Psychological strains after the crisis: evaluating separation anxiety among Iranian children and adolescents in the post-COVID-19 era

Abstract

Objectives: The objective of this study was to specifically investigate Separation Anxiety Disorder (SAD), as one of the noteworthy disorders within the spectrum of anxiety disorders, among children and adolescents, after overcoming the crises caused by the Coronavirus Disease 2019 (COVID-19) pandemic. Efforts were also made to identify socio-demographic factors that could be associated with changes in SAD level and also to assess the effect of different constituting dimensions of SAD on the severity of this disorder.

Methods: In this cross-sectional study, face-to-face interviews were conducted with the parents of 317 (7-13-year-old) Iranian students, who were selected through a multi-stage random sampling method in the city of Shiraz. During the interviews, socio-demographic data were collected, and subsequently, SAD symptoms and dimensions were assessed using the Separation Anxiety Assessment Scale (Parent Version) (SAAS-P) questionnaire. Later, employing the Partition Around Medoids (PAM) statistical method, the participants were categorized into two groups with low and high levels of SAD. Also, to understand the interaction between the different dimensions of SAD, the network analysis method was employed. Finally, univariate analysis and logistic regression were utilized, with a significance level of 0.05, to determine potential associating factors with the level of SAD.

Results: The sample included 128 girls and 189 boys with a mean age of 9.63 ± 2.63 and 9.63 ± 1.95 years respectively. Based on the PAM method, 51.1% of the participants presented a high level of SAD. According to network analysis, it was demonstrated that the "fear of abandonment" dimension plays a central role in high levels of SAD. Based on logistic regression, female gender, age ≥ 10 years, parents' unacademic educational background, mother's employment, and child's history of physical/mental problems were significantly associated with the high level of SAD.

Conclusions: A considerable number of the participants in this study presented a high level of SAD with the "fear of abandonment" being a key influential dimension of elevated levels of this disorder. Maternal employment, female gender, child's history of health issues, and low parental education were identified as important contributors to the high SAD level. Considering these factors allows for more effective diagnostic and therapeutic interventions. However, the need for further studies remains crucial.

Keywords: Adolescents; Children; Separation anxiety disorder.

Fig. 1

Network (relationship graph) for the 6 dimensions (nodes) of the SAAS-P questionnaire by risk clusters resulting from the PAM method (low- and high-level groups). FA: Fear of abandonment; FBA: Fear of being alone; FCE: Frequency of calamitous events; FPhI: Fear of physical illness; SSI: Safety signals index; WCE: Worry about calamitous events

Fig. 2

Standardized values of centrality measures for the 6 dimensions (nodes) of the SAAS-P questionnaire by risk clusters resulted from the PAM method (low- and high-level of SAD). Participants in the low-level group are represented by the blue line, and the high-level group by the red line. FA: Fear of abandonment; FBA: Fear of being alone; FCE: Frequency of calamitous events; FPhI: Fear of physical illness; SSI: Safety signals index; WCE: Worry about calamitous events