Uncovering the Mechanisms of Depression and Wellbeing Among Adolescent Girls In Sierra Leone

Introduction: In Sub-Saharan Africa, one out of every seven children suffer from psychological problems, and those in post-conflict contexts who experience violence are more vulnerable to high rates of depression. Mental health concerns for children continue to rise as global support wanes. In Sierra Leone, a post-conflict country, data reported that in 2009 only 2,058 of an estimated 102,000 people with severe mental illness received treatment, resulting in a treatment gap of 98.0%. Adolescent girls and young women (AGYW) experience high rates of trauma (e.g., gender-based violence); yet no research has documented their mental health and coping experiences.

Methods: Data from this convergent multi-methods study were drawn from AGYW, ages 12-25 (N=128) and qualitative and quantitative data were analyzed in tandem. Descriptive analyses identified potentially traumatic events (PTEs) and depression status, and bivariate analysis examined the relationships between shame, social support, food insecurity and depression as important variables. Qualitative in-depth interviews used grounded theory techniques to develop a set of themes related to depression and coping mechanisms unique to the participants (n=20).

Results: Half of the participants came from rural communities and the other 50% from urban communities. Sixty-six percent of the sample were girls and 34% were young women (i.e., 18-19). Ninety-two percent of the girls were school going, and 52% reported parental unemployment. Fourteen percent reported low trauma exposure (0-2 PTEs), 51% reported moderate (3-5 PTEs), and 34% reported extensive exposure (>5 PTEs). Sixty-six percent of the sample 66% (n=84) met the cut-off indicating mild to moderate depression, according to the CES-D (mean=19.68, SD= 8.07). Bivariate statistics revealed food insecurity (r=0.43, p<0.05) and shame (r=0.20, p<0.05) to be positively associated with depression, while social support was negatively associated with depression (r=−0.45, p<0.05). Additionally, two PTEs were positively correlated with depression, namely exposure to disasters (r=0.17, p<0.05), and experiencing sexual assault, i.e. rape (r=0.22, p<0.05). Three qualitative themes emerged: 1) Economic issues: “Well to be a girl child in Sierra Leone isn’t easy...If you don’t fall into a good family there are many disadvantages...you go through a lot, some days you don’t have food to eat unless you have a man who supports you, so its hard for girls in Sierra Leone”; 2) Enduring loss: “..I was with my aunt and then she passed away. We used to be happy and we would have long talks...She was the person who would have me come out. Then she passed it made me so sad.”; and, 3) Family support in education: “when my father sends for my school fees...I get very happy, because when I see my friends, I also know, I will attend school”. All participants discussed depression related symptoms in the qualitative interviews.

Conclusion: Findings highlight that as compared to global rates, depression symptoms among Sierra Leonean girls and young women are elevated. Data also emphasize how trauma and social support impacts girls. Data can inform interventions centering girls’ lived experiences; in particular, emphasizing parents as critical to female mental health and wellbeing.