Anguzu Ronald, Abbo Catherine, Dickson-Gomez Julia, Bobholz Max, Kiconco Arthur, Shour Abdul R, Kabanda Richard, Kalani Kenneth, Cassidy Laura D
Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
BMC Psychiatry. 2025 Jan 25;25(1):75. doi: 10.1186/s12888-025-06486-z.
During adolescence, a critical developmental phase, cognitive, psychological, and social states interact with the environment to influence behaviors like decision-making and social interactions. Depressive symptoms are more prevalent in adolescents than in other age groups which may affect socio-emotional and behavioral development including academic achievement. Here, we determined the association between depression symptom severity and behavioral impairment among adolescents enrolled in secondary schools of Eastern and Central Uganda.
This cross-sectional study was conducted among 1,669 adolescents enrolled in secondary schools in Eastern and Central Uganda. Our outcome variable was behavioral impairment defined as self-reported behavior that interferes with an individuals' ability to do schoolwork (school performance) or get along with others (peer interaction) (yes/no). The key independent variable was depression symptom severity assessed using the Child and Adolescent Symptom Inventory-5 (CASI-5), a behavior rating scale for symptoms of DSM-5 emotional and behavioral disorders. Modified Poisson regression models tested the independent association between depressive symptom severity and behavioral impairment. Prevalence Rate Ratios (PRR) and 95% confidence intervals (95%CI) were reported.
Participants' mean age was 15.3 years (SD = 1.8), 58.5% were female, 86.8% witnessed domestic violence, 47.4% had behavioral impairment, and 2.8% had mild depression symptoms. School-going adolescents with mild depression symptoms had two times higher risk of behavioral impairment when compared to those with no or slight depression symptoms, after controlling for potential confounders. Other factors independently associated with higher risk for behavioral impairment were female sex (Adj. PRR 1.27, 95%CI 1.12, 1.43) compared to males, taking alcohol (Adj. PRR 1.42, 95%CI 1.25, 1.61) compared to not taking alcohol, boarding school enrollees (Adj. PRR 1.62, 95%CI 1.33, 1.98), and day school enrollees (Adj. PRR 1.46, 95%CI 1.21, 1.76) compared to mixed (day and boarding) school enrollees respectively, advanced level enrolment (Adj. PRR 1.25, 95%CI 1.05, 1.48) compared to ordinary level enrolment, and attending urban schools (Adj. PRR 1.27, 95%CI 1.11, 1.45) compared to rural secondary school attendance.
Behavioral impairments are widespread among Ugandan secondary students. Mild depression symptoms adversely affect adolescents' academic and social lives, potentially leading to long-term consequences. Where feasible, early detection of depressive symptoms and treatment may mitigate their negative effects on student school performance ability and peer/social interaction. Future research should examine school-level factors influencing academic performance by depression status. Policymakers in education and gender sectors should prioritize mental health programs in secondary schools.
在青春期这一关键的发育阶段，认知、心理和社会状态与环境相互作用，影响决策和社交互动等行为。抑郁症状在青少年中比在其他年龄组中更为普遍，这可能会影响社会情感和行为发展，包括学业成绩。在此，我们确定了乌干达东部和中部中学就读青少年中抑郁症状严重程度与行为障碍之间的关联。
这项横断面研究在乌干达东部和中部中学就读的1669名青少年中进行。我们的结果变量是行为障碍，定义为自我报告的干扰个人做作业能力（学业表现）或与他人相处能力（同伴互动）的行为（是/否）。关键的自变量是使用儿童和青少年症状量表-5（CASI-5）评估的抑郁症状严重程度，这是一种用于DSM-5情绪和行为障碍症状的行为评定量表。修正泊松回归模型检验了抑郁症状严重程度与行为障碍之间的独立关联。报告了患病率比（PRR）和95%置信区间（95%CI）。
参与者的平均年龄为15.3岁（标准差=1.8），58.5%为女性，86.8%目睹过家庭暴力，47.4%有行为障碍，2.8%有轻度抑郁症状。在控制潜在混杂因素后，有轻度抑郁症状的在校青少年出现行为障碍的风险是没有或有轻微抑郁症状青少年的两倍。与行为障碍风险较高独立相关的其他因素包括：女性（调整后的PRR为1.27，95%CI为1.12，1.43）与男性相比；饮酒者（调整后的PRR为1.42，95%CI为1.25，1.61）与不饮酒者相比；寄宿制学校就读学生（调整后的PRR为1.62，95%CI为1.33，1.98）和日制学校就读学生（调整后的PRR为1.46，95%CI为1.21，1.76）分别与混合制（日制和寄宿制）学校就读学生相比；高级水平入学（调整后的PRR为1.25，95%CI为1.05，1.48）与普通水平入学相比；以及就读城市学校（调整后的PRR为1.27，95%CI为1.11，1.45）与农村中学就读相比。
行为障碍在乌干达中学生中普遍存在。轻度抑郁症状对青少年的学业和社交生活产生不利影响，可能导致长期后果。在可行的情况下，早期发现抑郁症状并进行治疗可能会减轻其对学生学业表现能力和同伴/社交互动的负面影响。未来的研究应考察影响学业成绩的学校层面因素与抑郁状态的关系。教育和性别部门的政策制定者应将中学心理健康项目作为优先事项。
