Prevalence and Factors Associated with Depression among Hill-Tribe High School Students in Chiang Rai Province, Thailand: A Multilevel Cross-Sectional Study

Background: Depression is a major mental health problem. High school-age adolescents living in the hill tribe villages are especially susceptible to depression due to their remote living environment and stigmatization, a situation that has been exacerbated by the COVID-19 pandemic. Objective: To estimate the prevalence and determine the associations of individual and contextual factors with depression among hill-tribe high school students in Chiang Rai Province, Thailand, during the COVID-19 crisis. Materials and Methods: A school-based, multilevel cross-sectional study was conducted. Participants were randomly selected from 18 classes of six high schools located in the hill tribe villages of Chiang Rai Province, Thailand. A validated questionnaire and the Patient Health Questionnaire for Adolescents (PHQ-A) were used to collect data. The present study was conducted between May and September 2022.The data were analyzed by the multilevel binary logistic regression at a significance level of α<0.05. Results: A total of 540 hill tribe high school students were recruited for the analysis, 71.3% were female, 81.7% were Thais, and the mean age was 16.81 years. The overall prevalence of depression was 21.9% (95% CI 18.4 to 25.4). In the multivariate multilevel analysis, nine variables were found to be significantly associated with depression: underlying disease, perceived stress, negative life events, smartphone addiction, family functioning, peer group relationship, social stigma, and study program. Conclusion: A substantial proportion of the hill-tribe high school students suffered with depression during the COVID-19 pandemic. Appropriate public health interventions should be developed and implemented to reduce the problem by focusing on those who had underlying diseases, perceived stress, negative life events, anxiety, and smartphone addiction. Moreover, implementation should be integrated into their families, peers, and social environments.