How Common Are Anxiety Disorders in School-Age Children and Teens in China?

What you need to know

• Anxiety disorders affect 4.7% of school-age children and teens in China
• Generalized anxiety disorder is the most common type, affecting 1.3% of youth
• Anxiety disorders are more prevalent in adolescents and girls
• Anxiety often co-occurs with ADHD and disruptive behavior disorders

Overview of anxiety disorders in children and adolescents

Anxiety disorders are a group of mental health conditions characterized by excessive fear, worry, and related behaviors. Common types include generalized anxiety disorder, social anxiety disorder, separation anxiety disorder, specific phobias, and panic disorder. While some anxiety is a normal part of childhood development, anxiety disorders involve more intense, persistent fears or worries that interfere with daily life.

This large study provides the first nationwide data on the prevalence of anxiety disorders among school-age youth in China. Understanding how common these conditions are and who they affect most can help guide screening, prevention, and treatment efforts.

How common are anxiety disorders?

The researchers found that 4.7% of Chinese children and adolescents ages 6-16 met criteria for an anxiety disorder. This overall rate is lower than estimates from some other countries, which have ranged from 6-32%. The lower rate in this study may be partially due to cultural differences in reporting mental health symptoms or the specific diagnostic criteria used.

Among the different types of anxiety disorders:

• Generalized anxiety disorder was most common, affecting 1.3% of youth
• Social anxiety disorder affected 0.8%
• Separation anxiety disorder affected 0.6%
• Specific phobias and panic disorder each affected 0.2%
• Agoraphobia (fear of open or crowded spaces) affected 0.1%

Age and gender differences

The study found some notable differences in anxiety rates based on age and gender:

Age differences:

• Adolescents (ages 13-16) had higher rates of most anxiety disorders compared to children (ages 6-12)
• Exceptions were separation anxiety and specific phobias, which were more common in children

Gender differences:

• Girls had slightly higher rates of generalized anxiety disorder and agoraphobia
• Girls were twice as likely as boys to have panic disorder (0.32% vs 0.15%)

These patterns are generally consistent with research from other countries showing anxiety tends to increase in adolescence, especially for girls. Hormonal changes, increased social pressures, and brain development during the teen years may contribute to this trend.

Anxiety across different regions

Interestingly, the study found no significant differences in anxiety rates between more economically developed areas (like Beijing) and less developed regions of China. This suggests that anxiety disorders affect youth across diverse socioeconomic backgrounds.

Common co-occurring conditions

The researchers found that 70% of youth with an anxiety disorder also met criteria for at least one other mental health condition. The most common co-occurring issues were:

• Attention-deficit/hyperactivity disorder (ADHD)
• Oppositional defiant disorder
• Conduct disorder
• Tic disorders

For example, among youth with generalized anxiety disorder, 27% also had oppositional defiant disorder. The high rates of co-occurrence highlight the importance of comprehensive mental health assessments to identify all relevant issues a child may be experiencing.

Understanding anxiety across development

The study provides interesting insights into how different anxiety disorders manifest across childhood and adolescence:

Separation anxiety: This was most common in children ages 7-10, which aligns with the developmental period when many children are adjusting to increased time away from caregivers at school.

Social anxiety: Rates of social anxiety increased sharply after age 10. This corresponds with the transition to adolescence when social relationships and others’ opinions become increasingly important.

Generalized anxiety: This was the most common type overall and increased steadily with age. As children get older, they may become more aware of potential dangers or problems in the world, leading to more general worries.

These patterns highlight how anxiety can shift focus as children develop and face new challenges.

Implications for identification and treatment

The findings have several important implications for supporting youth mental health:

School-based screening: Since anxiety disorders affected nearly 5% of students, schools may want to consider implementing mental health screening programs to identify at-risk youth.

Comprehensive assessment: The high rates of co-occurring conditions mean it’s important for mental health professionals to assess for multiple issues when a child presents with anxiety symptoms.

Age-appropriate interventions: Treatment approaches may need to be tailored based on a child’s developmental stage and the specific type of anxiety they’re experiencing.

Reducing stigma: Cultural stigma around mental health issues may lead to underreporting of symptoms. Public education efforts could help increase awareness and encourage youth to seek help.

Early intervention: Since anxiety often increases in adolescence, providing education and coping skills to younger children may help prevent more severe anxiety from developing later.

Conclusions

• Anxiety disorders affect a significant number of school-age youth in China, with generalized anxiety being most common
• Rates tend to increase in adolescence, especially for girls
• Anxiety frequently co-occurs with other mental health conditions like ADHD
• Comprehensive screening and assessment are important to identify anxiety early and provide appropriate support
• Cultural factors and stigma may influence reporting of anxiety symptoms

While this study focused on China, many of the patterns observed are consistent with research from other countries. The findings highlight the importance of paying attention to youth mental health and providing accessible, evidence-based treatments for anxiety disorders.