Academic- and Family-Related Correlates of Anxiety Among College-Going Adolescents in Central India: A Cross-Sectional Study.

BACKGROUND: Anxiety is the most common mental health disorder among adolescents worldwide. In India, intense academic competition and evolving family dynamics add to this burden, yet systematic data from smaller central Indian districts are scarce. OBJECTIVE: This study aims to determine the prevalence and severity of anxiety among college-going adolescents aged 17-19 years in Ratlam district, Madhya Pradesh, and to examine its association with academic- and family-related factors. METHODS: In this cross-sectional observational study, 550 first-year students were enrolled from 10 colleges (five professional, five nonprofessional) through multistage random sampling between June 2023 and November 2024. Depression, anxiety, and stress were measured with the validated Depression Anxiety Stress Scale-21 (DASS-21). Family-related factors included family type, parental marital status, sibling count, and paternal education, while academic-related factors included college type. Associations were assessed with the chi-square test and Cramér's V, and factors independently associated with clinically significant anxiety were assessed using binary logistic regression, yielding adjusted odds ratios (AORs) with 95% confidence intervals (CIs), using R (version 4.3); p < 0.05 was considered significant. RESULTS: Clinically significant anxiety was recorded in 178 participants (32.36%) (mild: 110 (20.00%); moderate: 57 (10.36%); severe: 11 (2.00%)), making anxiety the most prevalent DASS-21 domain ahead of stress (116; 21.09%) and depression (62; 11.28%). On multivariable analysis, female sex (AOR: 2.26; 95% CI: 1.45-3.52; p < 0.001), professional-college enrolment (AOR: 1.45; 95% CI: 1.05-2.01; p = 0.024), and hostel residence (AOR: 1.68; 95% CI: 1.15-2.45; p = 0.007) were independently associated with higher odds of clinically significant anxiety, whereas joint-family structure was associated with lower odds (AOR: 0.62; 95% CI: 0.42-0.91; p = 0.015). Nuclear-family students showed the highest anxiety prevalence (113 of 301; 37.54%) compared with joint-family students (59 of 230; 25.70%). Music (226; 41.09%) and social connection (95; 17.27%) were the most frequently used coping strategies, whereas physical exercise was rarely used (8; 1.45%). CONCLUSIONS: Academic- and family-related factors were associated with anxiety among college-going adolescents. These findings support the need for campus-based mental-health screening, accessible counselling services, and promotion of healthy coping strategies, including physical activity.