Factors Influencing Therapeutic Management of Major Depressive and Generalised Anxiety Disorder Among Adolescents at Hospital Kajang, Selangor
DOI:
https://doi.org/10.31674/mjn.2023.v15isupp1.003Abstract
Background: Major depressive disorder (MDD) and generalized anxiety disorder (GAD) have been leading causes of morbidity. In 2011, 20% of Malaysians between 5 and 16 years old had mental health issues, and this percentage escalated to 24.5% in 2015. Despite the abundance of reports of mental health problems and suicides among adolescents worldwide, specific data for Malaysian adolescents is limited. The statistics available are outdated, and management algorithms are unavailable. This study aims to identify the prevalence and factors that contribute to MDD and GAD among adolescents and the trend of therapeutic management. Methods: A cross-sectional retrospective study involving 102 adolescents aged 10 to 19 diagnosed with MDD and GAD was conducted at Hospital Kajang, in which a convenient sampling method was applied. The data obtained were analyzed using Statistical Package for the Social Sciences (SPSS) software version 23.0. Descriptive analysis was used to analyze demographics, and categorical data were analyzed for frequency and percentage. A Pearson's Chi-square test was used to assess the association between the improvement of symptoms and therapy type, and a paired t-test was used to compare the mean number of symptoms between pre- and post-therapeutic management. Results: The prevalence of adolescents with MDD is 0.15% and GAD is 0.02%. There was a higher percentage of patients with parents’ income below RM1000: 83.5% among MDD patients and 63.6% among GAD patients. Family factors are the major factors contributing to 32% of adolescents with MDD and GAD. The majority of patients (67.6%, n = 69) received a combination of psychotherapy and pharmacotherapy. There was a statistically significant difference in the number of MDD and GAD symptoms from the first day of treatment until the second follow-up (p<0.001). Conclusion: This study illustrates that family and academic examination factors were the main factors in adolescents’ mental health issues, and various drugs were prescribed to treat MDD and GAD. A collective strategy targeting identified triggers is needed to curb this population's growing mental health issues.
Keywords:
Adolescents, Generalized Anxiety Disorder, Major Depressive Disorder, ManagementDownloads
References
Bains, N., Abdijadid, S., & Miller, J. L. (2022). Major depressive disorder (nursing). In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK570554. Accessed on 20th February, 2022.
Bisby, M. A., Dear, B. F., Karin, E., Fogliati, R., Dudeney, J., Ryan, K., ... & Titov, N. (2023). An open trial of the Things You Do Questionnaire: Changes in daily actions during internet-delivered treatment for depressive and anxiety symptoms. Journal of Affective Disorders, 329, 483-492. https://doi.org/10.1016/j.jad.2023.02.117
Bitsko, R. H., Holbrook, J. R., Ghandour, R. M., Blumberg, S. J., Visser, S. N., Perou, R., & Walkup, J. T. (2018). Epidemiology and impact of health care provider–diagnosed anxiety and depression among US children. Journal of Developmental and Behavioral Pediatrics, 39(5), 395. https://doi.org/10.1097%2FDBP.0000000000000571
Boaden, K., Tomlinson, A., Cortese, S., & Cipriani, A. (2020). Antidepressants in children and adolescents: meta-review of efficacy, tolerability and suicidality in acute treatment. Frontiers in Psychiatry, 717. https://doi.org/10.3389/fpsyt.2020.00717
Borenstein, J. (2020, August). Stigma, prejudice and discrimination against people with mental illness. Psychiatry.org - Stigma, Prejudice and Discrimination Against People with Mental Illness. https://www.psychiatry.org/patients-families/stigma-and-discrimination . Accessed on 20th February, 2022
Cosci, F., & Chouinard, G. (2020). Acute and persistent withdrawal syndromes following discontinuation of psychotropic medications. Psychotherapy and Psychosomatics, 89(5), 283-306. https://doi.org/10.1159/000506868
Deighton, J., Lereya, S. T., Casey, P., Patalay, P., Humphrey, N., & Wolpert, M. (2019). Prevalence of mental health problems in schools: poverty and other risk factors among 28000 adolescents in England. The British Journal of Psychiatry, 215(3), 565-567. https://doi.org/10.1192/bjp.2019.19
De Paz, P. I., Armstrong, T. D., & Mullon, R. A. F. (2021). Level of anxiety, fatigue and depression among college graduating students enrolled in biliran province state university. The Malaysian Journal of Nursing (MJN), 13(1), 84-88. https://doi.org/10.31674/mjn.2021.v13i01.012
Dubovsky, S. L., & Marshall, D. (2022). Benzodiazepines remain important therapeutic options in psychiatric practice. Psychotherapy and Psychosomatics, 91(5), 307-334. https://doi.org/10.1159/000524400
Dwyer, J. B., & Bloch, M. H. (2019). Antidepressants for pediatric patients. Current Psychiatry, 18(9), 26. https://cdn.mdedge.com/files/s3fs-public/CP01809026.PDF
Feriante, J., Torrico, T. J., & Bernstein, B. (2023). Separation anxiety disorder. StatPearls.
https://www.statpearls.com/pharmacist/ce/activity/110776/?specialty=specialty
Gadermann, A. M., Petteni, M. G., Janus, M., Puyat, J. H., Guhn, M., & Georgiades, K. (2022). Prevalence of mental health disorders among immigrant, refugee, and nonimmigrant children and youth in British Columbia, Canada. Journal of the American Medical Association (JAMA) Network Open, 5(2), e2144934-e2144934. https://doi.org/10.1001%2Fjamanetworkopen.2021.44934
Halonen, J., Hakko, H., Riala, K., & Riipinen, P. (2021). Familial risk factors in relation to recurrent depression among former adolescent psychiatric inpatients. Child Psychiatry & Human Development, 1-11. https://psycnet.apa.org/doi/10.1007/s10578-021-01146-1
Hartono, D., Hidayat, U. A., Cahyati, Y., & Poddar, S. (2021). Reducing anxiety levels through integrative intervention of five-finger hypnosis and aromatherapy. Malaysian Journal of Medical Research (MJMR), 5(3), 5-10. https://doi.org/10.31674/mjmr.2021.v05i03.002
Hartono, D., Hidayat, U. A., Cahyati, Y., & Poddar, S. (2021). Reducing anxiety levels through integrative intervention of five-finger hypnosis and aromatherapy. Malaysian Journal of Medical Research (MJMR), 5(3), 5-10. https://doi:10.31674/mjmr.2020.v05i03.002
Hazell, P. (2022). Antidepressants in adolescence. Australian Prescriber, 45(2), 49. https://doi.org/10.18773%2Faustprescr.2022.011
Hutka, P., Krivosova, M., Muchova, Z., Tonhajzerova, I., Hamrakova, A., Mlyncekova, Z., & Ondrejka, I. (2021). Association of sleep architecture and physiology with depressive disorder and antidepressants treatment. International Journal of Molecular Sciences, 22(3), 1333. https://doi.org/10.3390/ijms22031333
Ibrahim, M. F., Ismail, W. S. W., Jaafar, N. R. N., Mokhtaruddin, U. K. M., Ong, H. Y., Bakar, N. H. A., & Sahimi, H. M. S. (2022). Depression and its association with self-esteem and lifestyle factors among school-going adolescents in Kuala Lumpur, Malaysia. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.913067
Institute for Public Health (2020). National Health and Morbidity Survey (NHMS) 2019: Non-communicable diseases, healthcare demand, and health literacy—Key Findings. https://iptk.moh.gov.my/images/technical_report/2020/4_Infographic_Booklet_NHMS_2019_-_English.pdf
Ito, M., Horikoshi, M., Kato, N., Oe, Y., Fujisato, H., Yamaguchi, K., ... & Takebayashi, Y. (2023). Efficacy of the unified protocol for transdiagnostic cognitive-behavioral treatment for depressive and anxiety disorders: a randomized controlled trial. Psychological Medicine, 53(7), 3009-3020. https://doi.org/10.1017/S0033291721005067
Khazanov, G. K., Xu, C., Hollon, S. D., DeRubeis, R. J., & Thase, M. E. (2021). Adding cognitive therapy to antidepressant medications decreases suicidal ideation. Journal of Affective Disorders, 281, 183-191. https://doi.org/10.1016/j.jad.2020.12.032
Lähdepuro, A., Savolainen, K., Lahti-Pulkkinen, M., Eriksson, J. G., Lahti, J., Tuovinen, S., ... & Räikkönen, K. (2019). The impact of early life stress on anxiety symptoms in late adulthood. Scientific Reports, 9(1), 4395. https://doi.org/10.1038/s41598-019-40698-0
Leonte, K. G., Puliafico, A., Na, P. J., & Rynn, M. A. (2022, April 14). Pharmacotherapy for anxiety disorders in children and adolescents. https://www.uptodate.com/contents/pharmacotherapy-for-anxiety-disorders-in-children-and-adolescents#H1311492. Accessed on 20th February, 2022
McCarthy, J. S. (2020). Childhood Anxiety, Cognitive Behavioral Therapy and/or Pharmacological Treatment. https://cornerstone.lib.mnsu.edu/etds/973/. Accessed on 21st February, 2022
Moreland, C. S., & Bonin, L. (2022, October 3). Patient education: Depression treatment options for children and adolescents (Beyond the Basics). https://www.uptodate.com/contents/depression-treatment-options-for-children-and-adolescents-beyond-the-basics#. Accessed on 20th February, 2022
Sahril, N. B., Yaacob, N. M., Ahmad, N. A., Abdullah, S., Naidu, B. M., & Aris, T. (2019). Depression severity and its associated factors among school-Going adolescents in Malaysia. Journal of Depression & Anxiety, 8, 2167-1044. https://doi.org/10.35248/2167-1044.19.8.350
Santomauro, D. F., Herrera, A. M. M., Shadid, J., Zheng, P., Ashbaugh, C., Pigott, D. M., & Ferrari, A. J. (2021). Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. The Lancet, 398(10312), 1700-1712. https://doi.org/10.1016/s0140-6736(21)02143-7
Sawyer, M. G., Reece, C. E., Sawyer, A. C., Johnson, S. E., & Lawrence, D. (2018). Has the prevalence of child and adolescent mental disorders in Australia changed between 1998 and 2013 to 2014?. Journal of the American Academy of Child & Adolescent Psychiatry, 57(5), 343-350. https://doi.org/10.1016/j.jaac.2018.02.012
Taufik, M. H., Rezali, M. S., Shahein, N. A., Sahril, N., Ying Ying, C., & Ab Wahab, N. ’Ain. (2022). Anxiety and Its Associated Factors among School-going Adolescents in Malaysia. International Journal of Public Health Research, 12(2). https://spaj.ukm.my/ijphr/index.php/ijphr/article/view/335
Wahab, I. A., Goh, K. W., Zainal, Z. A., Yusof, N. S. M., Huri, H. Z., Jacob, S. A., ... & Jamil, N. (2022). Targeted primary and secondary preventive strategies for depression among Malaysian pharmacy students. International Journal of Environmental Research and Public Health, 19(15), 9629. https://doi.org/10.3390/ijerph19159629
World Health Organization. (2021, November 17). Adolescent mental health. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health. Accessed on 23rd March, 2022.
World Health Organization. (2022, June 8). Mental disorders. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/mental-disorders. Accessed on 24th July, 2022.
Zhou, W., Ouyang, F., Nergui, O. E., Bangura, J. B., Acheampong, K., Massey, I. Y., & Xiao, S. (2020). Child and adolescent mental health policy in low-and middle-income countries: challenges and lessons for policy development and implementation. Frontiers in Psychiatry, 11, 150. https://doi.org/10.3389%2Ffpsyt.2020.00150
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 The Malaysian Journal of Nursing (MJN)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
