Prevalence and predictors of depressive symptoms among school-going adolescents in Kenya

Depression is a growing concern among adolescents, particularly in low- and middle-income countries (LMICs), such as Kenya, where mental health issues often remain unaddressed. This study assessed the prevalence and predictors of probable depression among adolescents in selected public secondary schools in rural Kenya during the post-COVID-19 era.This cross-sectional study was conducted among adolescents aged 13-19 years selected from thirty (30) public secondary schools in rural Kenya via a two-stage cluster sampling method. The calculated sample was distributed proportionally across schools by type, gender, and grade to ensure representativeness. Written informed consent and assent were obtained from all the respondents. The Patient Health Questionnaire for Adolescents (PHQ-A) was used to screen for probable depression and a cutoff of ≥ 10 was adopted. The CRAFFT (Car, Relax, Alone, Forget, Friends, and Trouble) and Childhood Adolescent Trauma Screener (CATS) tools screened for substance use and trauma exposure, respectively. The study had 1,020 participants (467 males,553 females) with a median age of 17 years (range 13-19 years) and a response rate of 98.3%. Overall prevalence for probable depression was 52.6% based on the PHQ-A cut-off of ≥ 10. Approximately 5% (47) of the participants were at high risk for substance use-related problems, whereas 17.2% (173) exhibited probable posttraumatic stress disorder (PTSD). Age, living away from one's parents, school related pressure, conflicts at home, trauma exposure, and a history of substance use were strongly linked to probable depression. Conversely, living with parents, holding religious beliefs, having accessed guidance and counselling services and having a trusted adult to confide in were associated with a reduced risk for probable depression. Cumulatively, prevalence of probable depression was significantly high among the participants and strongly correlated with psychosocial factors underscoring the importance of integrating routine mental health screening into school health programs.