Prevalence of anxiety symptoms, depression comorbidity, and related factors in adolescents in Jordan

Abstract Background Previous studies in Jordan reported high rates of mental disorders among Jordanian and refugee adolescents, but were limited by small samples, lack of representativeness and nuance, and inconsistent findings. Thus, this study aimed to determine the prevalence of anxiety symptoms, comorbid anxiety and depression, differences among nationalities, and associated factors among adolescents in Jordan. Methods A national school-based survey was conducted in 2023 among adolescents in grades 7-12 from the host and refugee populations using multi-stage stratified cluster sampling. The Revised Child Anxiety and Depression Scale (RCADS) was used to assess symptom levels in six subscales. Comorbid anxiety and depression were defined as elevated symptoms in at least one anxiety subscale and the depression subscale, based on the RCADS cut-off scores, and applied across all subscales. Proportions were compared by nationality using the Chi-square test. Binary logistic regression identified associated factors, with significance at p ≤ 0.05. Results A total of 4,407 adolescents were included (44.5% male, 55.5% female). Obsessive-compulsive disorder was the most prevalent (39.8%), followed by separation anxiety (32.5%), panic disorder (31.6%), and major depressive symptoms (21.9%). Comorbid anxiety and depression were present in 21.9%. Statistically significant differences (all p < 0.01) were in three RCADS subscales and the comorbidity variable, with higher rates among non-Jordanian adolescents, particularly Syrians. In the multivariable model, females had significantly higher odds in all RCADS subscales and the comorbid variable (OR 2.00-2.97; all p < 0.01). Higher odds were also observed in refugees, especially Syrians and Palestinians. Conclusions Findings suggest differences in adolescent mental health by nationality and sex in Jordan. Results highlight the need to address the psychosocial stressors facing refugee populations and females, and comorbid symptom patterns. Key messages • Addressing anxiety, depression, and related conditions collectively, rather than focusing on a single disorder, is suggested to enhance the effectiveness of mental health programs and screening. • Despite its cross-sectional design, the study underscores the need for research on co-occurring conditions and targeted interventions for possible high-risk groups as refugee adolescents and females.