Cultural Factors Influencing Depression among Adolescents in Aseer Region, Saudi Arabia

Background: Adolescent depression is an escalating global concern, particularly in regions undergoing rapid social and cultural change. In Saudi Arabia, mental health disparities across regions remain insufficiently examined, especially in culturally unique settings such as Aseer Region. Objectives: This study aimed to determine the prevalence and severity of depression among adolescents in Aseer Region, Saudi Arabia and to explore the socio-demographic and cultural factors influencing mental health and help-seeking behaviors. Subjects and methods: A cross-sectional survey that included 516 adolescents was conducted between January and April 2025 among adolescents aged 12–18 years from urban and rural communities. Stratified random sampling was applied. Data were collected through an online questionnaire containing demographic items, the Patient Health Questionnaire-9 (PHQ-9) and culturally oriented questions addressing stigma and mental health beliefs. Results: Depression was highly prevalent, with varying degrees of severity. Significant associations emerged between depressive symptoms and gender, age, parental education, place of residence, family history of mental illness and cultural perceptions of stigma and emotional expression. Adolescents reporting higher stigma or limited family support were less inclined to seek professional help. Conclusion: Depression was common among adolescents in Aseer Region and was strongly shaped by socio-demographic and cultural determinants. Culturally responsive mental health strategies that reduce stigma, support early identification, and strengthen family and school-based support systems are urgently needed.