The influence of depressive symptoms and school-going status on risky behaviors: a pooled analysis among adolescents in six sub-Saharan African countries
Date
2023
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Frontier in Psychiatry
Abstract
Background: Evidence from sub-Saharan Africa (SSA) regarding risky behaviors
among adolescents remains scarce, despite the large population (approximately
249 million out of 1.2 billion globally in 2019) of adolescents in the region. We
aimed to examine the potential influence of depressive symptoms and school going status on risky behaviors among adolescents in six SSA countries.
Methods: We used individual cross-sectional data from adolescents aged 10–19
based in eight communities across six SSA countries, participating in the ARISE
Network Adolescent Health Study (N = 7,661). Outcomes of interest were cigarette
or tobacco use, alcohol use, other substance use, getting into a physical fight, no
condom use during last sexual intercourse, and suicidal behavior. We examined
the proportion of adolescents reporting these behaviors, and examined potential
effects of depressive symptoms [tertiles of 6-item Kutcher Adolescent Depression
Scale (KADS-6) score] and school-going status on these behaviors using mixed effects Poisson regression models. We also assessed effect modification of
associations by sex, age, and school-going status.
Results: The proportion of adolescents reporting risky behaviors was varied, from
2.2% for suicidal behaviors to 26.2% for getting into a physical fight. Being in the
higher tertiles of KADS-6 score was associated with increased risk of almost all
risky behaviors [adjusted risk ratio (RR) for highest KADS-6 tertile for alcohol use:
1.70, 95% confidence interval (95% CI): 1.48–1.95, p < 0.001; for physical fight:
1.52, 95% CI: 1.36–1.70, p < 0.001; for suicidal behavior: 7.07, 95% CI: 2.69–18.57,
p < 0.001]. Being in school was associated with reduced risk of substance use (RR
for alcohol use: 0.73, 95% CI: 0.53–1.00, p = 0.047), and not using a condom (RR:
0.81, 95% CI: 0.66–0.99, p = 0.040). There was evidence of modification of the
effect of school-going status on risky behaviors by age and sex. Conclusion: Our findings reinforce the need for a greater focus on risky behaviors
among adolescents in SSA. Addressing depressive symptoms among adolescents,
facilitating school attendance and using schools as platforms to improve health
may help reduce risky behaviors in this population. Further research is also
required to better assess the potential bidirectionality of associations.
Description
Research Article
Keywords
sub-Saharan Africa, adolescents, risky behavior
Citation
Partap U, Assefa N, Berhane Y, Sie A, Guwatudde D, Killewo J, Oduola A, Sando MM, Vuai S, Adanu R, Bärnighausen T and Fawzi WW (2023) The influence of depressive symptoms and school-going status on risky behaviors: a pooled analysis among adolescents in six sub-Saharan African countries. Front. Psychiatry 14:1171231. doi: 10.3389/fpsyt.2023.1171231