Socio-ecological factors associated with probable depression among pregnant and parenting adolescent girls: findings from a cross-sectional study in Burkina Faso and Malawi

Plain English SummaryPregnant and parenting adolescents are at a higher risk of poor mental health. If unaddressed or untreated, the consequences may be dire throughout an individual's life. About one in four girls start childbearing before their 19th birthday in Africa. Most of these pregnancies are unintended or unplanned and occur outside wedlock, bringing untoward disruption to every facet of the girl's life. The burden of early parenthood and the stigma of starting childbearing too early and outside wedlock can affect the mental wellness of girls. Yet only a few studies have focused on understanding the burden and drivers of poor mental health among pregnant and parenting girls. Our study contributes to the research on depression among pregnant and parenting girls, highlighting its burden and individual, family, and community drivers. We conducted this study in Ouagadougou, Burkina Faso, and Blantyre, Malawi, between March and September 2021. A total of 980 and 669 pregnant and parenting girls were recruited into this study in Burkina and Malawi. Our analysis shows that 18.8% and 14.5% of pregnant and parenting girls in Burkina Faso and Malawi, respectively, had probable depression. Depression symptoms was higher when girls were older than 17 years, suffered violence from their partners, their partners denied paternity, received no support from their partners and parents, lived in violent neighborhoods, and had no support system in the community. We conclude that depression is high among pregnant and parenting girls. It necessitates screening them for depression during antenatal and postnatal care visits. To effectively address depression among these girls, interventions must canvass support at the family and community levels. BackgroundPregnant and parenting adolescent girls are at risk of poor mental health because of stigma and social exclusion. Despite one in four girls starting childbearing by the age of 19 in Africa, no study, to the best of our knowledge, has examined the multi-layered factors (individual, family, friends, and neighborhood-related factors) associated with depressive symptoms among pregnant and parenting girls in Africa. Our study contributes to addressing this gap by examining the socio-ecological factors associated with depression symptoms among pregnant and parenting adolescent girls.MethodsOur study adopted a cross-sectional design. Between March and September 2021, we interviewed 980 pregnant and parenting adolescent girls in Ouagadougou, Burkina Faso, and 669 in Blantyre, Malawi. We recruited pregnant and parenting adolescent girls in randomly selected urban and rural enumeration areas in Burkina Faso (n = 71) and Malawi (n = 66). We assessed depressive symptoms using the Patient Health Questionnaire (PHQ-9), which generated an overall score of 27. We considered a score of 10 or more as probable depression. We also obtained information on individual, family, friends, and neighborhood characteristics. We employed logistic regression models to examine the significant factors associated with probable depression among pregnant and parenting adolescent girls.ResultsThe prevalence of probable depression was 18.8% and 14.5% in Burkina Faso and Malawi, respectively. At the individual level, having secondary education was significantly associated with a lower likelihood of probable depression in Malawi (AOR: 0.47; 95% CI 0.27-0.82) but not in Burkina Faso. At the family level, denying paternity (AOR: 3.14; 95% CI 1.34-7.11 in Malawi) and no parental support (AOR: 2.08; 95% CI 1.22-3.55 in Burkina Faso) were associated with higher odds of probable depression. At the community level, perceived neighborhood safety was associated with a lower likelihood of probable depression in Malawi (AOR: 0.74; 95% CI 0.61-0.89) and Burkina Faso (AOR: 0.81; 95% CI 0.73-0.90). Having a safety net within the community was associated with lower odds of probable depression in Burkina Faso (AOR: 0.87; 95% CI 0.78-0.96) but not in Malawi.ConclusionDepressive symptoms are common among pregnant and parenting adolescents, suggesting the need to screen them regularly for depression during antenatal and postnatal visits. Factors associated with depression among pregnant and parenting girls operate at multiple levels suggesting a need for multilevel interventions that address all areas of vulnerabilities.