A cross-sectional study of depression with comorbid substance use dependency in pregnant adolescents from an informal settlement of Nairobi: drawing implications for treatment and prevention work.

Introduction: Adolescent pregnancy is a highly prevalent and significant public health problem in Kenya, and mental health needs of pregnant adolescent girls have been overlooked. Nearly, 50% of the world's population comprises children and adolescents and 85% live in lower and middle-income countries.

Objective: Pregnant adolescents were interviewed to ascertain certain social determinants of mental health such as social support, partner or parent support, and demographic profile and assessed for depression using EPDS and for severity of depression using BDI, and their alcohol abuse assessed using AUDIT.

Methods: A cross-sectional descriptive study using a purposive sample of 212 pregnant adolescents visiting Kangemi Health Centre in Nairobi was conducted.

Results: We found that 60.4% had depressive symptoms scores of 8 and above on EPDS, 51.9% were found to have severe depression score on BDI. About 26.9% were currently consuming alcohol. The more severely depressed participants were demonstrating greater alcohol use. Of the 110 pregnant adolescents who were severely depressed, 39 were currently consuming alcohol. We identified several alcohol use disorder factors associated with depression such as living with an alcoholic, ever and current use of alcohol, alcohol-related harm being experienced, being pressured to take alcohol. On our final multivariate logistic regression, we found that being a student (AOR 5.12, 95% CI 1.19-22.0, P  = 0.028); low family income (between 5000 and 10,000 shillings) (AOR 0.22, 95% CI 0.09-0.56, P  = 0.02); unplanned pregnancy (AOR 3.41, 95% CI 1.19-9.80, P  = 0.023); both negative and ambivalent attitudes of the unborn baby's father, respectively (AOR 8.72 95% CI 2.88-26.37 P  < 0.001; AOR 4.26 95% CI 1.35-13.45, P  = 0.013); early age at sexual debut (AOR 0.70, 95% CI 0.55-0.89, P  = 0.003); and ever used any psychoactive substances (AOR 3.21, 95% CI 1.31-7.88, P  = 0.011).

Conclusion and recommendations: Alcohol abuse during pregnancy presents a significant public health burden and the associated health risks for the adolescent mother and her baby are enormous. We need to bolster screening for the comorbid disorders such as depression and substance use disorders, particularly alcohol in order to address mental health and psychosocial functioning of adolescents. The underlying adversities and sociocultural challenges need to be better understood and mechanisms that lead to comorbidities require further research. Depression interventions for Kenyan adolescents would need to embed screening, treatment and management of substance abuse.