PREVALENCE AND CORRELATES OF MENTAL DISORDERS AND MALNUTRITION AMONG SCHOOL-GOING ADOLESCENTS IN THE EASTERN REGION OF FREETOWN, SIERRA LEONE

Abstract

Background Across the life cycle, adolescence marks a critical transition period for physical, psychological and social growth and development. Adolescents are vulnerable to mental and physical health challenges, which adversely impact on their successful navigation into adulthood. In Western countries, it has been reported that nutrition has both beneficial and adverse impacts on the mental and physical health of young people. Several studies have revealed an association between mental, physical and social health of adolescents. Despite this established link, there is a paucity of information on the prevalence and correlates of mental disorders and malnutrition among adolescents in Freetown, Sierra Leone. This study aimed to assess the relationship between mental and nutritional health in school-going adolescents in the Eastern region of Freetown.

Methodology A cross-sectional descriptive study was carried out among school-going adolescents. Five senior secondary coeducational schools were randomly selected from three geopolitical wards in the Eastern region of Freetown. A total of 550 randomly selected senior secondary school (SSS) students were selected to participate in the study. A socio-demographic questionnaire, the Global School Health questionnaire (GSHQ), the DISC Predictive Scales (DPS) and the Becks Depression Inventory (BDI) were given to the students to complete with some supervision provided by the researcher. Information on personal, family, and school-related, major life events, dietary and sexual behavior, physical activity, substance and alcohol use and symptoms of common mental disorders were obtained from the self-administered questionnaires. In addition, each participating student had anthropometric measurements taken and a clinical examination. Prevalence of common mental disorders and forms of malnutrition among participants were presented using percentages. Chi-square was used to establish any significant association between categorical variables and mental disorders or malnutrition and logistic regression analysis was further applied to determine variables that were independent predictors of common mental disorders and malnutrition.

Results A total of 471 SSS students with a male-to-female ratio of 1:1.2 fully completed the questionnaires and allowed for a physical examination. Their ages ranged from 15 to 19 years with a mean age of 17.8 years [SD=1.3]). Majority (77.7%) of the students reported being Muslim and two-thirds (68%) were from a monogamous family setting. The prevalence of depression among the students in the past 12 months using the DPS screening tool was 24% and 28% with the BDI. Approximately 14.3% and 9.7% of students reported suicidal ideation and suicidal attempt in the past one year respectively, while 11.6% met the screening criteria for social phobia. Other prevalence rates for mental health problems were conduct disorder in 17.6%, oppositional defiant disorder in 5.3%, alcohol use in 12.7% and psychoactive substance use (lifetime) in 10%. Elimination problems such as enuresis and encopresis were found in 21.4% and 10% respectively. With regards to malnutrition 18.3% had stunting, 6.2% were underweight, while 18.7% and 2.5% were overweight and obese respectively. Psychosocial correlates of common mental disorders in the past 12 months found to be statistically significant were family dysfunction, occupation of parents, parental smoking or poor monitoring, poor academic performance, frequent hunger, less intake of fruits, drinking alcohol, cigarette smoking and having experience traumatic event. Alcohol use (p=0.036; 95% CI=0.30-0.98), poor academic performance (p=0.04; 95% CI =2.08 10.88), involvement in a fight (p=0.035; 95% CI=0.45-0.91), poor parental monitoring (p=0.016; 95%CI=1.10-3.60) and parental smoking (p=0.004; 95% CI=1.07- 1.44) were strongly and independently predictive of a positive screen for depression. Frequent hunger (p=0.033; 95%CI 0.25-0.94), poor academic performance (p=0.023; 95%CI=1.186-10.498), cigarette smoking (p=0.03; 95%CI 1.01-1.49) and having had a serious injury (p=0.02; 95% CI=1.28-7.49) were strong predictors of suicidal ideation/attempt. Being a male (p=0.001; 95% CI=1.58-4.28), truancy (p=0.008; 95%CI=0.29-0.83) and alcohol use (p=0.004; 95% CI=0.17-0.71) were strongly and independently predictive of conduct disorder. Stunting was more likely to occur in participants whose mothers engaged in unskilled occupations (p=0.048; χ2 =3.08). Being underweight was significantly associated with suicidal attempts (p=0.029; χ2=9.050) but did not independently predict it (p=0.234; CI 0.418-35.38). Majority of the students (90%) had no obvious physical disability and about half (47%) were at Tanner stage V of sexual development.

Conclusion Mental health problems and malnutrition are prevalent among school-going Senior Secondary School students in Freetown. Several psychosocial factors are strongly and independently linked with their occurrence. This further buttresses the urgent need for policymakers to prioritize and invest in ensuring optimal mental and physical health for the growing adolescent.