Psychiatric disorders among adolescents from Lebanon: prevalence, correlates, and treatment gap
Adolescence is a critical age for the development of psychiatric disorders. Although Lebanon, a low-to-middle income country, has suffered from decades of war and political instability, the burden of psychiatric disorders among adolescents in Lebanon remains unclear. This study aims to estimate the prevalence of psychiatric disorders among adolescents in the Lebanese capital, Beirut, and to study the correlates and treatment seeking behavior associated with these disorders.
Through a multistage cluster sampling design, 510 adolescents, aged 11–17 years were recruited from a household sample in Beirut in 2012. Parents and adolescents completed a battery of self-reported questionnaires and interviews including the Development and Well-being Assessment (DAWBA), the Peer-Relations Questionnaire (PRQ), and a demographic/clinical information questionnaire. Logistic regression models were used to study the correlates of psychiatric disorders.
The 30-day prevalence of psychiatric disorders was 26.1 %, with anxiety disorders (13.1 %) and ADHD (10.2 %) being the most prevalent disorders. Only 6 % of those with disorders reported seeking professional help. Parental marital status, not attending school, having a chronic medical condition, having a family history of psychiatric disorders, as well as propensity to bullying and to being victimized by peers emerged as correlates of having psychiatric disorders.
A clear treatment gap is evident with a high 30-day prevalence of psychiatric disorders among adolescents in Beirut coupled with a very low percentage seeking treatment. Scaling up mental health services and addressing potential barriers to seeking care would be important to close this gap.
KeywordsAdolescence Mental health Lebanon Epidemiology Arab world
- 1.Kessler RC, Angermeyer M, Anthony JC, Graaf R DE, Demyttenaere K, Gasquet I, Gluzman S, Gureje O, Haro JM, Kawakami N, Karam A, Levinson D, Medina Mora ME, Oakley Browne MA, Posada-Villa J, Stein DJ, Adley Tsang CH, Aguilar-Gaxiola S, Alonso J, Lee S, Heeringa S, Pennell BE, Berglund P, Gruber MJ, Petukhova M, Chatterji S, Ustun TB (2007) Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry 6(3):168–176Google Scholar
- 4.Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J (2010) Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry 49(10):980–989. doi:10.1016/j.jaac.2010.05.017 CrossRefPubMedPubMedCentralGoogle Scholar
- 7.WHO (2011) Atlas: child, adolescent, and maternal mental health resources in the Eastern Mediterranean Region. EMRO technical publication series. World Health Organization, Regional Office for the Eastern Mediterranean, GenevaGoogle Scholar
- 8.Eapen V, al-Gazali L, Bin-Othman S, Abou-Saleh M (1998) Mental health problems among schoolchildren in United Arab Emirates: prevalence and risk factors. J Am Acad Child Adolesc Psychiatry 37(8):880–886. doi:10.1097/00004583-199808000-00019Google Scholar
- 10.Jaju S, Al-Adawi S, Al-Kharusi H, Morsi M, Al-Riyami A (2009) Prevalence and age-of-onset distributions of DSM IV mental disorders and their severity among school going Omani adolescents and youths: WMH-CIDI findings. Child Adolesc Psychiatry Ment Health 3(1):29. doi:10.1186/1753-2000-3-29 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Central Administration of Statistics (CAS) (2004) The national survey of household living conditions. Presidency of the Council of Ministers, Lebanese RepublicGoogle Scholar
- 22.Zeinoun P, Bawab S, Atwi M, Hariz N, Tavitian L, Khani M, Nahas Z, Maalouf FT (2013) Validation of an Arabic multi-informant psychiatric diagnostic interview for children and adolescents: development and Well Being Assessment-Arabic (DAWBA-Arabic). Compr Psychiatry 54(7):1034–1041. doi:10.1016/j.comppsych.2013.04.012 CrossRefPubMedGoogle Scholar
- 24.Goodman A, Heiervang E, Fleitlich-Bilyk B, Alyahri A, Patel V, Mullick MS, Slobodskaya H, Dos Santos DN, Goodman R (2012) Cross-national differences in questionnaires do not necessarily reflect comparable differences in disorder prevalence. Soc Psychiatry Psychiatr Epidemiol 47(8):1321–1331. doi:10.1007/s00127-011-0440-2 CrossRefPubMedGoogle Scholar
- 27.Dopfner M, Breuer D, Wille N, Erhart M, Ravens-Sieberer U (2008) How often do children meet ICD-10/DSM-IV criteria of attention deficit-/hyperactivity disorder and hyperkinetic disorder? Parent-based prevalence rates in a national sample–results of the BELLA study. Eur Child Adolesc Psychiatry 17(Suppl 1):59–70. doi:10.1007/s00787-008-1007-y CrossRefPubMedGoogle Scholar
- 39.Kessler RC, Avenevoli S, Costello EJ, Green JG, Gruber MJ, Heeringa S, Merikangas KR, Pennell BE, Sampson NA, Zaslavsky AM (2009) National comorbidity survey replication adolescent supplement (NCS-A): II. Overview and design. J Am Acad Child Adolesc Psychiatry 48(4):380–385. doi:10.1097/CHI.0b013e3181999705 CrossRefPubMedPubMedCentralGoogle Scholar
- 40.Hafekost J, Lawrence D, Boterhoven de Haan K, Johnson SE, Saw S, Buckingham WJ, Sawyer MG, Ainley J, Zubrick SR (2015) Methodology of young minds matter: the second Australian Child and Adolescent Survey of Mental Health and Well-being. Aust N Z J Psychiatry. doi:10.1177/0004867415622270 Google Scholar
- 41.Central Administration of Statistics (CAS) (2007) The national survey of household living conditions. Presidency of the Council of Ministers, Lebanese RepublicGoogle Scholar
- 42.Dursun OB, Guvenir T, Aras S, Ergin C, Mutlu C, Baydur H, Ozbek A, Ozek H, Alsen S, Iscanli L, Karaman BI, Goodman R (2013) A new diagnostic approach for Turkish speaking populations DAWBA Turkish version. Epidemiol Psychiatr Sci 22(3):275–282. doi:10.1017/s2045796012000479 CrossRefPubMedGoogle Scholar