Anxiety in Adolescents: Risk Factors Based on the Social Ecological Model

Emotional disorders can affect the overall health of adolescents. One frequent emotional disorder among adolescents is anxiety disorders. The fact that many factors play roles in the development of anxiety disorders in adolescents signifies the importance to investigate these factors among adolescents aged 14–17 years in Denpasar City. This study used a quantitative approach with a cross-sectional design and an analytical survey method. The results showed that out of 370 adolescents, 133 (35.9%) suffered from severe to extreme anxiety and other 125 (33.8%) experienced mild to moderate anxiety. History of any chronic disease, sleep quality, authoritarian parenting style, permissive parenting style, and family harmony were found to be associated with anxiety. Of these, sleep quality was the most predictive. Hence, it is necessary for the Health Department in Denpasar City, schools and parents to come together and raise awareness about the importance of sleep quality for adolescents. This study used a purposive sampling technique. The inclusion criteria in participant recruitment were age between 14–17 years, unmarried status, and residence in Denpasar City. The minimum sample size was calculated using the proportion estimation formula (See Equation 1). In this calculation, the tolerable error rate was set at 5% and the critical value at this value was 1.96. Meanwhile, the proportion in the population was taken from the proportion of high school students suffering from emotional disorders in a study by Mubasyiroh and colleagues (2017), which was 60.17%. From this calculation, the minimum sample size required is approximately 368 participants. the study involved 370 participants This study investigated risk factors of anxiety disorder among adolescents in Denpasar City using the social ecological framework. The results indicated five factors that significantly predicted levels of anxiety, namely history of chronic diseases, sleep quality, authoritarian parenting, permissive parenting, and family harmony. To be more specific, adolescents with a history of chronic disease were found three times more likely to suffer from mild-to-moderate anxiety. This finding is in line with a previous study reporting that female cancer patients are almost two times more (OR = 1.982) prone to emotional disorders (Khoiriyah & Handayani, 2020). Another study also documented a similar finding that 6.9% of adolescents lived with a chronic condition (e.g., stroke, asthma, heart disease, diabetes mellitus, etc.) and were three times more likely to experience emotional distress (Isfandari, 2013). Further, the risk of emotional disorders also increases along with the increasing number of chronic conditions that an (adolescent) individuals has (Widakdo & Besral, 2013). Additionally, this study also found that sleep quality was the most predictive risk factors of all research variables. Poor quality of sleeps was associated with a 4.5-fold increase in the risk of mild-to-moderate anxiety and a 7.8-fold increase in the risk of severe-to-very severe anxiety. Indeed, some components of sleep quality adolescents’ emotional and states, sleep latency, subjective sleep disturbances, sleep daytime sleepiness high short