The Association between Interpersonal Factors, Stress, Anxiety, and Depression Among Junior High School Students in the Greater Accra Region of Ghana

Background and Purpose: Mental health issues among adolescents have become a growing concern worldwide, with significant implications for individual well-being and public health. Given that interpersonal factors (e.g., family belongingness, social support) greatly influence the mental health of Ghanaian adolescents and the extant high risk for untreated depression among this group, it is important to examine the role of these factors in stress, anxiety, and depression for early identification and treatment. While numerous studies have explored the impact of interpersonal factors on adolescent mental health globally, there is a paucity of research specifically focusing on the Ghanaian context. Our study aims to fill this gap by examining how thwarted belongingness and perceived burdensomeness, alongside other mental health factors, predict stress, anxiety, and depression in this demographic. This exploratory study, therefore, provides crucial insights into the complex interplay between interpersonal dynamics and mental health among junior high school students in the Greater Accra Region.

Methods: Participants for this study were sampled from six selected junior high schools (JHS) in the Greater Accra Region of Ghana, specifically from the Ada, Weija, and Sege districts, resulting in an 82% participation rate out of 975 initially approached students. Thwarted belongingness was assessed using the Thwarted Belongingness Scale, which measures feelings of social disconnection and lack of belongingness. Perceived burdensomeness was evaluated using the Perceived Burdensomeness Scale, capturing perceptions of being a burden on others. Stress, anxiety, and depression levels were measured using standardized self-report questionnaires validated for use in the Ghanaian context. Data analysis involved descriptive analysis, bi-variate, and multivariate analyses using IBM SPSS Statistics, with Multiple Linear Regression to assess relationships between thwarted belongingness, perceived burdensomeness, and mental health outcomes.

Results: In terms of depression, 14% of males and 19% of females were classified as having depression while the prevalence of perceived stress was also high (92%). The mean scores for thwarted belongingness and perceived burdensomeness were significantly higher among students with depression. Results from logistic regression showed that students with anxiety have over three times the odds of experiencing depression compared to those without anxiety (OR = 3.61, 95% CI: 2.45 - 5.34, p < .01). Thwarted belongingness and perceived burdensomeness were significantly associated with depression in the unadjusted models (OR = 1.02, 95% CI: 1.01 - 1.05, p < .05 for thwarted belongingness; OR = 1.03, 95% CI: 1.02 - 1.06, p < .01 for perceived burdensomeness). Furthermore, the adjusted model revealed a gender difference in the likelihood of experiencing depression, with male students having a significantly lower odds ratio (OR = 0.63, 95% CI: 0.41 - 0.96, p < .05) compared to female students.

Conclusion and Implications: These findings challenge the universality of Interpersonal Theory of Suicide constructs among Ghanaian youth, emphasizing the need for culturally sensitive mental health research and intervention. This study contributes to adolescent mental health understanding in Ghana, highlighting cultural and developmental contexts' importance.