Stress symptoms and associated factors among adolescents in Dhaka, Bangladesh: findings from a cross-sectional study

(2022) 22:807 Anjum et al. BMC Psychiatry https://doi.org/10.1186/s12888-022-04340-0 Open Access RESEARCH Stress symptoms and associated factors among adolescents in Dhaka, Bangladesh: findings from a cross‑sectional study Afifa Anjum1,2* , Sahadat Hossain1,3, M. Tasdik Hasan4,5,6, Enryka Christopher7, Md. Elias Uddin8 and Md. Tajuddin Sikder1*    Abstract Background: Stress affects adolescents’ daily lives by disrupting their working capacity and begets comorbidity. This study aimed to estimate the prevalence of stress symptoms and the factors associated with these symptoms among secondary school-going adolescents in Bangladesh. Methods: A cross-sectional study using two-stage cluster sampling was conducted. A self-administered questionnaire was given to 2355 adolescents from nine secondary schools in Dhaka, Bangladesh. Of the respondents, 2313 completed the 10-item Perceived Stress Scale (PSS-10). Sociodemographic information, self-reported body image, a modified Leisure Time Exercise Questionnaire (LTEQ), and the WHO Global Physical Activity Questionnaire (GPAQ) were used to determine the sociodemographic and lifestyle factors associated with stress symptoms among adolescents. Results: Findings suggest that about 65% of adolescents experienced moderate stress symptoms, and about 9% experienced high-stress symptoms. Females (58.7%) suffered more from stress compared to males (41.3%). Age, grade, and residential setting were significantly associated with stress. Logistic regression estimates show that level of physical activity (AOR: 1.52; 95% CI:1.26–1.84), sleep dissatisfaction (AOR: 1.33; 95% CI: 1.07–1.65), and perception of self as overweight/obese (AOR: 1.46; 95% CI: 1.13–1.89) were significantly associated with stress symptoms among adolescents. Conclusions: Stress symptoms are highly prevalent among secondary school adolescents in Bangladesh. Further exploratory investigations are needed on possible intervention strategies to reduce the burden of stress among adolescents. Keywords: Stress, Physical activity, Lifestyle, Screens, Social media, Sleep, Adolescents, Bangladesh Introduction Adolescence, commonly defined as the period between 10 and 19 years [1], is an important phase of human growth and development, bridging childhood to *Correspondence: ; 1 Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh 2 Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka 1000, Bangladesh Full list of author information is available at the end of the article adulthood. The numerous psychosocial and physiological changes adolescents experience during this time make them especially vulnerable to stress [2]. In view of the magnitude of this transition, it is understandable that this period is often characterized as a tempestuous, stressful stage of life [3]. Identified adolescent stressors include rapid changes in their bodies, sexual awakenings, establishing social networks, and a multitude of others, all of which pose threats to stable development and mental well-being. © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Anjum et al. BMC Psychiatry (2022) 22:807 The most significant mental health issues that adolescent stress contributes to are depression, anxiety, suicide, drug use, and antisocial behaviour [4]. Adolescents with elevated stress levels have been found to indulge in a variety of maladaptive and harmful activities, such as increased alcohol and substance use, unprotected sexual intercourse, physical inactivity, unhealthy eating habits, and poor sleep hygiene [2]. The physiological impact stress has on general wellbeing, as well as specific health outcomes, such as weakened immune systems and diseases (cancer, diabetes, dermatological conditions, etc.), are well known. More recently, cognition, coping mechanisms, and social reinforcement have been identified as mediating and moderating factors between stress and different health consequences [4]. Persistent stress symptoms throughout adolescence can lead to chronic stress, which could have a significant impact on livelihood through factors such as job absenteeism. In Sweden, stress is the most frequently diagnosed reason for long-term sick leave, and adults who experienced chronic stress during childhood suffer most. A 2009Swedish study on children’s living conditions estimated that 60% of female and 38% of male high school adolescents suffer from stress-related problems due to daily life stressors [3]. Deterioration in health, an inevitable result of stress, can take the form of mental fatigue, physical weakness, or cognitive difficulties [5]. Studies have shown that Indian adolescents face additional stressors from cultural influences, such as strong parental expectations, constrictive living arrangements, social hierarchies, and academic concerns, to name just a few [6]. In Bangladesh, a substantial number of studies have been conducted on the mental health of youth or tertiary level students [7, 8]. These studies have measured depression, anxiety, and stress levels. However, most studies research stress along with multiple other symptom measures, and a review of the literature shows a dearth of studies on secondary school-aged youths. Furthermore, not a single study focused exclusively on stress among this important sub-population. But addressing stress among adolescents is necessary since chronic stress has the probability of triggering non-communicable diseases (NCDs), such as high blood pressure, heart disease as well as obesity. Apart from these, persisting stress can lead to other mental health conditions including clinical depression and anxiety, which have become more common among youths [9]. This study aims to fill these gaps in the literature by focusing on factors that influence stress levels in secondary school-aged adolescents. To the best of our knowledge, this is one of (...truncated)