Self-reported Health, Anxiety, Depression, Insomnia, and Fatigue in Adolescents With Difficulties/disabilities in Developing Countries: A Cross-sectional Study in Educational Settings

Understanding and addressing mental health in adolescents with sensory (vision and hearing), physical, health and participation difficulties/disabilities is particularly relevant in low- and middle-income countries, where structural and educational barriers may intensify vulnerability. This study examined the associations between functional difficulties/disabilities and self-perceived health (SPH), insomnia, fatigue, anxiety and depression in adolescents, and estimated the risk of presenting these conditions according to disability status. A cross-sectional study was conducted with data from 34,604 adolescents aged 15–16 years from seven participating countries in the PISA Development Survey (PISA-D). A descriptive analysis was performed to characterise the sample. Non-parametric statistical tests were used to examine dependence between variables (chi-square test) and differences in proportions between groups (z-test for independent proportions). Finally, odds ratios with 95% confidence intervals were estimated for negative SPH, insomnia, fatigue, anxiety and depression in adolescents with versus without difficulty/disability conditions. Adolescents with functional difficulties/disabilities showed the highest risks for negative self-perceived health (OR up to 3.19), followed by fatigue (up to 2.46) and insomnia (up to 2.41). Increased risks were also observed for anxiety (up to 2.12) and depression (up to 2.05). All associations were statistically significant (p < 0.05). Targeted, school-based strategies are needed to identify and support these students early. This study shows consistent associations between sensory and physical difficulties/disabilities and multiple adolescent health indicators in developing countries. Adolescents with visual, hearing and especially dual sensory impairments showed increased risks of anxiety and depression. Findings underscore the need for inclusive educational and psychological supports tailored to adolescents with functional difficulties/disabilities.