Prevalence of depression and anxiety, associated factors, and correlation with emotional dysregulation among school-attending adolescents in Dar es salaam: a mixed method study.

Abstract

ABSTRACT Introduction: The rising global burden of mental illnesses among adolescents, particularly depression, anxiety, and emotional disorders significantly impair their ability to thrive. Half of the estimated cases start by 14 years of age, but the majority remain undetected and unattended. It is both critical and timely to establish the evidence that will support the need for routine screening and guide future intervention design to address these disorders among school attending adolescents. Objective: To assess the prevalence of anxiety and depression, associated factors, and correlation with emotional dysregulation among school-attending adolescents in Dar-es-salaam. Furthermore, the study aimed to explore the perceived risk factors for anxiety and depression among parents, teachers, and adolescents themselves. Methodology: This mixed-method study involved adolescents from fifteen schools in Dar es Salaam. Depression, anxiety, and emotional dysregulation were assessed using PHQ-9, GAD 7, and DERS respectively. The correlation of DERS with anxiety and depression was assessed using Spearman’s rank test whereas Kruskal-Wallis test compared mean DERS subclass scores with anxiety and depression severity categories. Logistic regression was used to identify the factors associated with depression and anxiety. Perceptions towards depression and anxiety were explored using Focus group discussions and in-depth interviews followed, by thematic analysis by using NVIVO version 11. Results: Among 1111 adolescents, the median age was 16 years, 59.6% were females, 62.2% were secondary school students and 25.3% had separated/divorced parents. Overall, 50% had both anxiety and depression, 35.8% had depression only while 35.2% had anxiety only. 4.7% of the participants had co-existing moderate to severe forms of anxiety and depression. Emotional dysregulation scores increased with anxiety and depression severity. Depression was associated with orphanhood (aOR 3.26 95%CI 1.45-9.34) and longer home-to-school commuting time (aOR 1.21 95%CI 1.01-1.41). Private school adolescents had higher odds of anxiety (aOR 1.65 vi 95%CI 1.79-3.46). Adolescents who have witnessed their parents fighting had a higher likelihood of both anxiety and depression. Perceived risk factors included academic pressure, negative peer influence, and unstable family dynamics. Conclusion: Anxiety and depression were prevalent among school-attending adolescents in Dar-es-salaam. Emotional dysregulation had a positive correlation with depression and anxiety. Associated factors included negative family dynamics, orphanhood, academic pressure, and negative peer influence. Common adverse exposures among adolescents were parents’ fights, sexual assault, and alcohol and substance use. Recommendations: Addressing anxiety and depression among school-attending adolescents requires routine screening, enhancing adolescents’ emotional intelligence, and regulation of academic pressure. Community education on the negative effects of adverse exposures on adolescents is also paramount.