PERTANIKA JOURNAL OF SOCIAL SCIENCES AND HUMANITIES

This study aimed to determine the prevalence of depression, anxiety, and the associated factors among 632 adolescents (age range: 13-17 years, M_age = 14.47, SD = 1.32) staying in sheltered homes in Malaysia. The Malay versions of the Beck Depression Inventory, Beck Anxiety Inventory, Automatic Thoughts Questionnaire, and Rosenberg Self-Esteem Scale were applied. The overall prevalence of mild to severe depression and anxiety in this study was 70.9% and 82.3% respectively, with 64.1% for comorbidity of both symptoms. Specifically, the prevalence rates of minimal, mild, moderate, and severe depressive symptoms were 29.1%, 38.4%, 22.4%, and 10.1% respectively whereas the prevalence rates of minimal, mild, moderate, and severe anxiety symptoms were 17.7%, 27.7%, 33.2%, and 21.4% respectively. The severity of negative automatic thoughts increased with the severity of depression and anxiety. Age, anxiety, negative automatic thoughts, and self-esteem were significantly associated with depression while depression, negative automatic thought, and anger were significantly associated with anxiety. The high rates of depression and anxiety among adolescents residing in the sheltered homes indicate the need to identify these at-risk populations and provide trained personnel who can deliver psychiatric and psychological services at sheltered homes.

• Abbo, C., Kinyanda, E., Kizza, R. B., Levin, J., Ndyanabangi, S., & Stein, D. J. (2013). Prevalence, comorbidity and predictors of anxiety disorders in children and adolescents in rural north-eastern Uganda. Child and Adolescent Psychiatry and Mental Health, 7(1), 1-11. https://doi.org/10.1186/1753-2000-7-21

• Adlina, S., Suthahar, A., Ramli, M., Edariah, A. B., Soe, S. A., Mohd Ariff, F., Narimah, A. H., Nuraliza, A. S., & Karuthan, C. (2007). Pilot study on depression among secondary school students in Selangor. The Medical Journal of Malaysia, 62(3), 218-222.

• Alexander, B., David, E., & Grills, N. (2013). High prevalence of anxiety disorders among adolescent Tibetan refugees. Asian Journal of Psychiatry, 6(3), 218-221. https://doi.org/10.1016/j.ajp.2012.12.006

• Allan, N. P., Capron, D. W., Lejuez, C. W., Reynolds, E. K., MacPherson, L., & Schmidt, N. B. (2014). Developmental trajectories of anxiety symptoms in early adolescence: The influence of anxiety sensitivity. Journal of Abnormal Child Psychology, 42(4), 589-600. https://doi.org/10.1007/s10802-013-9806-0

• Avenevoli, S., Swendsen, J., He, J. P., Burstein, M., & Merikangas, K. R. (2015). Major depression in the national comorbidity survey-adolescent supplement: Prevalence, correlates, and treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 54(1), 37-44.e2. https://doi.org/10.1016/j.jaac.2014.10.010

• Baxter, A. J., Scott, K. M., Vos, T., & Whiteford, H. A. (2013). Global prevalence of anxiety disorders: A systematic review and meta-regression. Psychological Medicine, 43(5), 897-910. https://doi.org/10.1017/S003329171200147X

• Beck, A. T., & Steer, R. A. (1990). Manual for the Beck Anxiety Inventory. Person Corporation.

• Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4(6), 561-571. https://doi.org/10.1093/ndt/gfr086

• Beidel, D. C., & Alfano, C. A. (2011). Child anxiety disorders: A guide to research and treatment. (2nd ed.). Brunner-Routledge.

• Benjamin, C. L., Harrison, J. P., Settipani, C. A., Brodman, D. M., & Kendall, P. C. (2013). Anxiety and related outcomes in young adults 7 to 19 years after receiving treatment for child anxiety. Journal of Consulting and Clinical Psychology, 8(15), 865-876. https://doi.org/10.1037/a0033048

• Bulhões, C., Ramos, E., Lindert, J., Dias, S., & Barros, H. (2013). Depressive symptoms and its associated factors in 13-year-old urban adolescents. International Journal of Environmental Research and Public Health, 10(10), 5026-5038. https://doi.org/10.3390/ijerph10105026

• Chow, S. C., Shao, J., Wang, H., & Lokhnygina, Y. (2017). Sample size calculations in clinical research (3rd ed). Chapman and Hall/CRC. https://doi.org/10.1201/9781315183084

• Clark, M. S., Jansen, K. L., & Cloy, J. A. (2012). Treatment of childhood and adolescent depression. American Family Physician, 86(5), 442-448. https://www.ncbi.nlm.nih.gov/pubmed/22963063

• Cluver, L. D., Orkin, M., Gardner, F., & Boyes, M. E. (2012). Persisting mental health problems among AIDS-orphaned children in South Africa. Journal of Child Psychology and Psychiatry and Allied Disciplines, 53(4), 363-370. https://doi.org/10.1111/j.1469-7610.2011.02459.x

• Dabkowska, M., & Dabkowska-Mika, A. (2015). Risk factors of anxiety disorders in children: A fresh look at anxiety disorders. In F. Durbano (Ed.), IntechOpen (pp. 1-16). https://doi.org/10.5772/61169

• Derdikman-Eiron, R., Indredavik, M. S., Bratberg, G. H., Taraldsen, G., Bakken, I. J., & Colton, M. (2011). Gender differences in subjective well-being, self-esteem and psychosocial functioning in adolescents with symptoms of anxiety and depression: Findings from the Nord-Trøndelag health study. Scandinavian Journal of Psychology, 52(3), 261-267. https://doi.org/10.1111/j.1467-9450.2010.00859.x

• Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129-136. https://doi.org/10.1126/science.847460

• Engel, G. L. (1980). The clinical application of the biopsychosocial model. The American Journal of Psychiatry, 137(5), 535-544. https://doi.org/10.1176/ajp.137.5.535

• Essau, C. A., Lewinsohn, P. M., Olaya, B., & Seeley, J. R. (2014). Anxiety disorders in adolescents and psychosocial outcomes at age 30. Journal of Affective Disorders, 163, 125-132. https://doi.org/10.1016/j.jad.2013.12.033

• Fanaj, N., Melonashi, E., Drevinja, F., & Haxhibeqiri, S. H. (2015). Depression, anxiety, hopelessness and self-esteem in a clinical sample of adolescents in Kosovo. European Psychiatry, 30(1), 1189. https://doi.org/10.1016/S0924-9338(15)30935-4

• Farid, M. F., & Akhtar, M. (2013). Self-esteem of secondary school students in Pakistan. Middle-East Journal of Scientific Research, 14(10), 1325-1330.

• Fawzy, N., & Fouad, A. (2010). Psychosocial and developmental status of orphanage children: Epidemiological study. Current Psychiatry, 17(2), 41-48.

• Fergusson, D. M., & Woodward, L. J. (2002). Mental health, educational, and social role outcomes of adolescents with depression. Archives of General Psychiatry, 59(3), 225. https://doi.org/10.1001/archpsyc.59.3.225

• Getachew, H., Ambaw, F., Abebe, L., & Kasahun, W. (2011). Psychological distress and its predictors in AIDS orphan adolescents in Addis Ababa city: A comparative survey. Ethiopian Journal of Health Development, 25(2), 135-142.

• Guo, X., Meng, Z., Huang, G., Fan, J., Zhou, W., Ling, W., Jiang, J., Long, J., & Su, L. (2016). Meta-analysis of the prevalence of anxiety disorders in mainland China from 2000 to 2015. Scientific Reports, 6, 1-15. https://doi.org/10.1038/srep28033

• Hankin, B. L., Abramson, L. Y., Miller, N., & Haeffel, G. J. (2004). Cognitive vulnerability-stress theories of depression: Examining affective specificity in the prediction of depression versus anxiety in three prospective studies. Cognitive Therapy and Research, 28(3), 309-345. https://doi.org/10.1023/B:COTR.0000031805.60529.0d

• Hankin, B. L., Young, J. F., Abela, J. R. Z., Smolen, A., Jenness, J. L., Gulley, L. D., Technow, J. R., Gottlieb, A. B., Cohen, J. R., & Oppenheimer, C. W. (2015). Depression from childhood into late adolescence: Influence of gender, development, genetic susceptibility, and peer stress. Journal of Abnormal Psychology, 124(4), 803-816. https://doi.org/10.1037/abn0000089

• Heck, R., Thomas, S., Tabata, L. (2013). Multilevel and longitudinal modeling with IBM SPSS. Routledge

• Hollon, S. D., & Kendall, P. C. (1980). Cognitive self-statements in depression: Development of an automatic thoughts questionnaire. Cognitive Therapy and Research, 4(4), 383-395. https://doi.org/10.1007/BF01178214

• Ibrahim, N., Amit, N., & Wong, M. (2014). Psychological factors as predictors of suicidal ideation among adolescents in Malaysia. Plos One, 9(10), Article e110670. https://doi.org/10.1371/journal.pone.0110670

• Ibrahim, N., Mohd Sidik, S., Phang, C. K., Mukhtar, F., Awang, H., Ang, J. K., Zubaidah, J. O., Abdul Ghaffar, S. F. (2017). Prevalence and predictors of depression and suicidal ideation among adolescents attending government secondary schools in Malaysia. Medical Journal of Malaysia, 72(4), 221-227.

• Institute for Public Health. (2018). National Health and Morbidity Survey (NHMS) 2017: Key findings from the adolescent health and nutrition surveys. http://iku.moh.gov.my/images/IKU/Document/REPORT/NHMS2017/NHMS2017Infographic.pdf

• Ishikawa, S. (2015). A cognitive-behavioral model of anxiety disorders in children and adolescents. Japanese Psychological Research, 57(3), 180-193. https://doi.org/10.1111/jpr.12078

• Keane, L., & Loades, M. (2017). Low self-esteem and internalizing disorders in young people: A systematic review. Child and Adolescent Mental Health, 22(1), 4-15. https://doi.org/10.1111/camh.12204

• Kelley, K., & Maxwell, S. E. (2003). Sample size for multiple regression: Obtaining regression coefficients that are accurate, not simply significant. Psychological Methods, 8(3), 305-321. https://doi.org/10.1037/1082-989X.8.3.305

• Kessler, R. C., Avenevoli, S., Costello, E. J., Georgiades, K., Green, J. G., Gruber, M. J., He, J. P., Koretz, D., McLaughlin, K. A., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Merikangas, K. R. (2012). Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement. Archives of General Psychiatry, 69(4), 372-380. https://doi.org/10.1001/archgenpsychiatry.2011.160

• Khasakhala, L., Ndetei, D., Mutiso, V., Mbwayo, A., & Mathai, M. (2012). The prevalence of depressive symptoms among adolescents in Nairobi public secondary schools: Association with perceived maladaptive parental behaviour. African Journal of Psychiatry, 15(2), 106-113. https://doi.org/10.4314/ajpsy.v15i2.14

• Latiff, L. A., Sidik, S. M., Ibrahim, N., Othman, N., Abu Bakar, A. S., Awang, H., Mukhtar, F., Osman, Z. J., Ismail, S. I. F., Naing, N. K., Rahman, H. A., Ibrahim, F. H., & Akhtari-Zavare, M. (2015). Prevalence of anxiety and its association with socio-demographic factors among secondary school students in Pasir Gudang district, Johor. International Journal of Public Health and Clinical Sciences, 2(6), 104-112.

• Li, C. E., DiGiuseppe, R., & Froh, J. (2006). The roles of sex, gender, and coping in adolescent depression. Adolescence, 41(163), 409-415.

• Mahmoud, J. S. R., Staten, R. “Topsy,” Lennie, T. A., & Hall, L. A. (2015). The relationships of coping, negative thinking, life satisfaction, social support, and selected demographics with anxiety of young adult college students. Journal of Child and Adolescent Psychiatric Nursing, 28(2), 97-108. https://doi.org/10.1111/jcap.12109

• McGuinness, T. M., Dyer, J. G., & Wade, E. H. (2012). Gender differences in adolescent depression. Journal of Psychosocial Nursing and Mental Health Services, 50(12), 17-20. https://doi.org/10.3928/02793695-20121107-04

• Merikangas, K., He, J.-P., Burstein, M., Swanson, S., Avenevoli, S., Lihong, C., 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). Journal of the American Academy Children Adolescent Psychiatry, 49(10), 980-989. https://doi.org/10.1016/j.jaac.2010.05.017

• Mohammadzadeh, M., Awang, H., Kadir Shahar, H., & Ismail, S. (2018). Emotional health and self-esteem among adolescents in Malaysian orphanages. Community Mental Health Journal, 54(1), 117-125. https://doi.org/10.1007/s10597-017-0128-5

• Moksnes, U. K., Moljord, I. E. O., Espnes, G. A., & Byrne, D. G. (2010). The association between stress and emotional states in adolescents: The role of gender and self-esteem. Personality and Individual Differences, 49(5), 430-435. https://doi.org/10.1016/j.paid.2010.04.012

• Mukhtar, F., & Oei, T. P. S. (2008). Exploratory and confirmatory factor validation and psychometric properties of the Beck Depression Inventory for Malays (BDI-Malay) in Malaysia. Malaysian Journal of Psychiatry, 17(1), 51-64. https://doi.org/10.1017/CBO9781107415324.004

• Mukhtar, F., & Zulkefly, N. S. (2011). The Beck Anxiety Inventory for Malays (BAI-Malay): A preliminary study on psychometric properties. Malaysian Journal of Medicine and Health Sciences, 7(1), 75-81.

• Nalugya-Sserunjogi, J., Rukundo, G. Z., Ovuga, E., Kiwuwa, S. M., Musisi, S., & Nakimuli-Mpungu, E. (2016). Prevalence and factors associated with depression symptoms among school-going adolescents in Central Uganda. Child and Adolescent Psychiatry and Mental Health, 10(39), 1-8. https://doi.org/10.1186/s13034-016-0133-4

• Nasir, R., Zamani, Z. A., Yusooff, F., & Khairudin, R. (2010). Cognitive distortion and depression among juvenile delinquents in Malaysia. Procedia: Social and Behavioural Sciences, 5, 272-276. https://doi.org/10.1016/j.sbspro.2010.07.087

• Nilsen, S. T., Eisemann, M., & Kvernmo, S. (2013). Predictors and moderators of outcome in child and adolescent anxiety and depression: A systematic review of psychological treatment studies. European Child and Adolescent Psychiatry, 22(2), 69-87. https://doi.org/10.1007/s00787-012-0316-3

• Novaco, R. W. (2010). Anger and psychopathology. In M. Potegal, G. Stemmler, & C. Spielberger (Eds.), International handbook of anger: Constituent and concomitant biological, psychological, and social processes (pp. 465-497). Springer Science + Business Media. https://doi.org/10.1007/978-0-387-89676-2_27

• Oei, T. P. S., & Mukhtar, F. (2008). Exploratory and confirmatory factor validation and psychometric properties of the Automatic Thoughts Questionnaire for Malays (ATQ-Malay) in Malaysia. Hong Kong Journal of Psychiatry, 18(3), 92-100.

• Pelkonen, M., Marttunen, M., Kaprio, J., Huurre, T., & Aro, H. (2008). Adolescent risk factors for episodic and persistent depression in adulthood. A 16-year prospective follow-up study of adolescents. Journal of Affective Disorders, 106(1-2), 123-131. https://doi.org/10.1016/j.jad.2007.06.001

• Peugh, J. L. (2010). A practical guide to multilevel modeling. Journal of School Psychology, 48(1), 85-112. https://doi.org/10.1016/j.jsp.2009.09.002

• Piccinelli, M., & Wilkinson, G. (2000). Gender differences in depression. Critical review. The British Journal of Psychiatry, 177, 486-493. https://doi.org/10.1192/bjp.177.6.486

• Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry and Allied Disciplines, 56(3), 345-365. https://doi.org/10.1111/jcpp.12381

• Ramagopal, G., Narasimhan, S., & Devi, L. U. (2016). Prevalence of depression among children living in orphanage. International Journal of Contemporary Pediatrics, 3(4), 1326-1328. https://doi.org/10.18203/2349-3291.ijcp20163670

• Ramli, J., Yahaya, A., Yahaya, N., & Lazin, S. Z. M. (2014). Kemurungan dalam kalangan penghuni rumah anak yatim di daerah Kota Bharu, Kelantan [Depression Among Orphanage Residents In Kota Bharu District, Kelantan]. Universiti Teknologi Malaysia Institutional Repository. http://eprints.utm.my/id/eprint/10127/

• Rood, L., Roelofs, J., Bögels, S. M., & Alloy, L. B. (2010). Dimensions of negative thinking and the relations with symptoms of depression and anxiety in children and adolescents. Cognitive Therapy and Research, 34(4), 333-342. https://doi.org/10.1007/s10608-009-9261-y

• Rosenberg, M. (1965). Society and the adolescent self-image. Princeton University Press. https://doi.org/10.1515/9781400876136

• Schmitt, D. P., & Allik, J. (2005). Simultaneous administration of the Rosenberg Self-Esteem Scale in 53 nations: Exploring the universal and culture-specific features of global self-esteem. Journal of Personality and Social Psychology, 89(4), 623-642. https://doi.org/10.1037/0022-3514.89.4.623

• Seligman, L. D., & Ollendick, T. H. (1998). Comorbidity of anxiety and depression in children and adolescents: An integrative review. Clinical Child and Family Psychology Review, 1(2), 125-144. https://doi.org/10.1023/A:1021887712873

• Soenen, B., D’Oosterlinck, F., & Broekaert, E. (2014). Anxiety in youth in Flemish care: A multi-informant study. Therapeutic Communities: The International Journal of Therapeutic Communities, 35(2), 56-74. https://doi.org/10.1108/TC-02-2014-0007

• Sofian, M., Arffin, S., & Yasir, A. (2013). Orphanage welfare and care centre as integration with community. Arts and Design Studies, 13, 31-38. http://iiste.org/Journals/index.php/ADS/article/view/8082

• Sowislo, J. F., & Orth, U. (2013). Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies. Psychological Bulletin, 139(1), 213-240. https://doi.org/10.1037/a0028931

• Van Oort, F. V. A., Greaves-Lord, K., Verhulst, F. C., Ormel, J., & Huizink, A. C. (2009). The developmental course of anxiety symptoms during adolescence: The TRAILS study. Journal of Child Psychology and Psychiatry and Allied Disciplines, 50(10), 1209-1217. https://doi.org/10.1111/j.1469-7610.2009.02092.x

• Waite, P., Mcmanus, F., & Shafran, R. (2012). Cognitive behaviour therapy for low self-esteem : A preliminary randomized controlled trial in a primary care setting. Journal of Behavior Therapy and Experimental Psychiatry, 43(4), 1049-1057. https://doi.org/10.1016/j.jbtep.2012.04.006

• Wang, L., Feng, Z., Yang, G., Yang, Y., Wang, K., Dai, Q., Zhao, M., Hu, C., Zhang, R., Liu, K., Guang, Y., & Xia, F. (2016). Depressive symptoms among children and adolescents in Western China: An epidemiological survey of prevalence and correlates. Psychiatry Research, 246, 267-274. https://doi.org/10.1016/j.psychres.2016.09.050

• Weisz, J. R., Kuppens, S., Eckshtain, D., Ugueto, A. M., Hawley, K. M., & Jensen-Doss, A. (2013). Performance of evidence-based youth psychotherapies compared with usual clinical care a multilevel meta-analysis. JAMA Psychiatry, 70(7), 750-761. https://doi.org/10.1001/jamapsychiatry.2013.1176

• World Health Organization. (2019). Adolescent mental health. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health

• Yaacob, M. J. (2006). Validity and reliability study of Rosenberg Self-Esteem Scale in Seremban school children. Malaysian Journal of Psychiatry, 15(2), 35-39.

• Yavuzer, Y., Karatas, Z., Civilidag, A., & Gundogdu, R. (2014). The role of peer pressure, automatic thoughts and self-esteem on adolescents ’ aggression. Eurasian Journal of Educational Research, 54, 61-78. https://doi.org/10.14689/ejer.2014.54.4

• Zakaria, Z., & Yaacob, M. J. (2008). Psychiatric morbidity among children and adolescents living in orphanages, Kota Bharu, Malaysia. International Medical Journal, 15(3), 183-188.

• Zhou, X., Hetrick, S. E., Cuijpers, P., Qin, B., Barth, J., Whittington, C. J., Cohen, D., Giovane, C. D., Liu, Y., Michael, K. D., Zhang, Y., Weisz, J. R., & Xie, P. (2015). Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: A systematic review and network meta-analysis. World Psychiatry, 14(2), 207-222. https://doi.org/10.1002/wps.20217