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An Exploration of Anxiety and Depression Among Adolescents and Adults in Bulgaria

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An Exploration of Anxiety and Depression Among Adolescents and Adults in Bulgaria DOCTORAL THESIS An exploration of anxiety and depression among adolescents and adults in Bulgaria Tsocheva, Ivelina Award date: 2015 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Download date: 27. Sep. 2021 AN EXPLORATION OF ANXIETY AND DEPRESSION AMONG ADOLESCENTS AND ADULTS IN BULGARIA By Ivelina Tsocheva, BSc, PGDip Psychology Thesis submitted in partial fulfilment of the requirements for the degree of PhD Department of Psychology University of Roehampton 2015 2 ABSTRACT Anxiety and depression are among the most prevalent psychological disorders affecting a large number of people across different cultures. At present, these conditions have not been examined among the general population of Bulgaria. This thesis is a large-scale project involving Bulgarian adolescents aged 13-17 and Bulgarian adults aged 35-58. The main aims are: 1/ to investigate the prevalence and correlates of anxiety and depression in Bulgarian adolescents and adults because this population has been under- researched on these topics 2/ to assess mental health literacy about depression in these two groups. Research indicates that mental health literacy rates vary in adolescents and adults across countries and cultures and are influences by a number of factors such as: healthcare system, social attitudes and expectations, education and social support. 3/ to study the personal experience of anxiety through qualitative methods. The purpose of this analysis is to get the individual point of view. A significant overlap in symptoms exist between depression and anxiety but anxiety has many different forms and aspects (panic attacks, social phobia, generalised anxiety disorder, etc.) that are worthy of qualitative investigation. The two age groups were chosen because: A) their life experiences were very different from a cultural point of view: the adolescents grew in a global, modern and democratic Bulgaria and the adults used to live under the isolation and restrictions of the Communist rule. 3 B) adolescence and adulthood are two distinctive life stages characterised by: social/ emotional changes, changes in health attitudes/behaviour and transition between concrete/ abstract thinking. Three studies were carried out in Bulgaria: Study 1 and Study 2 were quantitative, cross-sectional and Study 3 was qualitative. For Study 1 and Study 2 adolescents (n=700) were randomly recruited from public schools and adults (n=250) were recruited from employment companies. Study 3 applied interpretative phenomenological analysis to unstructured interviews conducted with adolescents (n=10) and adults (n=10) recruited from a sub- sample of Study 1. Results from Study 1 suggested that adolescents and adults had marked differences in specific sub-types of anxiety with adults scoring higher on social phobia, physical injury anxiety and panic agoraphobia. Anxiety and depression correlated strongly in adults. Significant gender differences were observed with females having higher prevalence rates of anxiety and depression in both age groups. Adults also scored higher on interdependency, indicating a collectivist mind set associated with Communism. Results from Study 2 indicated that both age groups had low levels of mental health literacy. However, adults appeared to be more affected by stigma associated with psychological illnesses. Qualitative results from Study 3 highlighted personal experiences and identified additional risk factors associated with onset and persistence of anxiety. Some of these factors were prevalent across both age groups and others were age specific. Further research work needs to focus on identifying helpful strategies in prevention, diagnosis and treatment of these conditions in adolescents and adults. 4 Improving health education across different age groups and reducing stigma towards psychological illness are of particular importance. TABLE OF CONTENTS CONTENTS ABSTRACT .......................................................................................................................... 2 TABLE OF CONTENTS ...................................................................................................... 4 LIST OF TABLES ................................................................................................................ 8 LIST OF FIGURES ............................................................................................................... 9 ACKNOWLEDGEMENTS ................................................................................................ 10 5 PUBLICATIONS AND CONFERENCE PAPERS ......................................................... 11 CHAPTER 1: INTRODUCTION ...................................................................................... 13 1. Background and context of the thesis ........................................................................................... 13 1.2. Objectives of the Thesis ...................................................................................................................... 17 1.3. Bulgarian cultural context and modern history of mental healthcare .................................................. 18 1.4. Overview of anxiety and anxiety disorders ......................................................................................... 20 1.5. Overview of Depression ...................................................................................................................... 23 CHAPTER 2: METHODOLOGY ..................................................................................... 24 2.1. Overview ............................................................................................................................................. 24 2.2. Research methodology ........................................................................................................................ 24 2.3. Participants .......................................................................................................................................... 27 2.4. Measures: ............................................................................................................................................ 27 2.4.1. Quantitative measures .................................................................................................................. 28 2.4.2. Qualitative measures .................................................................................................................... 36 2.5. Data collection .................................................................................................................................... 36 2.6. Data analysis ....................................................................................................................................... 36 2.7. Ethical considerations ......................................................................................................................... 37 CHAPTER 3: PREVALENCE AND CORRELATES OF ANXIETY AND DEPRESSION IN BULGARIAN ADOLESCENTS AND ADULTS (STUDY 1) ....... 39 3.1. Literature review ........................................................................................................................... 39 3.1.1. A brief Introduction .............................................................................................................. 40 3.1.2. Prevalence, comorbidity and gender effects of anxiety disorders and depression ................ 42 3.1.3. Correlates and cross-cultural aspects of Anxiety and Depression. The role of social support and self-construals in Adolescents and Adults ...................................................................................... 47 3.2. Study aim ............................................................................................................................................. 50 3.3. Method ................................................................................................................................................ 51 3.3.1. Procedure and Participants ........................................................................................................... 51 3.3.2. Measures ...................................................................................................................................... 52 3.4. Results ........................................................................................................................................... 53 3.4.1. Adolescent data descriptives ................................................................................................ 53 3.4.2. Gender and age effects in Adolescents ........................................................................................ 57 3.4.3. Positive and negative correlations in adolescents ................................................................
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