Western Cape researchers are concerned after findings that 33% of 10- to 14-year-olds had experienced symptoms like sadness and hopelessness, with more than 80% having endured school bullying, and with girls being the most affected.
Little research has been done on depression and anxiety among South African adolescents in this age sector, existing studies having primarily targeted older adolescents and those with HIV.
In The Conversation, study team Mirriam Mkhize, Claire van der Westhuizen and Katherine Sorsdahl from the University of Cape Town write that this critical age group has been neglected, despite half of all mental health problems developing before the age of 14.
They write:
Our study targeted these adolescents in 10 schools in under-resourced areas within Cape Town and the Winelands, where, working with community-based organisations offering psychological and social support and counselling, we recruited 621 teenagers aged between 10 and 14 from 10 primary schools.
The criteria included adolescents who: (1) were enrolled in the selected schools in the province; (2) were aged 10 to 14 years; (3) provided assent; and (4) had caregivers who provided consent for their participation.
Using a tablet-based survey, we gathered information on socio-demographic factors, mental health symptoms, substance use, bullying, punishment, witnessing violence at home and self-esteem.
Mental health symptoms were measured with internationally accepted screening tools, namely the Patient Health Questionnaire for Adolescents for depression symptoms and the Generalised Anxiety Disorder Scale 7 for symptoms of anxiety.
Most of the adolescents were female (61%) and the average age was 12 years. More than half (58.6%) lived with a single parent and 15.3% did not live with either of their parents.
More than two-thirds spoke two languages at home, with 402 (64.7%) speaking English, 321 (51.2%) speaking isiXhosa, 112 (18.0%) speaking Afrikaans, and 60 (9.7%) speaking another language.
What we found
We found that a high percentage of adolescents reported bullying at school (80.5%), witnessing violence at home (78.6%), and being exposed to punishment by caregivers (56.4%).
A significant portion had tried alcohol at least once (23.8%).
Depression: 33% experienced symptoms of depression, like feeling sad or down, irritability, hopelessness, trouble sleeping, appetite changes and difficulty concentrating. Depressive symptoms were linked with being in a higher grade in school, alcohol consumption, the use of other drugs, and witnessing violence among adults at home.
Anxiety: 21% reported symptoms of anxiety. These included difficulty controlling worry, feeling afraid or scared, feeling irritable, trouble concentrating and feeling restless. Significant associations were found with being in a higher school grade, poor emotional regulation skills, and cannabis use.
Help
Although the high levels of depression and anxiety symptoms do not indicate a definite diagnosis for each of these youngsters, these figures are very concerning for this age group. They highlight the urgent need for comprehensive mental health support in schools.
To address this gap, the researchers are piloting the World Health Organisation’s Early Adolescent Skills for Emotions (EASE) programme at some of the schools in the province.
EASE is a group psychological intervention for 10- to 14-year-olds and their caregivers, which can be delivered by non-specialist providers to improve their mental health.
Study details
Prevalence and factors associated with depression and anxiety among young school-going adolescents in the Western Cape Province of South Africa
Mirriam Mkhize, Claire van der Westhuizen, Katherine Sorsdahl.
Published in Comprehensive Psychiatry in May 2024
Abstract
Introduction
Between 10 and 20% of children and adolescents globally experience common mental health conditions such as depression or anxiety. Given the dearth of mental health services in low- and middle-income countries, most mental health conditions among adolescents remain undiagnosed and untreated. In South Africa, few studies have explored the prevalence of depression and anxiety among young adolescents aged 10–14 years. This study examined the prevalence of, and factors associated with depression and anxiety among young school-going adolescents in the Western Cape Province of South Africa.
Methods
A cross-sectional study was conducted in 10 schools in the Western Cape Province from February to July 2022. Data were collected using a tablet-based survey and included sociodemographic items, the Generalized Anxiety Disorder 7-item scale (GAD-7), the Patient Health Questionnaire for Adolescents (PHQ-A) and other psychosocial measures. The prevalence of depression and anxiety was estimated based on cut-off scores for the GAD-7 and PHQ-A. Multivariable logistic regression models were used to investigate the associations between sociodemographic and psychosocial factors, and depression and anxiety.
Results
Of the 621 adolescents, 33.5% (n = 208) reported experiencing symptoms of depression and 20.9% (n = 130) symptoms of anxiety potentially indicative of a diagnosis. The results of the multivariable logistic regression model indicate that being in a higher grade in school (AOR = 1.65, CI:1.43–1.92), any lifetime alcohol use (AOR = 1.62, CI:1.04–2.64), other drug use (AOR = 2.07, CI:1.06–4.04), and witnessing violence among adults at home (AOR = 2.12, CI:1.07–1.41) were significantly associated with experiencing depressive symptoms. Being in a higher grade in school (AOR = 1.69, CI: 1.42–2.01), poor emotional regulation skills (AOR = 1.03, CI: 1.00–1.07), and the use of cannabis (AOR = 1.03, CI: 1.00–1.07) were significantly associated with experiencing anxiety symptoms.
Conclusion
These findings add to our understanding of school-going adolescents' pressing mental health needs and suggest that mental health adolescent and caregiver interventions may be required to address mental health symptoms and associated risk factors.
See more from MedicalBrief archives:
The triple A approach to tackling South Africa’s mental health challenges
Wellcome Data Prize to help understand young South Africans’ mental health crisis
Half an hour of physical activity reduces depression risk – SA study