A cross-sectional study of depression with comorbid substance use dependency in pregnant adolescents from an informal settlement of Nairobi: drawing implications for treatment and prevention work

Abstract

IntroductionAdolescent pregnancy is a highly prevalent and significant public health problem in Kenya, and mental health needs of pregnant adolescent girls have been overlooked. Nearly, 50% of the world’s population comprises children and adolescents and 85% live in lower and middle-income countries.ObjectivePregnant adolescents were interviewed to ascertain certain social determinants of mental health such as social support, partner or parent support, and demographic profile and assessed for depression using EPDS and for severity of depression using BDI, and their alcohol abuse assessed using AUDIT.MethodsA cross-sectional descriptive study using a purposive sample of 212 pregnant adolescents visiting Kangemi Health Centre in Nairobi was conducted.ResultsWe found that 60.4% had depressive symptoms scores of 8 and above on EPDS, 51.9% were found to have severe depression score on BDI. About 26.9% were currently consuming alcohol. The more severely depressed participants were demonstrating greater alcohol use. Of the 110 pregnant adolescents who were severely depressed, 39 were currently consuming alcohol. We identified several alcohol use disorder factors associated with depression such as living with an alcoholic, ever and current use of alcohol, alcohol-related harm being experienced, being pressured to take alcohol. On our final multivariate logistic regression, we found that being a student (AOR 5.12, 95% CI 1.19–22.0, P = 0.028); low family income (between 5000 and 10,000 shillings) (AOR 0.22, 95% CI 0.09–0.56, P = 0.02); unplanned pregnancy (AOR 3.41, 95% CI 1.19–9.80, P = 0.023); both negative and ambivalent attitudes of the unborn baby’s father, respectively (AOR 8.72 95% CI 2.88–26.37 P < 0.001; AOR 4.26 95% CI 1.35–13.45, P = 0.013); early age at sexual debut (AOR 0.70, 95% CI 0.55–0.89, P = 0.003); and ever used any psychoactive substances (AOR 3.21, 95% CI 1.31–7.88, P = 0.011).Conclusion and recommendationsAlcohol abuse during pregnancy presents a significant public health burden and the associated health risks for the adolescent mother and her baby are enormous. We need to bolster screening for the comorbid disorders such as depression and substance use disorders, particularly alcohol in order to address mental health and psychosocial functioning of adolescents. The underlying adversities and sociocultural challenges need to be better understood and mechanisms that lead to comorbidities require further research. Depression interventions for Kenyan adolescents would need to embed screening, treatment and management of substance abuse.

Prevalence and Correlates of Prenatal Depression, Anxiety and Suicidal Behaviours in the Volta Region of Ghana

“…In the adjusted models, the Enter method was used, and all the predictors were entered into the models predicting each of depression, anxiety and suicidal behaviors, respectively. All the variables (confounding) controlled for in the adjusted models were based on their significant associations with mental health problems as reported in previous literature, e.g., [ 4 , 7 , 8 , 9 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. In each adjusted model, the influence of a particular predictor was examined by controlling for all other predictors.…”

“…In a systematic review, strong evidence of an association between poor sleep and perinatal depression was reported [ 25 ]. In a study among pregnant girls in Kenya, it was observed that substance use significantly was significantly associated with depression [ 26 ]. These findings have demonstrated the impact of psycho-behavioral factors on prenatal mental health problems.…”

Impact of being an adolescent mother on subsequent maternal health, parenting, and child development in Kenyan low-income and high adversity informal settlement context

“…For adolescents growing up in informal settlements, they also face additional challenges , including exposure to high violence , maltreatment experience during childhood , with an absence of male partners or family support , and engaging in risky early and unprotected sexual exposure [ 22 , 23 ]. Moreover, adolescent mothers in SSA tend to experience greater barriers and stigma in navigating health services , being taken seriously by the health workers and relatives, which further exacerbates their stress and negative parenthood experience [ 24 – 27 ]. These cumulative stressors experienced during adolescent motherhood aggravates parenting stress [ 28 ] and increase the risk for depression [ 29 ].…”

Prevalence and correlates of depression and anxiety symptoms among out-of-school adolescent girls and young women in Tanzania: A cross-sectional study

“…Evidence from South Africa, Uganda and Kenya show that age-specific risk factors include poverty, lower socio-economic status, lack of social capital and support, substance use and exposure to violence and traumatic events[7–10]. Comorbid substance use and mental health disorders are also common, creating a double burden [11][12]. Some of the protective factors for mental health disorders in sub-Saharan Africa include good parenting and social support [13,14].…”