{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T16:38:33Z","timestamp":1790959113737,"version":"4.1.0"},"reference-count":46,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T00:00:00Z","timestamp":1780099200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Mental health problems often begin in adolescence, yet early detection and intervention remain limited. This study assesses the prevalence of psychological distress and its correlates among high-school students in Makkah, Saudi Arabia, and explores whether specific symptom clusters of depression, anxiety and bipolar\/mania can be identified using the General Health Questionnaire-30 (GHQ-30). Methods: A cross-sectional survey was conducted during the 2025\u20132026 academic year using stratified cluster sampling. A total of 535 students aged 15\u201318 years completed a questionnaire containing the validated Arabic GHQ-30 and demographic, socioeconomic and lifestyle items. The GHQ-30 was scored with binary 0-0-1-1 scoring (cut-off \u2265 6) to define cases of psychological distress. Item clusters were used to screen for probable depression, anxiety and bipolar\/mania. Descriptive statistics characterized the sample. Associations were examined using chi-square tests and multivariable logistic regression. Results: Overall, 70.5% of participants screened positive for psychological distress. The prevalences of probable depression, anxiety and bipolar\/mania were 33.1%, 28.2% and 31.2%, respectively. In adjusted models, female gender, insufficient sleep, lack of physical activity and exposure to bullying were associated with increased odds of psychological distress; longer sleep was protective. History of mental health conditions was a strong predictor of probable depression, whereas medication use was protective. Older age and higher paternal education were protective for anxiety. Bullying was the most consistent predictor across all symptom clusters. Conclusions: Psychological distress is highly prevalent among Makkah high-school students. Key determinants include gender, sleep duration, lack of physical activity and bullying. Routine school-based mental health screening, sleep-hygiene education, anti-bullying initiatives and early referral pathways are warranted. Further research should examine and validate GHQ-30 item clusters for specific disorders.<\/jats:p>","DOI":"10.3390\/ijerph23060733","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T18:08:07Z","timestamp":1780510087000},"page":"733","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Psychological Distress and Associated Factors Among High-School Students in Makkah, Saudi Arabia: A Cross-Sectional Study Using the Arabic GHQ-30"],"prefix":"10.3390","volume":"23","author":[{"given":"Arwa Hesham","family":"Hashim","sequence":"first","affiliation":[{"name":"Saudi Board Program of Preventive Medicine, Program, Makkah Health Cluster, Makkah 24242, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2724-8113","authenticated-orcid":false,"given":"Adeel Ahmed","family":"Khan","sequence":"additional","affiliation":[{"name":"Saudi Board Program of Preventive Medicine, Program, Makkah Health Cluster, Makkah 24242, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6609-0879","authenticated-orcid":false,"given":"Aalia Akhtar","family":"Hayat","sequence":"additional","affiliation":[{"name":"Department of Child Psychiatry, Maternity and Children Hospital, Makkah Health Cluster, Makkah 24242, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,30]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2021). Adolescent Mental Health [Internet], World Health Organization. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/adolescent-mental-health."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1016\/S0140-6736(18)31612-X","article-title":"The Lancet Commission on global mental health and sustainable development","volume":"392","author":"Patel","year":"2018","journal-title":"Lancet"},{"key":"ref_3","unstructured":"Goldberg, D.P., and Williams, P. (1988). A User\u2019s Guide to the General Health Questionnaire, NFER-Nelson."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1192\/bjp.177.6.534","article-title":"The strengths and difficulties questionnaire: A pilot study on the validity of the self-report version","volume":"177","author":"Goodman","year":"2000","journal-title":"Br. J. Psychiatry"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.psychres.2010.10.010","article-title":"Validity of the 12-item General Health Questionnaire in detecting depressive and anxiety disorders among high-school students","volume":"187","author":"Baksheev","year":"2011","journal-title":"Psychiatry Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1046\/j.1440-1614.2003.01133.x","article-title":"Validity and psychometric properties of the General Health Questionnaire-12 in young Australian adolescents","volume":"37","author":"Tait","year":"2003","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"ref_7","first-page":"207","article-title":"The General Health Questionnaire","volume":"19","author":"Jackson","year":"2007","journal-title":"Int. Rev. Psychiatry"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Hankins, M. (2008). The factor structure of the GHQ-30: Testing for method effects. BMC Public Health, 8.","DOI":"10.1186\/1471-2458-8-355"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1192\/bjp.169.5.662","article-title":"Validation of the Arabic versions of the Thirty- and Twelve-Item General Health Questionnaires in primary care patients","volume":"169","author":"Daradkeh","year":"1996","journal-title":"Br. J. Psychiatry"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1177\/0044118X211041383","article-title":"Prevalence and correlates of depression and anxiety among Jordanian adolescents: A cross-sectional study","volume":"55","author":"Dwekat","year":"2023","journal-title":"Youth Soc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1177\/1466424007070492","article-title":"Depression, anxiety and stress among Saudi adolescent school boys","volume":"127","year":"2007","journal-title":"J. R. Soc. Promot. Health"},{"key":"ref_12","first-page":"1","article-title":"Depression and its associated factors among adolescents in Saudi Arabia","volume":"28","author":"AlYousefi","year":"2021","journal-title":"J. Fam. Community Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"28","DOI":"10.4103\/jfcm.JFCM_386_20","article-title":"Screening for depression, anxiety, and obsessive-compulsive disorders among secondary school students in Al-Hasa Region, Saudi Arabia","volume":"28","author":"Khan","year":"2021","journal-title":"J. Fam. Community Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1017\/S0033291700021644","article-title":"A scaled version of the General Health Questionnaire","volume":"9","author":"Goldberg","year":"1979","journal-title":"Psychol. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.4088\/JCP.10m06290","article-title":"Meta-analysis of epidemiologic studies of paediatric bipolar disorder","volume":"72","author":"Moreira","year":"2011","journal-title":"J. Clin. Psychiatry"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1176\/appi.ajp.2009.08101569","article-title":"Four-year longitudinal course of children and adolescents with bipolar spectrum disorders: The Course and Outcome of Bipolar Youth (COBY) study","volume":"166","author":"Birmaher","year":"2009","journal-title":"Am. J. Psychiatry"},{"key":"ref_17","first-page":"231","article-title":"The assessment of paediatric bipolar disorder: Strengths and limitations of the current evidence","volume":"16","author":"Youngstrom","year":"2009","journal-title":"Clin. Psychol."},{"key":"ref_18","first-page":"4","article-title":"Screening the risk of bipolar spectrum disorders: Validity evidence of the Mood Disorder Questionnaire in adolescents and young adults","volume":"9","author":"Paino","year":"2016","journal-title":"Rev. Psiquiatr Salud Ment."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"6186","DOI":"10.1038\/s41598-023-33005-5","article-title":"Lifetime prevalence and treatment of mental disorders in Saudi youth and adolescents","volume":"13","author":"Altwaijri","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_20","unstructured":"Ministry of Education, Saudi Arabia (2023). Statistical Yearbook 2023, Ministry of Education."},{"key":"ref_21","first-page":"52","article-title":"Predictors of adolescents\u2019 mental health problems in Saudi Arabia: Findings from the Jeeluna\u00ae national study","volume":"26","author":"AlBuhairan","year":"2017","journal-title":"Child Adolesc. Psychiatry Ment. Health"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Mahsoon, A., Sharif, L., Banakhar, M., Alasmee, N., Almowallad, E., Jabali, R., Bahamil, A., and Assur, S. (2020). Parental support, beliefs about mental illness and mental help-seeking among young adults in Saudi Arabia. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17155615"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"5513817","DOI":"10.1155\/2021\/5513817","article-title":"Gender differences in sleep and mental health among Saudi adolescents","volume":"2021","author":"Rajab","year":"2021","journal-title":"Sleep Disord."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"673","DOI":"10.15537\/smj.2021.42.6.20200790","article-title":"Exploring the predictors of depression among Saudi adolescents","volume":"42","author":"AlYousefi","year":"2021","journal-title":"Saudi Med. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1192\/bjp.134.6.609","article-title":"Severity of psychiatric disorder and the 30-item General Health Questionnaire","volume":"134","author":"Murphy","year":"1979","journal-title":"Br. J. Psychiatry"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"368","DOI":"10.26719\/2018.24.4.368","article-title":"Factors associated with the mental health of high-school students in the Islamic Republic of Iran","volume":"24","author":"Bakhteyar","year":"2018","journal-title":"East Mediterr. Health J."},{"key":"ref_27","first-page":"200","article-title":"Mental health of high school students in Bandar Abbas, Iran: A cross-sectional study","volume":"1","author":"Tavafian","year":"2013","journal-title":"Health Scope"},{"key":"ref_28","first-page":"1","article-title":"Prevalence of depression, anxiety and stress among secondary school students in Jeddah City, Saudi Arabia","volume":"23","author":"Harazi","year":"2022","journal-title":"ASEAN J. Psychiatry"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1037\/bul0000102","article-title":"Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms","volume":"143","author":"Salk","year":"2017","journal-title":"Psychol. Bull."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e921","DOI":"10.1542\/peds.2014-1696","article-title":"Adolescent Sleep Working Group; Committee on Adolescence. Insufficient sleep in adolescents and young adults: An update on causes and consequences","volume":"134","author":"Owens","year":"2014","journal-title":"Pediatrics"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.smrv.2013.03.005","article-title":"Functional consequences of inadequate sleep in adolescents: A systematic review","volume":"18","author":"Shochat","year":"2014","journal-title":"Sleep Med. Rev."},{"key":"ref_32","first-page":"A120","article-title":"The human emotional brain without sleep","volume":"30","author":"Gujar","year":"2007","journal-title":"Sleep"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"60","DOI":"10.5498\/wjp.v7.i1.60","article-title":"Consequences of bullying victimization in childhood and adolescence: A systematic review and meta-analysis","volume":"7","author":"Moore","year":"2017","journal-title":"World J. Psychiatry"},{"key":"ref_34","unstructured":"Inchley, J., Currie, D., Young, T., Samdal, O., Torsheim, T., Augustson, L., Mathison, F., Aleman-Diaz, A., Molcho, M., and Weber, M. (2016). Growing up unequal: Gender and socioeconomic differences in young people\u2019s health and well-being. Health Behaviour in School-Aged Children (HBSC) Study: International Report from the 2013\/2014 Survey, WHO Regional Office for Europe. Health Policy for Children and Adolescents, No. 7."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.ijpam.2016.12.005","article-title":"The relationship of bullying and physical violence to mental health and academic performance: A cross-sectional study among adolescents in Kingdom of Saudi Arabia","volume":"4","author":"AlBuhairan","year":"2017","journal-title":"Int. J. Pediatr. Adolesc. Med."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Al-Ketbi, A., Elkonaisi, I., Abdullahi, A.S., Elbarazi, I., Hamada, B.A., and Grivna, M. (2024). Bullying victimization in schools in the United Arab Emirates: A cross-sectional study. BMC Public Health, 24.","DOI":"10.1186\/s12889-024-20392-1"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s13034-020-00344-4","article-title":"Psychosocial distress among in-school adolescents in Mozambique: A cross-sectional study using the Global School-Based Health Survey data","volume":"14","author":"Amu","year":"2020","journal-title":"Child. Adolesc. Psychiatry Ment. Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2171","DOI":"10.1007\/s40279-023-01895-0","article-title":"Mechanisms linking physical activity with psychiatric symptoms across the lifespan: A systematic review","volume":"53","author":"Ha","year":"2023","journal-title":"Sports Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1136\/bjsports-2011-090185","article-title":"Physical activity and mental health in children and adolescents: A review of reviews","volume":"45","author":"Biddle","year":"2011","journal-title":"Br. J. Sports Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.socscimed.2013.04.026","article-title":"Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review","volume":"90","author":"Reiss","year":"2013","journal-title":"Soc. Sci. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1001\/jamapsychiatry.2015.0730","article-title":"Adult functional outcomes of common childhood psychiatric problems: A prospective, longitudinal study","volume":"72","author":"Copeland","year":"2015","journal-title":"JAMA Psychiatry"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Bas, G. (2021). Relation between student mental health and academic achievement revisited: A meta-analysis. Health and Academic Achievement Findings, IntechOpen.","DOI":"10.5772\/intechopen.95766"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"470","DOI":"10.2466\/08.PR0.116k23w9","article-title":"Validation of an Arabic version of the GHQ-28 against the Beck Depression Inventory for screening depression in war-exposed civilians","volume":"116","author":"Farhood","year":"2015","journal-title":"Psychol. Rep."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1186\/1477-7525-1-66","article-title":"The 12-item General Health Questionnaire (GHQ-12): Translation and validation study of the Iranian version","volume":"1","author":"Montazeri","year":"2003","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e102","DOI":"10.1093\/ije\/dyac208","article-title":"Data resource profile: The global school-based student health survey\u2013behavioural risk and protective factors among adolescents","volume":"52","author":"Bischops","year":"2023","journal-title":"Int. J. Epidemiol."},{"key":"ref_46","unstructured":"World Health Organization (2018). Report of the Second Global School-Based Student Health Survey (2016) in Myanmar, World Health Organization."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/6\/733\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T18:10:19Z","timestamp":1780510219000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/6\/733"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,30]]},"references-count":46,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["ijerph23060733"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23060733","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,30]]}}}