An exploration of anxiety and depression among adolescents and adults in Bulgaria

  • Ivelina Tsocheva

Student thesis: Doctoral Thesis


Anxiety and depression are among the most prevalent psychological disorders affecting a large number of people across different cultures. At present, these conditions have not been examined among the general population of Bulgaria.
This thesis is a large-scale project involving Bulgarian adolescents aged 13-17 and Bulgarian adults aged 35-58. The main aims are:
1/ to investigate the prevalence and correlates of anxiety and depression in Bulgarian adolescents and adults because this population has been underresearched on these topics.
2/ to assess mental health literacy about depression in these two groups. Research indicates that mental health literacy rates vary in adolescents and adults across countries and cultures and are influences by a number of factors such as:
healthcare system, social attitudes and expectations, education and social support.
3/ to study the personal experience of anxiety through qualitative methods. The
purpose of this analysis is to get the individual point of view. A significant
overlap in symptoms exist between depression and anxiety but anxiety has many
different forms and aspects (panic attacks, social phobia, generalised anxiety
disorder, etc.) that are worthy of qualitative investigation.
The two age groups were chosen because:
A) their life experiences were very different from a cultural point of view: the
adolescents grew in a global, modern and democratic Bulgaria and the adults
used to live under the isolation and restrictions of the Communist rule.
B) adolescence and adulthood are two distinctive life stages characterised by: social/ emotional changes, changes in health attitudes/behaviour and transition between concrete/ abstract thinking.

Three studies were carried out in Bulgaria: Study 1 and Study 2 were quantitative, cross-sectional and Study 3 was qualitative. For Study 1 and Study 2 adolescents (n=700) were randomly recruited from public schools and adults (n=250) were recruited from employment companies. Study 3 applied interpretative phenomenological analysis to unstructured interviews conducted with adolescents (n=10) and adults (n=10) recruited from a sub-sample of Study 1.
Results from Study 1 suggested that adolescents and adults had marked differences in specific sub-types of anxiety with adults scoring higher on social phobia, physical injury anxiety and panic agoraphobia. Anxiety and depression correlated strongly in adults. Significant gender differences were observed with females having higher prevalence rates of anxiety and depression in both age groups. Adults also scored higher on interdependency, indicating a collectivist mind set associated with Communism.

Results from Study 2 indicated that both age groups had low levels of mental health literacy. However, adults appeared to be more affected by stigma associated with psychological illnesses.

Qualitative results from Study 3 highlighted personal experiences and identified additional risk factors associated with onset and persistence of anxiety. Some of these factors were prevalent across both age groups and others were age specific.

Further research work needs to focus on identifying helpful strategies in prevention, diagnosis and treatment of these conditions in adolescents and adults.
Improving health education across different age groups and reducing stigma towards psychological illness are of particular importance.
Date of Award2015
Original languageEnglish
Awarding Institution
  • University of Roehampton
SupervisorGeorge Georgiou (Supervisor)

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