Support and Emotional Intelligence as Protective Resources for Well-Being in Moroccan Adolescents

This study aimed to test a structural model to examine the protective role of psychosocial variables, such as social support, emotional intelligence and their interaction, on the cognitive dimension of subjective positive well-being (life satisfaction) and negative well-being (depression) in Moroccan adolescents. The participants consisted of 1277 students (571 men, 694 women and 12 missing values) with a mean age of 16.15 years (SD = 2.22; range = 9 to 23) who attended 26 public schools in different territories of Morocco. These students were in secondary education (n = 893) and high school (n = 378) (6 missing values). The scales for measuring the variables of interest had to be adapted and validated as a previous step for the further proposal of a model of relations. Statistical analyses were conducted using structural equation modeling (SEM) to test the proposed model. The model that optimally adjusted the data confirmed the protective role of social support in the well-being of Moroccan adolescents. Consistent with previous studies, social support was directly related to well-being. However, it also modulated levels of satisfaction with life. Likewise, the inclusion of emotional intelligence as an additional protective factor contributed to the explanation of the well-being mechanisms in adolescents. In addition to direct associations with the levels of social support, satisfaction with life and depression (negative in the latter case), emotional intelligence participated in a complex chain affecting life satisfaction and life satisfaction affecting depression. Moreover, the interaction of emotional intelligence with social support was confirmed to determine levels of life satisfaction in adolescents. Specifically, social support multiplied the effects of the relationship between satisfaction with life and emotional intelligence in cases of moderate and high levels in Moroccan adolescents. This study fills a gap in the literature by adapting and further analyzing several scales with Moroccan samples of adolescents and by proposing and verifying a relational model that can help researchers and teachers to more precisely clarify these relations according to their context. The enhancement of protective factors, such as social support and emotional intelligence, will promote healthy youth development, thus creating healthier societies in the future.

Comparison of the performance of the Beck Depression Inventory-II and the Center for Epidemiologic Studies-Depression Scale in Arab adolescents

BACKGROUND AND PURPOSE

Few instruments have been established as valid and reliable to screen for depression among Arab adolescents. The purpose of this study was to examine and compare the performance of two of the most widely used depression screening instruments, the Beck Depression Inventory-II (BDI-II) and the Center for Epidemiologic Studies-Depression scale (CES-D), with Arab adolescents.

METHODS

A nationwide school survey was conducted in Jordan. A total of 3,292 adolescents (1,766 females; 54%) aged 13-17 years completed and returned the survey that included the BDI-II, CES-D, sociodemographics, and health information. Comparisons were made between the BDI-II and CES-D on internal consistency and the reported prevalence of depression in the whole population and subgroups. Multivariate ordinary least squares and logistic regressions were used to assess factors associated with adolescent depression. Agreement regarding recommended cutoffs was also examined using Cohen's k.

RESULTS

Depression prevalence was significantly higher with the CES-D compared to the BDI-II among the same set of sample subgroups. Depression scores from both instruments showed different statistical associations with established risk factors for adolescent depression. The two instruments showed a moderate agreement (kappa = 0.55), indicating that the instruments do not completely identify the same cases. Different cutoff scores of the CES-D seemed to perform better for different age groups.

CONCLUSIONS

Our results varied systematically as a function of the measure used to identify depression prevalence. Caution in the interpretation of associations of depression scores with risk factors is required, as associations may be measurement artifacts. However, given the limited availability of mental health care resources in Arab countries, screening instruments like the BDI-II and CES-D may be a critical first step in preliminarily identifying cases, albeit neither can replace the clinical interview. We cautiously recommend using the CES-D with the risk of over diagnosing, but with the benefit of finding issues which are not typically addressed when there is a lack of mental health services. With the growing social and political unrest in Arab countries, increasing depression rates over time is expected to be a major public health issue. Methodical consideration for how to invest in community-based screening is warranted.