Depression and suicidal ideation among adolescent girls in refugee settlements in northern Uganda

Abstract

Depression is a leading cause of disability, morbidity, and mortality among adolescent girls in Africa, with varying prevalence across different populations. However, there is paucity of data on the burden of depression among priority groups in unique settings like adolescent girls living in refugee settlements, where access to mental health services including psychosocial support and psychiatric consultation is scarce. We conducted a cross-sectional, descriptive, observational study among adolescent girls from 4 selected refugee settlements in Obongi and Yumbe districts, Uganda. A multi-stage sampling, and cluster sampling techniques, where each settlement represented 1 cluster was done. Prevalence of depression was assessed using the patient health questionnaire-9 modified for adolescents, followed by the P4 screener assessment tool for suicidal risks. We performed modified Poisson regression analysis to establish predictors of depression. P < .05 was considered statistically significant. We included 385 participants with a mean age of 17 (IQR: 15-18) years. The prevalence of depression was 15.1% (n = 58, 95% confidence interval [CI]: 11.6-19.0). Overall, 8.6% (n = 33) participants had recent suicidal thoughts (within 1 month) and 2.3% (n = 9) attempted suicide. Participants who experienced pregnancy (adjusted prevalence ratio [aPR]: 2.4, 95% CI: 1.00-5.94, P = .049), sexual abuse (aPR: 2.1, 95% CI: 1.19-3.76, P = .011), and physical abuse (aPR: 1.7, 95% CI: 1.01-2.74, P = .044) were independently associated with depression. In this study, we found about one in every 6 adolescents living in refugee settlements of northern Uganda to suffer from depression, particularly among those who experienced adolescent pregnancy and various forms of abuses. Incorporating mental health care in the existing health and social structures within the refugee settlements, exploring legal options against perpetrators of sexual abuse and encouraging education is recommended in this vulnerable population.