Association between adolescents' anxiety, depressive symptoms

Main ConteThe School of Nursing of The Hong Kong Polytechnic University (PolyU) and Christian Family Service Centre (CFSC) have jointly conducted a large-scale study on the family life, physical and emotional health of high school students. The study, spanning over three years from 2011, found that 12% out of the 11,335 students interviewed have experienced moderate level of anxiety in the two weeks prior to the survey, and 5.7% experienced frequent severe anxiety in the same period of time.

Anxiety disorders are one of the most common mental health problems. To understand better anxiety among adolescents, the joint study mainly examined Generalized Anxiety Disorder (GAD) which is one of the most prevalent anxiety disorders. Everyone experiences anxiety in their everyday life. Mild or short periods of anxiety can be released by resolving the cause of anxiety. However, high levels of chronic anxiety can lead to co-existing problem of depression. Current research found that individuals who suffer from GAD are at higher risk of engaging in health risk behaviours such as smoking, drinking alcohol and using drug. Dependence on these substances might lead to increased levels of anxiety, and the individual is caught in a vicious circle.

However, a very limited the number of studies have examined anxiety disorders among adolescents in Hong Kong. Mental health promotion and planning in Hong Kong therefore rely mainly on overseas data which are not comprehensive enough to understand mental health state of young people.

A set of questionnaires has been used to investigate common anxiety symptoms, school experience and physical and emotional health of secondary school students. Questions in the survey collected information about their physical and emotional health conditions, stress about schoolwork, and levels of satisfaction in academic achievement, life orientations and perceptions about parents' psychological control over them. The questionnaires were filled by students in their classrooms during school time. 16 schools categorized according to boys' schools, girls' schools, co-education schools and sources of funding have been randomly selected from 109 secondary schools in Tseung Kwan O, Kwun Tong and Wong Tai Sin districts to complete the questionnaires. From 2011 to 2013, 14 schools have completed the survey with a total of 11,335 questionnaires collected. It is expected that the entire data collection will be completed in the second semester in 2013/2014.

The research results showed that students have experienced mild (30.2%) to moderate (12%) levels of anxiety in the two weeks prior to the survey while 5.7% students experienced severe levels of anxiety in the same period of time. Students who suffered from severe levels of anxiety in the two weeks prior to the survey were worse off in terms of physical health and mental health. Of the 614 students who reported experiencing severe levels of anxiety, 86.3% of them further reported feeling pressure of homework, compared to the 61.5% of 10,295 students who reported not having severe levels of anxiety.

The survey found that of the 637 students who reported experiencing severe levels of anxiety, 75.5% felt down, depressed and hopeless for more than half the week, or almost every day; 80.9% of these students even felt bad about themselves -- or that they were a failure or have let themselves and their families down for more than half the week, or almost every day; and 49.2% of them had thoughts that they were better off dead, or hurting themselves. Compared the situation to those students who reported experiencing not severe levels of anxiety, only a small portion of these students felt down, depressed and hopeless (2.8%), felt bad about themselves -- or that they were a failure or have let themselves and their families down (5.2%), or had thoughts that they were better off dead, or hurting themselves (1.2%) for more than half the week or almost every day.

In addition, 88.6% of the 637 students who reported experiencing severe levels of anxiety, indicated that they were not satisfied with their academic performance compared to the 81.4% of students who reported not severe anxiety. Moreover, 10.6% of students who reported experiencing severe levels of anxiety reported smoking, compared to 4.4% of students who reported experiencing not severe anxiety; similarly, 47.2% of students who reported suffering severe levels of anxiety indicated that they had used alcohol, compared to the 31.5% of students who reported not severe levels of anxiety, and 4.7% of the students who reported severe levels of anxiety indicated that they had used drugs, compared to the 2.2% of 10,268 students who reported not severe levels of anxiety.

59.8% of the students who reported severe levels of anxiety, scored lower mastery skills scores, compared to the 11.9% of students who reported not severe levels of anxiety. Similar findings were found in the 48.7% of students who reported severe levels of anxiety, scored lower on the life orientation scale, compared to the 11.8% of 10,390 students who reported not severe levels of anxiety.

Likewise, 56.3% of students who reported severe levels of anxiety, scored lower levels of perceived family support compared to the 29.3% of students who reported not severe levels of anxiety; and finally, 35% of the students who reported severe levels of anxiety, scored lower levels of perceived support from friends, compared to the 14% of students who reported not severe levels of anxiety.

A total of 17.7% of the students reported moderate/ frequent severe anxiety in the 2 weeks prior to the survey. Findings of the present study revealed that anxiety might affect students' academic performance as well as their physical and mental health.

The research team recommends that the Government should perform regular surveys on children and adolescents' physical and mental health to facilitate the development of timely and relevant health promotion policies and interventions. Parents, teachers and professionals who work with children or adolescents should pay more attention and offer support to children for the sake of mental and physical health. Asking simple questions like those in the Generalized Anxiety Disorder Scale (GAD-7) can facilitate detection of general anxiety. These questions include feeling not being able to control or stop worrying; having trouble relaxing; and feeling afraid as if something awful is likely to happen.

Parents could support their children more by active communication and being aware of their children's status of anxiety. Methods for building positive relationships such as love and encouragement could be used, particularly, if children are having learning difficulties or taking up health risk behaviour such as smoking or using drug. They should seek professional assistance if anxiety symptoms persist.