Primary school students’ mental health in Uganda and its association with school violence, connectedness, and school characteristics: a cross-sectional study

Abstract

BackgroundFew studies have explored risk factors for poor mental health in Ugandan primary schools. This study investigated whether individual- and contextual-level school-related factors including violence from school staff and other students, connectedness to school and peers, as well as school size and urban/rural location, were associated with mental health difficulties in Ugandan children. We also examined whether associations between violence exposure at school and mental health were mediated by connectedness as well as whether associations were different for boys and girls.MethodsThe analytic sample consisted of 3,565 students from 42 primary schools participating in the Good Schools Study. Data were collected through individual interviews conducted in June and July 2012. Mental health was measured using the Strengths and Difficulties Questionnaire. Multilevel logistic regression was applied to investigate factors associated with mental health difficulties.ResultsExperiences of violence from school staff and other students in the past week were strongly associated with mental health difficulties (OR = 1.58, 95 % CI 1.31 to 1.90 and 1.81, 1.47 to 2.23, respectively). Children with a low school connectedness had 1.43 times (1.11 to 1.83) the odds of mental health difficulties compared to those with a high school connectedness. The OR comparing children never feeling close to other students at their school with those always feeling close was 1.86 (1.18 to 2.93). The effect of violence on mental health was not mediated through the connectedness variables. School size was not related to mental health difficulties, but attending an urban school increased the odds of mental health difficulties after accounting for other factors. We did not find evidence that the effect of one or more of the exposures on the outcome differed between boys and girls.ConclusionsThese findings suggest that violence in school and low connectedness to school and peers are independently associated with mental health difficulties and interventions should address both concurrently. Extra support may be needed for students in urban schools.Trial registrationClinicaltrials.gov NCT01678846. Registered 24 August 2012.

The Strengths and Difficulties Questionnaire (SDQ) in Africa: a scoping review of its application and validation

“…The familial burden of HIV at baseline affected child behavioural problem as follow indirectly as a result of depression of the caregiver. Both internalising and externalising behaviour problems were indirectly affected by familial HIV burden and caregiver depression Thumann (2016) [ 75 ] Luwero District, Uganda 7–18 Examine whether individual and contextual factors in the school environment were associated with mental health difficulties, including the association of mental health difficulties with violence exposure and differences by gender School environment, violence, mental health Self-report 3565 primary school students Not specified None mentioned Binary variable created for those above and below the 80th percentile Did not compare to UK norms but applied rule that those above the 80 th percentile would be categorised as “borderline/abnormal” as outlined by Goodman, Meltzer and Bailey (1998) Overall Cronbach alpha score = .69 Experiences of violence by staff or students were associated with mental health difficulties. Low school connectedness also increased the odds of mental health difficulties.…”

The school social environment and oral health‐related quality of life in children: a multilevel analysis

“…When CPQ domains are considered, the occurrence of violence among students was associated with higher scores in nearly all domains (oral symptoms, functional limitation, and social well‐being), while the need for police security was associated with higher scores in the emotional well‐being domain. Experiences of violence in school may harm children's mental health, with emotional and behavioral implications . Our study highlights that violence from peers at school seems to damage children's perceptions of their oral health.…”

Risk or resource: Does school climate moderate the influence of community violence on children’s social‐emotional development in the Democratic Republic of Congo?

“…The SDQ measures both psychosocial problems and strengths in children and youths aged 3–16 years, has been translated into over 60 languages, and has been widely used internationally as a research and screening tool. The teacher version has been previously validated for use with 7–9 year olds in the DRC (Kashala, Elgen, Sommerfelt, & Tylleskar, ), and the self‐report version has been successfully implemented with primary school children in other low‐income sub‐Saharan countries such as Tanzania (Hecker, Hermenau, Salmen, Teicher, & Elbert, ) and Uganda (Thumann, Nur, Naker, & Devries, ). Sample items for each subscale include: Conduct problems (e.g., “you get in many fights with other children”, “you get angry and yell at people”), Hyperactivity (e.g., “it is difficult for you to sit quietly for a long time,” “it is difficult for you to concentrate”) and Emotional Symptoms (e.g., “you worry a lot,” “you feel nervous in situations that are new”).…”