Studies reported that externalizing and internalizing behavior problems are the main concern in children and adolescence that influence their health, families, and society (8, 19). Therefore, monitoring psychiatric symptoms based on valid scales and questionnaires is essential to diagnose the psychiatric health problems in adolescents’ life, as well as prevent problems and difficulties in future and help individuals have a better lifestyle(1, 6). Given this literature, assessing youth externalizing and internalizing behavior problems is a critical need to control and prevent these behavior problems within the school context (11–13). The main aim of this survey was to examine the frequency of psychiatric disorders in Iranian Student during the COVID-19 pandemic.
The current study shows that 58% students met criteria for all psychiatric symptoms except of the autism and Asperger’s disorders, and 39.5% suffered from more than one co-morbid categories of psychiatric disorders. Several studies with a variety of methods and tools have also reported prevalence of co-morbid psychiatric disorders in different regions of Iran (3, 4, 15, 18). In Esmaili’s study, 82.8% of student with learning disabilities in Tehran were diagnosed with co-morbid psychiatric disorders (3). However, the overall frequency of co-morbid psychiatric disorders in normal students in Tehran and Paveh (Western city in Iran) has been estimated at 34 % (20)and 27.8%(21), respectively. The ongoing shifts in the socio-cultural behaviors and the rapid change in cultural and social context in Iran as a developing country could be main factors that cause these psychiatric disorders(1, 3). However, similar reports regarding the frequency of co-morbid psychiatric symptoms in children and youth exist in worldwide studies (7). In China, USA, and India adolescents, the frequency of behavioral problems was 10.5%, 21.9%, 15.5%, respectively(5, 13).
Our finding showed that the most frequency of psychological disorders (except of MDD, enuresis, encopresis, and GAD) did not differ significantly between genders and the age distribution of the studied students. Likewise, the findings revealed that the disorders of ADHD, ODD, ADHD-C, GAD, ADHD: HI, and MDD were the most common disorders in students. The disruptive behavior disorders (ADHD, ADHD: HI and ADHD-C) in Iranian students has been previously discussed, and these studied confirmed the high rate of ADHD, ADHD: HI and ADHD-C in Iranian student(3, 15, 18). Further, two systematic and met-analysis studies assessed the prevalence of ADHD, ADHD: HI and ADHD-C in Iranian school-aged children and adolescents(5, 6). Their results showed that total prevalence of ADHD was 3.17% in the study of Hakim et al and 12%(5) in the study of Yadegari et al (6). It was evidenced that this differences are not acceptable based on biological setting, and cultural contexts, social facility, access rate to mental health services, and parent education and occupation could explain them better (5, 6).
In this study, the overall frequency of all disorders was higher than all previous studies in Iran (Table 3). Several surveys have indicated that public health emergencies such as COVID-19 outbreak affect mental and physical health among students and adolescence population, which expressed as fear, anxiety, stress, hyperactivity and depression(13, 14). Students' psychological disorders about COVID-19 could have been associate to the effect of the virus on student’ studies quality because of increasing social distances between individuals, sedentary lifestyle, fear of infecting family, cancellation and postponing of anticipated events, and family financial loss due to lockdown(11, 12). The mental health of students may be negatively affected by suspension of the semester-end final examinations, shifting face-to-face classes to online, and unavailability of computers, high-speed internet connection, and books at home (9, 13). Therefore, it is critical need to train students about self-protection, develop effective educational interventions, and organize a psychological crisis intervention program to decrease the psychological effect of the COVID-19 pandemic.
The findings in this survey are subject to several limitations. First, since a self-reported questionnaire based on parental reports has been used in this survey, the frequency of such symptoms in some samples could have been under or over diagnosed. A second limitation is that our findings may not be generalizable to other countries because of the cultural and social differences. Third, the physical risk factor, demographic factors (except of age and gender), and teacher’s information were not examined, which were lead to bias in interpretations in the present study. Furthermore, making precise comparisons among studies is very difficult because type of sampling and the assessment tools and method, which may influence frequency of estimates.