Depressive symptoms among adolescents in six sub-Saharan African countries: A pooled analysis of associated factors

Uttara Partap; Azan Nyundo; Adom Manu; Mathilda Regan; Abbas Ismail; Angela Chukwu; Yadeta Dessie; Tasiana Njau; Sylvia F Kaaya; Wafaie W Fawzi

doi:10.1016/j.pmedr.2023.102499

Depressive symptoms among adolescents in six sub-Saharan African countries: A pooled analysis of associated factors

Prev Med Rep. 2023 Nov 7:36:102499. doi: 10.1016/j.pmedr.2023.102499. eCollection 2023 Dec.

Authors

Uttara Partap¹, Azan Nyundo², Adom Manu³, Mathilda Regan¹, Abbas Ismail⁴, Angela Chukwu⁵, Yadeta Dessie⁶, Tasiana Njau⁷, Sylvia F Kaaya⁷, Wafaie W Fawzi^{1

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Affiliations

¹ Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
² Department of Psychiatry and Mental Health, School of Medicine, University of Dodoma, Dodoma, Tanzania.
³ Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana.
⁴ Department of Mathematics and Statistics, University of Dodoma, Dodoma, Tanzania.
⁵ Department of Statistics, University of Ibadan, Ibadan, Nigeria.
⁶ School of Public Health, College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia.
⁷ Department of Psychiatry and Mental Health, College of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
⁸ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁹ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Abstract

There is a need to identify risk factors, including nutrition-related factors, for depressive disorders among sub-Saharan African (SSA) adolescents. We examined the association of multiple measures with depressive symptoms among adolescents living across six SSA countries. Building on previous analyses, we used data from a cross-sectional study conducted from 2015 to 2017 among adolescents aged 10-19 years in six SSA countries (N = 7512). Depressive symptoms were defined as highest tertile of the 6-item Kutcher Adolescent Depression Scale score. Using mixed-effects Poisson regression models, we pooled data across sites and examined the association of sociodemographic, nutrition, and other indices with depressive symptoms. We additionally assessed effect modification by sex, age, and school-going status. We observed higher risk of depressive symptoms among girls (adjusted risk ratio [RR]: 1.29, 95 % confidence interval [95 % CI]: 1.05-1.58, P = 0.016), older adolescents (RR for 18-19 years: 1.59, 95 % CI: 1.44-1.76, P < 0.001), and adolescents experiencing bullying (RR: 1.43, 95 % CI: 1.26-1.62, P < 0.001) or violence (RR: 1.34, 95 % CI: 1.24-1.45, P < 0.001). Adolescents experiencing food insecurity also had a higher risk of depressive symptoms (RR: 1.90, 95 % CI: 1.64-2.19, P < 0.001) along with those consuming ≥ 5 servings of fruit and vegetables per day (RR: 1.18, 95 % CI: 1.03-1.34, P = 0.015); conversely, those who consumed grains, roots and tubers in the past day were at decreased risk (RR: 0.73, 95 % CI: 0.69-0.77, P < 0.001). There was no strong evidence of effect modification of associations. This study reinforces the potential role of multiple sociodemographic and nutrition-related measures on risk of depressive symptoms in these populations.

Keywords: Depressive disorders; Effect modification; Nutrition; Physical activity; Risk factors; Sociodemographic; Sub-Saharan Africa.