School-based prevalence and factors associated with depressive symptoms among secondary school adolescents in Mahagadhimai Municipality, Nepal

Depression is one of the most prevalent mental health disorders among adolescents globally and is a growing public health concern in Nepal. This study aimed to determine the school-based prevalence and factors associated with depressive symptoms among secondary school adolescents in Mahagadhimai Municipality, Nepal. An analytical cross-sectional study was conducted among 302 students in grades 11 and 12 from four public schools of Mahagadhimai Municipality, Madhesh Province, Nepal using multistage sampling. Depressive symptoms were assessed using the Centre for Epidemiological Studies Depression Scale (CES-D-20) via a self-administered questionnaire. Bivariate and multivariable logistic regression analysis were performed to identify the factors associated with depressive symptoms and results were presented as odds ratios (OR) with 95% CI. P < 0.05 was considered statistically significant. Nearly two-fifths of adolescents (39.70%) reported depressive symptoms, including 18.20% mild, 13.60% moderate and 7.90% severe depressive symptoms. Factors significantly associated with depressive symptoms included academic stress (AOR: 2.60, 95% CI: 1.48-4.56), problematic social media use (AOR: 2.93, 95% CI: 1.38-6.26), low support from friend (AOR: 2.14, 95% CI: 1.05-4.36) or other significant individuals (AOR: 2.09, 95% CI: 1.04-4.19). Poor help-seeking behavior such as keeping problems to oneself (AOR: 4.09, 95% CI: 2.19-7.64), not sharing concerns with parents (AOR: 2.21, 95% CI: 1.21-4.04) or friends (AOR: 2.51, 95% CI: 1.33-4.75) and low self-esteem (AOR: 2.16, 95% CI: 1.12-4.15). Sociodemographic characteristics showed no significant associations. Nearly two-fifths of secondary school adolescents reported depressive symptoms, which were independently associated with academic stress, problematic social media use, limited social support, poor help-seeking behavior and low self-esteem. While prospective studies are needed to establish causality, these findings highlight key psychosocial targets that should be prioritized in the development of future school-based mental health awareness and support strategies.