Globally, mental health problems contribute considerably to disability-adjusted life years and may be prevalent in about a quarter of young people. [1,2] In South Africa (SA), the adjusted prevalence of mental illnesses of adolescents in the Western Cape is estimated at 15-17%. [3] Also, the nationally representative South African Stress and Health (SASH) study showed that approximately 20% of youth in SA suffer from depression and stress-related conditions every year. [4,5] However, there remains a dearth of evidence on the rural-urban differences in prevalence and predictors of depression among adolescents in SA. Adolescents undergo various biological, cognitive, physiological, psychological, emotional and social changes. These changes affect their health and wellbeing. [6,7] As such, it has been noted that mental problems are more likely to develop during adolescence. [8] Generally, mental illnesses account for 45% of the burden of disease in people aged 10-24 years old, [7,9] with depression and anxiety noted as the leading causes of mental disorders. [2,10] Studies have also suggested that these disorders affect economic and educational outcomes and contribute to crime and suicide rates of adolescents. [2,10] Furthermore, research shows that female gender, [11,12] a low level of education, [13,14] higher age, [15,16] a lower socioeconomic status, [17,18] rural residency [19] and living in urban neighbourhoods [20] are associated with a higher prevalence of depression. In addition, racially advantaged population groups in any area appear to have a lower prevalence of depression, [21] while people's geographical location has also been shown to affect their depression status. [21,22] As mental health problems that develop during adolescence usually persist into adulthood, the prevalence of depression in adolescence remains a strong predictor for mental health problems in adulthood. [1,7] This means that mental health problems in lowand middle-income countries, including SA, must be addressed effectively to ensure optimal development of human capital for the future. [23] As such, the prevalence and predictors of depression among adolescents need to be assessed. This study examines the rural-urban differences in prevalence and predictors of depression among adolescents in SA. Methods The study used data from the 2014 National Income Dynamics Study (NIDS), which was a survey of individuals and households across the nine provinces of SA. Data for adolescents aged 15-19 years were extracted from the survey results and used for this study. Depression status of respondents, used as the dependent variable, was derived from responses to the 10-item Center for Epidemiological Studies Depression scale questionnaire (CES-D 10). The CES-D scale has been validated as a reliable measure of depression for the SA context based on NIDS data. [24] The 10 questions assess whether, in the week preceding the survey, certain feelings occurred: (i) rarely or none of the time; (ii) some or little of the time; (iii) occasionally or a mo...
