Common Phobias among Egyptian Primary Schoolchildren: An Emergency Trigger for Panic Disorder due to Corona Pandemic
BACKGROUND: In the wake of the adverse situation we are currently facing globally due to the coronavirus pandemic outbreak, it is normal to feel stressed, confused, and scared but what is abnormal is to turn this to panic. Phobias are more pronounced than fears. They develop when a person has an exaggerated or unrealistic sense of danger that may be evolved to experience panic attacks.
AIM: Our objective was to identify the prevalence of most common phobias as well as panic disorder (PD) due to the coronavirus pandemic among Egyptian primary schoolchildren and their determinants.
METHODS: A cross-sectional study was conducted among 2015 schoolchildren from 3 to 6 grades in three governorates of Egypt. Seven types of phobias were investigated: Agoraphobia, phobias from darkness, animal, untreatable illness (mainly coronavirus), insects, height, and social phobia. The childâ€™s self-reported PD symptoms were assessed using DSM-IV with psychiatric diagnoses.
RESULTS: Almost two-thirds of the surveyed primary schoolchildren have phobias of the low score (<9) versus one-third who had high phobias score (61.% vs. 35%, respectively) with highly significant difference (p < 0.001). The most prevalent phobias were from heights (66.5%) followed by darkness (60.0%). The important predictors of phobias were: Being a male child, living in an urban area, and studying at governmental school at fifth or sixth-grade residence. The prevalence of PD due to the corona epidemic is very high, it is reported by almost half of the surveyed primary schoolchildren. Fear of losing any of their family members, especially grandparents, was reported to be the highest PD symptom (97%).
CONCLUSION AND RECOMMENDATION: Phobia from heights and darkness was the most common. The prevalence of PD due to the coronavirus epidemic is reported to be very high. Calming down children who might be experienced with a phobia that is triggering their PD is recommended.
Plum Analytics Artifact Widget Block
NHS. Overview Phobias. Available from: https://www.nhs.uk/ conditions/phobias. [Last accessed on 2020 Feb 18].
Childrenâ€™s Hospital of Philadelphia. Phobias in Children and Adolescents; 2020. Available from: https://www.chop.edu/ conditions-diseases/phobias-children-and-adolescents. [Last accessed on 2020 Mar 23].
Lydon S, Healy O, Oâ€™Callaghan O, Mulhern T, Holloway J. A systematic review of the treatment of fears and phobias among children with autism spectrum disorders. Rev J Autism Dev Disord. 2015;2:141-54. https://doi.org/10.1007/ s40489-014-0043-4
Watson LR, Fraser M, Ballas P. Phobias in Children. University of Rochester Medical Center Rochester; 2020. Available from: https://www.urmc.rochester.edu/encyclopedia/content. aspx?contenttypeid=90&contentid=P01639. [Last accessed on 2020 Mar 23].
Bener A, Ghuloum S, Dafeeah EE. Prevalence of common phobias and their socio-demographic correlates in children and adolescents in a traditional developing society. Afr J Psychiatry (Johannesbg). 2011;14(2):140-5. https://doi.org/10.4314/ajpsy. v14i2.6 PMid:21687913
Nielsen MD, Andreasen CL, Thastum M. A Danish study of one-session treatment for specific phobias in children and adolescents. Scand J Child Adolesc Psychiatry Psychol. 2016;4(2):65-76. https://doi.org/10.21307/sjcapp-2016-011
Eaton WW, Bienvenu J, Miloyan B. Specific phobias. Lancet Psychiatry. 2018;5:678-86. https://doi.org/10.1016/ s2215-0366(18)30169-x PMid:30060873
Oar EL, Farrell LJ, Ollendick TH. Pediatric Anxiety Disorders. In: Specific Phobia. Ch. 7. Cambridge, Massachusetts: Academic Press; 2019. p. 127-50. https://doi.org/10.1016/ b978-0-12-813004-9.00007-4
Fehma L, Pelissolo A, Furmark T, Wittchen H. Size and burden of social phobia in Europe. Eur Neuropsychopharmacol. 2005;15:453-62. https://doi.org/10.1016/j.euroneuro.2005.04.002 PMid:15921898
George CM. Solution-focused therapy: Strength-based counseling for children with social phobia. J Humanist Couns Educ Dev 2008;47:144.
Yates WR, Munir KM. Pediatric Specific Phobia. Drugs and Diseases Pediatrics: Developmental and Behavioral Articles. Medscape; 2018. Available from: https://wwwemedicine. medscape.com/article/917056-overview. [Last accessed on 2018 Aug 09].
Ollendick TH. Panic disorder in children and adolescents: New developments, new directions. J Clin Child Psychol. 1998;27(3):234-45. PMid:9789184
Birmaher B, Ollendick TH. Childhood-onset panic disorder. In: Ollendick TH, March JS editors. Phobic and Anxiety Disorders in Children and Adolescents. New York: Oxford University Press; 2004. p. 306-33. https://doi.org/10.1093/ med: psych/9780195135947.003.0011
Leonard AD, Daniel FC, Adam MV, Peter FT. Panic disorder in clinically referred children and adolescents. Child Psychiatry Hum Dev. 2007;38:57-71. https://doi.org/10.1007/ s10578-006-0042-5
Goodman B. Know the Symptoms of COVID-19. WebMD Health News. Available from: https://www.webmd.com/lung/ news/20200310/know-the-symptoms-of-covid19?ecd=wnl_ gdh_032120&ctr=wnl-gdh-032120_nsl-LeadModule_c t a & m b = % 2 f 1 2 p f M M r 1 T q 6 E L Q O t S 4 z 1 u H n Ve v 1 i m b CveYL4%2fXv82Y%3d. [Last accessed on 2020 Mar 10].
WebMD News Staff. Coronavirus 2020 Outbreak: Latest Updates. WebMD Health News. Available from: https://www. webmd.com/lung/news/20200124/coronavirus-2020-outbreak-latest-updates?ecd=wnl_spr_032220&ctr=wnl-spr-032220_nsl- LeadModule_cta&mb=%2f12pfMMr1Tq6ELQOtS4z1uHnV ev1imbCveYL4%2fX v82Y%3d. [Last accessed on 2020 Mar 25]. https://doi.org/10.2174/1568026620999200305144537
Cleveland Clinic. What Happens When Your Immune System Gets Stressed Out? How Stress Impacts your Immunity and how to Chill Out. Health Essentials. Rheumatology and Immunology. Available from: https://www.health.clevelandclinic. org/what-happens-when-your-immune-system-gets-stressed-out. [Last accessed on 2017 Mar 01]. https://doi. org/10.4135/9781452229324.n2
Neal B. Can Stress Cause Physical Illness? This is how Anxiety Affects your Immune System. Available from: https://www. bustle.com/p/can-stress-cause-physical-illness-this-is-how-anxiety-affects-your-immune-system-7524590. [Last accessed on 2017 Dec 09].
Cherney K. Immune System. Effects of Anxiety on the Body. Healthline Media. Available from: https://www.healthline. com/health/anxiety/effects-on-body#7. [Last accessed on 2018 Jul 20].
Fleiss JL, Levin B, Paik MC. Statistical Methods for Rates and Proportions. 3rd ed. New York: John Wiley and Sons; 2003.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 2000.
Khan Academy. Z-statistics vs. T-statistics; 2018. Available from: Available from: https://www.khanacademy.org/math/ statistics-probability/significance-tests-one-sample/more-significance-testing-videos/v/z-statistics-vs-t-statistics. https:// doi.org/10.1016/0167-7152(84)90068-3. [Last accessed on 2020 Mar 15].
de Menezes S, Vance A. Social phobia in children risk and resilience factors. Aust Med Stud J. 2014;4(2):66-69.
Laporte PP, Pan PM, Hoffmann MS, Wakschlag LS, Rohde LA, Miguel EC, et al. Specific and social fears in children and adolescents: Separating normative fears from problem indicators and phobias. Rev Bras Psiquiatria. 2017;39(2):118- 25. https://doi.org/10.1590/1516-4446-2016-2064 PMid:28300935
Pitts CH, Klein-Tasman BP, Osborne JW, Mervis CB. Predictors of specific phobia in children with Williams syndrome. J Intellect Disabil Res. 2016;60(10):1031-42. https://doi.org/10.1111/ jir.12327 PMid:27545817
Varughese A, Peteru S. Specific phobia vs panic disorder in children: A unique case report and review of literature. J Depress Anxiety. 2019;8(1):327.
Sanna K, Rachel PW, Hanna E, Hurtig T, Joskitt L, Mattila ML, et al. Psychometric evaluation of social phobia and anxiety inventory for children (SPAI-C) and social anxiety scale for children-revised (SASC-R). Eur Child Adolesc Psychiatry. 2009;18(2):116-24. https://doi.org/10.1007/s00787-008-0712-x PMid:18807111
Tulbure BT, Szentagotai A, Dobrean A, David D. Evidence based clinical assessment of child and adolescent social phobia: A critical review of rating scales. Child Psychiatry Hum Dev 2012;43(5):795-820. https://doi.org/10.1007/ s10578-012-0297-y PMid:22438106
Archana S, Prasad K N, Jabeen B. Prevalence of social anxiety disorder and its determinants in school going adolescents in rural population of Ramnagara district. Int J Med Sci Public Health. 2017;6(8):1308-13. https://doi.org/10.5455/ ijmsph.2017.0513413062017
Mohammadi MR, Salehi M, Khaleghi A, Hooshyari Z, Ali Mostafavi S, Ahmadi N, et al. Social anxiety disorder among children and adolescents: A nationwide survey of prevalence, socio-demographic characteristics, risk factors and co-morbidities. J Affect Disord. 2020;263:450-7. https://doi. org/10.1016/j.jad.2019.12.015 PMid:31969277
de Vries YA, Al-Hamzawi A, Alonso J, Borges G, Bruffaerts R, Bunting B, et al. Childhood generalized specific phobia as an early marker of internalizing psychopathology across the lifespan: Results from the World Mental Health Surveys. BMC Med. 2019;17(1):101. https://doi.org/10.1186/s12916-019-1328-3 PMid:31122269
Metwally AM, Salah El-Din EM, Shehata MA, Shaalan A, El Etreby LA, Kandeel WA, et al. Early life predictors of socio-emotional development in a sample of Egyptian infants. PLoS One. 2016;11(7):e0158086. https://doi.org/10.1371/journal. pone.0158086
Kandeel WA, Rabah TM, Zeid DA, El-Din EMS, Metwally AM, Shaalan A, et al. Determinants of exclusive breastfeeding in a sample of Egyptian infants. Open Access Maced J Med Sci. 2018;6(10):1818-23. https://doi.org/10.3889/oamjms.2018.359 PMid:30455755
El Din EM, Rabah TM, Metwally AM, Nassar MS, Elabd MA, Shaalan A, et al. Potential risk factors of developmental cognitive delay in the first two years of life. Open Access Maced J Med Sci. 2019;7:2024-30. https://doi.org/10.3889/oamjms.2019.566 PMid:31406549
Narvaez DF. Be Worried About Boys, Especially Baby Boys. Allan Schore Discusses the Harmful Effects of Stressing Baby Boys. Available from: https://www.psychologytoday.com/ us/blog/moral-landscapes/201701/be-worried-about-boys-especially-baby-boys. [Last accessed on 2017 Jan 08]. https:// doi.org/10.3138/9781442662438-006
Peen J, Schoevers R, Beekman AT, Dekker J. The current status of urban rural differences in psychiatric disorders. Acta Psychiatr Scand. 2009;121(2):84-93. https://doi. org/10.1111/j.1600-0447.2009.01438.x PMid:19624573
Ahmed ZA, Abed El-Kader NM, Essa MA, Mohamed II. Impact of a specialized interaction program on behavioral modification of specific phobias among primary school students. Asian Acad Manag J. 2010;8:150-164.
Hitchcock CA, Chavira DA, Stein MB. Recent findings in social phobia among children and adolescents. Isr J Psychiatry Relat Sci. 2009;46(1):34-44. PMid:19728571
Kycheng K. Coronavirus: How Media Coverage of Epidemics Often Stokes Fear and Panic. United Kingdom: The Conversation Africa, Inc. Available from: https://www.theconversation.com/ coronavirus-how-media-coverage-of-epidemics-often-stokes-fear-and-panic-131844. [Last accessed on 2020 Feb 14].
Kumar M. Curing the Corona Fear. Available from: https://www. telanganatoday.com/curing-the-corona-fear. [Last accessed on 2020 Mar 09].
Coronaphobia. Urban Dictionary. Available from: https://www. urbandictionary.com/define.php?term=coronaphobia. [Last accessed on 2020 Mar 07].
Metwally AM, El-Sonbaty MM, El Etreby LA, Salah El-Din EM, Abdel Hamid N, Hussien HA, et al. Impact of National Egyptian school feeding program on growth, development, and school achievement of school children. World J Pediatr 2020. (In press). https://doi.org/10.1007/s12519-020-00342-8
El-Din EM, Elabd MA, Nassar MS, Metwally AM, Abdellatif GA, Rabah TM, et al. The interaction of social, physical and nutritive factors in triggering early developmental language delay in a sample of Egyptian children. 2019;7(17):2767-2774. https://doi. org/10.3889/oamjms.2019.642 PMid:31844434
Salah EM, Khalifa AG, Metwally AM, Hamid NA, Hussien HA, Moneer ZM. The impact of school snacks on cognitive function of primary school children in Egypt. J Appl Sci Res. 2012;8(12):5639-50.
Boraey NF, El-Sonbaty MM. Behavioral problems in children with nephrotic syndrome. J Appl Sci Res. 2011;7(12):2001-7.
Salem S, Salah H, El-Sonbaty MM, Fathy A. The impact of chronic chest trouble on cognitive functions, psychosocial behavior and academic achievement among Egyptian children. J Appl Sci Res. 2012;8(7):3459-68.
El-Sonbaty MM, Fathy A, Aljohani A, Fathy A. Assessment of behavioural disorders in children with functional constipation. Open Access Maced J Med Sci. 2019;7(23):4019-22. https:// doi.org/10.3889/oamjms.2019.677 PMid:32165945
Metwally AM, Saleh RM, El-Etreby LA, Salama SI, Aboulghate A, Amer HA, et al. Enhancing the value of womenâ€™s reproductive rights through community based interventions in upper Egypt governorates: A randomized interventional study. Int J Equity Health 2019;18(1):146. https://doi.org/10.1186/ s12939-019-1042-y
Metwally AM, Soliman M, Abdelmohsen AM, Kandeel WA, Saber M, Elmosalami DM, et al. Effect of counteracting lifestyle barriers through health education in Egyptian Type 2 diabetic patients. Open Access Maced J Med Sci. 2019;7(17):2886-94. https://doi.org/10.3889/oamjms.2019.624 PMid:31844454
Shiha G, Metwally AM, Soliman R, Elbasiony M, Mikhail NN, Easterbrook P. An educate, test, and treat programme to reduce hepatitis C in Egypt: Results from a community-based demonstration project. Lancet Gastroenterol Hepatol. 2018;3(11):778-89. https://doi.org/10.1016/ s2468-1253(18)30139-0 PMid:30030068
Salama II, Sami SM, Said ZN, Salama SI, Rabah TM, Abdel- Latif GA, et al. Early and long term anamnestic response to HBV booster dose among fully vaccinated Egyptian children during infancy. Vaccine. 2018;36(15):2005-11. https://doi. org/10.1016/j.vaccine.2018.02.103 PMid:29530634
Salama II, Sami SM, Said ZN, El-Sayed MH, El-Etreby LA, Rabah TM, et al. Effectiveness of hepatitis B virus vaccination program in Egypt: Multicenter national project. World J Hepatol. 2015;7(22):2418-26. https://doi.org/10.4254/wjh.v7.i22.2418 PMid:26464758
Metwally AM, Saad A, Ibrahim NA, Emam HM, El-Etreby LA. Monitoring progress of the role of integration of environmental health education with water and sanitation services in changing community behaviours. Int J Environ Health Res. 2007;17(1): 61-74. https://doi.org/10.1080/09603120600937856
Metwally AM, Ibrahim NA, Saad A, Abu El-Ela M. Improving rural women role in health and environmental issues. Int J Environ Health Res. 2006;16(2):133-44. https://doi. org/10.1080/09603120500539208 PMid:16546806
Copyright (c) 2020 A. M. Metwally, Marwa M. El-Sonbaty, Ghada A. Abdellatif, Lobna A. El-Etreby, Hanan Elsayed, Eman Elsheshtawy, Amal Elsaeid, Nihad A. Ibrahim (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All rights reserved.