Prevalence and Correlates of Mental Health Problems Among School Going Children In Southern Uganda: A Gender Stratified Analysis

Background: Mental health problems among children and adolescents in sub‑Saharan Africa remain under‑recognized, with limited evidence on how family and community contexts shape gender‑specific mental health outcomes. This study examined the prevalence and correlates of depressive and posttraumatic stress disorder (PTSD) symptoms among school‑going children in Southern Uganda, with particular attention to gender differences.

Methods: We analyzed baseline data from 899 adolescents participating in the Suubi4Stronger cluster‑randomized study conducted across 30 primary schools in southern Uganda. Mental health outcomes included symptoms of depression and PTSD. Key predictors comprised sociodemographic characteristics, orphanhood status, caregiver type, household economic resources (savings and asset ownership), family cohesion, perceived social support, and community satisfaction. Mixed‑effects linear regression models were estimated, accounting for clustering at the school and participant levels, followed by gender‑stratified analyses.

Results: Participants’ mean age was 12.7 years. The mean depression symptom score was 6.4 (SD = 5.1), and the mean PTSD symptom score was 49.6 (SD = 24.3), indicating a substantial burden of mental health symptoms among school‑going adolescents. Higher household assets, stronger family cohesion, greater perceived social support, and higher community satisfaction were independently associated with lower depressive and PTSD symptom scores. Gender‑stratified analyses revealed notable differences for depression. Among male adolescents, living with a non‑relative caregiver was associated with substantially lower depression (β = −3.81, 95% CI: −5.19 to −2.43, p < 0.001), while family cohesion (β = −0.10, p = 0.027), community satisfaction (β = −0.32, p < 0.001), and social support (β = −0.17, p < 0.001) showed strong protective associations. In contrast, among female adolescents, non‑relative caregiving was associated with higher depression symptoms (β = 2.27, 95% CI: 0.89 to 3.65, p = 0.001), while family cohesion, social support, community satisfaction, and household assets remained protective. For PTSD, psychosocial factors—including family cohesion, perceived social support, and community satisfaction—were strongly and consistently associated with lower symptom scores among both males and females, suggesting shared protective pathways across genders, while caregiver type did not demonstrate consistent associations with PTSD symptoms.

Conclusion and Implication: These findings demonstrate a substantial mental health burden among school‑going children in Southern Uganda and highlight the importance of family cohesion alongside interpersonal and community resources in shaping adolescent mental health. Gender‑responsive interventions that strengthen family functioning, enhance social support networks, and improve community environments—while accounting for caregiving contexts may be effective , particularly in low‑resource settings.