Data from the Global Burden of Disease (GBD) studies have shown that mental disorders contributes significantly to disability among children and adolescents and, in fact, these disorders are likely to rank high among major child and adolescent public health challenges of the twenty-first century [1]. Among the common mental disorders that afflict children and adolescents, GBD data also establish depression as ranking highest in terms of burden [2]. Though prevalence rates vary from one region of the world to another, one cross-national study which sampled adolescents from more than ten countries across the world reported that one out of ten adolescents have clinically significant symptoms of depression [3]. In Nigeria, despite varying prevalence rates, several studies conducted in different parts of the country, have established that depression is common among children and adolescents. For instance, in South-West Nigeria, a study conducted among school-going adolescents in Ibadan identified mild to moderate depression in nearly a quarter (23.8%) and severe depression in 5.7% of respondents [4]. Oderinde et al also reported a prevalence rate of 16.3% among a sample of school-going adolescents in Ido-Ekiti [5]. Adewuya & Ologun reported a lower but equally high prevalence rate of 9.0% prevalence rate in a different sample of adolescents sampled from schools in Ile-Ife [6]. Studies conducted in other regions of the country also established a significantly high burden of adolescent depression [7, 8].
When left untreated, depression among children and adolescents is associated with significant short/medium-term risks such as missed school days and suicidal behaviours [9] and long-term negative consequences such as persistent recurrence, poorer physical health morbidity, and chronic alcohol abuse [10–12]. It is therefore appropriate that investment in strategies to reduce the burden of depression at key developmental phases across lifespan, particularly during adolescence, is being seen as a global public health goal [13]. Fortunately, there is robust evidence for safe, effective, and affordable pharmacologic and non-pharmacologic interventions for adolescent depression worldwide (14–16). However, for a variety of reasons, there has been significant barriers to mental health services, including treatment for depression, among adolescents worldwide, worse in low- and middle-income countries, and as such, creating a treatment-gap [17].
Interventions to reduce adolescent depression treatment-gap must acknowledge the fact that access to treatment of depression among adolescents is, among other factors, a function of the degree of recognition of the constellation of experiences which characterizes the syndrome of depression, as a health concern which can be understood, prevented, or treated [18]. In other words, adolescent depression-literacy must improve as a pre-condition for the success, in terms of uptake, of available intervention strategies. This is because poor depression-literacy, whereby depressive symptoms were interpreted as normal inconveniences of puberty or a personality trait, has been identified as one of the potential barriers to help-seeking among depressed adolescents [19]. Furthermore, there is preliminary evidence, from around the world, that school-based mental health awareness programs which targets the provisioning of accurate information about the nature of and services for mental health conditions to parents, teachers, and students, can and does lead to improved symptom recognition and uptake of mental-health services among school children [20–22]. Aside from being the foundational component upon which additional structures for promoting mental-health, such as symptom recognition, tolerant attitude, and improved service utilization, can be built [23]; improved mental-health literacy of students also come with additional benefits such as reduced prejudice and stigma, more positive emotional response towards peers who may be experiencing depression [24], and positive personal mental health in general [25, 26].
Recent research in Nigeria has shown that the health-education curriculum of Nigerian elementary and secondary schools focused on hygiene and environmental health with hardly any meaningful mental-health content [27]. Hence, knowledge of school-going adolescents, and indeed their teachers, about mental illness in general, is limited [28, 29]. By extension, attitude of school-going adolescents towards individuals with mental disorders has been shown to be negative in one study and reflected desire for social distance [30]. There have been very few school-based short-term training programs aimed at improving mental-health literacy of students in Nigeria in recent times. Such efforts have yielded immediate and sustained positive change in aspects of general mental-health literacy among small samples of children and adolescents attending elementary and secondary schools in the country [31, 32]. However, there has not been any documented intervention (school- or community-based) aimed at improving depression-literacy in particular among adolescents in Nigeria, and indeed in sub-Saharan Africa. This is despite the fact that more recent research, which examined depression-literacy specifically among school-going adolescents, found that only a paltry 4.8% of the sample correctly identified a depression vignette while another paltry 1.5% recommended professional help as a treatment option [33]. Furthermore, the few earlier intervention studies for general mental-health literacy conducted in Nigeria did not involve teachers. Teachers are equally important members of the school environment and mental-health literacy has been shown to be equally poor among them [28, 29]. Improving the mental-health literacy of teachers alongside the students has been described as “critical” to the success of school-based mental-health promotion and intervention [34].
From the foregoing, it is obvious that more mental-health literacy programs are needed in Nigeria, and indeed Africa, especially large-scale intervention programs focussing on a specific mental-health problem such as depression. The present study, therefore, aimed to conduct an implementation of a standardized depression-literacy program among a large and representative sample of school-going adolescents and their teachers in Nigeria. In this paper, we report the immediate post-intervention impact, in terms of, satisfaction with the program, the knowledge gained and the socio-demographic factors that independently influenced it.