Social Psychiatry and Psychiatric Epidemiology

, Volume 51, Issue 8, pp 1105–1116 | Cite as

Psychiatric disorders among adolescents from Lebanon: prevalence, correlates, and treatment gap

  • Fadi T. MaaloufEmail author
  • Lilian A. Ghandour
  • Fadi Halabi
  • Pia Zeinoun
  • Al Amira Safa Shehab
  • Lucy Tavitian
Original Paper



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.


Adolescence Mental health Lebanon Epidemiology Arab world 



This study was funded through the Medical Practice Plan at the American University of Beirut. Data collection was completed by Information International, a research company based in Beirut, Lebanon. The authors would like to thank Dr. Robert Goodman, author of the DAWBA, for his guidance and support.

Compliance with ethical standards

Ethical considerations

The study was approved by the Institutional Review Board (IRB) at the American University of Beirut and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Written informed consents from participating parents/legal guardians and assents from adolescents were obtained.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 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
  2. 2.
    Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):593–602. doi: 10.1001/archpsyc.62.6.593 CrossRefPubMedGoogle Scholar
  3. 3.
    Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A (2003) Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry 60(8):837–844. doi: 10.1001/archpsyc.60.8.837 CrossRefPubMedGoogle Scholar
  4. 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
  5. 5.
    Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA (2015) Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry 56(3):345–365. doi: 10.1111/jcpp.12381 CrossRefPubMedGoogle Scholar
  6. 6.
    Okasha A, Karam E, Okasha T (2012) Mental health services in the Arab world. World Psychiatry 11(1):52–54CrossRefPubMedPubMedCentralGoogle Scholar
  7. 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. 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
  9. 9.
    Eapen V, Jakka ME, Abou-Saleh MT (2003) Children with psychiatric disorders: the A1 Ain Community Psychiatric Survey. Can J Psychiatry 48(6):402–407PubMedGoogle Scholar
  10. 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
  11. 11.
    Mahfouz AA, Al-Gelban KS, Al Amri H, Khan MY, Abdelmoneim I, Daffalla AA, Shaban H, Mohammed AA (2009) Adolescents’ mental health in Abha city, southwestern Saudi Arabia. Int J Psychiatry Med 39(2):169–177CrossRefPubMedGoogle Scholar
  12. 12.
    Drury J, Williams R (2012) Children and young people who are refugees, internally displaced persons or survivors or perpetrators of war, mass violence and terrorism. Curr Opin Psychiatry 25(4):277–284. doi: 10.1097/YCO.0b013e328353eea6 CrossRefPubMedGoogle Scholar
  13. 13.
    Karam EG, Mneimneh ZN, Karam AN, Fayyad JA, Nasser SC, Chatterji S, Kessler RC (2006) Prevalence and treatment of mental disorders in Lebanon: a national epidemiological survey. Lancet 367(9515):1000–1006. doi: 10.1016/s0140-6736(06)68427-4 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Karam EG, Mneimneh ZN, Dimassi H, Fayyad JA, Karam AN, Nasser SC, Chatterji S, Kessler RC (2008) Lifetime prevalence of mental disorders in Lebanon: first onset, treatment, and exposure to war. PLoS Med 5(4):e61. doi: 10.1371/journal.pmed.0050061 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Richa S, Rohayem J, Chammai R, Kazour F, Haddad R, Hleis S, Alameddine A, Gerbaka B (2014) ADHD prevalence in Lebanese school-age population. J Atten Disord 18(3):242–246. doi: 10.1177/1087054712445065 CrossRefPubMedGoogle Scholar
  16. 16.
    Mahfoud ZR, Afifi RA, Haddad PH, Dejong J (2011) Prevalence and determinants of suicide ideation among Lebanese adolescents: results of the GSHS Lebanon 2005. J Adolesc 34(2):379–384. doi: 10.1016/j.adolescence.2010.03.009 CrossRefPubMedGoogle Scholar
  17. 17.
    Karam EG, Fayyad J, Karam AN, Melhem N, Mneimneh Z, Dimassi H, Tabet CC (2014) Outcome of depression and anxiety after war: a prospective epidemiologic study of children and adolescents. J Trauma Stress 27(2):192–199. doi: 10.1002/jts.21895 CrossRefPubMedGoogle Scholar
  18. 18.
    Central Administration of Statistics (CAS) (2004) The national survey of household living conditions. Presidency of the Council of Ministers, Lebanese RepublicGoogle Scholar
  19. 19.
    Goodman R, Ford T, Richards H, Gatward R, Meltzer H (2000) The development and well-being assessment: description and initial validation of an integrated assessment of child and adolescent psychopathology. J Child Psychol Psychiatry 41(5):645–655CrossRefPubMedGoogle Scholar
  20. 20.
    Rigby K, Slee PT (1993) Dimensions of interpersonal relation among Australian children and implications for psychological well-being. J Soc Psychol 133(1):33–42. doi: 10.1080/00224545.1993.9712116 CrossRefPubMedGoogle Scholar
  21. 21.
    Alyahri A, Goodman R (2006) Validation of the Arabic Strengths and Difficulties Questionnaire and the Development and Well-Being Assessment. East Mediterr Health J 12(Suppl 2):S138–S146PubMedGoogle Scholar
  22. 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
  23. 23.
    Roberts RE, Attkisson CC, Rosenblatt A (1998) Prevalence of psychopathology among children and adolescents. Am J Psychiatry 155(6):715–725PubMedGoogle Scholar
  24. 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
  25. 25.
    Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164(6):942–948. doi: 10.1176/ajp.2007.164.6.942 CrossRefPubMedGoogle Scholar
  26. 26.
    Farah LG, Fayyad JA, Eapen V, Cassir Y, Salamoun MM, Tabet CC, Mneimneh ZN, Karam EG (2009) ADHD in the Arab world: a review of epidemiologic studies. J Atten Disord 13(3):211–222. doi: 10.1177/1087054708325976 CrossRefPubMedGoogle Scholar
  27. 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
  28. 28.
    Thabet AA, Vostanis P (1998) Social adversities and anxiety disorders in the Gaza Strip. Arch Dis Child 78(5):439–442CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Farhood LF, Dimassi H (2012) Prevalence and predictors for post-traumatic stress disorder, depression and general health in a population from six villages in South Lebanon. Soc Psychiatry Psychiatr Epidemiol 47(4):639–649. doi: 10.1007/s00127-011-0368-6 CrossRefPubMedGoogle Scholar
  30. 30.
    Zwaanswijk M, Verhaak PF, Bensing JM, van der Ende J, Verhulst FC (2003) Help seeking for emotional and behavioural problems in children and adolescents: a review of recent literature. Eur Child Adolesc Psychiatry 12(4):153–161. doi: 10.1007/s00787-003-0322-6 CrossRefPubMedGoogle Scholar
  31. 31.
    Costello EJ, He JP, Sampson NA, Kessler RC, Merikangas KR (2014) Services for adolescents with psychiatric disorders: 12-month data from the National Comorbidity Survey-Adolescent. Psychiatr Serv 65(3):359–366. doi: 10.1176/ CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Al Riyami AA, Al Adawi SH, Al Kharusi HA, Morsi MM, Jaju SS (2009) Health services utilization by school going Omani adolescents and youths with DSM IV mental disorders and barriers to service use. Int J Ment Health Syst 3(1):22. doi: 10.1186/1752-4458-3-22 CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Yehia F, Nahas Z, Saleh S (2014) A roadmap to parity in mental health financing: the case of Lebanon. J Ment Health Policy Econ 17(3):131–141PubMedGoogle Scholar
  34. 34.
    Corathers SD, Kichler J, Jones NH, Houchen A, Jolly M, Morwessel N, Crawford P, Dolan LM, Hood KK (2013) Improving depression screening for adolescents with type 1 diabetes. Pediatrics 132(5):e1395–e1402. doi: 10.1542/peds.2013-0681 CrossRefPubMedGoogle Scholar
  35. 35.
    Stadelmann S, Perren S, Groeben M, von Klitzing K (2010) Parental separation and children’s behavioral/emotional problems: the impact of parental representations and family conflict. Fam Process 49(1):92–108. doi: 10.1111/j.1545-5300.2010.01310.x CrossRefPubMedGoogle Scholar
  36. 36.
    Sandler IN, Wheeler LA, Braver SL (2013) Relations of parenting quality, interparental conflict, and overnights with mental health problems of children in divorcing families with high legal conflict. J Fam Psychol 27(6):915–924. doi: 10.1037/a0034449 CrossRefPubMedGoogle Scholar
  37. 37.
    Modecki KL, Hagan MJ, Sandler I, Wolchik SA (2015) Latent profiles of nonresidential father engagement six years after divorce predict long-term offspring outcomes. J Clin Child Adolesc Psychol 44(1):123–136. doi: 10.1080/15374416.2013.865193 CrossRefPubMedGoogle Scholar
  38. 38.
    Husky MM, Kaplan A, McGuire L, Flynn L, Chrostowski C, Olfson M (2011) Identifying adolescents at risk through voluntary school-based mental health screening. J Adolesc 34(3):505–511. doi: 10.1016/j.adolescence.2010.05.018 CrossRefPubMedGoogle Scholar
  39. 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. 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. 41.
    Central Administration of Statistics (CAS) (2007) The national survey of household living conditions. Presidency of the Council of Ministers, Lebanese RepublicGoogle Scholar
  42. 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
  43. 43.
    Angold A, Erkanli A, Copeland W, Goodman R, Fisher PW, Costello EJ (2012) Psychiatric diagnostic interviews for children and adolescents: a comparative study. J Am Acad Child Adolesc Psychiatry 51(5):506–517. doi: 10.1016/j.jaac.2012.02.020 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Fadi T. Maalouf
    • 1
    Email author
  • Lilian A. Ghandour
    • 2
  • Fadi Halabi
    • 1
  • Pia Zeinoun
    • 1
  • Al Amira Safa Shehab
    • 4
  • Lucy Tavitian
    • 3
  1. 1.Child and Adolescent Psychiatry Program, Department of Psychiatry, Faculty of MedicineAmerican University of Beirut Medical CenterBeirutLebanon
  2. 2.Department of Epidemiology and Population Health, Faculty of Health SciencesAmerican University of BeirutBeirutLebanon
  3. 3.Department of Cross-Cultural StudiesTilburg UniversityTilburgThe Netherlands
  4. 4.Department of Psychology, Queens CollegeCity University of New YorkNew YorkUSA

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