title: Stressors in secondary boarding school students: association with stress, anxiety and depressive symptoms.
abstract: BACKGROUND
  Chronic stress in adolescents may cause physical, mental and emotional health issues which lead to poor outcomes if left untreated. The present study aimed to determine the prevalence of depression, anxiety and stress, and their association with stressors.
  
  
  METHODS
  A cross-sectional study was conducted among 350 students in a selected boarding school. Two validated Malay version questionnaires were used as instruments, which comprised the 21-item Depression, Anxiety and Stress Scale to assess depression, anxiety and stress level, and Soalselidik Stressor Sekolah Menengah to assess stressors.
  
  
  RESULTS
  The prevalence of depression, anxiety and stress were 39.7%, 67.1% and 44.9%, respectively. The highest mean score was 2.3 (±0.80) for the academic-related stressor. All stressors (academic, interpersonal, intrapersonal, teacher, learning/teaching and social group) had significant association with depression, anxiety and stress (P < 0.001). Multiple regression showed that both the intrapersonal-related stressor and learning/teaching-related stressor were 2.8- and 2.0-times more likely (adjusted odds ratio [OR] = 2.8 [P < 0.001] and OR = 2.0 [P = 0.002], respectively) to cause depressive symptoms. On the other hand, the interpersonal-related stressor was 2.9-times more likely (adjusted OR = 2.9, P < 0.001) to cause anxiety. The learning/teaching-related and intrapersonal-related stressors were 2.7- and 2.5-times more likely to develop stress (adjusted OR = 2.7 [P < 0.001] and OR = 2.5 [P = 0.001], respectively).
  
  
  CONCLUSIONS
  The possibility of introducing screening for mental health problems among boarding school students needs to be considered and investigated. Addressing the possible stressors and employing healthy coping may help in reducing negative emotional outcomes in these students.
authors.affiliation: Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia. suzailywhb@yahoo.com
authors.forename: Suzaily
authors.initials: S
authors.lastname: Wahab
authors.forename: Fairuz Nazri Abdul
authors.initials: FN
authors.lastname: Rahman
authors.forename: Wan Muhammad Hafiz
authors.initials: WM
authors.lastname: Wan Hasan
authors.forename: Intan Zulaikha
authors.initials: IZ
authors.lastname: Zamani
authors.forename: Nabilah Che
authors.initials: NC
authors.lastname: Arbaiei
authors.forename: Siew Ling
authors.initials: SL
authors.lastname: Khor
authors.forename: Azmawati Mohammed
authors.initials: AM
authors.lastname: Nawi
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000453:epidemiology* / Q000209:etiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012574:Schools / Q000706:statistics & numerical data; D013315:Stress, Psychological / Q000453:epidemiology* / Q000209:etiology; D013334:Students / Q000523:psychology* / Q000706:statistics & numerical data
keywords: anxiety; depression; stress; stressors; students