Mental Health Burden and Sex Disparities in Libyan Secondary School Students: Findings from a Cross‑Sectional Survey

Abstract

Mental health problems and related risk behaviours among adolescents are major public health concerns. These behaviours can negatively affect physical, psychological, and social well-being. This study assessed emotional distress, suicidal behaviours, tobacco use, violence-related outcomes, and bullying among Libyan secondary school students, with attention to sex differences in Tripoli, Libya. A cross-sectional study was conducted across 17 public and 3 private secondary schools in Souq Al Juma municipality, Tripoli, in 2023. Data on mental health and sedentary behaviour were collected using a validated Arabic-version modified Global School-based Student Health Survey (GSHS) through face-to-face interviews and self-administered questionnaires. Data analysis was performed using SPSS version 26, employing both descriptive and inferential statistical methods. Sex differences were assessed using chi-square tests, with statistical significance set at P<0.05. Emotional and cognitive distress was frequent. Worry affecting appetite was reported by 29.7% of students; feeling down, depressed, or hopeless by 32.6%; nervousness or uncontrollable worrying by 25.8%; and difficulty concentrating by 32.1%; females reported significantly higher levels than males for all symptoms (P=0.001). Suicide attempts were reported by 11.0% of students, and 16.6% reported self-harm without suicidal intent. Tobacco use was common, with 28.1% ever smoking cigarettes, 13.3% smoking in the previous 30 days, 23.2% trying e-cigarettes, and 69.3% reporting second-hand smoke exposure; these behaviours were significantly more common among males (P=0.001). In addition, 12.2% sustained serious injuries, 22.5% were involved in physical fighting at school, and 43.6% reported cyberbullying, with males more frequently affected by violence-related outcomes. The findings demonstrate a substantial burden of mental health problems and health-risk behaviours among students. School-based interventions targeting mental health promotion, tobacco prevention, violence reduction, and bullying prevention are recommended.