The prevalence and risk factors of symptoms of depression, anxiety and somatic syndromes among ...

101 Pages·2017·5.13 MB·English

The prevalence and risk factors of symptoms of depression, anxiety and somatic
syndromes among secondary school students in Kampala, Uganda
Student name: James Roger Nsereko
Promotor: Dr. R. Roomaney
Dissertation presented for the degree of MPhil in Public Mental Health in the
Faculty of Arts and Social Sciences at Stellenbosch University
Date: March 2018
Stellenbosch University https://scholar.sun.ac.za
Declaration
I James Roger Nsereko, hereby declare that the work contained in this thesis is my original
work. I have not previously (in its entirety or in part) submitted it to any institution for any
award.
Signed:
James Roger Nsereko
Date : March 2018
Copyright © 2018 Stellenbosch University
All rights reserved
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Abstract

Aim: The aim of this study was to investigate the prevalence of symptoms of depression,
anxiety and somatic syndromes and to examine the association of these conditions with socio-
demographic factors (i.e. age, gender and family composition) in secondary school students in
Kampala.
Methods: Participants were selected from six schools, randomly drawn from Nakawa and
Makindye division in Kampala, Uganda. The participants were 549 adolescents, aged 14-17
years. Participants completed a battery of measures including a socio-demographic
questionnaire, Youth Self-Report (YSR) - DSM oriented scales for depression, anxiety and
somatic syndromes. Descriptive, bivariate and multivariate analysis were used to determine
the prevalence of depression, anxiety and somatic syndromes and associations between these
syndromes and demographic variables.
Results: Prevalence of symptoms of depression was 21.1% (95% CI 17.8% -24.6%), anxiety
was 38.5% (95% CI 34.9% - 42.6%) and somatic syndromes was 42% (95% CI 37.8% -
45.9%). There was a high comorbidity among conditions under study, with 31.4% of
respondents meeting the criteria for at least two conditions. Symptoms of depression were
significantly associated with gender, religion, and living arrangement. Symptoms of anxiety
were only associated with gender, whereas somatic syndromes were significantly associated
with gender, and living arrangement.
Conclusion: Symptoms of depression, anxiety and somatic syndromes were prevalent among
adolescents in schools in this study. Findings indicate that girls were more at risk of developing
symptoms of depression, anxiety and somatic syndromes than boys. Furthermore adolescents
not living with their biological parents were more vulnerable to depression and somatic
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syndromes than those living with both parents. These findings highlight the need to put in place
mechanisms for monitoring and addressing psychological problems in schools.

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Acknowledgement

In a special way, I would like to thank my supervisor Dr. Rizwana Roomaney for the
guidance and mentorship, motivation and inspiration that has enabled me to produce this
piece of work. Your reflective questions have helped me to deeply reflect on concepts. I also
thank you for being patient with me and being supportive whenever I had challenges.
I would also want to thank the AFrica Focus on Intervention Research for Mental
health (AFFIRM) project for extending me the opportunity to do this MPhil program. My
MPhil (Public Mental health) program and this study have been sponsored by the AFFIRM
project. I also extend my thanks to the entire AFFIRM fraternity, Dr. Katherine Sorsdahl for
the mentorship and support. Thank you for inspiring us to be innovative researchers.
I also thank the adolescents who participated and all those who wanted to but did not
have a chance. Thank you for understanding the importance of research. Thank you for
representing adolescents in school in various parts of the world.
To my special circle of friends, and my family. Thank you for sparing time to
encourage, support and refocus me.

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Table of Contents
The prevalence and risk factors of symptoms of depression, anxiety and somatic
syndromes among secondary school students in Kampala, Uganda...................................... 1
Declaration ...................................................................................................................... i
Abstract .......................................................................................................................... ii
Acknowledgement .......................................................................................................... i
Table of Contents ........................................................................................................... ii
List of Tables ................................................................................................................. v
List of Appendices ........................................................................................................ vi
Chapter 1 ........................................................................................................................ 1
Introduction .................................................................................................................... 1
1.1 Background .......................................................................................................... 1
1.2 Significance of the study ...................................................................................... 2
1.3 Aim ...................................................................................................................... 3
1.4 Objectives ............................................................................................................ 3
Chapter 2 ........................................................................................................................ 1
Literature Review........................................................................................................... 1
2.1 Introduction .......................................................................................................... 1
2.2 Prevalence of Depression ..................................................................................... 1
2.3 Prevalence of Anxiety disorders .......................................................................... 2
2.4 Prevalence of Somatic Complaints ...................................................................... 3
2.5 Co morbid conditions associated with Depression .............................................. 4
2.6 Comorbid conditions associated with Anxiety Disorders .................................... 5
2.7 Comorbid conditions associated with Somatic Syndromes ................................. 6
2.8 Socio-demographic factors .................................................................................. 6
2.8.1 Gender ........................................................................................................... 7
2.8.2 Age ................................................................................................................ 8
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2.8.3 Family composition- Number of siblings, living arrangement ................... 10
2.9 Theoretical framework ....................................................................................... 11
2.9.1 Biological theories ...................................................................................... 12
2.9.2 Psychological theories ................................................................................ 12
2.9.3 Social theories ............................................................................................. 13
Chapter 3 ........................................................................................................................ 1
Methods.......................................................................................................................... 1
3.1 introduction .......................................................................................................... 1
3.2 Research design ................................................................................................... 1
3.3Study setting.......................................................................................................... 1
3.4 Sampling .............................................................................................................. 2
3.5 Procedure ............................................................................................................. 2
3.6 Instruments ........................................................................................................... 4
3.6.1 Socio-demographic questionnaire. ................................................................ 4
3.6.2 Measures of symptoms of depression, anxiety and somatic syndromes. ...... 4
3.7 Data analysis ........................................................................................................ 6
3.8 Ethical considerations .......................................................................................... 7
3.8.1 Clearance at Research Ethics Committees .................................................... 7
3.8.2 Risks, Burdens, and Benefits ........................................................................ 7
3.8.3 Vulnerable groups and individuals ............................................................... 8
3.8.4 Privacy and Confidentiality .......................................................................... 8
Chapter 4 .................................................................................................................... 1
Results ........................................................................................................................ 1
4.1 Participants ....................................................................................................... 1
4.2 Prevalence of symptoms of depression, anxiety and somatic syndromes ........... 2
4.3 Co-morbidity ........................................................................................................ 4
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4.4 Associations between socio-demographic factors and symptoms of depression,
Anxiety and Somatic syndromes ........................................................................................... 6
4.5 Logistic regression ............................................................................................. 12
Chapter 5 ...................................................................................................................... 15
Discussion .................................................................................................................... 15
5.1 Introduction ........................................................................................................ 15
5.2 Prevalence of symptoms of depression. ............................................................. 15
5.3 Prevalence of symptoms of anxiety ................................................................... 17
5.4 Prevalence of symptoms of somatic syndromes ................................................ 17
5.5 Comorbidity ....................................................................................................... 18
5.6 Age as a risk factor ............................................................................................ 20
5.7 Gender as a risk factor ....................................................................................... 21
5.8 Family composition as a risk factor ................................................................... 22
5.9 Other findings .................................................................................................... 23
5.10 Limitations ....................................................................................................... 25
5.11 Recommendations ............................................................................................ 26
5.12 Conclusion ....................................................................................................... 26
References ................................................................................................................... 28
Appendix A: Introductory Letter to schools ............................................................ 42
Appendix B: Permission letter from Kampala Capital City Authority (KCCA) ..... 46
Appendix C: Parent Consent form ........................................................................... 47
Appendix D: Assent form ........................................................................................ 49
Appendix E: Study questionnaire- Socio-demographics and YSR.......................... 52
Appendix F: Authorization letter to use the Youth Self Report (11-18) ................. 59
Appendix G: Ethical Clearance from Stellenbosch University REC....................... 62
Appendix H: Ethical Clearance from Uganda National Council Science and
Technology .......................................................................................................................... 65

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List of Tables
Table Pg

1 Socio-demographic characteristics of study participants……………………. 27

2 Prevalence of symptoms of depression, anxiety and somatic complaints by 29
gender…

3 Participants scoring above cut-off on symptoms of more than one condition 30

4 Prevalence of Comorbidities of symptoms of Depression, Anxiety and 31
Somatic complaints…………………………………………………………

5 Associations between socio-demographic factors and symptoms of 35
Depression, Anxiety and Somatic complaints……………………………….

6 Associations between socio-demographic factors and symptoms of 37
Depression, Anxiety and Somatic complaints……………………………….

7 Multiple Regression model for factors associated with symptoms of 38
depression………

8 Multiple regression for factors associated with symptoms of 39
Anxiety……………………….

9 Multiple Regression for factors associated with Somatic 40
complaints…………………………

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List of Appendices

APPENDIX Pg
A Introductory Letter To School 64
B Permission letter from Kampala Capital City Authority 68
C Parent consent form 69
D Adolescent assent form 71
E Study questionnaire –Socio-demographics and YSR 74
F Authorization letter to use Youth Self Report 81
G Ethical clearance from Stellensbosch REC 84
H Ethical clearance from Uganda national council of science and 87
technology

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