Self-esteem and other risk factors for depressive symptoms among adolescents in United Arab Emirates

Autoři: Syed M. Shah aff001;  Fatima Al Dhaheri aff002;  Ammar Albanna aff003;  Najla Al Jaberi aff004;  Shaikha Al Eissaee aff005;  Nouf Ahmed Alshehhi aff005;  Shamma A. Al Shamisi aff001;  Maryam M. Al Hamez aff001;  Said Y. Abdelrazeq aff006;  Michal Grivna aff001;  Theresa S. Betancourt aff007
Působiště autorů: Institute of Public Health, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, UAE aff001;  Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America aff002;  Child and Adolescent Mental Health Centre, Al Jalila Children’s Specialty Hospital, Dubai, UAE aff003;  Division of Pediatric Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America aff004;  Internal Medicine, Tawam Hospital, Al Ain, UAE aff005;  Department of Epidemiology and Public Health, University, Ottawa, Ottawa, Canada aff006;  Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America aff007
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227483



Little is known about depressive symptoms among adolescents in the United Arab Emirates (UAE). This study aimed to identify the prevalence of depression and its association with self-esteem, individual, parental and family factors among adolescents aged 12 to 18 in UAE.


Six hundred adolescents, aged 12 to 18 years were recruited from 4 of 111 schools in a cross-sectional study. We administered Beck Depression Inventory Scale and Rosenberg Self-esteem Scale to measure self-report symptoms of depression and self-esteem. We used multiple linear regression to identify significant predictors of depression.


Over 86% of the identified sample participated to the survey. The mean age of the sample was 14.3 (±1.3) with an excess of girls (61%). Depressive symptoms were detected in 17.2% (95% CI 14.2–20.7). There was an inverse relationship between self-esteem scores and depressive symptoms. Positive predictors of depressive symptoms, having controlled for age, gender, and ethnicity included experiencing neglect, being verbally abused in school, having no monthly allowance to spend in school, a history of physical morbidities requiring treatment, being a current or past smoker and a low family income.


The high prevalence of depressive symptoms measured in this survey suggests a significant public health problem among adolescents in the UAE. Public health interventions aimed at facilitating education and early detection and potential treatment of depressive symptoms are a priority in the region.

Klíčová slova:

Adolescents – Arabic people – Depression – Emotions – Mental health and psychiatry – Schools – Smoking habits – United Arab Emirates


1. Dahl RE. Adolescent brain development: a period of vulnerabilities and opportunities. Ann NY Acad Sci 2004; 1021:1–22. doi: 10.1196/annals.1308.001 15251869

2. Giedd JN, Blumenthal J, Jeffries NO, Castellanos FX, Liu H, Zijdenbos A, Raporport JL. Brain development during childhood and adolescence: a longitudinal MRI study. Nature Neuroscience. 1999;2(10):861. doi: 10.1038/13158 10491603

3. Paus T, Keshavan M, Giedd JN. Why do many psychiatric disorders emerge during adolescence? Nature Reviews Neuroscience. 2008;9(12):947–957. doi: 10.1038/nrn2513 19002191

4. Cyranowski JM, Frank E, Young E. Shear MK. Adolescent onset of the gender difference in lifetime rates of major depression: a theoretical model. Arch Gen Psychiatry. 500;57(1): 21–27. doi: 10.1001/archpsyc.57.1.21 10632229

5. Patel V, Flisher AJ, AJ, Hetrick S, McGorry P. Mental health of young people: a global public-health Challenge. Lancet. 2007; 369:1302–13. doi: 10.1016/S0140-6736(07)60368-7 17434406

6. Hawton K, van Heeringen K. Sucide. Lancet. 2009; 373:1372–81.

7. Hankin BL, Abramson LY, Moffitt TE, McGee R, Silva PA, Angell KE, et al. Depression in childhood and adolescence. J Can Acad Child Adolesc Psychiatry 2013;22(1):35–40. 23390431

8. Meredith LS, Tanielian T, Hickey S, Burnam MA, Jaycox LH, Stein BD,et al. Impact of teen depression on academic, social, and physical functioning. Pediatrics. 2009;124:e596 doi: 10.1542/peds.2008-3348 19736259

9. Ralston TE, Palfai TP. Effect of depressed mood on drinking refusal self-efficacy: examining the specificity of drinking contexts. Cogn Behav Ther. 2010; 39(4): 262–9. doi: 10.1080/16506073.2010.501809 21038154

10. CHAITON MO, Cohen JE, O’Loughlin JE, Rehm J. A systematic review of longitudinal studies on the association between depression and smoking in adolescents. BMC Public Health. 2009; 9:356. doi: 10.1186/1471-2458-9-356 19772635

11. Keenan-Miller D, Hammen CL, Brennan PA. Health outcomes related to early adolescent depression. J Adolesc Health. 2007; 41:256–62. doi: 10.1016/j.jadohealth.2007.03.015 17707295

12. Fuchs S, Klein AM, Otto Y, von Klitzing K. Prevalence of emotional and behavioral symptoms and their impact on daily life activities in a community samples of 3 to 5 years old children. Child Psychiatry Hum dev. 2013; 44: 493–503. doi: 10.1007/s10578-012-0343-9 23111504

13. Maugham B, Collishaw S, Stringaris A, Depression in childhood and adolescence. J Can Acad Child Adolesc Psychiatry. 2013; 22:35–40. 23390431

14. Keshavan MS, Giedd J, Lau JYF, Lewis DA, Paus T. Changes in the adolescent brain and the pathophysiology of psychotic disorders. Lancet Psychiatry 2014; 1:549–58. doi: 10.1016/S2215-0366(14)00081-9 26361314

15. Waszczuk MA, Zavos HM, Gregory AM. Eley TC. The phenotypic and genetic structure of depression and anxiety disorder symptoms in childhood, adolescence, and young adulthood. JAMA Psychiatry. 2014; 71(8):905–16. doi: 10.1001/jamapsychiatry.2014.655 24920372

16. Lewinsohn PM, Rohde P, Klein DN, Seeley JR. Natural course of adolescent major depressive disorder: continuity into young adulthood. J Am Acad Child Adolesc Psychiatry. 1999; 38:56–63. doi: 10.1097/00004583-199901000-00020 9893417

17. Hankin BL, Abramson LY, Moffitt TE. Silva PA, McGee R. Angell KE. Development of depression from preadolescence to young adulthood: Emerging gender differences in a 10-year longitudinal study. J Abnor Psychol. 1998; 107: 128–140. doi: 10.1037//0021-843x.107.1.128 9505045

18. Wade TJ, Carirney J, Pevalin DJ. Emergence of gender differences in depression during adolescence: National panel results from three countries. J Am Acad Child Adoles Psychiatry. 2002; 41:190–198.

19. Patton G, Viner R. Pubertal transitions in health. Lancet. 2007; 369:1130–39. doi: 10.1016/S0140-6736(07)60366-3 17398312

20. Predicting female depression across puberty: a two-national longitudinal study. J Am Acad Child Adoles Psychiatry. 2008; 47(12): 1424–1432.

21. Cairns KE, Yap MBH, Pilkington PD, Jorm AF. Risk and protective factors for depression that adolescents canmodify: a systematic review and meta-analysis of longitudinal studies. J Affective Discord. 2014; 169:61–75.

22. Klasen F, Otto C, Kriston L, Patalay P, Schlack R, Ravens-Sieberer U. the BELLA study group. Risk and protective factors for the development of depressive symptoms in children and adolescents: results of the longitudinal BELLA study. Eur Child Adolesc Psychiatry 2015; 24: 695–703. doi: 10.1007/s00787-014-0637-5 25432629

23. Guberman C, Manassis K. Symptomatology and family functioning in children and adolescents with comorbid anxiety and depression. J Can Acad Child Adolesc Psychiatry 2011; 203:186–195.

24. Hummel A, Shelton KH, Heron J, Moore L. A systematic review of the relationships between family functioning, pubertal timing and adolescent substance use. Addiction. 2012; 108:487–496.

25. Cerniglia L, Cimino S, Tafa M, Marzilli E, Ballarotto G, Bracaglia F. Family profiles in eating disorders: family functioning and psychopathology. Pschol Res Behav Manag. 2017; 10:305–312.

26. Cerniglia L, Cimino S, Ballarotto G, Casini E. Motor vehicle accidents and adolescents: an empirical study on their emotional and behavioral profiles, defense strategies and parental support. Transp Res Part F Traffic Psychol and Behav. 2015;35: 28–36.

27. Cimino S, Simonelli A, Parolin M, Ballarotto G, Carbone P. A theoretical and empirical linkage between road accidents and binge eating behaviors in adolescence. Int. J. Environ Res. Public Health. 2018; 15:355; doi: 10.3390/ijerph150020355

28. Gilbert R, Wisdom CS, Browne K, Fergusson D, Webb E, Janson S. Burden and consequences of child maltreatment in high income countries. Lancet. 2009;373:68–81 doi: 10.1016/S0140-6736(08)61706-7 19056114

29. Koyanagi A, Carvalho AF, Smith L, Haro JM, Vancampfort D, Stubbs B, et al. Bullying victimization and suicide attempt among adolescents aged 12–15 years from 48 countries. J Am Acad Child Adolesc Psychiatry. 2019; 58(9):907–918 doi: 10.1016/j.jaac.2018.10.018 30926574

30. Gallo EA, DeMola CL, Wehrmeister F, Goncalves H, Kieling C, Murray J. Childhood maltreatment preceding depressive disorder at age 18 years: A prospective Brazilian cohort study. J Affect Disord. 2017; 217:218–224. doi: 10.1016/j.jad.2017.03.065 28431382

31. Norman RE, Byambaa M, De R, Butchart A, Scott J, Vos T. The long-term health consequences of child physical abuse, emotional abuse and neglect: a systematic review and meta-analysis. PLoS Med. 2012; 9(11):e1001349. doi: 10.1371/journal.pmed.1001349 23209385

32. Opel N, Redlich R, Dohm K, Zaremba D, Giltermann J, Repple J, et al. Mediation of the influence of the childhood maltreatment on depression relapse by cortical structure: a 2-year longitudinal observational study. Lancet Psychiatry 2019;6: 318–26. doi: 10.1016/S2215-0366(19)30044-6 30904126

33. GBD 2015 Eastern Mediterranean Region Mental Health Collaborators. The burden of mental disoderders in the Eastern Mediterranean region, 1990–2015: findings from the global burden of disease 2015 study. Int J Public Health. 2018; 63(1):S25–S37.

34. Schulte SJ, Thomas J. Relationship between eating pathology, body dissatisfaction, and depressive symptoms among male and female adolescents in the United Arab Emirates. Eat Behav. 2013; 14:157–160. doi: 10.1016/j.eatbeh.2013.01.015 23557812

35. Razzak HA, Harbi A, Ahli S. Depression: prevalence and associated risk factors. Oman Med J. 2019;34(4):274–283. doi: 10.5001/omj.2019.56 31360314

36. Swadi H. and Issa M. Depressive symptoms in a community sample of UAE teen age girl. Arab j. Psychiatry. 1995;9(1):22–38.

37. MacMillan H, Fleming J, Trocme N, Boyle MH, Wong M, Racine YA, et al. Prevalence of child physical, and sexual abuse in the community. JAMA. 1997; 278:131–135. 9214528

38. Beck A, Brown G, Steer R. Beck Depression Inventory-II (BDI-II): The Psychological Corporation. San Antonio TX. 1996.

39. Lakdawalla Z, Hankin BL, Mermelstein R. Cognitive theories of depression in children and adolescents: a conceptual and quantitative review. Clinical Child and Family Psychology. 2007 doi: 10.1007/s10567-0013.1

40. American Psychiatric Association Diagnostic and statistical manual of mental disorders, 5th Edn. Washington DC:2013.

41. Beck A, Brown G, Steer R. Beck Depression Inventory-II (BDI-11): The Psychological Corporation, San Antonio TX. 1996.

42. Alansar BM. Internal consistency of an Arabic adaptation of the Beck Depression Inventory-II with college students in eighteen Arab countries. Soc behav pers. 2006; 34(4):425–430.

43. Naja S, Al-Kuubaisi N, Chehab M, Al-Dahshan A. Psychometric properties of the Arabic version of EPDS and BDI-II as a screening tool for antenatal depression: evidence from Qatar. BMJ Open. 2019;9:e030365. doi: 10.1136/bmjopen-2019-030365 31519679

44. Rosenberg M. Society and the adolescent self-image. Princeton, NJ: Princeton University Press. 1965.

45. Abu-Saad I. self-esteem among Arab adolescents in Israel. J Soc Psychol. 1999; 139: 479–486. doi: 10.1080/00224549909598407 10457762

46. Afari E, Ward G, Khine MS. Global self-esteem and self-efficacy correlates: relation of academic achievement and self-esteem among Emirati students. Int. Education Studies. 2012; 5(2):49–57.

47. Greenland S. Avoiding power loss associated with categorization and ordinal scores in dose-response and trend analysis. Epidemiology. 1995;6(4):450–454. doi: 10.1097/00001648-199507000-00025 7548361

48. Tracy RG, Gladstone, Kaslow NJ. Depression and attribution in children and adolescents: a meta-analytic review. J Abnorm child Psychol. 1995; 33(6):559–576.

49. Kessler RC, Avenevoli S, Costello EJ, Georgiades K, Gren JG, Gruber MJ, et al. Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement. Arch Gen Psychiatry 2012;69(4):

50. Costello EJ, Eggr H, Angold A. 1o-year research update review: the epidemiology of child and adolescents psychiatric disorders: 1. Methods and public health burden. J Am Acad Child Adolesc Psychiatry. 2005; 44: 972–86. Arch Gen Psychiatry. 2012;69(4):372–380. doi: 10.1097/01.chi.0000172552.41596.6f 16175102

51. Stewart S.T. Symptom pattern in depression and sub-threshold depression among adolescent in Hong Kong and the United States, J cross cult psychol. 2002;33(6): 559–576.

52. Fergusson DM, L., John Horwood LH, Ridder EM, Beautrais AL. Sub-threshold depression in adolescence and mental health outcomes in adulthood, Arch Gen Psychiatry. 2005; 62: 66–72. doi: 10.1001/archpsyc.62.1.66 15630074

53. United Arab Emirates Ministry of Economy Report. Available at:

54. Al-Maskari F, Shah SM, Al-Sharhan R, Al-Haj E, Al-Kaabi K, Khonji D, Schneider JDet al. Prevalence of depression and suicidal behaviors among male migrant workers in United Arab Emirates. J Immigrant Minority Health. doi: 10.1007/s10903-011-9470-9 21503739

55. Foo SQ, Tam WWW, Ho CS, Tran BX, Nquyen LH, Mclntyre RS, et al. Prevalence of depression among migrants: a systematic review and meta-analysis. Int J Environ Res Public Health. 2018;15(9): 1986. doi: 10.3390/ijerph15091986 30213071

56. Keen DV, Reid FD, Arnone D. Autism, ethnicity and maternal immigration. Br J Psychiatry. 2010;196(4):274–81. doi: 10.1192/bjp.bp.109.065490 20357302

57. Wang J, Liu K, Zheng J, Liu J, You L. Prevalence of mental health problems and associated risk factors among rural-to-urban migrant children in Guangzhou, China. Int J Environ Res Public Health 2017;14(11):1385. doi: 10.3390/ijerph14111385 29135949

58. Schraedley PK, Golib JH, Hayward C. Gender differences in correlates of depressive symptoms in adolescents. J Adolescent Health. 1999;25(2):98–108.

59. Silberg J, Pickles A, Rutter M. Hewitt J, Smirnoff E, Maes H, et al. The influence of genetic factors and life stress on depression among adolescent girls. arch Gen Psychiatry. 1999;56(3):225–32. doi: 10.1001/archpsyc.56.3.225 10078499

60. Howell AJ, Watson DC. Impairment and distress judgments of symptoms composing childhood externalizing and internalizing syndromes. J Child Fam Stud. 2009;18: 172–182

61. Yong M, Fleming CB, McCarty CA, Catalano CF. Mediators of the associations between externalizing behaviors and internalizing symptoms in late childhood and early adolescence. J Early Adolesc. 2014; 34(7): 967–1000. doi: 10.1177/0272431613516827 25554717

62. Gayman MD, Lloyd DA, Ueno K. The history and timing of depression onset as predictors of young-adult self-esteem. J Res Adolesc 2011;21(3):691–702. doi: 10.1111/j.1532-7795.2010.00702.x 21860585

63. Pinquart M, Shen Y. Depressive symptoms in children and adolescents with chronic physical illness: an updated meta-analysis. J Pediatr Psychol. 2011;36(4): 375–384. doi: 10.1093/jpepsy/jsq104 21088072

64. Tafa M, Cerniglia L, Cimino S, Ballarotto G, Marzilli E, Tambelli R. Predictive values of early parental loss and psychopathological risk for physical problems in early adolescents. Front Psychol. 2018;9:922. doi: 10.3389/fpsyg.2018.00922 29928249

65. Raposa EB, Hammen CL, Brenan PA, O’Callaghan F, Najman JM. Early adversity and health outcomes in young adulthood: the role of ongoing stress.Health Psychol. 2014; 33(5):410–418. doi: 10.1037/a0032752 23730716

66. Kosidou K, Dalman C, Lundberg M, Hallqvist J Isacsson G, Magnusson C. Socioeconomic status and risk of psychological distress and depression in the Stockholm Public Health Cohort: a population-based study. J Affect Disord 2011;134 (1–3):160–7. doi: 10.1016/j.jad.2011.05.024 21665286

67. Scales MB, Monahan J, Rhodes N, Woldson DR. Adolescents’ perception of smoking and stress reduction. Health Educ Behav. 2008; 36(4): 746–758. doi: 10.1177/1090198108317628 18477670

68. Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A. Prevalence and development of psychiatric disorders in childhood and adolescence. Arach Gen Psychiatry. 2003;60(8): 837–44.

69. Ballarotto G, Volpi B, Marzilli E, Tambelli. Adolescent internet abuse: a study on the role of attachment to parents and peer in a large community sample. BioMed Research International. 2018; doi: 10.1155/2018/5769250

70. Chaiton MO, Cohen JE, O’Loughlin J, rehm J. A systematic review of longitudinal studies on the association between depression and smoking in adolescents. BMC Public Health. 2009; 9:356. doi: 10.1186/1471-2458-9-356 19772635

71. McGee R, Williams S, Nada-Raja S, Olsson CA. Tobacco smoking in adolescence predicts maladaptive coping styles in adulthood. Nicotine Tob Res. 2013;5(12): 1971–1977.

72. Maison CL, Munhoz TN, Santos IS, Anselmi L, Barros FC, Matijasevich A. Prevalence and risk factors of psychiatric disorders in early adolescence: 2004 Pleotas (Brazil) birth cohort. Soc Psychiatry Psychiatr Epidemiol. 2018; 53:685–697. doi: 10.1007/s00127-018-1516-z 29654332

73. Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, et al. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health. 2017; 2:e356–66. doi: 10.1016/S2468-2667(17)30118-4 29253477

74. Klomek AB, Sourander A, Kumpulainen K, Piha J, Tamminen T, Moilanen I, et al. Childhood bullying as a risk for later depression and suicidal ideation among Finish males. J Affect Disord. 2008;109(1–2): 47–55. doi: 10.1016/j.jad.2007.12.226 18221788

75. Kaltiala-Heino R, Rimpela M, Rantanen P, Rimpela A. Bullying at school, an indicator of adolescents at risk for mental disorders. J Adolesc. 2002;23(6): 661–74.

76. Guillery-Girard B, Dayan J. Adolescent behaviors and cerebral development: Psychoanalysis and the neurosciences. Adolescence. 2011;3(77):479–515

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