Increasing Factors of Depression Among School Children Aged 10-15 Years 10-15

Objective: Major depressive disorder is an escalating problem in both developed and under developed countries. Similar to the adolescents, depressive symptoms have been diagnosed at an extensive level among school going children. The study is based around investigating the increasing factors of depression among school going children of Jordan. Methods: A sample of 1650 school going students from Amman has been considered, which was assessed on behalf of two instruments. The age group of 10-15 years was identified for recruiting students from five government and five private schools. The collected data was analyzed through SPSS version 20. Results: Findings of the study reflected that depression in childhood is strongly associated with ecological factors and psychiatric co-morbidities. Furthermore, the results revealed that age, gender, living arrangements, and domestic violence are also associated with childhood depression. The results further identified that the prevalence rate of depression is higher in girls as compared to the boys. Conclusion: Depression can become more severe, if it is not managed at the early stage. Similarly, depression in childhood is likely to continue in adulthood if it is not properly treated at initial stages. Moreover, the rate of depression vary across the globe due to the different social and economic factors of each country.


INTRODUCTION
Major depressive disorder (MDD) is widely linked with the extensive complicated symptoms in regards of physical and psychological systems.The early treatment of disorder may decrease the serious consequences of disorder; however, the problem seems to be extremely common across the globe, especially in the developing countries.The study aimed to comprehend the increasing factors of depression among school children aged 10-15 years.Therefore, it has contributed to the fields of psychology and physiology to highlight the prevalence of depressive disorders among the individuals so that the patients can be treated by the improved ways.
Depression is the seventh major cause of diseases in the low income countries, which is tending to be untreated, inveterate, and persistent.Similarly, depression will become the second major cause of disease by the end of 2020 in developing countries.Different studies have revealed that prevalence of depression among adolescents is higher in females as compared to males.The differences in diagnosis have been reported between 13-15 years of age among both genders (1,2).
According to past researches, MDD is persistent and common in both adults and children.Major depressive disorders (MDD) have increased the risks of suicide, bullying, and substance use in children and adults.The prevalence rate of MDD during the whole life is 1.5%.Similarly, the prevalence rate of depression has been identified in between the ranges of 6% to 20%.The lowest depression rate was found in China i.e. 6%; whereas, the highest depression rate has been found in USA i.e. 20%.The survey conducted in United Arab Emirates revealed that the depression rate in the life-time for females is 9.5%; whereas, for males is 2.5%.The survey also found that the depression rate is higher in women; accordingly, the ratio of depression among both females and males is 4:1 (3,4).
Another study conducted in Saudi Arabia, used the sample of patients from psychiatric hospital, which revealed that the prevalence rate of depression in Saudi Arabia was 17% with the increased risk of symptoms among females.As per the survey conducted in Pakistan, it was revealed that the depression rate in men was 15%; whereas, the depression rate in women was 46%.Such findings clearly depicts that the depression rate in women is much higher as compared to men.The prevalence rate of depression is also higher in Jordan; evidence from one study revealed that the depression rate is higher than 30% in the females of Jordan (1,5,6).
In order to decrease the severe consequences of major depressive disorder (MDD); developed countries have used different medical treatments, which permanently reduced the symptoms of depression among the individuals of different age groups.Through medical treatments, developed countries have reduced the consequences of depression up to 80%; however, the situation is completely different with the Middle Eastern countries, especially Jordan.The reason behind the depression in adolescents of Jordan is differences in the socio-cultural settings, inappropriate management settings of medical, and lack of resources.Moreover, Jordan adolescents are highly dependent on their parents; due to which, they experience abnormal psychological and social reactions during their personal and professional life (3,4).Depression amongst adults is common and unrelenting.However, the complicating factors in childhood have also increased the prevalence of comorbid psychiatric problems.The major occurrence of co-morbid psychiatric disorders include anxiety, substance abuse, and attention-deficit/hyperactivity disorder.The prevalence rate of co-morbid psychiatric disorder among adolescents and children is 40-70%.Symptoms of psychotic disabilities are commonly seen in children and adolescents that are experiencing pediatric depression (1,7,8).
High depression is linked with enormous social challenges and poor behavior of health.Moreover, increased risk of suicide among youth leads to greater risk of psychological disorders such as anxiety and substance abuse.Those who are experiencing high depression are most likely to involve in endangered sexual practices and other behaviors.Depression that occurs during the age of late childhood will continue to adulthood in most of the cases; however, in certain cases, depressive disorders are diminished with the growing age (9,10).Another study has revealed, that 75% of the adults, who are experiencing Major depressive disorders (MDD) during their adult age, have experienced their first episode of depression during the age of childhood.Furthermore, highly depressed adolescents and youth face the problem of communication among peers, and are most likely to be involved in physical fights with peers (1,11,13).
The symptoms of depression among children are different from that of adults.The depression of children includes irritable mood, anger, and poor academic performance.Children, who are facing the problem of depression, may also demonstrate psychomotor agitation, symptoms of apprehension (anxiety disorder), irrational fear, regressive behavior, and separation anxiety.Vegetative and somatic complaints can also be linked with the depression in children (9,14).
The studies revealed that major risk factors for depression among children are substance use and bullying.The association between substance use and depression is also common among the individuals, having emotional disorder.Among children, bullying is recognized as the common practice at personal settings or within school territories.Different studies have indicated that bullying is associated with low self-esteem, psychosomatic complaints, symptoms of apprehension and depression, and desires of suicidal attempt (12; 13, 15).Similar case is with the youth; children who are highly depressed are engaged in bullying, both as perpetrators and victims.They are prone to counter the problem of emotional adjustments and poor psychosocial aspects, which in turn results in increased seclusion and social isolation.Due to high prevalence of bullying, as both perpetrators and victims, the association between depression and bullying should be examined.Almost 10-20% of adolescents and children are rapidly engaged in bullying; and as compared to girls, boys are more involved in the practices of bullying (10,15,16).
This study has mainly focused on the major factors of the depression and the prevalence of symptoms of depression among children.Alongside, it has performed an investigation closer to the certain areas, which includes the prevalence of depressive symptoms in Jordanian children between the ages of 10-15 years.It has also evaluated the increasing risk factors of depression and its association with different causative agents.

METHODS
This study has been conducted in the capital city of Jordan i.e.Amman.Five districts of Amman, which include Jubeiha, Al-Abdali, Na'our, Marj Al-Hamam and Al-Muwaqqar, were identified as the selected schools for the research.Random sampling method has been used during the selection stage of districts.However, equal selection of the children was done from five districts and their schools.Kish's formula has been introduced to conduct this study, which is commonly used for cross-sectional studies.Each school has been categorized in five districts by using the dataset of school authority.Multistage sampling method has been used in order to obtain the sample size of school.In the first stage, five districts of Amman have been selected randomly; and in the second stage, schools were categorized into two groups.The first group is comprised of government schools and the second group is comprised of private schools.Five schools of government and five private schools have been selected randomly from each district.
The list of schools was prepared in order to select the students that lie between the ages of 10-15 years.During the scrutiny process, 2000 students have been found who were liable to be aligned with the aforementioned criteria.The researcher then scrutinized the students by using the mental health test.A sample paper has been provided to 2000 students, which was comprised of 10 different IQ questions.Those students who got marks below 5 were selected for further study.After completing the scrutiny process, 300 students have been excluded who have scored marks above 5.Moreover, 50 students were also excluded who were reluctant to take part in the study.Finally, 1650 students were selected as the final sample for the study.
Two assessment tools have been selected for assessing the psychological concepts of the selected students.The selected tools were M.I.N.I.-KID (Mini International Neuropsychiatric Interview for Children and Adolescents) and SDQ (Strengths and Difficulties Questionnaire).Neuropsychiatric interviews were conducted from children through the first tool; however, the difficulties and strengths were identified through SDQ tool.In order to assess the behavioral and emotional problems of school going children, the SDDQ (Susceptibility to Driver Distraction Questionnaire) has also been used in this study.This instrument is based on 25 item questionnaire, which identified the possible psychological distress among children.This instrument is valid for both developed and developing countries, and it mainly covers the areas of behavioral and emotional difficulties.This instrument has used the scoring range of Likert scale.Depressive syndrome (depressive episode, dysthymia): obstinate feelings of insignificance and sadness.Anxiety syndrome disorder (separation and generalized anxiety disorder, social phobia): Anxiety is a worry regarding any event.These syndromes can lead to shakiness and fast heart rate.Disorder of psychotic syndrome (manic episode): diminished association with reality, which leads to delusions and hallucinations.Disorder of behavioral developmental syndrome (pervasive development disorder): involves autism, and use of substance.
In order to analyze the mental problems of children, three questions have been asked from each student; 1) Have you ever tried to die due to feeling bad or depressed?2) Have you ever attempted to harm yourself?3) Have you ever endeavored to kill yourself?These questions were helpful in evaluating the mental state of the children due to the fact that, the depressed souls often think of attempting suicide, or seek for the ways that might hurt them.They believe that practicing these values would help them to get rid of all the negative thoughts.
The variables includes age, gender, level of education, district, place of living, mental illness history, living arrangements, total income of the family, housing nature and attendance in the facility of mental health.Moreover, other variables that have been considered during the study were domestic violence, bullying, substance use and suicide.Data was analyzed through SPSS Version 20, which has applied regression and correlation analysis to investigate the strength of relationship.Backward elimination regression model has been used to investigate the association of socio demographic determinants.All ethical concerns were taken into consideration by taking the approval from the Ministry of Health of Jordan.The complete activity of mental disorder was performed in the school setting to provide more familiar and relaxed environment to the students as shown in Table 1.

Out of 2000 students, the final sample size was comprised of 1650
Out of the total sample of 1650 students, the proportion of males and females was between 700 males and 950 females.All of the selected participants were aged between 10-15 years.Equal selection was done from government and private schools to avoid any bias in the study.Comprehensive demographic information has been placed in Table 1.In this study, the prevalence of depressive syndrome disorder was 9.5%.Evidence from the study also revealed that the prevalence rate was slightly higher in females as compared to males.The prevalence rate of depressive disorder syndrome in females was 10%; whereas, it was 9% in males.
Table 2 has been categorized in both males and females to identify the prevalence of depression rate in both genders.The prevalence of depressive episode was 8% and dysthymia was evaluated as 4%.Table 3 has depicted the prevalence of Depressive Disorders (DDs) in two categories i.e. psycho-social and psychiatric characteristics.Results from the study revealed that the prevalence rate was higher in those students who have experienced domestic violence as compared to those who have not experienced any type of domestic violence during their life.Depressive disorder syndrome showed more prevalence in both genders as compared to other psychiatric problems, emotional and behavioral developmental disorder problem.Prevalence rate of DDs was higher in those children whose parents were not alive.GMJ 2017; 28: 11-16 The results generated from the model of multiple logistic regression clearly depicted that age, arrangements of district and place of living is significantly linked with depressive disorder syndrome among children.Evidence from the results also suggested that the factors of psychiatric disorder and emotional distress are also linked with DDs.The disorders of anxiety, eating and motor syndrome are slightly associated with DDs.Moreover, the students with developmental and behavioral disorder syndrome showed less possibility to have the depressive disorder syndrome.

Kawafha Depression factors
Table 4 clearly depicted that students who are living with both father and mother have less possibility to have DDs as compared to those who are living with grandfathers and caretakers.Those students who are living in the district of Jubeiha had excessive DDs as compared the other districts of Amman.Results from the study revealed that psychiatric and psychosocial factors, sociodemographic and ecological factors were independently and positively associated with the depression of children.In this study, districts were categorized as ecological factors.Indication from the study revealed that nature of arrangement of living and domestic violence was significantly associated with the depression of children.No overwhelming evidence was found that depicted the independent and significant association between the childhood depression and deprivation of socio economic factors (family income, housing nature, and educational level of parents/caretakers).It is possible that all these factors are the risk determinants of depression of childhood.Results from the study revealed that the prevalence of depression among school going children is high in Jordan.Ecological factors, the existence of psychiatric co-morbidities and the quality of relationship of child-principle caregiver are the most essential independent variables of depression in childhood.The use of substance and bullying are also significantly associated with the depression of children.The study has not found any significant association between the orphan hoods, deprivation of socio-economic factors and depression of children.

CONCLUSION
Major depressive disorder is considered as the second most important cause of death globally.Depression is escalating in both developed and developing countries; however, the prevalence of depression is higher in developing countries.It can be observed that the trend of depression has vastly shifted from old age people to young adolescents.The study mainly focused on the prevalence of depression in school going children between the ages of 10-15 The extent of disability is caused due to major physical disorders including heart disease, stroke, and headache.As treatment of depression is highly receptive, it is deteriorated by the gratitude and diagnosis of low rates.MDD often starts during the period of late childhood or early adolescence.Studies revealed that 20% to 50% of adolescents experience the problem of high level of depression.In order to reduce depression and to prevent its negative outcomes, it is obligatory to recognize it as early as possible.Similarly, early diagnosis of depression would also prevent severe consequences of depressive symptoms (1,2).
In order to conduct the study, five districts of Amman were selected by random sampling method.Two assessment tools have been used to assess the mental health of 1650 students.Findings of the study revealed that age, gender and living arrangements are significantly associated with the childhood depression.Moreover, there was no evidence found related to the association between childhood depression and social deprivation (nature of housing, parents education, and income of the family).But all these factors may indirectly affect the childhood depression.Results suggested that the most important independent variables of childhood depression were disturbed ecological factors, psychiatric co-morbidities, and quality of relationship of caregiver.The study concluded that those students, who faced the problem of depression in childhood, may likely to experience severe depression in their adulthood.However, the early recognition of depression may prevent children from severe consequences of depression.The prevalence rate of depression in school going children is high in Jordan.
The problem of depression is higher in females as compared to males, and comparatively developing countries have higher rate of depression among females than the developed countries.Moreover, the difference in the rate of depression in school going children is different across the countries due to the different social and economic factors present in each country.Most of the studies have been conducted on the symptoms of depression among high school students.However, further investigation is needed to be conducted on the prevalence and risk determinants of depression among young children.
.N.I.-KID has been utilized as instrument in the study, which holds the DSM IV (Diagnostic and Statistical Manual of Mental Disorders) criteria for assessing the children and adolescents mental disorder.The mental judgment evaluated in this study are panic disorder, episode of depression, substance use disorder, social phobia, dysthymia, generalized anxiety disorder, manic episode, and pervasive development disorder.Syndrome recognition for the purpose of analysis has been grouped as follows:

Table 1 :
Demographic Data

Table 2 :
Depression and relationship with gender

Table 3 :
Psychosocial determinants and psychiatric problems among children

Table 4 :
Determinants and depression in children