Depression is the leading cause of disability worldwide and a major contributor to the overall global burden of disease (World Health Organization, 2017). Among adolescents aged 15-19 years old worldwide, depression is the leading cause of illness and disability (World Health Organization, 2014). Suicide, for which depression is a significant risk factor, is the second leading cause of death among young adults aged 15-29 (World Health Organization, 2016). Most mental disorders begin during adolescence but often go undetected and untreated, exacting enduring effects on physical health and educational achievement and increasing the risk of substance abuse, violence, and poor reproductive and sexual health (Patel et al., 2007; Thapar et al., 2012). Because low and middle income countries (LMICs) are home to 80% of the world’s population, including the largest proportion of youth, depression has emerged as a major public health concern there (Kieling et al., 2011). Efficacious and affordable treatments for depression among youth in these settings are available and can potentially bring a wealth of benefit to future adult life (Patton et al., 2016). However, a major gap in knowledge involves the prevalence of depression and associated factors in these settings (Yatham et al., 2018).
In Uganda, more than 75% of the population is under 30 years of age, and another 22.5% is between ages 18-30 (Ministry of Health of Uganda, 2017; Uganda Bureau of Statistics, 2017). Youth may face multiple psychosocial stressors, including exposure to physical, emotional, interpersonal, and sexual violence (Devries et al., 2017; Self-Brown et al., 2018; Swahn et al., 2018). Millions of children have been orphaned by the AIDS epidemic and suffer high levels of psychosocial and psychological distress as a result (Atwine et al., 2005). Children living in the slums of Kampala have reported high rates of abuse (N=380, 34.0%) and commercial sexual exploitation (N=593, 39%), (Clarke et al., 2016; Swahn et al., 2017; Swahn et al., 2016). Though country-wide poverty has declined significantly in the recent decades, the unemployment rate is disproportionately higher for youth versus adults and even higher among urban and female youth when compared to their rural and male counterparts (Uganda Bureau of Statistics, 2017). Poverty and unemployment, in turn, make youth susceptible to forced-labour and sex trafficking (U.S. Department of State, 2017). Cumulatively, these stressors can contribute to significant psychiatric morbidity, including depression, anxiety, and post-traumatic stress disorder, especially among more vulnerable young people (Kessler et al., 2015; Kilpatrick et al., 2003; Thapar et al., 2012).
The existing literature documenting the need for mental health care among groups of Ugandan youth is very limited. Several studies have focused on the elevated psychological distress experienced by Ugandan adolescents with HIV or exposed to war trauma, including being abducted to become child soldiers (Amone-P’Olak & Ovuga, 2017; Knizek et al., 2017; Mutumba et al., 2017, 2016; Olak et al., 2015). High rates of suicidal ideation among youth (N=1134, 23.54%), depressive symptoms among adolescents (N=519, 21.0%), and anxiety disorders among children and adolescents (N=1680, 26.6%) have also been reported (Abbo et al., 2013; Culbreth et al., 2018; Nalugya-Sserunjogi et al., 2016).
These findings underscore the importance of determining the prevalence of common mental illnesses among groups of Ugandan youth in settings that could provide mental health care. Enabling young people to enter the workforce is essential for reducing the burden of poverty in Uganda. Identifying key groups of youth likely to enter the workforce and in need of mental healthcare is key to capitalizing on their full socioeconomic potential. The present study attempts to address this critical gap in knowledge by describing the prevalence of depression, anxiety, and PTSD among impoverished and unemployed Ugandan youth participating in vocational training programs. We compare youth based on gender because of depression’s well-established disproportionate prevalence among post-pubertal adolescent and adult females across diverse settings (Kessler & Bromet, 2013; Thapar et al., 2012), as well as the greater risk Ugandan female youth face for unemployment and sexual exploitation (U.S. Department of State, 2017; Uganda Bureau of Statistics, 2017). Due to the unique stressors facing rural youth, including proximity to health care, lacking daily necessities, and greater likelihood of unemployment, this study also included an urban versus rural analysis (Cooper-Vince et al., 2018; Uganda Bureau of Statistics, 2017).