Prevalence and correlates of depression and anxiety symptoms among out-of-school adolescent girls and young women in Tanzania: A cross-sectional study

Abstract

Background In sub-Saharan Africa, adolescent girls and young women (AGYW) who are out of school are at higher risk of depressive and anxiety disorders compared to their school attending peers. However, little is known about the prevalence and risk factors for these conditions among out-of-school AGYW. This study examines the prevalence of depression and anxiety and associated factors in a community sample of out-of-school AGYW in Tanzania. Methods A cross-sectional analysis of baseline data from an on-going cluster randomized controlled trial in North-West Tanzania was conducted. A total of 3013 out-of-school AGYW aged 15 to 23 years from 30 clusters were included. Anxiety and depression were assessed using the Patient Health Questionnaire (PHQ-4), a tool comprising of PHQ-2 and Generalized Anxiety Disorders (GAD-2) screeners. Data were collected using Audio Computer-Assisted Self-Interview (ACASI). A random-effects logistic regression was fitted for binary outcomes and an ordinal logistic regression model with robust variance was used to adjust for clustering at the village level. Logistic regression and ordinal logistic regression were used to explore the associations between mental disorders symptoms and other factors. Results The prevalence of depressive (PHQ-2 ≥ 3) and anxiety (GAD-2 ≥ 3) symptoms among out-of-school AGYW were 36% (95% CI 33.8%-37.3%) and 31% (95% CI 29.0%-32.3%) respectively. Further, using the PHQ-4 tool, 33% (95% CI 30.8%-34.2%) had mild, 20% (95% CI 18.3%-21.1%) moderate and 6% (95% CI 5.5%-7.2%) had severe symptoms of anxiety and depression. After adjusting for other covariates, two factors most strongly associated with having anxiety symptoms were violence experience from sexual partners (AOR = 1.63, 95% CI: 1.36–1.96) and HIV positive status (AOR = 1.54, 95% CI: 1.03–2.31). Likewise, living alone, with younger siblings or others (AOR = 2.51, 95% CI: 1.47–4.29) and violence experience from sexual partners (AOR = 1.90, 95% CI: 1.59–2.27) were strongly associated with depression symptoms. Having savings (AOR = 0.81, 95% CI: 0.70–0.95) and emotional support (AOR = 0.82, 95% CI: 0.67–0.99) were protective against depression and anxiety, respectively. Conclusion Depressive and anxiety symptoms are prevalent among out-of-school AGYW in Tanzania. The findings emphasize the need to strengthen preventive interventions and scale-up mental health disorder screening, referral for diagnosis and management.

Living Conditions and the Mental Health and Well-being of Refugees: Evidence from a Large-Scale German Survey

“…In another sample, the PHQ-4 diagnosed depression and anxiety disorders with AUCs of 0.84 and 0.79 [28]. The PHQ-4 also shows good internal reliability with Cronbach's alphas of 0.79 for a Tanzanian [33], 0.84 for a Colombian [34], and 0.78 for a German sample [27]. In our sample, the internal consistency of the scale was equally acceptable (Cronbach's alpha = 0.77).…”

The psychometric properties of PHQ-4 anxiety and depression screening scale among out of school adolescent girls and young women in Tanzania: a cross-sectional study

“…CARE study is also registered at Clinical-Trials.gov, number NCT03597243. Details on CARE study are documented elsewhere [18].…”

“…Within the CARE study, the study participants were interviewed using audio computer-assisted self-interviews (ACASI). ACASI is an electronic self-administered questionnaire, where participants listen privately to prerecorded interview questions using a tablet connected to earphones [18,19]. The participants could also simultaneously read each interview question, including the PHQ-4 items, on the tablet screen as the question was being read.…”

“As a Young Pregnant Girl… The Challenges You Face”: Exploring the Intersection Between Mental Health and Sexual and Reproductive Health Amongst Adolescent Girls and Young Women in South Africa

“…The development of poor mental health outcomes during this period is influenced by neurological, hormonal, and physical changes associated with puberty, combined with changes in adolescents' social environments [11]. Evidence from South Africa and other countries in the sub-Saharan African region show that age-specific risk factors for depression and anxiety disorders include lower socio-economic status, lack of social capital and support, substance use, and exposure to violence and traumatic events [12]. Adolescents growing up in the context of socio-economically adverse communities are faced with a range of additional psychosocial and health risks that may evoke stress and negatively affect their mental health; these risks include exposure to HIV, substance use, violence, and other stressors [13].…”

“…Recommendations have been made for integrating mental health care into care for patients with chronic non-communicable diseases, as well as communicable diseases such as HIV [ 10 ], but few recommendations for integrating mental health into SRH delivery exist [ 36 ]. The links between mental health, HIV status, and ‘unintended’ pregnancy, exacerbate the need to strengthen the integration of routine mental health screening in SRH and HIV programming in order to enhance the health outcomes amongst AGYW [ 12 ]. Addressing underlying mental health risks may be an important additional strategy to promote sexual risk reduction, and behavioural interventions which are able to improve mental health are also more effective in preventing negative sexual health outcomes such as HIV infection [ 22 ].…”