Anxiety Prevalence among High School Students

A wide range of individuals experience some form of anxiety. Literature surrounding the topic of anxiety, specifically prevalence, the relation of anxiety and age, the implications of anxiety, and the importance of the school setting and interventions has been reviewed. Anxiety has implications for students in academic, personal, and social areas of life. The changes in anxiety have been studied among children and in various ways. Few studies have looked specifically at the changes in anxiety levels that happen within the high school years. This study aims to fill that gap by surveying high school students in grades 9-12, to determine prevalence of anxiety. Based on the results, suggestions for school interventions are made. HIGH SCHOOL ANXIETY 7 Anxiety Prevalence among High School Students Mental illness throughout the world and in the United States is a common occurrence. Neuropsychiatric disorders, including mood and anxiety disorders, “account for approximately 14% of global burden of disease and affect over 450 million people worldwide.” (Chou et al., 2012). According to The World Health Organization (WHO), (2004) there is a wide range in prevalence of mental disorders. They added that the United States has consistently high prevalence rates across all classes of disorder as compared to other countries (The World Health Organization, 2004). Within the mental illness category, internalizing disorders, such as major depression and phobias, are the most common anxiety-mood disorders in the United States (Kessler, Petukhova, Sampson, Zaslavsky, & Wittchen, 2012). Anxiety has been shown to interfere with people’s overall wellbeing. Anxiety consists of, often irrational, fears or worries as well as physical symptoms (Muris, Mayer, Freher, Duncan, & van den Hout, 2010; Thompson, Robertson, Curtis, & Frick, 2013). Research surrounding the general topic of anxiety is readily available (Costello, Copeland, & Angold, 2011; Essau, 2003; Keller, & Rowley, 1962; Sportel, Nauta, Hullu, de Jong, & Hartman, 2011). Though there is an abundance of literature surrounding the topic, not all areas or specific issues have been studied extensively. Anxiety is one of the most prevalent mental health concerns for children and adolescents (Essau, 2003; Moksnes, & Espnes, 2012; Muris et al., 2010). Anxiety can be extremely impactful for adolescents, given the importance of wellbeing during times of transition (Costello et al., 2011). Sources of anxiety can vary greatly. Children and adolescents often experience anxiety when they have other psychological disorders HIGH SCHOOL ANXIETY 8 (Essau, 2003), if they are raised with anxious parents (Bogels, van Dongen, & Muris, 2003; Pereira, Barros, Mendonca, & Muris, 2014), and during times of transition (Broeren & Muris, 2009; Costello et al., 2011; De Wit, Karioja, Rye, & Shain, 2011; Grills-Taquechel, Norton, & Ollendick, 2010), to name a few. Treatment and awareness of anxiety can be essential in reducing the experience of negative symptoms that can continue throughout one’s life. School consumes a major part of children and adolescent’s lives and a significant portion of their time. The school setting is highly connected to adolescents and their experience with anxiety (De Wit et al., 2011; Ingul, Klockner, Silverman, & Nordahl, 2012; Thompson et al., 2013). Troublesome anxiety can be exacerbated during the high school years as students face extreme transitions and social and academic pressures (Grills-Taquechel et al., 2010; Henry, Jamner, & Whalen, 2012; Moksnes, & Espnes, 2011). The school setting is not all bad. Teachers, counselors, administrators, and peers are all in a unique position to bring awareness to anxiety and teach effective ways to cope or manage anxiety (Thompson et al., 2013; Thompson, & Trice-Black, 2012; Tillfors et al., 2011; Tomba et al., 2010). Often, the school setting can be a first line of defense for students in dealing with mental health concerns. Unfortunately, more adolescents are experiencing problematic anxiety than are recognized or treated within the school setting (De Wit et al., 2011; Miller, Gold, LayeGindhu, Martinez, Yu, & Waechtler, 2011; Thompson et al., 2013). Effective coping skills can help adolescents overcome many of the challenges they face during adolescence and throughout life (Lothmann, Holmes, Chan, & Lau, 2011; Marks, Sobanski, & Hine, 2010; Muris, Meesters, & Gobel, 2002; Thompson et al., 2013; HIGH SCHOOL ANXIETY 9 Thompson, & Trice-Black, 2012; Von Der Embse, Barterian, & Segool, 2013). The longer problems with anxiety go unnoticed the more impact they will have on adolescent’s lives (Ingul et al., 2012). Awareness and treatment of anxiety can be crucial in reducing comorbidity among mental health disorders (Miller, Laye-Gindhu, Bennett, Liu, Gold, March, Olson, & Waechtler, 2011), slowing progression of anxiety into adulthood (Lothmann et al., 2011), and offering adolescents protection from the stressors that are frequent during that stage of life (Broeren & Muris, 2009; Leikanger, Ingul, & Larsson, 2012; Marks et al., 2010). Students would be able to function more effectively and focus more on academics, reducing behavioral, attendance, and social concerns for students themselves, teachers, and administrators (Bostick & Anderson, 2009; Lothmann et al., 2011; Marks et al., 2010; Muris et al., 2002; Thompson et al., 2013; Thompson, & Trice-Black, 2012; Von Der Embse et al., 2013). Involving parents could help create consistent support and potentially encourage them to seek help for their own needs, if they exist (Bogels et al., 2003). Though anxiety is a common mental health concern among individuals of all ages and has an abundance of literature, there are areas that could benefit from further exploration (Keough & Schmidt, 2012; Leikanger et al., 2012). Existing literature that focuses on the prevalence and comparing level of anxiety between high school grade levels is not as wide spread (Muris et al., 2010). Literature surrounding the topic of anxiety, specifically within adolescents, will be reviewed as current research is considered. An overview and the prevalence of anxiety are important to look at in connection with age and developmental level to demonstrate the significance of anxiety concerns for adolescents. The implications of anxiety and what can be done, specifically HIGH SCHOOL ANXIETY 10 within a school setting, to prevent and reduce anxiety concerns that could lead to ongoing problems will also be taken into account. The purpose of this study was to determine the presence of anxiety among high school students in varying grade levels in a rural high school through the administration of a survey. Many high school students experience developmentally appropriate stressors that are related to anxiety (De Wit et al., 2011; Grills-Taquechel et al., 2010; Marks et al., 2010; Moksnes & Espnes, 2011). Often, students do not seek help for a problem or recognize that they have one until it is severely interfering with their overall functioning. If students are not able to recognize when they have a problem with anxiety they can suffer physically, socially, academically, and emotionally (Bostick & Anderson, 2009; Ingul et al., 2012; Thompson et al., 2013). By understanding if there are more students experiencing anxiety than are known of, students can be taught to recognize signs and symptoms and learn coping mechanisms. It is important to know the population affected in order to tailor intervention techniques. To gain insight into the prevalence of students experiencing anxiety, the Screen for Child Anxiety Related Disorder (SCARED) Child Version was administered to 146 general education students in grades 9-12 in a rural high school. As a result, the school, specifically the counseling department, will have a better understanding of the students affected by anxiety. Given this information, the counselors can determine what level of intervention would be most appropriate and beneficial for students. This research will look specifically at what the prevalence of anxiety among high school students is, what the most frequent subcategories of anxiety are, and what the differences are between grade level and sex. HIGH SCHOOL ANXIETY 11 Review of Literature Prevalence and Overview Frequently, anxiety is seen and diagnosed in school aged children and adolescents. Approximately 8-12% of children meet some criteria for an anxiety disorder (Cristea, Bengam & Opre, 2008; Miller, Laye-Gindhu, Bennett, Liu, Gold, March, Olson, & Waechtler, 2011; Thompson, Robertson, Curtis, & Frick, 2013). Anxiety can be defined as “subjective feelings and thoughts and observable fight-flight-freeze behavior, but also in physical symptoms such as palpations, trembling, and shortness of breath.” (Muris, Mayer, Freher, Duncan, & van den Hout, 2010). Interpretations and misperceptions often exacerbate anxiety, in that individuals interpret situations as more threatening than they actually are. According to Muris et al., (2010), a cycle of thinking is created in which people internalize and reflect on the negative implications their symptoms have and become fearful of the anxiety itself, as well as the situation provoking the anxiety. Severe anxiety impacts overall functioning and wellbeing. Developmentally, children and adolescents experience anxiety that adapts to their stage of development (Broeren & Muris, 2009; Leikanger et al., 2012; Thompson et al., 2013). Broeren and Muris (2009), suggest these normal fears and developmental anxiety are the starting point for pathology in adolescents. Miller, Laye-Gindhu, Bennett, Liu, Gold, March, Olson, and Waechtler, (2011) describe anxiety as becoming significant when it is excessive and interferes with children’s ability to function and experience healthy development. Comorbidity is frequently associated with anxiety related disorders. Essau (2003), found that the majority of adolescents met criteria for one anxiety disorder, and up to HIGH SCHOOL ANXIETY 12 80% of anxious adolescents met the diagnosis for multiple subtypes of anxiety. Essau (2003) reports that comorbidity leads to more distress, and higher rates of distress often encourage people to seek help. Adolescents do not however, have high rates of comorbidity at this stage, decreasing the likelihood that they will seek out help for specific anxiety concerns. Though anxiety can be typical during child development, signs of something more serious can be missed (American Academy of Child and Adolescent Psychiatry, 2012). When anxiety symptoms are unnoticed or misinterpreted as behavioral or academic concerns, children’s social, academic, and emotional wellbeing can be negatively affected (Thompson et al., 2013). Thompson et al., (2013) also discussed that children learn to suppress their anxiety, which hides the outward signs, but does nothing to reduce internal symptoms. It can be difficult to recognize symptoms of anxiety and other mental health issues because children often internalize the problem (Miller, Gold, Laye-Gindhu, Martinez, Yu, & Waechtler, 2011). When children and adolescents internalize their problems it is difficult for adults to offer support. According to De Wit, Karioja, Rye, and Shain, (2011) and Miller, Gold, Laye-Gindhu, Martinez, Yu, and Waechtler, (2011), only a small portion of students experiencing mental health problems actually receives diagnosis or treatment. When the root of their problems goes unnoticed and children do not receive support, those problems can continue or escalate and cause issues in personal, social, and academic areas of life (De Wit et al., 2011; Grills-Taquechel, Norton, & Ollendick, 2010; Pereira, Barros, Mendonca, & Muris 2014; Thompson et al., 2013). Early knowledge of coping is important for proper long-term management of anxiety concerns (Muris, Meesters, & Gobel, 2002). Symptoms of anxiety and lack of coping HIGH SCHOOL ANXIETY 13 skills can continue into adulthood if adolescents do not receive help (Grills-Taquechel et al., 2010; Muris et al., 2002). Marks, Sobanski, and Hine (2010) indicate that negative thinking and behavior patterns adapted during adolescence could increase the likelihood of developing psychological maladjustment when dealing with stressful life events. Additionally, Pereira et al., (2014) explores the idea that childhood anxiety disorders often lead to adult disorders along with comorbid disorders. Similarly, Miller, Gold, Laye-Gindhu, Martinez, Yu, and Waechtler, (2011) discuss how early intervention has long lasting effects and can decrease future secondary disorders such as depression, suicide, and substance abuse.