Peer Affiliation, School Bullying Victimization, and Substance Misuse Among Adolescents in Malawi: The Mediating Effect of Depression

Background: Across the globe, health-risk behaviors such as school bullying, substance abuse, and negative peer influence among adolescents are likely to have a lasting negative effect on their health and wellbeing (World Health Organization, 2012). The burden of such synergistic risk behaviors are more pronounced in resource-limited countries, such as Malawi, where research and evidence-informed interventions are scant. In fact, there is a paucity of research from sub-Saharan Africa, on how factors such as peer influence, victimization and mental health problems, might be  associated with risk behaviors especially within school settings. Thus, it is important to examine the pathways and correlates of these factors among students in Malawi to provide adolescent health providers with evidence to inform culturally-relevant context specific prevention and intervention programs. Therefore, this study contributes to this research gap by hypothesizing that: 1) peer affiliation, bullying victimization, and depression are significantly associated with tobacco use or alcohol use, 2) depression would significantly mediate the relationship between bullying victimization and tobacco use or alcohol use, and 3) gender would moderate the relationship between bullying victimization and substance misuse in the conceptual models of tobacco use and alcohol use.

Methods: Data for this study were obtained from the 2009 Malawi Global School-based Health Survey (GSHS), a national collaborative program with the US centers for Disease Control and Prevention to measure and assess behavioral risk and protective factors among high school students (2,359) Adolescents between 14-17 years were included in the analysis; 43.5% female and 57.5% male. Independent variables were peer affiliation and school bullying. The mediating variable was depression, while gender was the moderating variable. The outcome variable was tobacco and alcohol use. Path analysis method using Mplus 7.0., was used to assess the direct and indirect pathways between peer affiliation, bullying, depression and substance use. 

Results: The structural path models for tobacco use and alcohol use showed excellent model fit: χ²/df=2.503 (p<.05), RMSEA=0.025, 990% CI [.005, .045]), CFI=0.997, TLI=0 .990. The results partially supported our hypotheses. Peer affiliation, bullying victimization, and depression were significantly associated with tobacco use as an outcome in the first path model. However, only bullying victimization and depression were significantly associated with alcohol use, but peer affiliation was not significantly associated with alcohol use as an outcome in the other conceptual model. In addition, depression partially mediated the relationship between bullying victimization and substance misuse (alcohol use or tobacco use) in both models. Gender did not moderate any of the relationships.

Conclusions/ Implications: Knowing the relationship between risk behaviors of bullying, depression, and substance use could impact how we design health prevention and early intervention programs for adolescents in Malawi. In this study, adolescents who reported tobacco and alcohol use  were more likely to be victims of bullying and were likely to report feelings of sadness and depression. The findings have implications for social work practitioners in schools and mental health settings.