Anxiety and Depression among Final-Year High School Students in Serbia: A Cross-Sectional Study Following a National School Tragedy

Abstract Anxiety and depression are prevalent among adolescents and may be exacerbated by exposure to traumatic events. This study aimed to assess the levels of anxiety and depression among high school seniors in Kragujevac, Serbia, in the relation with tragic school shooting in Belgrade. A cross-sectional, population-based study was conducted from November to December 2024, including 145 final-year high school students. Participants completed the Hamilton Anxiety Rating Scale (HAM-A) and Beck Depression Inventory-II (BDI-II), along with a detailed sociodemographic survey. Of the participants, 39.3% exhibited mild to severe anxiety, while 31.7% reported mild to severe depressive symptoms. Female students, those living away from parental homes, individuals who consumed alcohol or psychoactive substances, and those with poor peer relationships or experiences of bullying showed significantly higher anxiety and depression levels. Emotional responses to the tragic event were strongly associated with elevated psychological distress. Behaviors such as school refusal, thoughts of transferring schools, and seeking psychological help also correlated with higher symptom severity. This study highlights the acute psychological vulnerability of adolescents following national traumatic event. The findings underscore the importance of early emotional development, social support systems, and school-based mental health programs in mitigating the long-term consequences of trauma exposure during adolescence.