Prevalence and correlates of anxiety and depressive symptoms among adolescents aged 10–19 years in six sub-Saharan African countries, China and India: A cross-sectional study

Although adolescence (10-19 years) signifies a vulnerable phase for the onset of depression and anxiety, research on the symptoms of these mental health conditions is scarce in low- and middle-income countries. This study examined the prevalence and correlates of anxiety and depressive symptoms among adolescents in six sub-Saharan African countries (SSA), China, and India, where these conditions are often underdiagnosed, highlighting the need for evidence to support culturally appropriate interventions. We analyzed cross-sectional survey data from 9,849 adolescents in Burkina Faso, Ethiopia, Ghana, Nigeria, Tanzania, Uganda, China, and India. The Patient Health Questionnaire (PHQ-4) assessed the prevalence of anxiety and depressive symptoms. Log-linear regression models estimated the relative risk and 95% confidence intervals (CI) for the correlates of anxiety and depressive symptoms. The overall prevalence of anxiety and depressive symptoms was 11.3% (95%CI 10.6-11.9%) and 9.9% (95%CI 9.3-10.5%), respectively. Prevalence varied significantly across countries (p-value<0.001), with high rates of anxiety and depressive symptoms found in China (26.3%, 17.0%), Ghana (17.6%, 19.6%), and Nigeria (13.2%, 13.7%). Adolescents aged 15-19 years, females, with low socioeconomic status (SES), who visited a health facility, those with a history of alcohol use, or those who experienced multiple serious injuries in the past year, had an increased risk of anxiety and depressive symptoms. Adolescents with regular physical activity had a reduced risk of anxiety and depressive symptoms. Anxiety and depressive symptoms are common among adolescents in China, Ghana, and Nigeria, but relatively rare in India and Ethiopia. These symptoms of mental health issues are associated with socio-demographic characteristics and behaviors. These findings suggest a need for policies promoting healthy lifestyles and programs to reduce risks among adolescents through physical activity, integrated mental health screening, and substance use prevention, particularly for older adolescents, females, those with a low SES, and those with a history of substance use.