Hemoglobin level and common mental disorder among school adolescent girls in Central Ethiopia: Structural Equation Model

The prevalence of common mental disorder (CMD) and anemia is observed to be on the rise over time, adversely affecting the health and overall quality of life among adolescents. Extensive literature corroborates the significant impact of anemia on cognitive development, intelligence and developmental milestones. Nevertheless, the linkage between hemoglobin level and CMD emerging during adolescence remains relatively unexplored. Thus, the objective of this study was to investigate the association between hemoglobin level and CMD as well as the mediating factor among school adolescent girls residing in Central Ethiopia. A cross-sectional study design was conducted among adolescent girls attending schools in Silti Woreda, Central Ethiopia, comprising a total sample size of 516 individuals during the period from October 2-20, 2023. Hemoglobin level was adjusted for altitude, while CMD was evaluated utilising the summation score of a 20-item Self-Reporting Questionnaire. Data were analysed through fitting Structural Equation Model and the maximum likelihood estimation method. Goodness of fit was assessed using the χ2The -test statistic, Comparative Fit Index, Root Mean Square Error of Approximation, Standardised Root Mean Square Residual, Non-Normed Fit Index, Pclose and coefficient of determination (R²). The prevalence of CMD was 22.3% (95% CI: 18.6%-25.8%). Hemoglobin level (UTE = -0.73, CI: -0.93, -0.53) and experience of morbidity symptoms (UTE = 1.05; CI: 0.74, 1.38) were significantly associated with CMD. Furthermore, hemoglobin level is significantly influenced by morbidity frequency symptoms (UDE = -0.63, CI = -0.77, -0.49) and animal source food (ASF) (UDE = 0.09, CI = 0.01, 0.17). Hemoglobin level has been identified as a significant mediator of the experience of morbidity symptoms and ASF on CMD. However, household food insecurity and wealth index had no significant association with CMD. A significant proportion of adolescent girls face CMD, often linked to a lower hemoglobin level. Having a significant association with CMD, the hemoglobin level is found to mediate a significant effect of morbidity symptom experience and ASF on CMD. Hence, addressing early infection prevention, promoting ASF and treating anemia are promptly needed.