Adolescence is often marked by a rise in risky behaviours, especially when adolescents are with peers. This period is also a time in which the incidence of depression peaks. Several studies conducted in high-income countries have found that adolescents with depression are more likely to engage in high-risk behaviours, such as unprotected sex and binge drinking. Evidence from low- and middle-income countries, where 90% of the world’s adolescents live, remains scarce.
This new research identified and systematically reviewed all relevant literature reporting on the association between depression and risky behaviours among adolescents living in low-and middle-income countries. Studies were considered eligible for inclusion if they were cohort or case-control studies that recruited adolescents (10–24 years) in low-and middle-income countries, measured depression with validated tools, and accounted for variables that are known to predict depression, such as age, sex, and socioeconomic status. Risky sexual behaviours and substance use were defined as the primary outcomes. Secondary outcomes included delinquency, adverse school behaviour, self-harm, and suicidal behaviour.
Julia Ruiz Pozuelo, Department of Psychiatry, University of Oxford, said:
'Given the high prevalence of depression among adolescents in low- and middle-income countries, our results underline the need for scalable and sustainable approaches to prevent and/or treat depression in resource-poor settings.'
The research included 33 studies, which together encompassed 35,918 adolescents living in 17 low-and middle-income countries: 5 from Africa, 7 from Asia, and 5 from Latin America and the Caribbean. Adolescents with depressive symptoms were more likely to engage in risky sexual behaviours and substance use compared with non-depressed adolescents. Results for other outcomes showed a similar pattern, with higher delinquency, self-harm, and suicidal behaviour among adolescents with depression compared with healthy adolescents.
The study suggests that adolescents with depression in low-and middle-income countries carry a double burden: depression and increased risk of engaging in risky behaviours. This combination may lead to further psychological and physical health problems that persist over the life course and may impose a health burden on society as a whole.
Read the full paper in the Journal of the American Academy of Child & Adolescent Psychiatry.