Research Article
Year 2021,
, 210 - 218, 13.09.2021
Abstract
Amaç: Düzenli yapılan egzersizin başta depresyon ve kaygı bozuklukları olmak üzere birçok ruh sağlığı bozukluğu riskini azaltabildiği gösterilmiştir. Bu çalışmanın amacı düzenli egzersizin ergenlerde depresyon ve kaygı düzeyleri üzerine etkisini araştırmaktır.
Gereç ve Yöntem: Çalışmaya yaş ortalaması 16 olan 42 kız basketbol sporcusu ve benzer yaşlardaki düzenli spor yapmayan kızlar katılmıştır. Egzersizin ruh sağlığı üzerindeki etkilerini değerlendirebilmek amacı ile katılımcılara psikiyatrik muayene yapılmış, Okul Çağı Çocukları İçin Duygulanım Bozuklukları ve Şizofreni Görüşme Çizelgesi-Şimdi ve Yaşam boyu Şekli Türkçe uyarlaması (ÇDŞG-ŞY), Beck depresyon ölçeği, Beck kaygı ölçeği, Yeme tutumu testi – 40 (YTT – 40) ve Beden algısı ölçekleri uygulanmıştır. İstatiksel yöntem olarak ölçekler kesme puanlarına göre kategorize edildikten sonra gruplar arasında karşılaştırma yapmak amacı ile Pearson ki-kare testi uygulanmıştır. Parametreler arasında ilişki olup olmadığını incelemek için Spearman korelasyon testi yapılmıştır.
Bulgular: Düzenli olarak spor yapan kişilerin depresyon ve kaygı düzeyleri istatiksel olarak anlamlı düzeyde daha düşük olarak saptanmıştır (p = 0,041ve p = 0,002; sırasıyla). Yeme davranışlarındaki bozukluk riski düzenli egzersiz alışkanlığı olmayan kızlarda daha yüksek bulunmuştur (p = 0,023). Beden algısı açısından ise gruplar arasında anlamlı bir fark gözlenmemiştir (p = 0,682). Beden algısı ile depresyon ve kaygı düzeyleri arasında istatiksel olarak anlamlı düzeyde negatif bir ilişki gözlenmiştir (r = - 0,396, p = 0,000; r = - 0,437, p = 0,000; sırasıyla).
Sonuç: Bu çalışmanın sonucuna göre düzenli yapılan egzersizin ergenlerde depresyon ve kaygı düzeylerini azaltabileceği düşünülmektedir. Özellikle de aktivite düzeyi az olan ergenlerin spora katılımlarının teşvik edilmesi, ruh sağlıklarının gelişmesine katkıda bulunabilir
Keywords
References
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- Kessler RC, Amminger GP, Aguilar- Gaxiolac S, Alonso J, Lee S, Ustün TB. Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry 2007; 20: 359–64.
- Balazs J, Miklósi M, Keresztény A, et al. Adolescent subthreshold-depression and anxiety: psychopathology, functional impairment and increased suicide risk. J Child Psychol Psychiatry 2013; 54 (6): 670–7.
- Carli V, Hoven CW, Wasserman C, et al. A newly identified group of adolescents at “invisible” risk for psychopathology and suicidal behavior: findings from the SEYLE study. World Psychiatry 2014; 13(1):78–86.
- Thapar A, Collishaw S, Pine DS, Thapar AK. Depression in adolescence. Lancet 2012; 379:1056–67
- World Health Organization. Depression (2015). Available at: https://www.who.int/health-topics/depression
- GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 10; 392 (10159): 1789-858.
- Wilson S, Hicks B, Foster K, McGue M and Iacono W. Age of onset and course of majör depressive disorder: associations with psychosocial functioning outcomes in adulthood. Psychol Med 2015; 45 (3): 505-14.
- duRoscoät E, Legleye S, Guignard R, Husky M, Beck F. Risk factors for suicide attempts and hospitalizations in a sample of 39,542 French adolescents. J Affect Disord 2016; 15; 190:517-21.
- Naicker K, Galambos NL, Zeng Y, Senthilselvan A, Colman I. Social, demographic, and health outcomes in the 10 years following adolescent depression. J Adolesc Health 2013; 52 (5): 533-8.
- Glover J, Fritsch SL. Kids anxiety and social media: a review. Child Adolesc Psychiatr Clin N Am 2018; 27 (2): 171-82.
- Meier SM, Mattheisen M, Mors O, Mortensen PB, Laursen TM, Penninx BW. Increased mortality among people with anxiety disorders: Total population study. Br J Psychiatry 2016; 209 (3): 216-21.
- Calzo JP, Sonneville KR, Haines J, Blood EA, Field AE, Austin SB. The development of associations among body mass index, body dissatisfaction, and weight and shape concern in adolescent boys and girls. J Adolesc Health 2012; 51 (5): 517–23.
- Paxton SJ, Neumark-Sztainer D, Hannan PJ, Eisenberg ME. Body dissatisfaction prospectively predicts depressive mood and low self-esteem in adolescent girls and boys. J Clin Child Adolesc Psychol 2006; 35 (4): 539-49.
- Lewinsohn PM, Striegel-Moore RH, Seeley JR. Epidemiology and natural course of eating disorders in young women from adolescence to young adulthood. J Am Acad Child Adolesc Psychiatr 2000; 39: 1284–92.
- McGorry PD, Hickie IB, Yung AR, Pantelis C, Jackson HJ. Clinical staging of psychiatric disorders: a heuristic frame work for choosing earlier, safer and more effective interventions. Aust N Z J Psychiatry 2006; 40: 616–22.
- Trainor S, Delfabbro P, Anderson S, Winefield A. Leisure activities and adolescent psychological well-being. J Adolesc 2010; 33 (1):173-86.
- Rodriguez-Ayllon M, Cadenas-Sánchez C, Estévez-López F, et al. Role of Physical activity and sedentary behavior in the mental health of preschoolers, children and adolescents: A systematic review and meta-analysis. Sports Med. 2019; 49 (9): 1383-410.
- Jorm AF, Wright A. Beliefs of young people and their parents about the effectiveness of interventions for mental disorders. Aust N Z J Psychiatry 2007; 41: 656–66.
- Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U. Global physical activity levels: Surveillance progress, pitfalls, and prospects. Lancet 2012; 380 (9838): 247–57.
- World Health Organisation, Global Recommendations on Physical Activity for Health (2010). Available from: https://www.who.int/dietphysicalactivity/global-PA-recs-2010
- Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, et al. Schedule for affective disorders and schizophrenia for school-age children present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 1997; 36 (7): 980-8.
- Saka MC, Uluşahin A, Batur S, Sütçü A ve Kara S. Duygulanım bozuklukları ve şizofreni görüşme çizelgesi-Türkçe formu güvenirlik çalışması. Türk Psikiyatri Dergisi 1998; 9 (4): 265-8.
- Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561-71.
- Hisli N. Beck Depresyon Envanterinin üniversite öğrencileri için geçerliği, güvenirliği. Psikoloji dergisi 1989; 7: 3-13.
- Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988; 56 (6): 893–7.
- Ulusoy M, Şahin N, Erkmen H. Turkish version of the Beck Anxiety Inventory: Psychometric properties. J Cogn Psychother 1998; 12: 163-72.
- Garner DM, Garfinkel PE. The Eating Attitudes Test: An index of the symptoms of anorexia nervosa. Psychol Med 1979; 9: 273-9
- Savaşır I, Erol N. Yeme Tutum Testi: Anoreksi Nervoza belirtileri indeksi. Psikoloji Dergisi 1989; 7: 19-25.
- Secord PF, Jourard SM. The appraisal of body-cathexis: body-cathexis and the self. J Consult Psychol 1953; 17 (5):343-7.
- Hovardaoğlu S. Vücut algısı ölçeği. Psikiyatri, Psikoloji, Psikofarmakoloji Dergisi, Testler Özel Eki 1993; 1 (1): 26-7.
- Teychenne M, Costigan SA, Parker K. The association between sedentary behaviour and risk of anxiety: a systematic review. BMC Public Health 2015; 15: 513.
- Hoare E, Milton K, Foster C, Allender S. The associations between sedentary behaviour and mental health among adolescents: a systematic review. Int J Behav Nutr Phys Act 2016; 13: 108.
- Bélair MA, Kohen DE, Kingsbury M, Colman I. Relationship between leisure time physical activity, sedentary behaviour and symptoms of depression and anxiety: evidence from a population-based sample of Canadian adolescents. BMJ Open. 2018; 17; 8 (10): e021119.
- Biddle SJH, Ciaccioni S, Thomas G, Vergeer I. Physical activity and mental health in children and adolescents: an updated review of reviews and an analysis of causality. Psychol Sport Exerc 2019; 42: 146–55.
- Mammen G, Faulkner G. Physical activity and the prevention of depression: A systematic review of prospective studies. Am J Prev Med 2013; 45 (5): 649-57.
- Brown HE, Pearson N, Braithwaite RE, Brown WJ, Biddle SJ. Physical activity interventions and depression in children and adolescents: A systematic review and meta-analysis. Sports Med 2013; 43 (3): 195-206.
- Larun L, Nordheim LV, Ekeland E, Hagen KB, Heian F. Exercise in prevention and treatment of anxiety and depression among children and young people. Cochrane Database Syst Rev 2006; 19 (3):CD004691.
- Pascoe M, Bailey AP, Craike M, et al. Physical activity and exercise in youth mental health promotion: a scoping review. BMJ Open Sport Exerc Med 2020; 23; 6 (1): e000677.
- Bassett-Gunter R, McEwan D, Kamarhie A. Physical activity and body image among men and boys: A meta-analysis. Body Image 2017; 22: 114-28.
- Babiss LA, Gangwisch JE. Sports participation as a protective factor against depression and suicidal ideation in adolescents as mediatedby self-esteem and social support. J Dev Behav Pediatr 2009; 30 (5): 376–84.
- Strohle A, Graetz B, Scheel M, et al. The acute antipanic and anxiolytic activity of aerobic exercise in patients with panic disorder and healthy control subjects. J Psychiatr Res 2009; 43 (12): 1013-7.
- Schuch FB, Stubbs B, Meyer J, et al. Physical activity protects from incident anxiety: A meta-analysis of prospective cohort studies. Depress Anxiety 2019; 36 (9): 846-58.
- Paxton SJ, Neumark-Sztainer D, Hannan PJ, Eisenberg ME. Body dissatisfaction prospectively predicts depressive mood and low self-esteem in adolescent girls and boys. J Clin Child Adolesc Psychol 2006; 35 (4): 539-49.
- Manaf NA, Saravanan C, Zuhrah B. The Prevalence and Inter-Relationship of Negative Body Image Perception, Depression and Susceptibility to Eating Disorders among Female Medical Undergraduate Students. J Clin Diagn Res 2016; 10 (3): VC01-VC04.
- El Ansari W, Stock C, Phillips C, Mabhala A, Stoate M, Adetunji H. Does the association between depressive symptomatology and physical activity depend on body image perception? A survey of students from seven universities in the UK. Int J Environ Res Public Health 2011; 8 (2): 281-99.
- Campbell A, Hausenblas HA. Effects of exercise interventions on body image: a meta-analysis. J Health Psychol 2009; 14 (6): 780-93.
- Lubans D, Richards J, Hillman C, et al. Physical activity for cognitive and mental health in youth: a systematic review of mechanisms. Pediatrics 2016; 138 (3). pii: e20161642.
- Mendonça G, Cheng L, Mélo E, Farias Júnior J. Physical activity and social support in adolescents: a systematic review. Heal Educ Res 2014; 29: 822–39.
- Boone EM, Leadbeater BJ. Game on: diminishing risks for depressive symptoms in early adolescence through positive involvement in team sports. J Res Adolesc 2006; 16 (1): 79-90.
- Sabiston CM, Jewett R, Ashdown-Franks G, Belanger M, BrunetJ, O’Loughlin E, et al. Number of years of team and individual sport participation during adolescence and depressive symptoms in early adulthood. J Sport Exerc Psychol 2016; 38 (1):105-10
Year 2021,
, 210 - 218, 13.09.2021
Abstract
Aim: Regular exercises have been shown to reduce the risk of many mental health problems, especially depression and anxiety. The aim of this study was to investigate the effect of regular exercise on depression and anxiety levels in adolescents.
Materials and Methods: 42 girls basketball players with an average age of 16 and girls of similar ages who don’t exercise regularly participated in the study. In order to evaluate the effects of exercise on mental health, psychiatric examination, K-SADS-PL (Schedule for Affective Disorders and Schizophrenia for School Aged Children, Present and Lifetime Version), Beck depression scale, Beck anxiety scale, Eating attitude test - 40 (EAT - 40) and Body image scales were performed. As the statistical method, Pearson chi-square test was used to compare the groups after the scales were categorized according to cut-off scores. Spearman correlation test was performed to examine whether there is a relationship between parameters
Results: Depression and anxiety levels of girls who exercise regularly were statistically significantly lower (p = 0.041 and p = 0.002; respectively). The risk of eating disorders was found higher in girls without regular exercise habits (p = 0.023). In terms of body perception, there was no significant difference between the groups (p = 0.682). There was a statistically significant negative relationship between body perception and depression and anxiety levels (r = - 0.396, p = 0.000; r = - 0.437, p = 0.000; respectively).
Conclusion: It is seen that regular exercises can decrease depression and anxiety levels. To improve the mental health of adolescents with low activity levels by increasing the participation in sports is possible.
Keywords
References
- World Health Organization. Health for the world’s adolescents: A second chance in the second decade (Accessed November 16, 2015). Available at: http://apps.who.int/adolescent/second-decade/
- Kessler RC, Amminger GP, Aguilar- Gaxiolac S, Alonso J, Lee S, Ustün TB. Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry 2007; 20: 359–64.
- Balazs J, Miklósi M, Keresztény A, et al. Adolescent subthreshold-depression and anxiety: psychopathology, functional impairment and increased suicide risk. J Child Psychol Psychiatry 2013; 54 (6): 670–7.
- Carli V, Hoven CW, Wasserman C, et al. A newly identified group of adolescents at “invisible” risk for psychopathology and suicidal behavior: findings from the SEYLE study. World Psychiatry 2014; 13(1):78–86.
- Thapar A, Collishaw S, Pine DS, Thapar AK. Depression in adolescence. Lancet 2012; 379:1056–67
- World Health Organization. Depression (2015). Available at: https://www.who.int/health-topics/depression
- GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 10; 392 (10159): 1789-858.
- Wilson S, Hicks B, Foster K, McGue M and Iacono W. Age of onset and course of majör depressive disorder: associations with psychosocial functioning outcomes in adulthood. Psychol Med 2015; 45 (3): 505-14.
- duRoscoät E, Legleye S, Guignard R, Husky M, Beck F. Risk factors for suicide attempts and hospitalizations in a sample of 39,542 French adolescents. J Affect Disord 2016; 15; 190:517-21.
- Naicker K, Galambos NL, Zeng Y, Senthilselvan A, Colman I. Social, demographic, and health outcomes in the 10 years following adolescent depression. J Adolesc Health 2013; 52 (5): 533-8.
- Glover J, Fritsch SL. Kids anxiety and social media: a review. Child Adolesc Psychiatr Clin N Am 2018; 27 (2): 171-82.
- Meier SM, Mattheisen M, Mors O, Mortensen PB, Laursen TM, Penninx BW. Increased mortality among people with anxiety disorders: Total population study. Br J Psychiatry 2016; 209 (3): 216-21.
- Calzo JP, Sonneville KR, Haines J, Blood EA, Field AE, Austin SB. The development of associations among body mass index, body dissatisfaction, and weight and shape concern in adolescent boys and girls. J Adolesc Health 2012; 51 (5): 517–23.
- Paxton SJ, Neumark-Sztainer D, Hannan PJ, Eisenberg ME. Body dissatisfaction prospectively predicts depressive mood and low self-esteem in adolescent girls and boys. J Clin Child Adolesc Psychol 2006; 35 (4): 539-49.
- Lewinsohn PM, Striegel-Moore RH, Seeley JR. Epidemiology and natural course of eating disorders in young women from adolescence to young adulthood. J Am Acad Child Adolesc Psychiatr 2000; 39: 1284–92.
- McGorry PD, Hickie IB, Yung AR, Pantelis C, Jackson HJ. Clinical staging of psychiatric disorders: a heuristic frame work for choosing earlier, safer and more effective interventions. Aust N Z J Psychiatry 2006; 40: 616–22.
- Trainor S, Delfabbro P, Anderson S, Winefield A. Leisure activities and adolescent psychological well-being. J Adolesc 2010; 33 (1):173-86.
- Rodriguez-Ayllon M, Cadenas-Sánchez C, Estévez-López F, et al. Role of Physical activity and sedentary behavior in the mental health of preschoolers, children and adolescents: A systematic review and meta-analysis. Sports Med. 2019; 49 (9): 1383-410.
- Jorm AF, Wright A. Beliefs of young people and their parents about the effectiveness of interventions for mental disorders. Aust N Z J Psychiatry 2007; 41: 656–66.
- Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U. Global physical activity levels: Surveillance progress, pitfalls, and prospects. Lancet 2012; 380 (9838): 247–57.
- World Health Organisation, Global Recommendations on Physical Activity for Health (2010). Available from: https://www.who.int/dietphysicalactivity/global-PA-recs-2010
- Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, et al. Schedule for affective disorders and schizophrenia for school-age children present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 1997; 36 (7): 980-8.
- Saka MC, Uluşahin A, Batur S, Sütçü A ve Kara S. Duygulanım bozuklukları ve şizofreni görüşme çizelgesi-Türkçe formu güvenirlik çalışması. Türk Psikiyatri Dergisi 1998; 9 (4): 265-8.
- Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561-71.
- Hisli N. Beck Depresyon Envanterinin üniversite öğrencileri için geçerliği, güvenirliği. Psikoloji dergisi 1989; 7: 3-13.
- Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988; 56 (6): 893–7.
- Ulusoy M, Şahin N, Erkmen H. Turkish version of the Beck Anxiety Inventory: Psychometric properties. J Cogn Psychother 1998; 12: 163-72.
- Garner DM, Garfinkel PE. The Eating Attitudes Test: An index of the symptoms of anorexia nervosa. Psychol Med 1979; 9: 273-9
- Savaşır I, Erol N. Yeme Tutum Testi: Anoreksi Nervoza belirtileri indeksi. Psikoloji Dergisi 1989; 7: 19-25.
- Secord PF, Jourard SM. The appraisal of body-cathexis: body-cathexis and the self. J Consult Psychol 1953; 17 (5):343-7.
- Hovardaoğlu S. Vücut algısı ölçeği. Psikiyatri, Psikoloji, Psikofarmakoloji Dergisi, Testler Özel Eki 1993; 1 (1): 26-7.
- Teychenne M, Costigan SA, Parker K. The association between sedentary behaviour and risk of anxiety: a systematic review. BMC Public Health 2015; 15: 513.
- Hoare E, Milton K, Foster C, Allender S. The associations between sedentary behaviour and mental health among adolescents: a systematic review. Int J Behav Nutr Phys Act 2016; 13: 108.
- Bélair MA, Kohen DE, Kingsbury M, Colman I. Relationship between leisure time physical activity, sedentary behaviour and symptoms of depression and anxiety: evidence from a population-based sample of Canadian adolescents. BMJ Open. 2018; 17; 8 (10): e021119.
- Biddle SJH, Ciaccioni S, Thomas G, Vergeer I. Physical activity and mental health in children and adolescents: an updated review of reviews and an analysis of causality. Psychol Sport Exerc 2019; 42: 146–55.
- Mammen G, Faulkner G. Physical activity and the prevention of depression: A systematic review of prospective studies. Am J Prev Med 2013; 45 (5): 649-57.
- Brown HE, Pearson N, Braithwaite RE, Brown WJ, Biddle SJ. Physical activity interventions and depression in children and adolescents: A systematic review and meta-analysis. Sports Med 2013; 43 (3): 195-206.
- Larun L, Nordheim LV, Ekeland E, Hagen KB, Heian F. Exercise in prevention and treatment of anxiety and depression among children and young people. Cochrane Database Syst Rev 2006; 19 (3):CD004691.
- Pascoe M, Bailey AP, Craike M, et al. Physical activity and exercise in youth mental health promotion: a scoping review. BMJ Open Sport Exerc Med 2020; 23; 6 (1): e000677.
- Bassett-Gunter R, McEwan D, Kamarhie A. Physical activity and body image among men and boys: A meta-analysis. Body Image 2017; 22: 114-28.
- Babiss LA, Gangwisch JE. Sports participation as a protective factor against depression and suicidal ideation in adolescents as mediatedby self-esteem and social support. J Dev Behav Pediatr 2009; 30 (5): 376–84.
- Strohle A, Graetz B, Scheel M, et al. The acute antipanic and anxiolytic activity of aerobic exercise in patients with panic disorder and healthy control subjects. J Psychiatr Res 2009; 43 (12): 1013-7.
- Schuch FB, Stubbs B, Meyer J, et al. Physical activity protects from incident anxiety: A meta-analysis of prospective cohort studies. Depress Anxiety 2019; 36 (9): 846-58.
- Paxton SJ, Neumark-Sztainer D, Hannan PJ, Eisenberg ME. Body dissatisfaction prospectively predicts depressive mood and low self-esteem in adolescent girls and boys. J Clin Child Adolesc Psychol 2006; 35 (4): 539-49.
- Manaf NA, Saravanan C, Zuhrah B. The Prevalence and Inter-Relationship of Negative Body Image Perception, Depression and Susceptibility to Eating Disorders among Female Medical Undergraduate Students. J Clin Diagn Res 2016; 10 (3): VC01-VC04.
- El Ansari W, Stock C, Phillips C, Mabhala A, Stoate M, Adetunji H. Does the association between depressive symptomatology and physical activity depend on body image perception? A survey of students from seven universities in the UK. Int J Environ Res Public Health 2011; 8 (2): 281-99.
- Campbell A, Hausenblas HA. Effects of exercise interventions on body image: a meta-analysis. J Health Psychol 2009; 14 (6): 780-93.
- Lubans D, Richards J, Hillman C, et al. Physical activity for cognitive and mental health in youth: a systematic review of mechanisms. Pediatrics 2016; 138 (3). pii: e20161642.
- Mendonça G, Cheng L, Mélo E, Farias Júnior J. Physical activity and social support in adolescents: a systematic review. Heal Educ Res 2014; 29: 822–39.
- Boone EM, Leadbeater BJ. Game on: diminishing risks for depressive symptoms in early adolescence through positive involvement in team sports. J Res Adolesc 2006; 16 (1): 79-90.
- Sabiston CM, Jewett R, Ashdown-Franks G, Belanger M, BrunetJ, O’Loughlin E, et al. Number of years of team and individual sport participation during adolescence and depressive symptoms in early adulthood. J Sport Exerc Psychol 2016; 38 (1):105-10
There are 51 citations in total.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | September 13, 2021 |
| Submission Date | May 4, 2020 |
| Published in Issue | Year 2021 |