Exploring multilevel social determinants of depressive symptoms for Tanzanian adolescents: Evidence from a cross-sectional study

Leah Prencipe*, Tanja A.J. Houweling, Frank J. Van Lenthe, Tia M. Palermo, Lusajo Kajula

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Scopus)
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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 linear mixed models. We estimated depressive symptoms using the 10-item Centre for Epidemiological Studies Depression Scale, which ranges from 0 to 30 and increases with additional symptoms. Results 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 with 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 girls, while employment status, and extreme precipitation were more important for boys. Conclusion 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.

Original languageEnglish
Pages (from-to)944-954
Number of pages11
JournalJournal of Epidemiology and Community Health
Issue number10
Publication statusPublished - 1 Oct 2021

Bibliographical note

Funding Information:
Funding Funding for the Cash Plus pilot and evaluation has been provided by Oak Foundation (#OCAY-16-73) and UNICEF. Additional funding for the evaluation was provided by the UK’s Department of International Development (DFID 203529-102) and the Swedish Development Cooperation Agency (Sida G41102), both through a grant to UNICEF Office of Research—Innocenti supporting the Transfer Project. Additional funding for implementation activities was provided by Irish Aid. Additional funding for analysis and write-up of this manuscript was provided to TAJH and LP by the D.P. Hoijer Fonds, Erasmus Trustfonds, Erasmus University Rotterdam, The Netherlands and though a grant awarded by the Norwegian Research Council (project number 288638) to the Centre for Global Health Inequalities Research (CHAIN) at the Norwegian University for Science and Technology (NTNU). The funders had no role in analysis or interpretation of data.

Publisher Copyright:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.


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