MENTAL HEALTH PROBLEMS AMONG IN-SCHOOL ADOLESCENTS IN HARARI REGIONAL STATE , EASTERN ETHIOPIA

Abstract

Background: Mental health problems are a significant public health concern among adolescents. Evidence showed that 14% of the world's 1.2 billion adolescents suffered from mental illnesses. In connection with this, over 46,000 adolescents commit suicide each year, placing it among the top five causes of mortality. People with mental health issues are also more likely to develop physical health problems, obtain poor health care, and adhere less to treatment, all leading to poor physical health outcomes, including early death. However, adolescents' mental health problems, various attributes, and associations with quality of life have not been studied in Eastern Ethiopia. Therefore, this study aimed to assess the magnitude and socio-demographic correlates of mental health problems, their association with social capital, and quality of life among in-school adolescents in Harari regional state, Eastern Ethiopia.

Methods and Materials: A school-based cross-sectional study was conducted among 3227 in-school adolescents. Multistage sampling technique was used to select study participants. We used guided, self-administered, standardized questionnaires to collect the data. A strength and difficulty questionnaire (SDQ), the social capital questionnaire for adolescent students (SCQ-AS), and the KIDSCREEN-10 were used to assess mental health issues, the social capital and health-related quality of life (HrQoL), respectively. Epidata version 3.1 and STATA version 14.1 software were used for data entry and analysis, respectively. An ordinal logistic regression model investigated the relationship between each objective's outcome and independent variables. The result was reported using an odds ratio and a 95% confidence interval (CI). A p-value < 0.05 was considered statistically significant.

Results: The overall magnitude of mental health problems was 22.93% (95% CI: 22; 24), of which 24.17% (95% CI: 22.72; 25.67) was internalizing and 11.93% (95% CI: 10.85; 13.09) was externalizing problems. Social capital domains such as increased school friend networks (AOR = 0.75, 95% CI: 0.58–0.99), high neighborhood or school trust (AOR = 0.52, 95% CI: 0.44-0.63), and high social cohesion in the community (AOR = 0.75, 95% CI: 0.62-0.89) were associated with a deceased odds of mental health problems. Similarly, adolescents with abnormal (AOR = 0.48, 95% CI: 0.39, 0.59) and borderline (AOR = 0.59, 95% CI: 0.45, 0.78) levels of internalizing problems had 52% and 41% lower odds of having high HrQoL compared to those with normal levels. Furthermore, the odds of having a high HrQoL were 41% and 36% lower for adolescents with abnormal (AOR = 0.59, 95% CI: 0.45, 0.77) and borderline (AOR = 0.64, 95% CI: 0.45, 0.92) levels of externalizing problems.

Conclusion: Internalizing and externalizing mental health problems are high among in-school adolescents in eastern Ethiopia, where higher social capital was associated with decreased odds of the problems. A high score for internalizing and externalizing mental health problems had an adverse impact on the adolescents’ health-related quality of life. This highlights the need to address mental health issues in the school setting through screening, early detection, and treatment of internalizing and externalizing problems to improve adolescents' health-related quality of life. Tailored intervention targeting prevention strategies should consider the social capital at the individual, school, household, and neighborhood level to reduce adolescent mental health problems.