Family system disruptions, probable depression and stress levels among caregivers of children aged 0–17 years in Uganda: evidence from baseline data of a cluster randomized controlled trial

BACKGROUND: Probable depression and stress significantly burden Ugandan caregivers, with prevalence rates up to 30%. Stress triggers harsh discipline, while depression leads to neglect. Guided by Family Systems Theory (FST), this study used Parenting for Respectability (PfR) programme data to examine how family system disruptions especially past exposure to violence, household size and partner status affect caregiver mental health outcomes to inform context-specific parenting interventions. METHODS: Baseline data from 2,314 caregivers in the PfR cRCT (2021-2022) were analysed. Data on demographics, probable depression and Stress were collected using structured questionnaires. Mixed-effects regression models, adjusting for clustering, examined the associations between family system disruptions and probable depression and stress using STATA 16.0. RESULTS: Among 2,314 caregivers, 53.4% were female, with a mean age of 37.9 ± 11.9 years. Nearly half reported depressive symptoms (47.4%, 95% CI: 45.3%-49.4%), and the mean parental stress score was 36.5 ± 15.9. Family system disruptions were significant predictors of poor mental health: past exposure to violence showed a strong, consistent association with both depression (β range: 0.28-0.36) and stress (β range: 0.38-0.49). We report adjusted beta coefficients β (95% CI). Regarding household structure, being a single mother 1.48 (0.21, 2.71), residing in a large household 1.53 (0.86, 2.20), and caregiver disability 1.58 (0.11, 3.05) were significantly linked to increased symptoms. Conversely, having a partner was strongly protective against both probable depression - 4.41 (- 5.87, - 2.96) and stress - 2.87 (- 4.01, - 1.73). Compared with caregivers aged 18-30, those aged 31-40 and 41-50 had higher probable depression: 1.96 (0.95-2.97), 2.59 (1.44-3.73), and stress: 2.28 (1.50-3.07), 2.98 (2.10-3.87) respectively. Those > 50 reported highest stress: 3.55 (2.58-4.52). Female caregivers had higher depression and stress, while social support and equitable gender norms reduced distress. CONCLUSION: Family system disruptions influence caregiver mental health. Stress and depressive symptoms were higher among caregivers aged 31-50 compared to those aged 18-30. Targeted interventions should focus on violence-exposed, middle-aged, and female caregivers by strengthening social support and providing skills to identify and manage early mental health symptoms.