Prevalence and correlates of depressive symptoms among high school adolescent girls in southern Uganda

Proscovia Nabunya, Christopher Damulira, William Byansi, Joelynn Muwanga, Ozge Sensoy Bahar, Flavia Namuwonge, Eloho Ighofose, Rachel Brathwaite, Wilberforce Tumwesige, Fred M Ssewamala, Proscovia Nabunya, Christopher Damulira, William Byansi, Joelynn Muwanga, Ozge Sensoy Bahar, Flavia Namuwonge, Eloho Ighofose, Rachel Brathwaite, Wilberforce Tumwesige, Fred M Ssewamala

Abstract

Background: In sub-Saharan Africa (SSA), adolescent girls and young women are three times more likely than boys to have depressive disorders. Understanding adolescents' unique and common vulnerabilities and protective factors is essential for the development of appropriate interventions and programming focused on child and adolescent mental health. This paper examines the prevalence and predictors of depressive symptoms among high school adolescent girls in southern Uganda.

Methods: Baseline data from a longitudinal cluster randomized study involving 1260 adolescent girls (14-17 years), recruited from 47 secondary schools were utilized. Depressive symptoms were estimated using the 21-item Beck's Depression Inventory. Hierarchical linear regression modelling was utilized to estimate key predictors of depressive symptoms among adolescent girls.

Results: Of the total sample, 16.35% (n = 206) reported severe depressive symptoms and almost one in every three adolescent girls interviewed (29.68%, n = 374) reported moderate symptoms. These symptoms were more prevalent among older adolescents (16 years and above). In addition, family relationships, social support, as well as measures of psychological wellbeing (self-concept and self-esteem) were all associated with lower levels of depressive symptoms. Hopelessness was associated with higher levels of depressive symptoms among adolescent girls.

Conclusion: Findings from this study indicate a high prevalence of depressive symptoms, especially among older adolescent girls. In addition, family support factors and adolescents' psychological wellbeing were associated with low levels of depressive symptoms -pointing to the need to strengthen family functioning and adolescent's psychological wellbeing to mitigate risks. Taken together, findings support increasing calls for early screening and detection of depressive symptoms to facilitate timely referral to care and treatment. Findings may also inform the development and incorporation of gender-specific mental health components in programming targeting adolescent girls, in low-resource communities in SSA.

Trial registration: This trial was prospectively registered with ClinicalTrials.gov (registration number: NCT03307226 ) on 11 October 2017.

Keywords: Adolescent girls; Depressive symptoms; Mental health; Prevalence; Uganda.

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. World Health Organization. Adolescent mental health. 2019. Accessed on 27 Feb 2020 from: .
    1. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367(9524):1747–1757. doi: 10.1016/S0140-6736(06)68770-9.
    1. Cortina MA, Sodha A, Fazel M, Ramchandani PG. Prevalence of child mental health problems in sub-Saharan Africa: a systematic review. Archives Pediatrics Adolescent Med. 2012;166(3):276–281. doi: 10.1001/archpediatrics.2011.592.
    1. Nduna M, Jewkes RK, Dunkle KL, Jama Shai NP, Colman I. Prevalence and factors associated with depressive symptoms among young women and men in the eastern Cape Province, South Africa. J Child Adolesc Ment Health. 2013;25(1):43–54. doi: 10.2989/17280583.2012.731410.
    1. Crabb J, Stewart RC, Kokota D, Masson N, Chabunya S, Krishnadas R. Attitudes towards mental illness in Malawi: a cross-sectional survey. BMC Public Health. 2012;12(1):541. doi: 10.1186/1471-2458-12-541.
    1. Hugo CJ, Boshoff DE, Traut A, Zungu-Dirwayi N, Stein DJ. Community attitudes toward and knowledge of mental illness in South Africa. Soc Psychiatry Psychiatr Epidemiol. 2003;38(12):715–719. doi: 10.1007/s00127-003-0695-3.
    1. Atilola O, Balhara YP, Stevanovic D, Avicenna M, Kandemir H. Self-reported mental health problems among adolescents in developing countries: results from an international pilot sample. J Dev Behav Pediatrics. 2013;34(2):129–137. doi: 10.1097/DBP.0b013e31828123a6.
    1. Kariuki SM, Abubakar A, Kombe M, Kazungu M, Odhiambo R, Stein A, Newton CR. Burden, risk factors, and comorbidities of behavioural and emotional problems in Kenyan children: a population-based study. Lancet Psychiatry. 2017;4(2):136–145. doi: 10.1016/S2215-0366(16)30403-5.
    1. Owen JP, Baig B, Abbo C, Baheretibeb Y. Child and adolescent mental health in sub-Saharan Africa: a perspective from clinicians and researchers. BJPsych international. 2016;13(2):45–47. doi: 10.1192/S2056474000001136.
    1. Giaconia RM, Reinherz HZ, Silverman AB, Pakiz B, Frost AK, Cohen E. Ages of onset of psychiatric disorders in a community population of older adolescents. J Am Acad Child Adolesc Psychiatry. 1994;33(5):706–717. doi: 10.1097/00004583-199406000-00012.
    1. Hankin BL, Abramson LY, Moffitt TE, Silva PA, McGee R, Angell KE. Development of depression from preadolescence to young adulthood: emerging gender differences in a 10-year longitudinal study. J Abnorm Psychol. 1998;107(1):128. doi: 10.1037/0021-843X.107.1.128.
    1. Kieling C, Baker-Henningham H, Belfer M, Conti G, Ertem I, Omigbodun O, Rohde LA, Srinath S, Ulkuer N, Rahman A. Child and adolescent mental health worldwide: evidence for action. Lancet. 2011;378(9801):1515–1525. doi: 10.1016/S0140-6736(11)60827-1.
    1. Kessler RC, Angermeyer M, Anthony JC, De Graaf RO, Demyttenaere K, Gasquet I, De Girolamo G, Gluzman S, Gureje OY, Haro JM, Kawakami N. Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's world mental health survey initiative. World Psychiatry. 2007;6(3):168.
    1. Kapphahn CJ, Morreale MC, Rickert VI, Walker LR. Financing mental health services for adolescents: a position paper of the Society for Adolescent Medicine. J Adolesc Health. 2006;39(3):456–458. doi: 10.1016/j.jadohealth.2005.12.013.
    1. Allgood-Merten B, Lewinsohn PM, Hops H. Sex differences and adolescent depression. J Abnorm Psychol. 1990;99(1):55–63. doi: 10.1037/0021-843X.99.1.55.
    1. Burke RJ, Weir T. Sex differences in adolescent life stress, social support, and well-being. J Psychol. 1978;98(2):277–288. doi: 10.1080/00223980.1978.9915972.
    1. Nolen-Hoeksema S. Gender differences in depression. Curr Dir Psychol Sci. 2001;10(5):173–176. doi: 10.1111/1467-8721.00142.
    1. Schraedley PK, Gotlib IH, Hayward C. Gender differences in correlates of depressive symptoms in adolescents. J Adolesc Health. 1999;25(2):98–108. doi: 10.1016/S1054-139X(99)00038-5.
    1. World Health Organization. Health for the World’s Adolescents: A second chance in the second decade. 2014. . Accessed 27 Feb 2020.
    1. Kapungu C, Petroni S. Understanding and tackling the gendered drivers of poor adolescent mental health. International Center for Research on Women. 2020.
    1. Petroni S, Patel V, Patton G. Why is suicide the leading killer of older adolescent girls? Lancet. 2015;386(10008):2031–2032. doi: 10.1016/S0140-6736(15)01019-3.
    1. Viner RM, Ozer EM, Denny S, Marmot M, Resnick M, Fatusi A, Currie C. Adolescence and the social determinants of health. Lancet. 2012;379(9826):1641–1652. doi: 10.1016/S0140-6736(12)60149-4.
    1. Albert PR. Why is depression more prevalent in women? J Psychiatry Neurosci. 2015;40(4):219. doi: 10.1503/jpn.150205.
    1. Patton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB, Arora M, Azzopardi P, Baldwin W, Bonell C, Kakuma R. Our future: a lancet commission on adolescent health and wellbeing. Lancet. 2016;387(10036):2423–2478. doi: 10.1016/S0140-6736(16)00579-1.
    1. Beck AT. Depression: clinical, experimental, and theoretical aspects: Hoeber Medical Division, Harper & Row; 1967.
    1. Beck JS, Beck AT. Cognitive therapy: basics and beyond. New York: Guilford press; 1995.
    1. Beck AT. Cognitive therapy and the emotional disorders. Penguin. 1979.
    1. Johnson NI, Barrett R, Horricks L, Akintan O, Van Blyderveen S. Adolescent mental health and risky sexual behavior: a Canadian perspective. J Adolesc Health. 2014;54(2):S49. doi: 10.1016/j.jadohealth.2013.10.111.
    1. Murphey D, Barry M, Vaughn B, Guzman L, Terzian M. Adolescent health highlight: use of illicit drugs. Trends Child. 2013; Accessed on 27 Feb 2020 from: .
    1. Anatale K, Kelly S. Factors influencing adolescent girls’ sexual behavior: a secondary analysis of the 2011 youth risk behavior survey. Issues Mental Health Nurs. 2015;36(3):217–221. doi: 10.3109/01612840.2014.963902.
    1. Lehrer JA, Shrier LA, Gortmaker S, Buka S. Depressive symptoms as a longitudinal predictor of sexual risk behaviors among US middle and high school students. Pediatrics. 2006;118(1):189–200. doi: 10.1542/peds.2005-1320.
    1. Seth P, Patel SN, Sales JM, DiClemente RJ, Wingood GM, Rose ES. The impact of depressive symptomatology on risky sexual behavior and sexual communication among African American female adolescents. Psychol Health Med. 2011;16(3):346–356. doi: 10.1080/13548506.2011.554562.
    1. Goin DE, Pearson RM, Craske MG, Stein A, Pettifor A, Lippman SA, Kahn K, Neilands TB, Hamilton EL, Selin A, MacPhail C. Depression and Incident HIV in Adolescent Girls and Young Women in HIV Prevention Trials Network 068: Targets for Prevention and Mediating Factors. Am J Epidemiol. 2020;189(5):422–32. doi: 10.1093/aje/kwz238.
    1. Babore A, Trumello C, Candelori C, Paciello M, Cerniglia L. Depressive symptoms, self-esteem and perceived parent–child relationship in early adolescence. Front Psychol. 2016;7:982. doi: 10.3389/fpsyg.2016.00982.
    1. Battle J. Relationship between self-esteem and depression among high school students. Percept Mot Skills. 1980;51(1):157–158. doi: 10.2466/pms.1980.51.1.157.
    1. Orth U, Robins RW. Understanding the link between low self-esteem and depression. Curr Dir Psychol Sci. 2013;22(6):455–460. doi: 10.1177/0963721413492763.
    1. Sowislo JF, Orth U. Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies. Psychol Bull. 2013;139(1):213. doi: 10.1037/a0028931.
    1. Steiger AE, Allemand M, Robins RW, Fend HA. Low and decreasing self-esteem during adolescence predict adult depression two decades later. J Pers Soc Psychol. 2014;106(2):325. doi: 10.1037/a0035133.
    1. Masselink M, Van Roekel E, Oldehinkel AJ. Self-esteem in early adolescence as predictor of depressive symptoms in late adolescence and early adulthood: the mediating role of motivational and social factors. Journal of youth and adolescence. 2018;47(5):932–946. doi: 10.1007/s10964-017-0727-z.
    1. Rieger S, Göllner R, Trautwein U, Roberts BW. Low self-esteem prospectively predicts depression in the transition to young adulthood: a replication of Orth, Robins, and Roberts (2008) J Pers Soc Psychol. 2016;110(1):e16. doi: 10.1037/pspp0000037.
    1. Cunningham S, Gunn T, Alladin A, Cawthorpe D. Anxiety, depression and hopelessness in adolescents: a structural equation model. J Can Acad Child Adolesc Psychiatry. 2008;17(3):137.
    1. Greene SM. The relationship between depression and hopelessness: implications for current theories of depression. Br J Psychiatry. 1989;154(5):650–659. doi: 10.1192/bjp.154.5.650.
    1. Almedom AM. Social capital and mental health: an interdisciplinary review of primary evidence. Soc Sci Med. 2005;61(5):943–964. doi: 10.1016/j.socscimed.2004.12.025.
    1. De Silva MJ, Huttly SR, Harpham T, Kenward MG. Social capital and mental health: a comparative analysis of four low income countries. Soc Sci Med. 2007;64(1):5–20. doi: 10.1016/j.socscimed.2006.08.044.
    1. Flores EC, Fuhr DC, Bayer AM, Lescano AG, Thorogood N, Simms V. Mental health impact of social capital interventions: a systematic review. Soc Psychiatry Psychiatr Epidemiol. 2018;53(2):107–119. doi: 10.1007/s00127-017-1469-7.
    1. McPherson KE, Kerr S, McGee E, Morgan A, Cheater FM, McLean J, Egan J. The association between social capital and mental health and behavioural problems in children and adolescents: an integrative systematic review. BMC psychology. 2014;2(1):7. doi: 10.1186/2050-7283-2-7.
    1. Boudreault-Bouchard AM, Dion J, Hains J, Vandermeerschen J, Laberge L, Perron M. Impact of parental emotional support and coercive control on adolescents' self-esteem and psychological distress: results of a four-year longitudinal study. J Adolesc. 2013;36(4):695–704. doi: 10.1016/j.adolescence.2013.05.002.
    1. Gariepy G, Honkaniemi H, Quesnel-Vallee A. Social support and protection from depression: systematic review of current findings in Western countries. Br J Psychiatry. 2016;209(4):284–293. doi: 10.1192/bjp.bp.115.169094.
    1. Holahan CJ, Valentiner DP, Moos RH. Parental support, coping strategies, and psychological adjustment: an integrative model with late adolescents. J Youth Adolescence. 1995;24(6):633–648. doi: 10.1007/BF01536948.
    1. Cheng Y, Li X, Lou C, Sonenstein FL, Kalamar A, Jejeebhoy S, Delany-Moretlwe S, Brahmbhatt H, Olumide AO, Ojengbede O. The association between social support and mental health among vulnerable adolescents in five cities: findings from the study of the well-being of adolescents in vulnerable environments. J Adolesc Health. 2014;55(6):S31–S38. doi: 10.1016/j.jadohealth.2014.08.020.
    1. Delsing MJ, Van Aken MA, Oud JH, De Bruyn EE, Scholte RH. Family loyalty and adolescent problem behavior: the validity of the family group effect. J Res Adolesc. 2005;15(2):127–150. doi: 10.1111/j.1532-7795.2005.00089.x.
    1. Fulkerson JA, Story M, Mellin A, Leffert N, Neumark-Sztainer D, French SA. Family dinner meal frequency and adolescent development: relationships with developmental assets and high-risk behaviors. J Adolesc Health. 2006;39(3):337–345. doi: 10.1016/j.jadohealth.2005.12.026.
    1. Ying YW, Han M. Parental contributions to southeast Asian American adolescents' well-being. Youth Soc. 2008;40(2):289–306. doi: 10.1177/0044118X08315506.
    1. Arat G, Wong PW. The relationship between parental involvement and adolescent mental health in six sub-Saharan African countries: findings from global school-based health surveys (GSHS) Int J Ment Health Promot. 2016;18(3):144–157. doi: 10.1080/14623730.2016.1194305.
    1. Bireda AD, Pillay J. Perceived parental involvement and well-being among Ethiopian adolescents. J Psychol Afr. 2017;27(3):256–259. doi: 10.1080/14330237.2017.1321852.
    1. Springer A, Parcel G, Baumler E, Ross M. Supportive social relationships and adolescent health risk behavior among secondary school students in El Salvador. Soc Sci Med. 2006;62(7):1628–1640. doi: 10.1016/j.socscimed.2005.08.018.
    1. Yugo M, Davidson MJ. Connectedness within social contexts: the relation to adolescent health. Healthcare Policy. 2007;2(3):47.
    1. Henry MB, Kitaka SB, Lubega K, Snyder SA, LaRussa P, Pfeffer B. Depressive symptoms, sexual activity, and substance use among adolescents in Kampala, Uganda. Afr Health Sci. 2019;19(2):1888–1896. doi: 10.4314/ahs.v19i2.12.
    1. Kyohangirwe L, Okello E, Namuli JD, Ndeezi G, Kinyanda E. Prevalence and factors associated with major depressive disorder among adolescents attending a primary care facility in Kampala. Uganda Tropical doctor. 2019;9:0049475519879586.
    1. Kivumbi A, Byansi W, Ssewamala FM, Proscovia N, Damulira C, Namatovu P. Utilizing a family-based economic strengthening intervention to improve mental health wellbeing among female adolescent orphans in Uganda. Child Adolesc Psychiatry Ment Health. 2019;13(1):14. doi: 10.1186/s13034-019-0273-4.
    1. Musisi S, Kinyanda E, Nakasujja N, Nakigudde J. A comparison of the behavioral and emotional disorders of primary school-going orphans and nonorphans in Uganda. Afr Health Sci. 2007;7(4):202–13.
    1. Ssewamala FM, Han CK, Neilands TB. Asset ownership and health and mental health functioning among AIDS-orphaned adolescents: findings from a randomized clinical trial in rural Uganda. Soc Sci Med. 2009;69(2):191–198. doi: 10.1016/j.socscimed.2009.05.019.
    1. Ssewamala FM, Karimli L, Torsten N, Wang JS, Han CK, Ilic V, Nabunya P. Applying a family-level economic strengthening intervention to improve education and health-related outcomes of school-going AIDS-orphaned children: lessons from a randomized experiment in southern Uganda. Prev Sci. 2016;17(1):134–143. doi: 10.1007/s11121-015-0580-9.
    1. Ssewamala FM, Nabunya P, Ilic V, Mukasa MN, Ddamulira C. Relationship between family economic resources, psychosocial well-being, and educational preferences of AIDS-orphaned children in southern Uganda: baseline findings. Global Social Welfare. 2015;2(2):75–86. doi: 10.1007/s40609-015-0027-z.
    1. Ssewamala FM, Neilands TB, Waldfogel J, Ismayilova L. The impact of a comprehensive microfinance intervention on depression levels of AIDS-orphaned children in Uganda. J Adolesc Health. 2012;50(4):346–352. doi: 10.1016/j.jadohealth.2011.08.008.
    1. Akimana B, Abbo C, Balagadde-Kambugu J, Nakimuli-Mpungu E. Prevalence and factors associated with major depressive disorder in children and adolescents at the Uganda Cancer institute. BMC Cancer. 2019;19(1):466. doi: 10.1186/s12885-019-5635-z.
    1. Cavazos-Rehg P, Xu C, Kasson E, Byansi W, Bahar OS, Ssewamala FM. Social and economic equity and family cohesion as potential protective factors from depression among adolescents living with HIV in Uganda. AIDS Behav. 2020;24:1–9. doi: 10.1007/s10461-020-02812-6.
    1. Kemigisha E, Zanoni B, Bruce K, Menjivar R, Kadengye D, Atwine D, Rukundo GZ. Prevalence of depressive symptoms and associated factors among adolescents living with HIV/AIDS in South Western Uganda. AIDS Care. 2019;31(10):1297–1303. doi: 10.1080/09540121.2019.1566511.
    1. Kinyanda E, Hoskins S, Nakku J, Nawaz S, Patel V. The prevalence and characteristics of suicidality in HIV/AIDS as seen in an African population in Entebbe district, Uganda. BMC Psychiatry. 2012;12(1):63. doi: 10.1186/1471-244X-12-63.
    1. Musisi S, Kinyanda E. Emotional and behavioural disorders in HIV seropositive adolescents in urban Uganda. East Afr Med J. 2009;86(1):16–24. doi: 10.4314/eamj.v86i1.46923.
    1. Abbo C, Kinyanda E, Kizza RB, Levin J, Ndyanabangi S, Stein DJ. Prevalence, comorbidity and predictors of anxiety disorders in children and adolescents in rural North-Eastern Uganda. Child Adolesc Psychiatry Ment Health. 2013;7(1):21. doi: 10.1186/1753-2000-7-21.
    1. Okello J, Onen TS, Misisi S. Psychiatric disorders among war-abducted and non-abducted adolescents in Gulu district, Uganda: a comparative study. African J Psychiatry. 2007;10(4):225–231.
    1. Nalugya-Sserunjogi J, Rukundo GZ, Ovuga E, Kiwuwa SM, Musisi S, Nakimuli-Mpungu E. Prevalence and factors associated with depression symptoms among school-going adolescents in Central Uganda. Child Adolesc Psychiatry Ment Health. 2016;10(1):39. doi: 10.1186/s13034-016-0133-4.
    1. Harandi TF, Taghinasab MM, Nayeri TD. The correlation of social support with mental health: a meta-analysis. Electron Physician. 2017;9(9):5212. doi: 10.19082/5212.
    1. Ssewamala FM, Bermudez LG, Neilands TB, Mellins CA, McKay MM, Garfinkel I, Bahar OS, Nakigozi G, Mukasa M, Stark L, Damulira C. Suubi4Her: a study protocol to examine the impact and cost associated with a combination intervention to prevent HIV risk behavior and improve mental health functioning among adolescent girls in Uganda. BMC Public Health. 2018;18(1):693. doi: 10.1186/s12889-018-5604-5.
    1. Ssewamala FM, Nabunya P, Bahar OS, William B, Namuwonge F, Damulira C, Mukasa M, Ahmed R, Tumwesige W, Zmachinski L, Team IC. Suubi4Her: A Combination Intervention Addressing HIV Risk Among Older Adolescent Girls Transitioning into Adulthood in Uganda. 2019. Accessed on 25 Feb 2020, from: .
    1. Damulira C, Mukasa MN, Byansi W, Nabunya P, Kivumbi A, Namatovu P, Namuwonge F, Dvalishvili D, Sensoy Bahar O, Ssewamala FM. Examining the relationship of social support and family cohesion on ART adherence among HIV-positive adolescents in southern Uganda: baseline findings. Vulnerable children and youth studies. 2019;14(2):181–190. doi: 10.1080/17450128.2019.1576960.
    1. Karimli L, Ssewamala FM, Ismayilova L. Extended families and perceived caregiver support to AIDS orphans in Rakai district of Uganda. Child Youth Serv Rev. 2012;34(7):1351–1358. doi: 10.1016/j.childyouth.2012.03.015.
    1. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4(6):561–571. doi: 10.1001/archpsyc.1961.01710120031004.
    1. Fitts WH, Warren WL. Tennessee self-concept scale: TSCS-2. Los Angeles: Western Psychological Services; 1996.
    1. Rosenberg M. Princeton University Press; Princeton, NJ: 1965. Society and the adolescent self-image. Accessed 20 Feb 2020, from: .
    1. Beck AT, Weissman A, Lester D, Trexler L. The measurement of pessimism: The Hopelessness Scale. J Consult Clin Psychol. 1974;42(6):861–5. doi: 10.1037/h0037562.
    1. Moos RH. Family environment scale manual: Consulting Psychologists Press; 1994.
    1. Skinner HA, Steinhauer PD, Santa-Barbara J. The family assessment measure. Can J Commun Mental Health. 2009;2(2):91–103. doi: 10.7870/cjcmh-1983-0018.
    1. Vaux A, Riedel S, Stewart D. Modes of social support: the social support behaviors (SS-B) scale. Am J Community Psychol. 1987;15(2):209–232. doi: 10.1007/BF00919279.
    1. Bukowski WM, Hoza B, Boivin M. Measuring friendship quality during pre-and early adolescence: the development and psychometric properties of the friendship qualities scale. J Soc Pers Relat. 1994;11(3):471–484. doi: 10.1177/0265407594113011.
    1. Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. San Antonio: Psychological Corporation; 1996.
    1. Fergusson DM, Woodward LJ. Mental health, educational, and social role outcomes of adolescents with depression. Arch Gen Psychiatry. 2002;59(3):225–231. doi: 10.1001/archpsyc.59.3.225.
    1. Hale DR, Bevilacqua L, Viner RM. Adolescent health and adult education and employment: a systematic review. Pediatrics. 2015;136(1):128–140. doi: 10.1542/peds.2014-2105.
    1. Lewinsohn PM, Rohde P, Klein DN, Seeley JR. Natural course of adolescent major depressive disorder: I. continuity into young adulthood. J Am Acad Child Adolesc Psychiatry. 1999;38(1):56–63. doi: 10.1097/00004583-199901000-00020.
    1. Kosunen E, Kaltiala-Heino R, Rimpelä M, Laippala P. Risk-taking sexual behaviour and self-reported depression in middle adolescence–a school-based survey. Child Care Health Dev. 2003;29(5):337–344. doi: 10.1046/j.1365-2214.2003.00357.x.
    1. Thapar A, Collishaw S, Pine DS, Thapar AK. Depression in adolescence. Lancet. 2012;379(9820):1056–1067. doi: 10.1016/S0140-6736(11)60871-4.
    1. Fletcher JM. Adolescent depression and educational attainment: results using sibling fixed effects. Health Econ. 2010;19(7):855–871. doi: 10.1002/hec.1526.
    1. McLeod JD, Uemura R, Rohrman S. Adolescent mental health, behavior problems, and academic achievement. J Health Soc Behav. 2012;53(4):482–497. doi: 10.1177/0022146512462888.
    1. Nyundo A, Manu A, Regan M, Ismail A, Chukwu A, Dessie Y, Njau T, Kaaya SF, Smith Fawzi MC. Factors associated with depressive symptoms and suicidal ideation and behaviours amongst sub-Saharan African adolescents aged 10-19 years: cross-sectional study. Tropical Med Int Health. 2020;25(1):54–69. doi: 10.1111/tmi.13336.
    1. Atwine B, Cantor-Graae E, Bajunirwe F. Psychological distress among AIDS orphans in rural Uganda. Soc Sci Med. 2005;61(3):555–564. doi: 10.1016/j.socscimed.2004.12.018.
    1. Chi P, Li X. Impact of parental HIV/AIDS on children’s psychological well-being: a systematic review of global literature. AIDS Behav. 2013;17(7):2554–2574. doi: 10.1007/s10461-012-0290-2.
    1. Cluver L, Boyes M, Orkin M, Sherr L. Poverty, AIDS and child health: identifying highest-risk children in South Africa. S Afr Med J. 2013;103(12):910–915. doi: 10.7196/SAMJ.7045.
    1. Cluver LD, Orkin M, Gardner F, Boyes ME. Persisting mental health problems among AIDS-orphaned children in South Africa. J Child Psychol Psychiatry. 2012;53(4):363–370. doi: 10.1111/j.1469-7610.2011.02459.x.
    1. Nabunya P, Padgett D, Ssewamala FM, Courtney ME, Neilands T. Examining the nonkin support networks of orphaned adolescents participating in a family-based economic-strengthening intervention in Uganda. J Commun Psychol. 2019;47(3):579–593. doi: 10.1002/jcop.22139.
    1. Han CK, Ssewamala FM, Wang JS. Family economic empowerment and mental health among AIDS-affected children living in AIDS-impacted communities: evidence from a randomised evaluation in southwestern Uganda. J Epidemiol Community Health. 2013;67(3):225–230. doi: 10.1136/jech-2012-201601.
    1. Karimli L, Ssewamala FM, Neilands TB, Wells CR, Bermudez LG. Poverty, economic strengthening, and mental health among AIDS orphaned children in Uganda: mediation model in a randomized clinical trial. Soc Sci Med. 2019;228:17–24. doi: 10.1016/j.socscimed.2019.03.003.
    1. Nyoni T, Nabunya P, Ssewamala FM. Perceived social support and psychological wellbeing of children orphaned by HIV/AIDS in southwestern Uganda. Vulnerable Children Youth Stud. 2019;14(4):351–363. doi: 10.1080/17450128.2019.1634855.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir