Prevalence and Correlates of Depressive Symptoms Among High School Adolescent Girls in Southern Uganda

Background and Purpose: In sub-Saharan Africa, it is estimated that 1 in 7 adolescents have significant mental health difficulties, with 1 in 10 having a specific psychiatric disorder. Adolescent girls and young women are three times more likely than boys to have depressive disorders. Gender-specific factors including economic inequality, gender-based violence, early and forced marriage, sexual abuse and exploitation, exclusion from education and decision-making, heighten this risk. Yet, there are fewer resources dedicated to the mental health of children and adolescents in the region. Given that most mental health disorders start early in childhood and continue to rise through adolescence, if unaddressed, these conditions extend to adulthood resulting in poor health outcomes, limiting opportunities for a productive adult life. As such, understanding adolescents’ unique and common vulnerabilities and protective factors is essential for the development of appropriate interventions and programming focused on child and adolescent mental health. This study examines the prevalence and correlates of depressive symptoms among adolescent girls in southern Uganda.

Methods: Data from Suubi4Her, a National Institutes of Health funded study of 1260 adolescent girls (14-17 years) recruited from 47 secondary schools in Uganda were utilized. Data were collected using a 90-minute interviewer administered survey. Depressive symptoms were estimated using the 21-item Beck’s Depression Inventory. Hierarchical linear regression modelling was utilized to estimate key predictors of depressive symptoms among adolescent girls. Each of the three models controlled for a block of predictors: socio-demographic and household characteristics (model 1), family and social support factors (model 2), and psychological wellbeing (model 3).

Results: Of the total sample, 16.35% (n=206) reported severe depressive symptoms and almost one in every three adolescent girls (29.68%, n=374) reported moderate symptoms. These symptoms were more prevalent among older adolescents (16+ years). In addition, family relationships (b = -0.24, 95% CI= -0.37, -0.11, p =.001), social support (b = -0.16, 95% CI= -0.29, -0.016, p ≤.05), as well as measures of psychological wellbeing i.e. self-concept (b = -0.28, 95% CI= -0.33, -0.22, p =.001) and self-esteem (b = -0.21, 95% CI: -0.33, -0.09, p =.001) were all associated with lower levels of depressive symptoms. Feelings of hopelessness were associated with higher levels of depressive symptoms (b= 0.56, 95% CI= 0.35, 0.77, p =.001).

Implications and Conclusion: Findings from this study contribute to the limited literature on the prevalence of depressive symptoms among adolescent girls in SSA. Given that depressive symptoms tend to increase during later adolescence, our findings support increasing calls for early screening and detection of poor mental health functioning to facilitate timely referral to care and treatment among children and adolescents. Findings may also inform the development and incorporation of gender-specific mental health components in programming targeting adolescent girls, in low-resource communities in SSA.