Anxiety is a normal human emotion characterized by various responses (e.g., behavioral, affective, and cognitive) to perceived threat [1]. However, anxiety can be considered excessive or pathological when such responses cause significant distress or are out of proportion to the perceived source of stress [1]. The World Health Organization (WHO) reported the number of people with anxiety or depression increased by almost 50% between 1990 and 2013 [2], with around 10% of the world’s population affected by these disorders.
Anxiety disorders are common among children and adolescents [1, 3, 4]. Reported rates of anxiety among children and adolescents were 31.9% in the United States (age: 13–18 years) [5], 26.41% in Spain (age: 8–17 years) [6], 22.5% in Chile (age: 4–18 years) [7], 21.9% in Iran [4], and 36.7% in India (secondary school children) [8]. Anxiety disorders that remain undetected and untreated in childhood and adolescence may affect well-being in adulthood, which challenges earlier views that high levels of anxiety are developmentally normal [9, 10].
Current diagnostic frameworks identify several anxiety disorders that commonly occur during childhood and adolescence, including generalized anxiety disorder (GAD), panic disorder, social anxiety disorder, and significant school refusal/avoidance disorder [11-13]. Although there are differing perspectives on the etiology of anxiety in childhood, multiple factors (e.g., the child’s temperament and characteristics, genetic factors, environmental factors) are thought to contribute to the development of anxiety disorders among children and adolescents [14]. Specific risk factors include adverse family experiences (e.g., marital conflict, death of a parent), school stressors (e.g., bullying), abuse (emotional, physical, or sexual), maternal substance abuse, and parental mental health [15, 16]. Parental characteristics (e.g., education level, unemployment) or living without parents may also contribute to the risk for anxiety disorders among young people [17]. Anxiety disorders are also reported to be more prevalent in girls and among children with comorbidities or chronic conditions (e.g., diabetes) [14, 18-20]. Although there is some evidence that heritability (i.e., anxiety runs in families) may have a role in anxiety, there is debate as to whether this can be explained by modeling of anxious behaviors within a family [1, 21, 22]. However, anxiety disorders may involve complex interactions between a child’s unique characteristics and their environment [23].
Although anxiety disorders among children and adolescents are common, they remain distressing and impairing for the child/adolescent and the family. In particular, school and social functioning is lower in children with anxiety disorders compared with children without such disorders [24]. Anxiety disorders may also interfere with a young person’s social communication, peer relationships, schooling, and family life [19, 25]. Despite anxiety being common and debilitating in children and adolescents, it frequently remains unidentified and untreated [24]. For example, a previous study found teachers had limited sensitivity to variations in students’ levels of anxiety symptoms, and often struggled to identify students that required targeted interventions or additional classroom support [26]. Research conducted in the United Arab Emirates (UAE) reported that correct identification of mental health problems and accurate identification of appropriate evidence-based interventions for affected children was limited among healthcare professionals [27, 28]. This was attributed to low levels of mental health literacy among respondents, combined with religious and cultural factors that potentially affected their interventions.
The UAE is a progressive, highly developed, and stable country, but is surrounded by countries experiencing political and economic instability. Approximately 80–90% of the UAE population is expatriates and immigrants [29]. Challenges for these people include separation from their families and loved ones, financial hardships, and potentially having witnessed violence or atrocities back home. In addition, the UAE has a large percentage of young people with developmental needs that may predispose them to anxiety in adulthood, especially those with chronic conditions [27]. The UAE also has specific environmental and cultural risk factors that contribute to mental health problems, particularly among young people [28, 30]. These risk factors include large family units and consanguineous marriages, which are common in the UAE and the wider Arab world [31].
Much of the epidemiological research on anxiety disorders in children and adolescents has been conducted in Western settings [32]. Data on the prevalence, comorbidity, and predictors of anxiety disorders among children and adolescents are scarce in the Middle East, including in the UAE. Previous UAE-based studies in this area date back to 1998 [33] and 2004 [34], and more up-to-date data are required. It is of particular concern that many social, emotional and behavioral problems among young children are not identified during pediatric healthcare contacts [35], which suggests a preventive approach is necessary. An initial national epidemiological study is needed to clarify the extent of the problem in the UAE, increase awareness of this issue, and inform further interventional studies. This study aimed to determine the prevalence of specific anxiety-related disorders (i.e., GAD, panic disorder, separation anxiety, social anxiety, and significant school avoidance), and identify correlations between these disorders and adolescents’ demographic variables.