Influence of stress, anxiety, and depression on sleep quality and academic performance of medical students in Fallujah University, Iraq.

BACKGROUND: There is a relation between sleep quality, mental health, and academic performance among medical students. Students who experience better sleep quality and have good mental health will exhibit higher academic performance compared to those who have reduced sleep quality and poor psychological health. OBJECTIVE: To assess the relation between mental health problems, sleep quality, and academic performance among medical students in the stage of clinical training at the University of Fallujah, Iraq. METHODS: In this cross-sectional study, a self-administered questionnaire was adopted that gathered three validated and previously used screening tools: The Pittsburgh Sleep Quality Index (PSQI), Depression Anxiety Stress Scale (DASS-21), and the AHELO Self-Assessment Questionnaire. RESULTS: The findings revealed a high prevalence of anxiety, 40% of the students reported experiencing mild to moderate anxiety, while 24.1% showed severe anxiety, 20.0% experienced mild depression, and 10.8% had moderate depression. There was a significant negative correlation between stress and academic performance (Pearson's r = -.333, p < .001), between depression and academic performance (Pearson's r = -.437, p < .001), and between anxiety and academic performance (Pearson's r = -.417, p < .001). CONCLUSION: Mental health problems are prevalent among medical students represented by the study sample, and are significantly correlated to the students' academic performance.

Understanding context of violence against healthcare through citizen science and evaluating the effectiveness of a co-designed code of conduct and of a tailored de-escalation of violence training in Eastern Democratic Republic of Congo and Iraq: a study protocol for a stepped wedge randomized controlled trial.

BACKGROUND: Violence against health care workers (HCWs) is a multifaceted issue entwined with broader social, cultural, and economic contexts. While it is a global phenomenon, in crisis settings, HCWs are exposed to exceptionally high rates of violence. We hypothesize that the implementation of a training on de-escalation of violence and of a code of conduct informed through participatory citizen science research would reduce the incidence and severity of episodes of violence in primary healthcare settings of rural Democratic Republic of Congo (DRC) and large hospitals in Baghdad, Iraq. METHODS: In an initial formative research phase, the study will use a transdisciplinary citizen science approach to inform the re-adaptation of a violence de-escalation training for HCWs and the content of a code of conduct for both HCWs and clients. Qualitative and citizen science methods will explore motivations, causes, and contributing factors that lead to violence against HCWs. Preliminary findings will inform participatory meetings aimed at co-developing local rules of conduct through in-depth discussion and input from various stakeholders, followed by a validation and legitimization process. The effectiveness of the two interventions will be evaluated through a stepped-wedge randomized-cluster trial (SW-RCT) design with 11 arms, measuring the frequency and severity of violence, as well as secondary outcomes such as post-traumatic stress disorder (PTSD), job burnout, empathy, or HCWs' quality of life at various points in time, alongside a cost-effectiveness study comparing the two strategies. DISCUSSION: Violence against HCWs is a global issue, and it can be particularly severe in humanitarian contexts. However, there is limited evidence on effective and affordable approaches to address this problem. Understanding the context of community distrust and motivation for violence against HCWs will be critical for developing effective, tailored, and culturally appropriate responses, including a training on violence de-escalation and a community behavioral change approach to increase public trust in HCWs. This study aims therefore to compare the effectiveness and cost-effectiveness of different interventions to reduce violence against HCWs in two post-crisis settings, providing valuable evidence for future efforts to address this issue. TRIAL REGISTRATION: ClinicalTrial.gov Identifier NCT05419687. Prospectively registered on June 15, 2022.

Suicide and suicidality in Iraq: a systematic review.

Suicide is the third-leading cause of death globally, predominantly among youth. We aimed at reviewing the available published literature and some reports about suicide, in an attempt to unveil aspects of this mental health problem in Iraq. Articles about suicide in Arab/Middle Eastern countries were also included to compare those populations of a similar race and religion. The estimated suicide rate in Iraq is 1.7/100000 population (mostly among youth), which is still lower than in western countries. However, underreporting is the reason actual numbers are not known and many who attempt suicide do not report it and so hide their intent to die. The most common method of suicide is self-hanging, followed by firearms, self-burning, and self-poisoning. Suicide and suicidality in Iraq are on the increase even though it is believed to be underreported. Many socio-demographic, psychological and environmental factors predispose to ideation, attempts, and completed suicides despite the religious and social taboos. Young females are more represented in suicide attempts and ideation using potentially lethal methods like self-burning as a consequence of higher rates of depression, community and domestic violence. A key component in suicide prevention is improving the accessibility and quality of mental and social health care services.

Mental and social burden of COVID-19 on the Iraqi people.

BACKGROUND: COVID-19 pandemic has affected all crucial aspects of daily life, including; food security, education, gender relation, mental health, and environmental air pollution, in addition to the impact of the lockdown that had far-reaching effects in different strata of life. AIMS: To study the impact of COVID-19 on people with respect to their mental and social suffering and consequences. METHODS: This cross sectional study was conducted during the period from November 2020 through August 2021. A sample of 1,000 attendants to four teaching hospitals and eight PHCCs, was collected. The mental and social sequels of COVID-19 were assessed for all participants whether previously infected or not. RESULTS: Out of the total sample (1,000), 389 had a history of infection with COVID-19. The main mental symptoms reported were depression (67.8%), and anxiety (46.9%), males and females equally reported symptoms of anxiety, while depressive symptoms were reported more among females (59.9%), Fear and worries of the participants about their health and their families' was the main reason for mental symptoms (94.7%). CONCLUSIONS: Symptoms of depression and anxiety in time of COVID-19 are prevalent. Suspending educational activities was the most social burden that affect people while increase the price of food and cessation of work were the main causes of economic burden.

Trends in COVID-19: Incidence, mortality, and case fatality in Iraq.

OBJECTIVES: To detect the epidemiological trend of coronavirus disease-19 (COVID-19) in Iraq, the distribution of cases by age, gender, and governorates, and to assess its burden on the health system by estimating morbidity and mortality rates. METHODS: This biometric study was carried out in 2021. The distribution, incidence, mortality, and case fatality rates in a 17-month period was sketched in a biometric design. A semi-structured questionnaire was distributed to a number of decision makers in the Ministry of Health regarding health system challenges that have been faced during this pandemic. RESULTS: More than half (55.1%) of the cases were among males, and 67.5% were in the age group 30-60 years. Mortality was also predominant among males (62.7%), and 50.0% of the deaths were in the age group >50 years. The predominant age group for both genders was 30-60 years. Case fatality rate was 1.2%; again higher among males (1.3% versus 1.1%). CONCLUSION: The trend of COVID-19 in Iraq showed 2 peaks, August-October 2020 and March-July 2021, with males being more affected by morbidity, mortality, and fatality. The main challenge faced by the Iraqi health system was the rapid increase of COVID-19 cases with limited bed capacity and medical equipment.

Domestic violence in time of unrest, a sample from Iraq.

Domestic violence is a worldwide problem, and there are over a billion women who have been exposed to violence from their husband or male partner. In Iraq, since the 2003 invasion, domestic violence has risen dramatically. In this study we aim to estimate the prevalence of domestic violence against women (and some associated factors) in Baghdad city. A sample of 735 women was collected from the attendants of the outpatients-Obstetrics/Gynaecology clinics of four randomly chosen health facilities located on either side of Baghdad city. A questionnaire form was developed to enquire about the occurrence of violence, its frequency, source, and reasons. The results showed that 81.2% of the women were exposed to violence (100% verbal/emotional and 39.18% physical), usually by the husband (41.4%) or brother (20.4%), mostly attributed to a stressful life of unrest (41.9%). Older and currently married women are significantly more exposed to domestic violence (p = 0.001 & 0.004, respectively). Consanguinity was associated with less violence (p = 0.0001) as was higher education (p = 0.001), employment (p = 0.044) and women's independence (p = 0.044). A stressful life of unrest was significantly associated with all types of violence (p < 0.001).

Women's mental health in Iraq post-conflict.

Women are the silent sufferers of war, they have higher rates of anxiety and depression after terror events than men who have been similarly exposed. In this study, we aim to explore the prevalence of anxiety, depression and suicidal thoughts/attempts among Iraqi women post-conflict. A sample of 1000 women was collected in this cross-sectional study that was conducted in Baghdad city from January through September 2020. Their mental state was addressed by assessing anxiety and depression on symptomatic basis using standard questions from the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) scale. The results showed that the vast majority (91.1%) of the sampled women had experienced war-related trauma since 2003. Anxiety symptoms were reported by 39.7% of the women, depressive symptoms by 34.2% and suicidal thoughts/attempts by 35.8%. More than two-thirds of the women experienced difficulties in their social life and relationships. The majority of the studied women had negative expectations regarding their future and more than half of them expressed their intention to emigrate. The findings of this study indicate that anxiety, depression and suicidal thoughts/attempts are prevalent among this sample of Iraqi women post-conflict. Significant associated factors were losing a husband and having early married girls in the household.

Cancer Trends in Iraq 2000-2016.

OBJECTIVES: Precise and quantitative assessment of the trend of cancer burden enables policymakers and health managers to prioritize diseases and allocate resources better. This infers what caused a decrease or increase in the rate of cancer occurrence, and if it denotes timing of implementation of a control measure, it presents the impact on the disease rate. This study's objective was to evaluate trends in child and adult cancer in Iraq from 2000 onwards. METHODS: We used the registries of the Iraqi Ministry of Health that were gathered from all governorates from 2000-2016. Data were presented as incidence rates to depict the trends of different types of cancers distributed by age, gender, and governorates. RESULTS: Breast cancer witnessed a significant increase with predominance in females. Lung cancer rate increased significantly from 4.08 to 5.60/100 000 (p = 0.038), affecting males more than females. The brain cancer trend showed a bimodal pattern (two peaks in 2004 and 2011) with no significant trend change (p = 0.788). Both genders were similarly affected. The trend of stomach and colorectal cancer showed an accelerated increase after 2007. CONCLUSIONS: Almost all cancers (particularly lung and gastrointestinal) showed constantly raising trends, especially after 2007. Only cervical and laryngeal cancer had a decreasing trend. Most cancers were predominant in males.

Association Between Subnational Vaccine Coverage, Migration, and Incident Cases of Measles, Mumps, and Rubella in Iraq, 2001-2016.

OBJECTIVE: This analysis examines governorate-level disease incidence as well as the relationship between incidence and the number of persons of concern for three vaccine-preventable diseases-measles, mumps, and rubella-between 2001 and 2016. METHODS: Using Iraqi Ministry of Health and United Nations High Commissioner for Refugees (UNHCR) data, we performed descriptive analyses of disease incidence and conducted a pooled statistical analysis with a linear mixed effects regression model to examine the role of vaccine coverage and migration of persons of concern on subnational disease incidence. RESULTS: We found large variability in governorate-level incidence, particularly for measles (on the order of 100x). We identified decreases in incident measles cases per 100,000 persons for each additional percent vaccinated (0.82, 95% CI: [0.64, 1.00], p-value < 0.001) and for every additional 10,000 persons of concern when incorporating displacement into our model (0.26, 95% CI: [0.22, 0.30], p-value < 0.001). These relationships were insignificant for mumps and rubella. CONCLUSIONS: National level summary statistics do not adequately capture the high geospatial disparity in disease incidence between 2001 and 2016. This variability is complicated by MMR vaccine coverage and the migration of "persons of concern" (refugees) during conflict. We found that even when vaccine coverage was constant, measles incidence was higher in locations with more displaced persons, suggesting conflict fueled the epidemic in ways that vaccine coverage could not control.

Faith healers are taking over the role of psychiatrists in Iraq.

Background: Due to lack of education and awareness, faith healing has become a popular way of treating psychiatric patients. Objective: To ascertain the role of faith healers in the treatment of psychiatric illnesses by exploring the percentage of patients attending those healers. Methods: A semi-structured questionnaire was applied through a direct face-to-face interview with the patients and their companions; it inquired whether the patient has ever visited faith healers, the method of treatment the patients were subjected to, and their opinion about the benefit they got regarding improvement in their condition. Results: Among the total 482 cases; 279 (57%) reported going to faith healers (FHs) at any time before, during, or after a psychiatric consultation. Of those, 84.6% reported visiting FHs less than 10 times, while 15.4% went 10 times or more; 36.9% still believe that the treatment of FHs is accepted or even good (21.5%), while 30.9% realized that it is useless, and 10.7% think it is bad. No association was found between going to FHs and patient age or gender, while there was a significant association with marital status (p < 0.02) and with education (p < 0.001). Patients with schizophrenia/psychosis or bipolar disorders visited FHs significantly more often than those with other diagnoses. Conclusion: Faith healing is prevalent in Iraq and FHs may overwhelm the role of psychiatrists in treating mental illnesses. Sincere efforts are needed to help build public awareness and to improve accessibility and utilization of mental health services for this vulnerable group.

War or health: a four-decade armed conflict in Iraq.

Iraq has suffered 40 years of continual conflict, with large-scale traumatic events including successive wars, economic sanctions, sectarian conflict, terrorism, and organized crime. Population health and the health systems and other services and infrastructure that support a population's health usually suffer severe consequences in conflict-affect countries and Iraq has been no exception. In this article we aim to provide a historical narrative of the four decades of successive wars in Iraq and present some of the consequences of this particular situation of persistent violence and how it has reflected on the health status of the Iraqi people, as indicated by increasing morbidity, mortality, injuries, mental health problems and displacement. Continutation of the current situation of insecurity is anathema for health as war and health can never be compatible, it is a choice between war or health.

Burden of non-communicable diseases in Iraq after the 2003 war.

OBJECTIVES: To figure out the burden of chronic non-communicable diseases in Iraq on the health system through measuring the incidence and trend of these diseases. Methods: This descriptive study that was conducted between January 2016 and 2017, involved treatment data of chronic non-communicable diseases (hypertension, diabetes mellitus, ischemic heart disease, stroke, asthma and epilepsy). The data was collected from the registry of the Department of Health and Vital Statistics in the Ministry of Health, Babylon, Iraq, between 2000 and 2016. Results: The prevalence of diabetes mellitus had significantly increased from 19.58/1000 in the year 2000 to 42.27 in 2015 (p=0.0002). The prevalence of hypertension also increased from 31.33 to 45.82 (p=0.003) in the same period. The prevalence of cerebrovascular accidents showed a significant increase especially after 2008 (p=0.007), while ischemic heart diseases increased from 6.3/1000 in the year 2000 to 8.2/1000 in 2014 with no significant change. Conclusion: Non-communicable diseases in Iraq continue to show as a new developing burden after the 2003 war. Hypertension and diabetes mellitus demonstrate rapidly rising trends which may, in turn, enhance the occurrence of ischemic heart diseases and cerebrovascular accidents.

Accidents in Iraq during the period of conflict (2003-2016).

Background: Injuries are increasingly recognized as a major component of the global burden of disease, as they tend to affect mainly youth and are usually followed by premature death or severe disability. The longstanding conflict in Iraq has resulted in a situation of continuous violence and ongoing instability, which has in turn led to an increasing incidence of injuries and a crippled health system. Objective: To sketch a trend of non-military accidents in Iraq (road traffic accidents [RTA], falls, burns, firearm injuries, assaults by sharp objects and sexual assaults) among civilians during the last 14 years associated with the period of conflict (2003-2016). Methods: This descriptive study was conducted during the period from January 1st through to December 31st, 2017 using already available surveillance data from the Ministry of Health in Iraq. The methodology was based on measuring the incidence of each accident for the period from 2003 through 2016 and plotting it against time. Linear regression was computed to estimate the trends of the disease. Results: The rate of RTAs significantly increased between 2003 and 2016, from 1.85 to 2.9 per 1000 (p ≤ 0.01), as did accidental falls especially after 2008 (males more than females) (p ≤ 0.01). By contrast, after a peak in 2011, burns dropped significantly from 4.19 to 3.42/1000, along with firearm accidents, which fell from 2.2/1000 in 2007 to 0.39 in 2016 (p ≤ 0.01), mostly among males. Assaults with sharp objects also decreased with time to a rate of 0.47/1000 (p = 0.0001). Sexual assaults showed a significant downward sloping trend over time to p = 0.037. Conclusion: Accidents still add a burden on the already deteriorated Iraqi health system. Understanding the impact of this burden is essential to better prepare for future plans and interventions that may help improve the quality of health services.

Violence against health-care workers in a conflict affected city.

The problem of aggression towards health care staff is global. It negatively impacts on their psychological and physical well-being, and on their performance. This study was set to explore the exposure of healthcare personnel to different forms of violence and the influence of this violence on their work and life. A sample of 700 healthcare workers was collected from six major hospitals and 20 primary health care centers in Baghdad. The questionnaire inquired about exposure to any sort of violence including insult, assaults, and displacement, being arrested, kidnapped, and intentionally injured or threatened at the workplace. More than 85% of respondents reported exposure to violence. The most important reason for violence was the poor medical services and lack of hospital supplies (22.1%). Young doctors were significantly more exposed to violence, especially verbal, mostly during the day. A significant association was seen between exposure to physical violence, male gender and short duration of experience. The most significant source of violence was the patient's relatives.  There is an overwhelming surge of violence against health workers that may adversely reflect on their performance. Passing legislation that protects health workers against violence is an urgent need at this time of unrest.

Prevalence of self-medication among university students in Baghdad: a cross-sectional study from Iraq.

The objective of this study is to find out the prevalence and determinants of self-medication among college students in Baghdad, Iraq. A cross-sectional survey was conducted in Al-Mustansiriyah and Al-Nahrain universities, Baghdad, from January to April 2015. A multistage random sampling technique was adopted to collect data from 1435 college students using a questionnaire form. The mean age of the joining students was 19.8 years. Females form 53% of the sample. Self-medications use was prevalent among 92.4% of students. Antipyretics and antibiotics were the most used medicines. Self-medication was higher among urban residents (OR= 7.99, P < 0.001). Students living with their families practiced self-medication more than others (OR= 2.501, P = 0.037). Students at health-related colleges showed greater resilience to self-medication (OR=0.455, P = 0.001). Despite free access to healthcare institutions, nine out of ten college students from Baghdad universities have practiced self-medication. Education of students about the safe use of medications and supervision of pharmacies are effective ways to control this malpractice.

Prevalence of self-medication among university students in Baghdad: a cross-sectional study from Iraq

The objective of this study is to find out the prevalence and determinants of self-medication among college students in Baghdad, Iraq. A cross-sectional survey was conducted in Al-Mustansiriyah and Al-Nahrain universities, Baghdad, from January to April 2015. A multistage random sampling technique was adopted to collect data from 1435 college students using a questionnaire form. The mean age of the joining students was 19.8 years. Females form 53% of the sample. Self-medications use was prevalent among 92.4% of students. Antipyretics and antibiotics were the most used medicines. Self-medication was higher among urban residents [OR= 7.99, P < 0.001]. Students living with their families practiced self-medication more than others [OR= 2.501, P = 0.037]. Students at health-related colleges showed greater resilience to self-medication [OR=0.455, P = 0.001]. Despite free access to healthcare institutions, nine out of ten college students from Baghdad universities have practiced self-medication. Education of students about the safe use of medications and supervision of pharmacies are effective ways to control this malpractice

La présente étude a pour objectif d'estimer la prévalence de l'automédication et d'en identifier les déterminants parmi les étudiants à l'Université de Bagdad [Iraq]. Une étude transversale a été menée dans les universités d'AlMustansiriyah et d'Al-Nahrain à Bagdad, entre janvier et avril 2015. Une technique d'échantillonnage aléatoire à plusieurs degrés a été adoptée afin de collecter les données auprès de 1435 étudiants à l'aide d'une questionnaire. L'âge moyen des étudiants ayant participé à l'étude était de 19,8 ans, et 53% étaient des femmes dans l'échantillon. L'automédication était prévalente pour 92,4% des étudiants. Les médicaments les plus utilisés étaient les antipyrétiques et les antibiotiques. L'automédication était plus élevée parmi les citadins [OR = 7,99, p < 0,001]. Les étudiants vivant encore chez leurs parents pratiquaient davantage l'automédication que les autres [OR = 2,501, p = 0,037]. Les étudiants qui suivaient des études dans le domaine de la santé avaient moins tendance à recourir à l'automédication [OR = 0,455, p = 0,001]. Malgré un accès libre aux établissements de soins de santé, neuf étudiants sur dix des universités de Bagdad avaient déjà pratiqué l'automédication. Eduquer les étudiants à une consommation sans risque des médicaments et mettre en place une surveillance des pharmacies constituent des moyens efficaces pour remédier à cette mauvaise pratique

Effects of witnessing or exposure to community violence on mental health of Iraqi men.

BACKGROUND: Iraq is consistently exposed to large-scale traumatic events such as successive wars since 1980 to the present day, economic sanctions, sustained organized violence, and terrorism. These unsafe circumstances have negatively impacted the psychosocial status of the Iraqi community. OBJECTIVE: To study the prevalence of witnessing or exposure to various types of violence, and its association with mental health problems in a sample of Iraqi men. METHODS: This is a cross-sectional study that was conducted from April to September 2014. The target population were men from different age groups that were collected through a convenience sampling technique from two large cities; Baghdad (the capital city) and Mosul (the second largest city in Iraq). The source of data was from different institutions, colleges and lay people. The data collection process was done using the Self-Reporting Questionnaire 20 which is recommended by the World Health Organization for screening psychiatric disturbances. RESULTS: A total of 480 Iraqi males agreed to participate in the study. The main type of violence reported was witnessing violence (55.4%), followed by exposure of friends or relatives to violence (51.4%), and witnessing or exposure to sexual assault was least reported (3.8%). The most frequent feeling recorded was of worry (72.9%), getting easily upset (65.4%), suffering from headaches (62.7%) and lethargy (59.4%). Severe psychological changes were evident in 68.5% of men, while moderate changes were present in 31.5%. Analysis of the feelings and behavioral changes in relation to the participants' history of exposure to violence revealed a significant association with witnessing shooting or stabbings, displacement, friends or relatives' exposure to violence, and viewing corpses. CONCLUSION: There is a high prevalence among Iraqi men of exposure to, or witnessing violence that showed an association with their mental condition, which, if proved causally, may be a leading cause for future devastating effects on their health, wellbeing and quality of life.

Effect of adverse childhood experiences on physical health in adulthood: Results of a study conducted in Baghdad city.

BACKGROUND: Studies have revealed a powerful relationship between adverse childhood experiences (ACEs) and physical and mental health in adulthood. Literature documents the conversion of traumatic emotional experiences in childhood into organic disease later in life. OBJECTIVE: The aim was to estimate the effect of childhood experiences on the physical health of adults in Baghdad city. SUBJECTS AND METHODS: A cross-sectional study was conducted from January 2013 to January 2014. The study sample was drawn from Baghdad city. Multistage sampling techniques were used in choosing 13 primary health care centers and eight colleges of three universities in Baghdad. In addition, teachers of seven primary schools and two secondary schools were chosen by a convenient method. Childhood experiences were measured by applying a modified standardized ACEs-International Questionnaire form and with questions for bonding to family and parental monitoring. Physical health assessment was measured by a modified questionnaire derived from Health Appraisal Questionnaire of Centers for Disease Control and Prevention. The questionnaire includes questions on cerebrovascular diseases, diabetes mellitus, tumor, respiratory and gastrointestinal diseases. RESULTS: Logistic regression model showed that a higher level of bonding to family (fourth quartile) is expected to reduce the risk of chronic physical diseases by almost the half (odds ratio = 0.57) and exposure to a high level of household dysfunction and abuse (fourth quartile) is expected to increase the risk of chronic physical diseases by 81%. CONCLUSION: Childhood experiences play a major role in the determination of health outcomes in adulthood, and early prevention of ACEs. Encouraging strong family bonding can promote physical health in later life.

Relation between childhood experiences and adults' self-esteem: A sample from Baghdad.

BACKGROUND: Adverse childhood experiences are associated with significant functional impairments and loss of life in adolescence and adulthood. Literature documents the conversion of traumatic emotional experiences in childhood into psychological disorders later in life. The family is one of the most critical risks and resilient factors for mental health in adolescence and emerging adulthood. OBJECTIVE: To estimate the effect of childhood experiences on self-esteem during adulthood in a sample from Baghdad city. METHODS: This cross-sectional study was conducted in Baghdad city during the period from January 2013 through to January 2014. Multistage sampling techniques were used to choose 13 primary healthcare centers and eight colleges from three universities in Baghdad. Childhood experiences were measured by applying a modified standardized Adverse Childhood Experiences International Questionnaire (ACE-IQ) form. RESULTS: A total of 1040 subjects were surveyed and 1000 responded giving a response rate of 96.2%. The results revealed that 82.7% of the participants were confident within themselves, 14.9% (149) reported to feel a failure, while 28.3% of subjects expressed feeling useless at times. The score for family bonding is expected to significantly increase the score for self-esteem by a mean of 21.48. University, diploma and higher education are expected to significantly decrease the self-esteem score by a mean of - 6.31 compared to those with less than secondary school education. Parents education show statistically insignificant association with the mean score for self-esteem. CONCLUSION: The findings of this study give an insight into the essential role of childhood experiences in building self-esteem and adaptation later in their life. National health programs are suggested for intervention targeting early adverse childhood experiences and their consequences.