Relationships between students' stress, anxiety and depression and; parents' obsessive‒compulsive disorder

doi:10.21203/rs.3.rs-4816176/v1

Background

According to the World Health Organization, stress disorders, anxiety and depression are among the most common mental disorders in the adolescent age group. These disorders have a lot of negative effects on the educational process, social relations and mental and physical health of teenagers. Currently, among mental disorders, the impact of parental depression and anxiety on children's depression and anxiety is known and accepted, but studies conducted on the impact of other parental mental disorders on children's health are limited. Obsessive compulsive disorder is an important mental disorder due to its prevalence and associated disabilities, and patients with obsessive compulsive disorder have an adverse effect on the quality of life of their relatives. Therefore, this study was conducted with the aim of investigating the relationships between parents' obsessive‒compulsive disorder and students' stress, anxiety, and depression.

Methods

In this descriptive-analytical and cross-sectional study, 378 students aged 12 to 15 years from Arak city and their parents were selected by simple random cluster sampling. The data were collected via two standard questionnaires, the Maudsley Obsession Scale and the Stress, Anxiety and Depression Questionnaire (DASS-21), and were analyzed via SPSS 26 software.

Results

According to the findings of this research, the prevalence rates of stress, anxiety and depression at mild to very severe levels among the students were 32%, 40.7% and 36.3%, respectively. The percentage of obsessive-compulsive disorder in the parents of the study was 14.5%. There was a positive and significant relationship between students' stress and anxiety and parents' obsessive‒compulsive disorder (p = 0.0001), but no significant relationship was observed between depression and parents' obsessive‒compulsive disorder (p = 0.181).

Conclusions

The presence of obsessive‒compulsive disorder in parents was associated with greater stress and anxiety in students, and the presence of obsessive‒compulsive disorder in parents increased the severity of these disorders; however, the presence of obsessive‒compulsive disorder in parents was not related to students' depression.

Trial registration:

Arak University of Medical Sciences. ID: IR.ARAKMU.REC.1402.207

Stress

anxiety

depression

obsessive‒compulsive disorder

student

parents

According to statistics from the World Health Organization (WHO) in 2019, one out of every seven adolescents aged 10–19 years has a mental disorder, which constitutes 13% of the global disease burden in this age group(1). Many health care providers and adults believe that childhood is a time when a person is free from any pressure or problems(2). However, the seed of vulnerability is planted early in life, and children can feel mental and emotional pressure from environmental situations and people and become stressed(2).

Adolescence is a period of increased life stress(3). Stress affects both the brain and the body(4), and the importance of this issue is that some studies have revealed a connection between stress in life and the development of cancer(5, 6). According to the American Stress Institute, approximately 33% of American people suffer from severe stress, and according to the World Stress Organization, stress is the first health concern of high school students in the United States(7). Additionally, if not managed, stress can increase the incidence of depression and anxiety disorders(8).

According to the 2019 WHO, anxiety disorders are the most common mental disorders worldwide(9). According to the statistics of this organization, in 2019, 301 million people, including 58 million children and adolescents, had anxiety disorders(9). The average age of onset and prevalence of anxiety disorders are 13 and 14 years, respectively(10). Anxiety symptoms are among the most common clinical diagnoses in children and adolescents and can be important risk factors for the occurrence of other psychiatric disorders in adulthood(11). If not treated, anxiety disorders may persist until adulthood and can lead to other problems, such as depression, sleep problems, substance abuse, suicidal behavior and academic failure(11). Therefore, it is necessary to prevent the occurrence of anxiety with proper knowledge of the factors that cause anxiety disorders(11).

According to statistics from the WHO (2019), the second most common mental disorder worldwide is depression. According to these statistics, 280 million people, including 23 million children and adolescents, were suffering from depression(9). The average age of occurrence and prevalence of depression disorders is 14–16 years(10). Depression in children is much more serious than it is in adults, and the possibility of its continuation into adulthood is very high(12). Depression in childhood and adolescence is associated with social, emotional and academic disturbances, as well as with a wide range of mental and physical health problems and suicide in adulthood(12).

Research shows that depression is closely related to problems such as cardiovascular diseases, cerebrovascular diseases, malignancies, metabolic endocrine disorders and infectious diseases(13). Anxiety and depression are very common in childhood and adolescence, and the early onset of these symptoms and disorders predicts a worse course throughout life(14). Research by Rui Zhong and Xiaofei Mao revealed that anxiety and depression can directly and indirectly affect quality of life by causing sleep problems (15, 16).

Identifying the underlying factors that contribute to the onset of childhood mental disorders will help improve prevention and intervention efforts for this population(17). In terms of the etiology of stress, depression and anxiety are the result of several factors, such as biological, genetic and psychosocial factors(8), among which one of the potentially important effects is the child's family environment(17). The quality of the environment in which children and adolescents grow is effective for their well-being and growth(18). In addition to early negative experiences in homes, schools or digital spaces, such as exposure to violence, bullying and poverty, another known and important factor is the mental illness of parents or other caregivers, which increases the risk of mental illness(18). Moreover, the effects of parents' depression and anxiety on children's depression and anxiety are known and accepted(8).

Among other mental disorders, obsessive‒compulsive disorder (OCD) is an important mental disorder due to its prevalence and disability(19, 20). According to the reviews, limited evidence is available on the impact of parents with OCD on their children. One of the valuable studies in this field is the study of Frias and colleagues, which was conducted in 2020(21). In this study, only mothers with OCD were investigated, and the results showed that children of mothers with OCD suffer more from anxiety and depression than children of healthy mothers do(21). Another valuable study that was similar to the present study was the study of Thiago and colleagues, which was published in 2021(22). In this study, a positive and meaningful relationship was observed between the symptoms of OCD in the mother and psychological injuries in her child, and the researchers suggested that fathers also participate in future research(22).

Research has shown that patients with OCD have an adverse effect on the quality of life of their relatives(21, 23); thus, the parenting style of parents with OCD, such as overprotection, affects children’s anxiety-producing behavior(21, 24). Therefore, given that children and teenagers are vulnerable groups of society and stress, anxiety and depression disorders are highly prevalent in this age group and lead to many problems in the health and mental state of children, this research investigated the factors related to children's stress, anxiety and depression and parents' OCD. The results of this research can be effectively used to prevent children's psychiatric problems by performing effective and timely interventions in families with an emphasis on parents to improve the mental health of children and adolescents as high-risk sections of society.

This descriptive-analytical and cross-sectional study was conducted among students aged 12–15 years and their parents in public schools in Arak city. Students and their parents entered the study after providing informed consent for the content of the research. This study was approved by Arak University of Medical Sciences. Written informed consent and verbal agreement were obtained from all participants. The confidentiality principle was maintained so that there was no need to mention the names of the individuals in the questionnaires, and it was assured that the information was just provided to the researcher and used in the study. All methods were carried out in accordance with relevant guidelines and regulations or the Declaration of Helsinki.

Participants

The present study was conducted with the aim of determining the relationships among stress, anxiety and depression in students and parents' OCD. The sampling method in this research was a multistage method that included clustering and simple random sampling. Education in the Arak metropolis is divided into two districts, districts 1 and 2, which are the main clusters. Education in the first district included 20 boys' schools (with 5369 students) and 21 girls' schools (with 6059 students) at the first secondary level. Education in District Two includes 13 boys' schools (3624 students) and 12 girls' schools (3358 students) at the first secondary level; that is, the statistical population of the research includes 18410 students and their parents. According to the Cochran formula, the sample size was estimated to be at least 376 students (752 parents), and to equalize the number of samples at each educational level, the sample size was 378 (756 parents). The sample size for each school was calculated according to the number of students in that school.

α = 0.05 p = 0.5 d = 0.05 N = 18410 n = 376

$$\:\text{n}=\frac{\frac{{\text{z}}^{2}\text{p}\text{q}}{{\text{d}}^{2}}}{1+\frac{1}{\text{N}}\left(\frac{{\text{z}}^{2}\text{p}\text{q}}{{\text{d}}^{2}}-1\right)}$$

Sixteen schools were randomly selected from these two districts, and the number of samples was determined according to the size of the schools. Notably, to minimize the effects of the background variables of gender and age, the number of boys and girls in the sample was equal, and an equal number of samples were taken from each educational level.

The inclusion criteria in this research included willingness to participate in the study, not being a single-parent family, minimum education (primary school) for the parents, no long-term absence of the student (for example, due to being hospitalized) and the complete completion of the questionnaire by the students and their parents.

Student research tools

In this study, 2 questionnaires were used to collect students' information. The first questionnaire collected the students’ demographic information, which included their age, gender, and educational level. The second questionnaire is the Dass-21 questionnaire, which contains 21 questions about stress, anxiety and depression. Each subscale of the DASS-21 consists of 7 questions. The final score of each item is obtained through the sum of the scores of the related questions. Each question is scored from 0 (does not apply to me at all) to 3 (completely applies to me).

Te original study reporting the high reliability of the DASS-21, the Cronbach’s alpha coefficients for depression, anxiety, and stress were reported to be 0.91, 0.84, and 0.90, respectively(25). Henry and Crawford reported that this scale has good concurrent and discriminant validity as well as excellent internal consistency (α = .93)(26). The results of Mellor et al.'s study, which examined 4 studies conducted with this questionnaire in China, Chile, Australia and Malaysia with children aged 11–19 years, support this questionnaire in this age group(27).

Parent research tools

In this study, 2 questionnaires were used to collect information from students' parents. The first questionnaire collected the parents' demographic information, which included age, sex, family economic status, employment status, and education. The second questionnaire is the Maudsley questionnaire. This questionnaire has 30 questions, half of which are scored with a correct key and half with an incorrect key. In addition to a general score of OCD, this questionnaire provides four subscores for review, washing, slowness and doubt.

In Mohammadirizi's study conducted in 2015, the cutoff point was 11, and the reliability of the total score of obsession and its subscales, i.e., washing, review, slowness, and doubt, through the correlation index was 0.98, 0.92, 0.96, 0.88, and 0.93, respectively(28). In this study, similar to many studies performed in Iran, the cutoff point was 11.

Procedure

After approving the proposal and obtaining the code of ethics and necessary permits to conduct the research, the researcher, after attending the school, randomly selected the desired number of samples from the students of each class by using the list of students and according to the entry criteria. Notably, simple random sampling was obtained via R software because of access to the list of students of each class and the identification of each student's number. After talking with the students and their parents, their verbal and written consent to participate in the research was obtained. In the next step, the Maudsley Obsessive Compulsive Disorder Questionnaire was completed by the parents, and the DASS-21 questionnaire was completed and collected by the students.

Using SPSS 26 software, descriptive statistics were expressed for quantitative variables with means and standard deviations and for qualitative variables with frequencies and percentages. The chi-square test and Fisher's exact test were used to assess the associations between qualitative variables. For quantitative variables, owing to the large sample size and the use of the central limit theorem, the distribution of the average sample tends to be normal, so we used parametric tests. Independent t tests and analysis of variance with post hoc tests were used to compare the average quantitative variables with the average qualitative variables. Pearson's correlation test was used to assess the relationships between quantitative variables. The significance level in this study was considered to be 0.05.

The number of boys and girls in the sample was equal, and an equal number of samples were taken from each age and educational level. Most of the researched fathers had a secondary education (35/4%) and were self-employed (61/4%). Most of the mothers studied had a primary school (40/2%), and most of them were housewives (72/2%). Most of the families in the study had an average income (54.5%). (Other details of the demographic results resulting from the research are available in Table 4.)

Table 1 shows the means and standard deviations of the fathers' OCD scores and their subscale scores. The highest score of 1.09±1.831 was related to the doubt dimension (conscientiousness), the lowest score of 0.938±0.3 was related to the washing dimension, and the total score of the fathers' OCD questionnaire was 5.140±3.20, which was in the range of 0-22. A total of 36 fathers (9.5%) had OCD.

Table 1 shows the means and standard deviations of the mothers' OCD scores and their subscale scores. The highest score of 2.13±2.780 was related to the washing dimension, the lowest score of 1.294±0.78 was related to the slowness/repetition dimension, and the total score of the maternal OCD questionnaire was 6.665±5.17, ranging from 0-23. A total of 74 mothers (19.5%) had OCD.

Table 1: Means and standard deviations of the OCD scores of fathers and mothers

Variables

Variable level

Min

Max

Std. Deviation

Mean

Father's Obsessive Compulsive Disorder

doubt (Conscientiousness)

Slowness. Repetition

Washing

Review

Obsessive Compulsive Disorder score

0

7

9

22

1.09

0.83

0.3

0.98

3.20

1.831

1.484

0.938

1.905

5.140

Mother's Obsessive Compulsive Disorder

doubt (Conscientiousness)

Slowness. Repetition

Washing

Review

Obsessive Compulsive Disorder score

0

7

11

9

23

0.93

0.78

2.13

1.31

5.17

1.485

1.294

2.780

2.110

6.665

A total of 66 students (17.5%) had one obsessive parent, and 22 students (5.8%) had two obsessive parents.

In Table 2, the results related to the frequency, mean and standard deviation of students' anxiety, stress and depression scores and their dimensions are shown. The average anxiety score was 6.88±6.917 in the interval 0–32, the average stress score was 10.61±9.847 in the interval 0–40, and the average depression score was 8.35±8.831 in the interval 0–40.

Table 2: Frequency distributions and means and standard deviations of students' anxiety, stress and depression

Mean

±

standard deviation

Percent

Frequency

Variables level

Variable

6.91

±

6.88

59.3

18.5

9.8

6.6

5.8

224

70

37

25

22

normal

mild

medium

intense

very intense

anxiety

9.64

±

10.61

68

13.2

10.6

4.8

3.4

257

50

40

18

13

normal

mild

medium

intense

very intense

Stress

8.83

±

8.35

63.8

14.6

11.4

5.8

4.5

241

55

43

22

17

normal

mild

medium

intense

very intense

depression

According to the data in Table 3, the average anxiety and stress scores of the students with parental OCD were significantly different (p=0.0001). The average anxiety and stress scores of the students who had healthy parents were lower than those of the students who had one parent (p=0.0001) or two parents (p=0.00001) with OCD. Additionally, the average anxiety and stress scores of students who had one parent with OCD were lower than those of students who had both parents with the disorder (p=0.0001). Additionally, according to Table 4, the results revealed that the mean depression score of students with parental OCD was not significantly different (p=0.181).

Table 3: Comparison of the means and standard deviations of anxiety, stress and depression based on parental OCD

Variables	Parental Obsessive Compulsive Disorder						Analysis of variance test
	Healthy (I)		single parent(II)		two parents (III)		Analysis of variance test
	Std. Deviation	Mean	Std. Deviation	Mean	Std. Deviation	Mean	statistics	p value	Pairwise comparison of Bonferroni
anxiety	4.823	4.63	6.75	9.027	17.82	17.82	F=109.256	0.0001	0.0001>I-II 0.0001>I-III 0.0001>II-III
Stress	6.77	6.86	7.202	6.89	29.82	29.82	F=201.216	0.0001	0.0001>I-II 0.0001>I-III 0.0001>II-III
depression	8.45	8.15	11.73	8.83	8.35	8.35	F=1.717	0.181	-

According to the results shown in Table 4, the average stress scores of students of both sexes were significantly different (p=0.036) and were significantly greater for girls. The average stress scores of students at different levels of education were significantly different (p=0.013), and the average stress score of first-grade students was lower than that of third-grade students (p=0.01). The average stress scores of students with different levels of maternal education were significantly different (p=0.014); the average stress score of children of mothers with a primary school was greater than that of mothers with a secondary education (p=0.01), and the average stress score of students whose mothers had a post-secondary education was greater than that of students whose mothers had a secondary education (p=0.016). There was a direct and statistically significant relationship between student age and stress score (p=0.003). However, there was no statistically significant relationship between other demographic characteristics and stress score (p<0.05).

According to the results, the average anxiety score of students of the two genders was significantly different (p=0.037) and was greater for girls. The average anxiety score of students at different levels of education has a statistically significant difference (p=0.039). The average anxiety score of first-grade students was lower than that of third-grade students (p=0.03), and the average anxiety score of second-grade students was significantly lower than that of third-grade students (p=0.025). There was a direct and statistically significant relationship between student age and anxiety score (p=0.03). However, there was no statistically significant relationship between other demographic characteristics and anxiety scores (p<0.05).

According to the results, there was a statistically significant difference in the average depression score of students of both sexes (p=0.004), and it was greater for girls. The average depression scores of students with different levels of education were significantly different (p=0.001). The average depression score for first-grade students was lower than that for third-grade students (p=0.0001). There was a direct and statistically significant relationship between student age and depression score (p=0.0001), and there was also a statistically significant relationship between maternal age and depression score (p=0.013). However, there was no statistically significant relationship between other demographic characteristics and depression scores (p<0.05).

Table 4: Correlation results of students' stress, anxiety and depression scores with demographic characteristics

Variables		Variable level		Frequency	Stress	Anxiety	Depression
Variables		Variable level		Frequency	Mean ± std.deviation	Mean ± std.deviation	Mean ± std.deviation
Sex		Girl Boy		189(50%) 189(50%)	9/54 ± 9/06 11/67 ± 10/48	6.14 ± 6/36 7.62 ± 7/37	7.06 ± 8/33 9.64 ± 9/13
P-Value*					P=0/03 ,T=-2/109	P=0/037 ,T=2/091	P=0/004 ,T=2/869
Grade		First base(I) Second base(II) Third base(III)		126(33/3%) 126(33/3%) 126(33/3%)	8.81 ± 9/06 10.57 ± 9/87 12.44 ± 10/295	6.27 ± 6/79 6.21 ± 6/50 8.16 ± 7/30	6.33 ± 6/801 8.14 ± 8/23 10.57 ± 10/58
P-Value** Pairwise comparison of Bonferroni					P=0/001 , F=7.561 0.458> I-II 0.01> I-III 0.368> II-III	P=0/001 , F=7.561 0.942> I-II 0.03> I-III 0.025> II-III	P=0/001 , F=7.561 0.297> I-II 0.0001> I-III 0.081> II-III
Father's education		primary School secondary education post-secondary education		124(32/8%) 134(35/4%) 120(31/7%)	11.40 ± 10/3 9.76 ± 8/66 10.73 ± 10/58	7.10 ± 7/01 6.13 ± 6/33 7.48 ± 7/40	8.53 ± 8/94 8.25 ± 8/44 8.27 ± 9/20
P-Value**					P=0/404 , F=0.909	P=0/274 , F=1.298	P=0/961 , F=0.04
Mother's education	primary School(I) secondary education(II) post-secondary education (III)			152(40.2%) 135(35.7%) 91(24.1%)	11.62 ± 10/79 8.64 ± 8/60 11.58 ± 9/56	6.72 ± 7/03 6.10 ± 6/66 8.29 ± 9/95	9.04 ± 9/72 7.53 ± 8/16 8.42 ± 8/17
P-Value** Pairwise comparison of Bonferroni					P=0/014 , F=4.298 0.01> I-II 0.860> I-III 0.016> II-III	P=0/062 , F=2.795	P=0/350 , F=1.054
Father's job	Employee freelance job Retired jobless			126(33.3%) 232(61/4%) 12(3/2%) 8(2/1%)	11.11 ± 10/50 10.48 ± 9/65 10 ± 7/48 7.25 ± 8/34	7.62 ± 7/43 6.67 ± 6/71 5.83 ± 6/17 2.75 ± 2/81	8.25 ± 8/75 8.24 ± 8/94 11.50 ± 8/27 8.25 ± 8/24
P-Value**					P=0/721 , F=0.446	P=0/189 , F=1.599	P=0/014 , F=4.298
Mother's job	housewife Employee freelance job Retired			273(72/2%) 37(9/8%) 66(17/5%) 2(0/5%)	10.43 ± 9/92 10.97 ± 9/16 11.33 ± 10.07 4 ± 2.82	6.61 ± 6/93 8.54 ± 7/29 7.24 ± 6/60 1 ± 1/41	8.38 ± 8/81 7.46 ± 8/28 8.67 ± 9/26 10 ± 14/4
P-Value**					P=0/708 , F=0.464	P=0/243 , F=1.398	P=0/912 , F=0.177
Income	Less than average Average More than average			143(37/8%) 206(54/5%) 29(7/7%)	9.45 ± 8/98 11.23 ± 10/36 11.86 ± 9/92	6.39 ± 7/09 6.94 ± 6/54 8.83 ± 8/39	8.59 ± 8/54 8.17 ± 9/17 8.41 ± 7/88
P-Value**					P=0/196 , F=1.518	P=0/220 , F=1.518	P=0/912 , F=0.093
Student's age			13 ± 0/818		P***=0/003 , r=0.151	P=0/03 , r=0.112	P=0/0001 , r=0.196
Father's age			42.64 ± 5/179		P***=0/380 , r=0.045	P=0/315 , r=0.052	P=0/101 , r=0.085
Mother's age			39 ± 3/928		P***=0/439 , r=0.04	P=0/162 , r=0.072	P=0/013 , r=0.128

* Independent test

** Anova test

*** Pearson test

According to Table 5, the results showed that the frequency distribution of fathers' OCD at different levels of education was significantly different (p=0.0001), and the frequency ratio was greater for those with a post-secondary education. The frequency distribution of fathers' OCD in different jobs is significantly different (p=0.015), and this ratio is greater for employees. The frequency distribution of fathers' OCD at different levels of income was significantly different (p=0.029), and this ratio was greater for middle-income families.

Additionally, the results revealed that the frequency distribution of mothers' OCD at different educational levels significantly differed (p=0.0001) and was greater for mothers with a primary School. The frequency distribution of mothers' OCD at different levels of the mother's job significantly differed (p=0.029), and it was greater for the housewife job. The frequency distribution of mothers' OCD at different levels of family income was significantly different (p=0.031), and it was greater for mothers with middle income.

Table 5: Frequency distribution of OCD among fathers and mothers on the basis of demographic characteristics

Variables

Variable level

has

does not have

Chi-square

-

Fisher's exact test

Percent

Frequency

Percent

Frequency

Value

p-value

Father's OCD

Father's education

primary School

secondary education

post-secondary education

22.2

19.4

58.3

8

7

21

33.9

37.1

28.9

116

127

99

chi-square

=

13.093

0.001

Father's job

Employee

freelance job

Retired

jobless

58.3

41.7

0

21

15

0

30.7

63.5

3.5

2.3

105

217

12

8

fisher exact

=

9.846

0.015

Income

Less than average

Average

More than average

22.2

61.1

16.7

8

22

6

39.5

53.8

6.7

135

184

23

chi-square

=

7.078

0.029

Mother's OCD

mother's education

primary School

secondary education

post-secondary education

50

13.5

36.5

37

10

27

37.8

41.1

21.1

115

125

64

chi-square

=

20.779

0.0001

mother's job

Employee

freelance job

Retired

jobless

59.5

16.2

24.1

0

44

12

18

0

75.3

8.2

15.8

0.7

229

25

48

2

fisher exact

=

8.490

0.029

Income

Less than average

Average

More than average

25.7

62.2

12.2

19

46

9

40.8

52.6

6.6

124

160

20

chi-square

=

7.004

0.031

According to Table 6, the results indicated that the average score for OCD in both genders and the frequency distribution of OCD in both genders were significantly different (p=0.0001) and were greater in women.

Table 6: Comparison of the means and standard deviations of OCD in men and women

Variables	Woman		Man		Independent T-test
Obsessive Compulsive Disorder score	Mean	Std. Deviation	Mean	Std. Deviation	t	p-value
Obsessive Compulsive Disorder score	5.17	6.665	3.20	5.14	-4.552	0.0001

The findings highlight the role of parents' OCD and their children's stress, anxiety and depression disorders to some extent. In the study of stress and anxiety in students, it was found that students who had an obsessive parent suffered more from stress and anxiety than did students who had healthy parents. Students whose parents had OCD had greater stress and anxiety intensity than did those in the other two groups. In the study of depression in the three groups of students, no statistically significant difference was found.

According to the findings of this research, among the parents, 36 fathers (4.76%) and 74 mothers (9.78%) had OCD (14.5% of parents). In the present study, the mean of obsession subscales in fathers was reported. The highest score of 1.09 ± 1.831 was related to the hesitance dimension (task science) and the lowest score was 0.3 ± 0.938 related to the washing dimension, and the total score of the fathers' algebraic obsession questionnaire was 3.20 ± 5.140.

The mean obsession subscale score for mothers was also reported in this study; the highest score was 2.13 ± 2.780 for the washing dimension, and the lowest score was 0.78 ± 1.294 for the slowness‒repetition dimension. The total score of the OCD questionnaire of mothers was 5.17 ± 6.665. In examining the difference in OCD scores between fathers and mothers, the average OCD score of mothers (5.17) was significantly higher than that of fathers (3.20).

In examining the relationship between fathers' OCD and demographic characteristics, the results revealed that the distribution of obsessions in men with post-secondary education, Employee, and average and below-average income levels is greater than that in other men. In examining the relationship between mothers' obsessions and demographic characteristics, the results revealed that the prevalence of obsessions in mothers with primary School, housewife occupations, and average and below-average income levels is greater than that in other mothers. The results of our study of OCD in fathers and mothers may indicate the fundamental differences in OCD between men and women.

Benatti's study, which examined the demographic characteristics of 491 OCD patients, reported that OCD has a lower onset age in men than in women and that it is more common in married women with lower education levels than in other patients(29). In Pampaloni's study and Fawcett's study, as in the present study, it was stated that women are more at risk of OCD (30, 31). In Torresan's study and Pampaloni's study, as in the present study, there were fundamental differences between the subscales of obsession in women and men. These studies revealed that male patients are more likely to experience sexual-religious obsessions and that female patients are more likely to experience disorders related to washing and cleaning obsessions(31, 32).

The results of this study are in line with some of the results of Thiago et al.'s study, which was published in 2021 and was a type of correlation study. In the study of Tiago et al., a positive and significant relationship was observed between symptoms of OCD in the mother and psychological injuries in her child. In this study, there was a positive statistical relationship between mothers’ OCD symptoms and all areas of the CBCL (aggressive behavior, law breaking, attention problems, thinking problems, social problems, physical complaints, withdrawal, depression and anxiety) (22). In the present study, similar to Tiago's study, there was a positive and significant relationship between parents’ OCD and children's anxiety, but unlike Tiago's study, there was no significant relationship between parents’ OCD and children's depression. This difference may be due to the difference in the average age of the samples (10.1 ± 2.9) in Thiago's research compared with the present study (0.818 ± 13). The influence of parents on their children is likely different across different age groups, and younger children are more likely to be influenced by their parents' behavior.

The results of the study by Frias et al., which was conducted in 2020, are also in line with those of the present study. In this study, children of mothers with OCD presented significantly more emotional symptoms than did children of mothers without OCD. The presence of obsession in parents predicts the severity of anxiety symptoms in their children(21).

In the present study, the percentages of students with mild to very severe stress, anxiety and depression were 32%, 40.7%, and 36.3%, respectively. This amount is significant in our country, as are the statistics of the World Health Organization, and requires corrective measures. Racine et al.'s study, which was a meta-analysis of the prevalence of depression and anxiety in children and adolescents, reported prevalences of depression and anxiety of 25.2% and 20.5%, respectively (33). The results of the present study revealed that the incidence of stress, anxiety and depression disorders is greater in girls than in boys and is positively related to increasing age and educational level. Piqueras and colleagues reported that the means of depression and anxiety were greater in girls than in boys(34). In Racine's study, 58 studies reported an increase in the prevalence of depression and anxiety in girls, and 59 studies reported a higher rate of depression in older children(33).

Limitations

Since this study was an academic study and was the result of a master's thesis, the time and budget available to the researcher were very limited. Unfortunately, owing to the mentioned cases and the high number of samples, we could not hold an interview session with a psychiatrist for the students and their parents. Additionally, it was not possible to directly observe the behavior of students in families, and we had to use only the results of the questionnaires.

The presence of OCD in parents was associated with greater severity of stress and anxiety disorders in students, and the presence of OCD in parents caused greater severity of these disorders but had no effect on depression. The present study revealed that there is a relationship between the presence of OCD and symptoms in fathers as well as in mothers with children's mental disorders. If the obsessions of parents come together, they can cause much more serious damage to children's mental health. The results of this study show that to control children's stress and anxiety, we need to focus more on parents and their mental disorders, which can affect their children.

OCD

obsessive‒compulsive disorder

Ethics approval and consent to participate

Arak University of Medical Sciences approved the current research by the University Research Council with a code of ethics (IR.ARAKMU.REC.1402.207). First, the students' parents completed the written consent form to participate in the research, and then the students also completed the written consent form to participate in the research.

Authors and affiliations

¹Student Research Committee, Arak University of Medical Sciences, Arak, Iran

Mohammad Rezvanpour

²Assistant professor of Nursing, Department of Nursing, Arak School of Nursing, Arak University of Medical Sciences

Fatemeh Ganjeh

³Department of Epidemiology and Biostatistics, School of Public health, Tehran University of Medical Sciences, Tehran, Iran.

Fatemeh Rafiei

⁴Department of Pediatric Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran.

Sharareh khosravi

Competing interests

The authors declare that they have no competing interests.

Consent for publication

Not applicable.

Funding

This study was funded by Arak University of Medical Sciences.

Author Contribution

M.R. designed the main idea. M.R. , F.G. and Sh.Kh. designed the study and wrote the protocol. M.R. performed the sampling and distributed and collected the questionnaires. F.R. undertook the statistical analysis and wrote the first draft of the manuscript. Sh.Kh. participated in critical revision of the manuscript drafts. All the authors have read and approved the final manuscript and agree to be accountable for all aspects of the work.

Acknowledgement

The authors thank and appreciate all the participants in this study. The authors are thankful for the support of Education Organization of Arak throughout this project.

Data Availability

All data generated or analyzed during this study are included in this published article.

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Chart 1 is available in the Supplementary Files section.

No competing interests reported.

Chart1.jpg
Chart 1: Frequency percentage of students based on parental OCD

Relationships between students' stress, anxiety and depression and; parents' obsessive‒compulsive disorder

Status:

Version 1

Abstract

Background

Methods

Results

Conclusions

Trial registration:

Figures

Introduction

Methods

Participants

Student research tools

Parent research tools

Procedure

RESULTS

DISCUSSION

Limitations

CONCLUSIOUNS

Abbreviations

Declarations

Ethics approval and consent to participate

Authors and affiliations

Competing interests

Funding

Author Contribution

Acknowledgement

Data Availability

References

Chart 1

Additional Declarations

Supplementary Files

Status:

Version 1