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Anxiety and Depression Often Shadow Arab Youth

This article is part of a series on mental health in the Arab world, its impact on Arab youth, and their access to support and treatment. See the companion articles, Study To Map Mental-Health Needs of Lebanese Youth and Access to Mental-Health Care on Campuses Varies.

BEIRUT—Arab youth are frequently troubled by anxiety and depression, researchers and clinicians working in the Middle East say.

That emotional shadow is growing more intense over time, and the rate of mental-heath problems among Arab young people matches or exceeds global rates, research has found. But treatment and support are often not available.

“Everywhere you look, you’ll find depression,” explains Justin Thomas, an associate professor in psychology at Zayed University, in Abu Dhabi, whose research has focused on how psychological well-being is influenced by culture.

The data are scattered: A 2009 study screened 1,552 adolescents in Saudi Arabia and found the most common mental-health problem was anxiety. A 2005 study concluded that 16 percent of Lebanese adolescents had suicidal thoughts. It’s tough to find any accurate and reliable data to describe the overall prevalence of mental-health problems in the region.

The emotional difficulties Arab youth can suffer from are mirrored in the rest of the world: Twenty percent of adolescents in the United Kingdom, for example, may experience some kind of mental-health problem in any given year, according to the Mental Health Foundation, a British charity that promotes mental health.

No matter what part of the world is being examined, the toll that mental illness takes on young people trying to make their way through education and into employment is high. The cost is not just in wages lost but in time lost from school, university, and work.

A study published last year quantified the days and years that people in the Eastern Mediterranean region are prevented from going to school or work because of mental disorders, using a metric known as “disability-adjusted life years.”

The study found that depression, followed by anxiety, represented the biggest mental-health burden in the Arab world. The study didn’t focus on young people, but the results correspond with what experts say they would expect to see among young-adult and adolescent populations in the Middle East.

The researchers also explored how the burden of mental-health disorders varies in different parts of the Arab world, by looking at number of disability-adjusted life years as a proportion of the population. Palestine was shown to suffer the highest rate of disability-adjusted life years in the region, but throughout the Arab world the burden is higher than the global average, the study’s authors found, and the problem is getting worse.

The researchers charted an increase of nearly 11 percent in disability-adjusted life years in the Middle East between 1990 and 2013. In the Arab world and globally, mental illness is the single largest source of economic burden due to disease, according to a 2015 report from the Mental Health Foundation.

The complexity of diagnosing mental disorders contributes to the challenges they can present to health care providers.

“A child or young person never comes with one diagnosis,” says Suaad Moussa, a professor of child and adolescent psychiatry at Cairo University. In addition to anxiety and depression, she also sees a lot of patients with attention-deficit disorder in her clinic.

“The biggest studies show a prevalence of depression in the Gulf of between 10 and 13 percent,” says Thomas, at Zayed University, referring to the Gulf Cooperation Council countries. Those figures roughly correspond to what researchers find in Europe and North America.

A 2016 study surveyed 350,000 young people in the United States and found that 11 percent of those 12 to 17 years old, and close to 10 percent those between the ages of 18 and 25, showed signs of depression.

While youth in the Gulf suffer similar levels of depression as their Western counterparts, those in Arab countries that have recently experienced armed conflict are disproportionately more affected.

“In Gaza, for example, with its ongoing conflict, the rate of anxiety is 20 to 25 percent,” says Fadi Maalouf, chief of the division of child and adolescent psychiatry at the American University of Beirut Medical Center. (See a pair of related articles, “Refugee Youth Traumatized by War: Overwhelmed, Understudied and “How to Help Refugee Youth Recover From Trauma.”)

“There is a sense of insecurity here in Lebanon, but the conflict is not ongoing,” says Maalouf. “We’re somewhere in between Gaza and the Gulf countries.”

Young people with anxiety, depression and other mental-health issues often have difficulty finding treatment. Psychiatrists and psychologists are scarce, and families are often skeptical that young people need treatment or other assistance. In Lebanon, Maalouf’s research has shown that 94 percent of minors needing treatment do not get it.

In Egypt, Moussa says the Ministry of Health and Population has gathered a fair amount of data but has yet to release any statistics. She estimates that there are approximately 2,000 general psychiatrists practicing in Egypt, which has a total population of nearly 100 million. Meanwhile, the United States, with a population of 323 million, has an estimated 30,000 psychiatrists.

“I can’t imagine that access to mental-health care for minors in Egypt is any higher than it is in Lebanon or elsewhere in the region,” she says.

To combat the treatment gap, psychiatrists say it would be helpful if schools and universities could provide counseling and other emotional support to students. And to tackle societal misunderstanding of mental illness, Maalouf recommends raising awareness and running prevention programs where children and young people can already be found. As one example, a group of adolescents could be taught coping skills for anxiety in the classroom, to avoid stigmatizing any one individual.

“Let’s promote mental health where we get vaccines, or at school,” he says. “It’s about including it in structures that already exist.”


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