Contextual factors associated with depression among urban refugee and displaced
youth in Kampala, Uganda: findings from a cross-sectional study
#MMPMID32665785
Logie CH
; Okumu M
; Mwima S
; Hakiza R
; Chemutai D
; Kyambadde P
Confl Health
2020[]; 14
(?): 45
PMID32665785
show ga
BACKGROUND: Advancing mental health among refugee and displaced adolescents and
youth is critically important, as chronic psychological stress can have lifelong
harmful impacts. These groups experience socio-environmental stressors that can
harm mental health. Informed by a social contextual framework, this study
explored the prevalence of depression among urban refugee and displaced youth in
Kampala, Uganda and associations with symbolic (violence), relational (social
support), and material (food and community insecurity) contexts. METHODS: We
implemented a cross-sectional survey with refugee and displaced adolescent girls
and young women and adolescent boys and young men aged 16-24 living in Kampala's
informal settlements. We conducted peer-driven recruitment, whereby peer
navigators shared study information with their networks and in turn participants
were invited to recruit their peers. We conducted gender disaggregated analyses,
including stepwise multiple regression to examine factors associated with
depression. We then conducted structural equation modeling (SEM) using weighted
least squares estimation to examine direct paths from violence, food insecurity,
and community insecurity to depression, and indirect effects through social
support. RESULTS: Among participants (n?=?445), young women (n?=?333) reported
significantly higher depression symptoms than young men (n?=?112), including any
symptoms (73.9% vs. 49.1%, p?0.0001), mild to moderate symptoms (60.4% vs.
45.5%, p?=?0.008), and severe symptoms (13.5% vs 3.6%, p?=?0.002). SEM results
among young women indicate that the latent violence factor (lifetime sexual and
physical violence) had direct effects on depression and social support, but
social support did not mediate the path from violence to depression. The model
fit the data well: ?2(3)?=?9.82, p?=?0.020; RMSEA?=?0.08, 90% CI [0.03, 0.14],
CFI?=?0.96). Among young men, SEM findings indicate that food insecurity had
direct effects on social support, and an indirect effect on depression through
the mediating role of social support. Fit indices suggest good model fit:
?2(3)?=?2.09, p?=?0.352; RMSEA?=?0.02, 90% CI [0.000, 0.19], CFI?=?0.99.
CONCLUSIONS: Findings reveal widespread depression among urban refugee and
displaced youth in Kampala, disproportionately impacting young women. Contextual
factors, including food insecurity and violence, increase depression risks.
Strategies that reduce gender-based violence and food insecurity, and increase
social support networks, have the potential to promote mental health among urban
refugee and displaced youth.