Abstract
BACKGROUND: Schools could play a vital role in mental health care, particularly in low-income countries such as Uganda. An understanding of the prevalence and associated factors of mental health symptoms among school-going adolescents is essential for designing effective school-based interventions in Uganda This is important given Uganda's regional disparities, where adolescents in post-conflict areas may face higher exposure to trauma and limited access to mental health care compared to those in non-conflict regions. This study aimed to investigate the prevalence rates of depressive and anxiety symptoms among school-going adolescents aged 14 to 17 years in both post-conflict and non-conflict settings. It also examines factors associated with moderate depressive and anxiety symptoms in both settings. METHODS: In total, 2845 school-going adolescents (1,273 boys; 16.3 ± 1.0 years) were screened using the Patient Health Questionnaire-9 - adolescent version, Generalized Anxiety Disorder-7, and self-report items on food insecurity, health and wealth status, history of childhood abuse and neglect and level of physical activity. Logistic regression models were applied to examine predictors of moderate to severe levels of depression and anxiety symptoms. RESULTS: Findings indicate that 67.5% (n = 1905) reported at least mild, 34.1% (n = 962) at least moderate, 12.7% (n = 359) at least moderate-severe and 4.9% (n = 138) severe symptoms of depression, while 65.6% (n = 1860) at least mild, 27.5% (n = 777) at least moderate and 7.8% (n = 219) severe symptoms of anxiety. In the multivariable analyses, female sex, food insecurity, poor self-reported health, co-morbid anxiety symptoms, and a history of abuse and neglect were all significantly associated with a higher odds of moderate symptoms of depression, while female sex, living in a post-conflict setting, food insecurity, poor self-reported health, co-morbid depressive symptoms, and a history of abuse were all significantly associated with a higher odds of moderate anxiety symptoms. CONCLUSIONS: A substantial proportion of school-going adolescents in Uganda report at least moderate symptoms of depression and anxiety. Government and public sector agencies should re-evaluate their strategies at both family and school levels, particularly in underserved settings. Schools can serve as platforms for screening-and-referral pathways and group-based psychosocial programs, while the health system should strengthen capacity for co-occurring conditions.