The Prevalence, and Social Determinants of Depression among In-school Adolescents in Dhaka and Khulna Divisions of Bangladesh: A Comparative Cross-Sectional Study

Abstract

Background: Depression is one of the leading causes of illness and disability among adolescents globally, with a disproportionately higher burden in low- and middle-income countries. In Bangladesh, rapid urbanization, intense academic pressure, socioeconomic inequality, and recurrent climate-related disasters may substantially influence adolescent mental health, particularly depression. Objective: To determine the prevalence of depression and to identify its associated sociodemographic, familial, academic, lifestyle, digital, and environmental factors among adolescents in Dhaka and Khulna Divisions of Bangladesh. Methods: A school-based cross-sectional study was conducted among 5,600 adolescents aged 10–18 years (Dhaka: n=2,800; Khulna: n=2,800) using a multistage cluster sampling technique. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Associations between depression and explanatory variables were analyzed using chi-square tests. Results: The prevalence of moderate-to-severe depressive symptoms (PHQ-9 ≥10) was significantly higher among adolescents in Khulna Division compared to Dhaka (p<0.001). Overall depressive symptoms were reported by 61.2% of adolescents in Dhaka and 97.2% in Khulna. Severe depression was rare in Dhaka (2.5%) but highly prevalent in Khulna, where nearly three-quarters of adolescents fell into moderately severe or severe categories. Minimal or no depression was common in Dhaka (57.3%) but nearly absent in Khulna (~3%). Depression was significantly associated with older age (15–18 years), higher grade level (10–12), low household income, and low parental education in both divisions (all p<0.001), with stronger associations observed in Khulna. Urban residence showed a particularly strong association in Khulna (χ²=832.41, p<0.001). Family and social factors—including poor parent–child communication, low parental interaction, family conflict, and low peer support—were significantly linked to depressive symptoms in both regions (all p<0.001). Academic stressors such as high academic pressure, exam anxiety, and heavy study workload were also strong predictors. Lifestyle factors, including short sleep duration, poor sleep quality, unhealthy diet, and excessive digital media use (>3 hours/day), demonstrated robust associations with depression across both divisions (all p<0.001). Environmental stressors showed the greatest regional disparity, particularly flood exposure in Khulna (χ²=285.44, p<0.001). PHQ-9 item analysis revealed higher mean scores for key symptoms, including anhedonia and suicidal ideation, among adolescents in Khulna compared to Dhaka. Conclusion: Adolescent depression is highly prevalent in both divisions, with a markedly higher burden in environmentally vulnerable Khulna. Interventions addressing academic stress, family support, lifestyle behaviors, and climate-related vulnerabilities are urgently required.