Assessing the associated factors of anxiety and depression among the adult population to harness the demographic dividend in Nepal using the socio-ecological model

Anxiety and depression are major global public health concerns and a growing mental health burden among working-age adults, potentially hindering low- and middle-income countries from realizing the demographic dividend. This study aims to examine associated factors with anxiety and depression among adults using a socio-ecological model. This study used secondary data from the Demographic and Health Survey (DHS) 2022 of Nepal among adults aged 15–49 years. Anxiety and depression were measured using GAD-7 and PHQ-9 and categorized as binary outcomes. Multivariable binary logistic regression was performed using complex sample analysis, accounting for stratification, clustering, and sampling weights to identify associated factors. The prevalence of anxiety and depression was higher among women (21.9% and 21.1%, respectively) than among men (11.3% and 11.1%, respectively). Among women, higher odds of anxiety and depression were observed among widowed/divorced/separated (AOR = 1.813 for anxiety;1.850 for depression), smokers (AOR = 1.615;1.528), those in the poorer wealth group (AOR = 2.033;1.848), and residents of Karnali province (AOR = 1.831;1.667) compared to their respective reference groups. Similarly, among men, higher odds were found among widowed/divorced/separated (AOR = 3.980;2.844), smokers (AOR = 1.583;1.354), those in the poorer wealth group (AOR = 2.094;2.280), and residents of Karnali province (AOR = 4.190;6.079), compared to their respective reference groups, respectively. Harnessing demographic dividend requires prioritizing mental health through a comprehensive multisectoral approach that addresses not only existing individual-level anxiety and depression but also underlying interpersonal, community and societal factors such as structural disparities, economic inequalities, and uneven development across regions through coordinated actions across health, education, employment, social protection, culture-sensitive, and region-specific responsive strategies.