Exploring Multilevel Social Determinants of Depressive Symptoms Among Tanzanian Adolescents: Evidence From a Cross-Sectional Study

Abstract

Background: Depression has substantial and enduring impacts for adolescents, particularly those living in poverty. Yet, evidence on its determinants in low-income countries remains scarce. We examined the social determinants of depressive symptoms for Tanzanian adolescents. Methods: We used cross-sectional data for 2458 adolescents (aged 14-19), to describe associations with depressive symptoms within and across five domains—demographic, economic, neighbourhood, environmental, and social-cultural—using multilevel generalized linear models. We estimated depressive symptoms using the ten-item Centre for Epidemiological Studies Depression Scale, which ranges from zero to 30 and increases with additional symptoms. Findings: Factors associated with depressive symptoms in the fully adjusted models included experiencing five or more household economic shocks (β=2·40; 95% CI 1·48 to 3·32), experiencing droughts/floods (β=0.76; 95% CI 0.36 to 1.17), being in a relationship (β=1·82; 95% CI 1·30 to 2·33), and having moderate (β=1·26; 95% CI 0·80 to 1·71) or low (β=2·27; 95% CI 1·81 to 2·74) social support. Exclusive schooling was protective compared to being engaged in both school and paid work (β=1·07; 95% CI 0·05 to 2·61) and not engaged in either (β=0·73; 95% CI 0·24 to 1·22). Household size and relationship status were more important factors for females, while employment status, and extreme precipitation were more important for males. Interpretation: Mental health is associated with determinants from multiple domains. Results suggest that environmental shocks related to climate change contribute to poor mental health in adolescents, highlighting an important area for intervention and research. Funding: Oak Foundation, DFID, Sida, CHAIN-TNU, Erasmus Trustfonds Declaration of Interests: We declare no competing interests. Ethics Approval Statement: Ethics approval for the study was granted by the National Institute for Medical Research (NIMR/HQ/R.8a/Vol.IX/2784) and the Tanzania Commission for Science and Technology (COSTECH).