Bobholz Max, Dickson-Gomez Julia, Abbo Catherine, Kiconco Arthur, Shour Abdul R, Kasasa Simon, Cassidy Laura D, Anguzu Ronald
Institute for Health and Humanity, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America.
Makerere University College of Health Sciences, Kampala, Uganda.
PLOS Glob Public Health. 2025 Jun 12;5(6):e0003907. doi: 10.1371/journal.pgph.0003907. eCollection 2025.
Adolescence is a critical development transition period that increases vulnerability to poor mental health outcomes. Recent evidence suggests that adolescents in Uganda experience high rates of behavioral and emotional disorders. We examined the factors associated with emotional and behavioral health outcomes among school-going adolescents in Uganda.
In this cross-sectional study, we surveyed 1,953 students aged 10-18 enrolled in Central and Eastern Uganda secondary schools selected by stratified random sampling. Our outcome variables were (i) emotional and (ii) behavioral disorders that were measured using the Child and Adolescent Symptom Inventory-5 (CASI-5) diagnostic criteria outlined in the Diagnostic Statistical Manual-5 (DSM-5). Emotional disorders included major depressive disorder, generalized anxiety disorder, social anxiety disorder, and separation anxiety disorder. Attention deficit/hyperactivity disorder, conduct disorder, and oppositional defiant disorder were considered behavioral disorders. Covariates included socio-demographic, hardship-related experiences, and school-related characteristics. Modified Poisson and logistic regression models were appropriately run for the factors independently associated with respective outcomes. Prevalence ratios (PR), odds ratios (OR), and corresponding 95% confidence intervals (95%CI) were reported with p < 0.05 considered significant.
Participants' mean age was 15.5 (SD = 2.0) years; 54.7% were female, 5.7% had a behavioral disorder, and 17.4% had an emotional disorder. In the adjusted models, factors independently associated with higher odds of behavioral disorder were age (OR=1.2; 95%CI 1.1 - 1.4) and family history of mental illness (OR=1.9; 95%CI 1.2 - 3.3). Factors independently associated with a higher risk of emotional disorder were being female (PR = 1.5; 95%CI 1.2 - 1.8), being enrolled in advanced education (PR = 1.7; 95%CI 1.2 - 2.4) and attending private school (PR = 1.4; 95%CI 1.1 - 1.8).
Behavioral and emotional disorders are prevalent among adolescents enrolled in secondary schools in Central and Eastern Uganda. Investigating potential causal pathways of the identified associations is critical to support school mental health initiatives. School-based programs should enhance routine mental health assessments and target at-risk students in order to improve the mental health of school-going adolescents in Uganda.
青春期是一个关键的发育转型期，这一时期会增加出现心理健康不良后果的易感性。最近的证据表明，乌干达的青少年行为和情绪障碍发生率很高。我们研究了乌干达在校青少年中与情绪和行为健康结果相关的因素。
在这项横断面研究中，我们对1953名年龄在10至18岁的学生进行了调查，这些学生是通过分层随机抽样从乌干达中部和东部的中学选取的。我们的结果变量为：（i）情绪障碍和（ii）行为障碍，使用《精神疾病诊断与统计手册》第5版（DSM-5）中概述的儿童青少年症状量表-5（CASI-5）诊断标准进行测量。情绪障碍包括重度抑郁症、广泛性焦虑症、社交焦虑症和分离焦虑症。注意力缺陷多动障碍、品行障碍和对立违抗障碍被视为行为障碍。协变量包括社会人口统计学、与困难相关的经历以及与学校相关的特征。针对与各自结果独立相关的因素，适当运行了修正泊松回归模型和逻辑回归模型。报告了患病率比（PR）、比值比（OR）以及相应的95%置信区间（95%CI），p < 0.05被视为具有统计学意义。
参与者的平均年龄为15.5岁（标准差 = 2.0）；54.7%为女性，5.7%有行为障碍，17.4%有情绪障碍。在调整后的模型中，与行为障碍较高几率独立相关的因素是年龄（OR = 1.2；95%CI 1.1 - 1.4）和精神疾病家族史（OR = 1.9；95%CI 1.2 - 3.3）。与情绪障碍较高风险独立相关的因素是女性（PR = 1.5；95%CI 1.2 - 1.8）、接受高等教育（PR = 1.7；95%CI 1.2 - 2.4）以及就读私立学校（PR = 1.4；95%CI 1.1 - 1.8）。
行为和情绪障碍在乌干达中部和东部中学的青少年中普遍存在。调查已确定关联的潜在因果途径对于支持学校心理健康倡议至关重要。基于学校的项目应加强常规心理健康评估并针对高危学生，以改善乌干达在校青少年的心理健康。
