Abstract

BackgroundAdvancing mental health among refugee and displaced adolescents and youth is critically important, as chronic psychological stress can have lifelong harmful impacts. These groups experience socio-environmental stressors that can harm mental health. Informed by a social contextual framework, this study explored the prevalence of depression among urban refugee and displaced youth in Kampala, Uganda and associations with symbolic (violence), relational (social support), and material (food and community insecurity) contexts.MethodsWe implemented a cross-sectional survey with refugee and displaced adolescent girls and young women and adolescent boys and young men aged 16–24 living in Kampala’s informal settlements. We conducted peer-driven recruitment, whereby peer navigators shared study information with their networks and in turn participants were invited to recruit their peers. We conducted gender disaggregated analyses, including stepwise multiple regression to examine factors associated with depression. We then conducted structural equation modeling (SEM) using weighted least squares estimation to examine direct paths from violence, food insecurity, and community insecurity to depression, and indirect effects through social support.ResultsAmong participants (n = 445), young women (n = 333) reported significantly higher depression symptoms than young men (n = 112), including any symptoms (73.9% vs. 49.1%, p < 0.0001), mild to moderate symptoms (60.4% vs. 45.5%, p = 0.008), and severe symptoms (13.5% vs 3.6%, p = 0.002). SEM results among young women indicate that the latent violence factor (lifetime sexual and physical violence) had direct effects on depression and social support, but social support did not mediate the path from violence to depression. The model fit the data well: χ2(3) = 9.82, p = 0.020; RMSEA = 0.08, 90% CI [0.03, 0.14], CFI = 0.96). Among young men, SEM findings indicate that food insecurity had direct effects on social support, and an indirect effect on depression through the mediating role of social support. Fit indices suggest good model fit: χ2(3) = 2.09, p = 0.352; RMSEA = 0.02, 90% CI [0.000, 0.19], CFI = 0.99.ConclusionsFindings reveal widespread depression among urban refugee and displaced youth in Kampala, disproportionately impacting young women. Contextual factors, including food insecurity and violence, increase depression risks. Strategies that reduce gender-based violence and food insecurity, and increase social support networks, have the potential to promote mental health among urban refugee and displaced youth.

Highlights

  • Advancing mental health among refugee and displaced adolescents and youth is critically important, as chronic psychological stress can have lifelong harmful impacts

  • Our study applied gender-stratified analyses [40] that revealed important differences in prevalence and correlates of depression symptoms with urban refugee and displaced youth. These findings can inform research and practice to advance mental wellbeing among urban refugee and displaced youth at large, with a particular relevance for Kampala

  • Social support mediated the pathway from food insecurity to depression, signalling its role as a protective factor for boys’ mental wellbeing. Taken together these findings underscore the importance of relational contextual factors in shaping mental wellbeing among urban refugee and displaced youth

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Summary

Introduction

Advancing mental health among refugee and displaced adolescents and youth is critically important, as chronic psychological stress can have lifelong harmful impacts. These groups experience socio-environmental stressors that can harm mental health. Halting psychological distress and promoting mental wellbeing among refugee and displaced adolescents and youth is critically important, as chronic psychological stress in this developmental phase can have harmful and lifelong impacts on neurobiological systems connected with emotional and behavioural regulation [2]. Social and environmental stressors in slums—such as elevated exposure to violence and poverty—may contribute to mental health challenges and yet are underexplored with urban refugee and displaced youth [11]

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