Prevalence of Generalized Anxiety Disorder (GAD) Among Saudi Teenagers During COVID-19 Pandemic in Saudi Arabia
Introduction:
Many countries across the world have been affected by the novel coronavirus. The affected countries were quarantined for several months, followed by distancing measures. To slow down the transmission of COVID-19 and break the chain of infection, lockdowns were enforced in affected areas of many countries, thus affecting lifestyle, educational activities, festivals, tourism, and international meetings. People were devastated by being quarantined in their houses [1]. The beginning of March became horrible for Saudi Arabia when the first case of COVID-19 was identified. The number of reported cases reached above 137,300 from March to June, of which many patients died and recovered. Still, there are many active cases in the country [2]. Quarantine and lockdown may have affected many people mentally. The people in quarantine who were isolated were negatively affected by social factors [3]. Middle and late adolescence is the age of 15 to 25 years and is known as youth. Many physical, mental, and social changes are developed during this age. Adolescence is the developmental stage during which changes in behavior are also observed. Mental illness is also characterized during this age, among which generalized anxiety disorder (GAD) is most common. In Saudi Arabia, there is a 71% prevalence of GAD [4].
Generalized anxiety disorder is a condition in which a person is worried excessively over little things, such as family, money, or health, and shows overly concerns. Several studies have identified the occurrence of GAD symptoms among teenagers [5]. The outbreak of COVID-19 majorly affected the young population who were infected with the virus or close relatives of infected patients. In Saudi Arabia, teenagers were the victims of the deadly virus because quarantine increased their depression and stress levels [6]. Generalized anxiety disorder (GAD) often shows co-occurrence with post-traumatic stress disorder (PSTD). Adolescents who experienced the natural disaster of COVID-19 are more prevalent to GAD [7]. COVID-19 has also affected the mental health of healthcare workers and nurse staff. The symptoms of GAD include poor sleep quality, high depression, hyperarousal, physical pain, hyperactivity, and perceived anxiousness [8]. The college and university going studies are more prevalent to GAD, which has now become a great health concern. In Saudi Arabia, the physicians, during the COVID-19 pandemic, have acquired GAD because of the challenging hospital routines [9].
Many genetic factors predispose the generalized anxiety disorder along with the depression. However, GAD has recently been shown to share heritability with neuroticism. Many natural disasters and adverse life events intensify the symptoms of GAD, such as COVID-19 pandemic, has increased the prevalence of pathognomic GAD symptoms [7]. The physicians and healthcare workers have shown GAD prevalence of 15% in Saudi Arabia because of the economic burden and increased facilitation of healthcare services [10]. Teenager students during COVID-19 pandemic have shown more frequency to GAD because the pandemic has negatively affected their academic performance, professional development, and academic grades [11]. However, the prevalence of GAD in female teenagers is higher than teenager males in Saudi Arabia [12].
Many pandemics have occurred in different centuries across the globe, but a minimal investigation has been performed on uncontrolled and dangerous symptoms of generalized anxiety disorder among teenager population [13]. A recent study has reported that GAD, anxiety, and stress can have a significant outcome on daily work routine and lifestyle. Since the young population during the pandemic was confined to isolation, the chances of developing GAD and emotional distress have increased due to social avoidance [14]. Significant levels in stress, nervousness, GAD, and PSTD have been shown in individuals who were kept isolated or experienced quarantine during the pandemic. The high mortality rate due to the pandemic has also scared people psychologically ranging from physicians and patients to students, families, and mentally ill patients [15].
Furthermore, there’s very little knowledge about the impact of COVID-19 on the psychiatric health of the people. Almost 50% young population of the United Kingdom has suffered from generalized anxiety disorder (GAD) along with depression during the pandemic [16]. It is important to diagnose the GAD in early stages without disturbing the quality of life. The COVID-19 pervasiveness has affected people with severe symptoms of GAD and anxiety. If left untreated, the outcomes can be complicated. Therefore, there is a need for preventive measures and early detection to prevent the youth population from GAD during the COVID-19 outbreak [12].
Literature Review:
People have confined themselves to homes but have become more prevalent to psychological distress. In the Kingdom of Saudi Arabia (KSA), the chances for psychological distress due to the pandemic are greater because of various reasons. KSA has shown a large number of reported cases due to which fear of infection and pressure on the healthcare services has increased. Because of no knowledge about mental illnesses, no research has been performed to determine the groups of people who have psychological disorders [17].
Khaled et al. 2020 conducted research about the effects of the COVID-19 pandemic on psychological distress among the general population of Saudi Arabia. Self-reported questionnaires were provided to people via the online system. To identify the stress levels from mild to severe, Peritraumatic Distress Index was used for the classification of people based on psychological distress. This survey showed that distress levels were incident in 40% of the Saudi population. Mild distress levels were prevalent in 33% of the population. The severe distress levels showed great incidence among teenager females, frontline health workers, and private sector employees. This study showed how COVID-19 caused the development of distress levels in people with different sociodemographic characteristics [18].
Mental health is essential for cognitive development and wellbeing. The college going students, who are mostly teenagers, are greatly concerned about their good academic records. The pandemic has affected their academic performance. GAD has many serious outcomes such as depression, which should be controlled at initial levels [19]. A research study was carried out to estimate the GAD prevalence among undergraduate students in Saudi Arabia. An electronic questionnaire was provided to the students of three major departments. GAD-7 and demographic questions were included in the questionnaire. The result showed that 69% of students feel nervous and anxious, GAD was more incident in females as compared to males, and many reported that they experience stress and depression every day. The students with low family income and high GPA were found to have more stress levels. This study concluded that treatment plans should be accompanied by online mental treatment strategies [12].
Comorbidities of PSTD (post-traumatic stress disorder) and GAD (generalized anxiety disorder) have been observed in children and young people during the outbreak of COVID-19. American Psychological Association, 2013 reported that patients with PSTD should have symptoms within one month period. Many symptoms of PSTD have been observed during the pandemic. Y. Li et al. 2020 examined the comorbidity of PSTD and DAG in young adolescents and children who were infected with COVID-19 in Hubei, China. They conducted several measurements to determine the levels of comorbidity. Perceived infection of COVID-19 increased the comorbidity symptoms in young adolescents. To reduce stigma and perceived threat, healthcare interventions should be introduced for COVID-19 infected adolescents [20].
The frontline healthcare workers have been continuously serving humanity during this pandemic. In Saudi Arabia, the psychological burden increased in healthcare workers and nursing staff, which included the symptoms of anxiety, depression, and disturbance in sleep cycle [21]. Alzaid et al. 2020 investigated a research study to identify the anxiety symptoms among healthcare workers during the outbreak of COVID-19. Their aim was also the identification of stress predictors so that high-risk people could also be identified. The questionnaires were made according to Saudi sociodemographic differences in Dammam, Saudi Arabia. The assessment of psychological impact was done by the GAD-7 scale. The results showed a great prevalence of GAD among HCW with low family income, and those infected with COVID-19 [8]. A survey was also conducted among HCW from Wuhan, China. The results reported that depression (12.8%) and anxiety (20%) levels were elevated during the pandemic. The symptoms included poor sleep, loss of appetite, and increased distress levels [22].
Although there has been plenty of research on psychological disorders during the pandemic in the United Kingdom, but a very little knowledge exists about the psychological impacts in a populated country. L.Z. Li and S. Wang, 2020 investigated a research study to identify the prevalence of psychiatric disorders during COVID-19 outbreak as well as the loneliness frequency in the United Kingdom. A 12-questions questionnaire was given to the general population. The results stated that 37% of people in the United Kingdom felt loneliness, and the incidence of loneliness was shown to be increased during the pandemic. Teenagers and women showed to be more prevalent to loneliness and psychiatric disorders [16].
China was the first country being infected with COVID-19 infections. Many people suffered from mental disorders during the outbreak. Y. Huang and N. Zhao, 2020 evaluated the mental burden among the general population and identified the influence factors. Data was collected from a large population with demographic history, COVID-19 infection history, travel history, generalized anxiety disorder and quality of sleep. The frequency of GAD was 36.2% among the general population of China. Moreover, depressive symptoms were observed among 20% population. Teenagers and adolescents experienced GAD more than the older population. People overthinking during the pandemic, healthcare workers, and teenagers were at great risk of generalized anxiety disorder [7].
COVID-19 outbreak has spread across the worldwide, thus a large number of people, including older adults, children, women, and doctors. In Bangladesh, mental illness is of great concern and has been shown to be increased during the outbreak. Md. S. Islam et al. 2020 conducted a cross-sectional survey among Bangladesh residents. The survey included sociodemographic variables in the form of a questionnaire. Moreover, symptoms of panic and anxiety were assessed by Generalized Anxiety Disorder scale (GAD-7) and Panic Disorder Severity Scale followed by regression analysis. The results showed the prevalence of panic by 80% and GAD by 37%. The people more prevalent to panic disorder were older males living in a joint family system. The older females having no job opportunity showed prevalence to GAD [23].
DAS (depression, anxiety, and stress) are more prevalent in the young population of every country, and COVID-19 pandemic has increased their prevalence. Al Omari et al. 2020 investigated a research study to assess the anxiety and stress among the youth. A multisectional study was conducted in six countries to determine the factors that increased the frequency of DAS during the pandemic. Each of the six countries showed a high prevalence of depression by 45%. The teenager females who had a close relation with friends having psychiatric disorders showed more prevalence to DAS [24].
Youth in the Middle Eastern countries has been greatly affected psychologically during the COVID-19 outbreak. Preservation of mental health among young population is essential for the growth of the country, but unfortunately, COVID-19 has drastically affected every life on earth. Psychological interventions and healthcare programs should be developed for making an improvement in the mental development of youth population.
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