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      The influence of depressive symptoms and school-going status on risky behaviors: a pooled analysis among adolescents in six sub-Saharan African countries

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          Abstract

          Background

          Evidence from sub-Saharan Africa (SSA) regarding risky behaviors among adolescents remains scarce, despite the large population (approximately 249 million out of 1.2 billion globally in 2019) of adolescents in the region. We aimed to examine the potential influence of depressive symptoms and school-going status on risky behaviors among adolescents in six SSA countries.

          Methods

          We used individual cross-sectional data from adolescents aged 10–19 based in eight communities across six SSA countries, participating in the ARISE Network Adolescent Health Study ( N = 7,661). Outcomes of interest were cigarette or tobacco use, alcohol use, other substance use, getting into a physical fight, no condom use during last sexual intercourse, and suicidal behavior. We examined the proportion of adolescents reporting these behaviors, and examined potential effects of depressive symptoms [tertiles of 6-item Kutcher Adolescent Depression Scale (KADS-6) score] and school-going status on these behaviors using mixed-effects Poisson regression models. We also assessed effect modification of associations by sex, age, and school-going status.

          Results

          The proportion of adolescents reporting risky behaviors was varied, from 2.2% for suicidal behaviors to 26.2% for getting into a physical fight. Being in the higher tertiles of KADS-6 score was associated with increased risk of almost all risky behaviors [adjusted risk ratio (RR) for highest KADS-6 tertile for alcohol use: 1.70, 95% confidence interval (95% CI): 1.48–1.95, p < 0.001; for physical fight: 1.52, 95% CI: 1.36–1.70, p < 0.001; for suicidal behavior: 7.07, 95% CI: 2.69–18.57, p < 0.001]. Being in school was associated with reduced risk of substance use (RR for alcohol use: 0.73, 95% CI: 0.53–1.00, p = 0.047), and not using a condom (RR: 0.81, 95% CI: 0.66–0.99, p = 0.040). There was evidence of modification of the effect of school-going status on risky behaviors by age and sex.

          Conclusion

          Our findings reinforce the need for a greater focus on risky behaviors among adolescents in SSA. Addressing depressive symptoms among adolescents, facilitating school attendance and using schools as platforms to improve health may help reduce risky behaviors in this population. Further research is also required to better assess the potential bidirectionality of associations.

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          Most cited references30

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          Our future: a Lancet commission on adolescent health and wellbeing

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            Social media use and risky behaviors in adolescents: A meta-analysis

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              The prevalence of mental health problems in sub-Saharan adolescents: A systematic review

              Background and purpose Most research regarding child and adolescent mental health prevention and promotion in low-and middle-income countries is undertaken in high-income countries. This systematic review set out to synthesise findings from epidemiological studies, published between 2008 and 2020, documenting the prevalence of mental health problems in adolescents from across sub-Saharan Africa. Methods A systematic search of multiple databases (MEDLINE, PsycINFO, Scopus) and Google Scholar was conducted guided by the Joanna Briggs Institute (JBI) Reviewer’s manual for systematic reviews of observational epidemiological studies. Studies included reported prevalence outcomes for adolescents aged 10–19 using either clinical interviews or standardized questionnaires to assess psychopathology. Clinical samples were excluded. Results The search yielded 1 549 records of which 316 studies were assessed for eligibility and 51 met the inclusion criteria. We present a qualitative synthesis of 37 of these 51 included articles. The other 14 studies reporting prevalence rates for adolescents living with HIV are published elsewhere. The prevalence of depression, anxiety disorders, emotional and behavioural difficulties, posttraumatic stress and suicidal behaviour in the general adolescent population and selected at-risk groups in 16 sub-Saharan countries (with a total population of 97 616 adolescents) are reported.
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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                24 July 2023
                2023
                : 14
                : 1171231
                Affiliations
                [1] 1Department of Global Health and Population, Harvard T.H. Chan School of Public Health , Boston, MA, United States
                [2] 2School of Public Health, College of Health and Medical Sciences, Haramaya University , Dire Dawa, Ethiopia
                [3] 3Addis Continental Institute of Public Health , Addis Ababa, Ethiopia
                [4] 4Nouna Health Research Center , Nouna, Burkina Faso
                [5] 5Department of Epidemiology and Biostatistics, Makerere University School of Public Health , Kampala, Uganda
                [6] 6Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences , Dar es Salaam, Tanzania
                [7] 7University of Ibadan Research Foundation, University of Ibadan , Ibadan, Nigeria
                [8] 8Africa Academy for Public Health , Dar es Salaam, Tanzania
                [9] 9College of Natural and Mathematical Sciences, University of Dodoma , Dodoma, Tanzania
                [10] 10Department of Population, Family and Reproductive Health, University of Ghana School of Public Health , Accra, Ghana
                [11] 11Heidelberg Institute of Global Health, University of Heidelberg , Heidelberg, Germany
                [12] 12Africa Health Research Institute , KwaZulu-Natal, South Africa
                [13] 13Department of Epidemiology, Harvard T.H. Chan School of Public Health , Boston, MA, United States
                [14] 14Department of Nutrition, Harvard T.H. Chan School of Public Health , Boston, MA, United States
                Author notes

                Edited by: Ruth Aston, The University of Melbourne, Australia

                Reviewed by: Sandhya Yatirajula, George Institute for Global Health, India; Valeriane Leroy, Institut National de la Santé et de la Recherche Médicale (INSERM), France

                *Correspondence: Uttara Partap, upartap@ 123456hsph.harvard.edu
                Article
                10.3389/fpsyt.2023.1171231
                10406520
                37555002
                eee0c3fc-d5a9-4551-82ff-9527d3a13f7c
                Copyright © 2023 Partap, Assefa, Berhane, Sie, Guwatudde, Killewo, Oduola, Sando, Vuai, Adanu, Bärnighausen and Fawzi.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 21 February 2023
                : 10 July 2023
                Page count
                Figures: 0, Tables: 5, Equations: 0, References: 31, Pages: 9, Words: 7381
                Categories
                Psychiatry
                Original Research
                Custom metadata
                Adolescent and Young Adult Psychiatry

                Clinical Psychology & Psychiatry
                sub-saharan africa,adolescents,risky behavior,depressive symptoms,schools

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