Currently, there are 1.3 billion adolescents worldwide, which makes up 16% of the world population. ¹ Adolescents make up 20% of the population in countries in the South-East Asia region (SEAR) of the World Health Organization (WHO), and 21.8% of the Indian population. ^{2 , 3}

Adolescence is a distinct period in human development and crucial for setting the groundwork for long-term health. Today nine out of ten adolescents are living in underdeveloped countries, where they confront particularly difficult obstacles in everyday lives from getting an education to simply surviving. ⁴ Over 20% of adolescents around the world are thought to have behavioural or mental health issues. Lifetime mental health disorders commonly begin by the age of 14, and depression is the leading cause of the global disease burden among adolescents. ⁴

Adolescents frequently suffer from emotional disturbances. Anxiety disorders predominate among adolescents and are more frequently seen in older adolescents compared to younger ones. Anxiety disorders are thought to affect 3.6% of 10–14-year-olds and 4.6% of 15–19-year-olds. ⁵ Depression and anxiety share some common features and together can result in poor performance in school and poor school attendance. ⁵ This, in addition to the marked social impairment experienced by depressed adolescents, will result in poor workplace relationships which in turn leads to poor connections and can affect one’s ability to make academic and workplace progress. Depression in adolescents also decreases the chance of them pursuing higher education and can also lead to lower employment rates. Depression in adolescents is also associated with earlier pregnancy and early parenthood. ⁶

Adolescents with depression run a very high risk of suicide. ⁷ Smoking, substance abuse, and obesity are all also more prevalent among adolescents who are depressed. ^{8 , 9} Depressive disorders are among the top three causes of adolescent disability adjusted life years (DALYs) lost globally and anxiety happens to be among the top five causes of loss of DALYs among adolescent girls. ¹⁰ About 7% of adolescents between the ages of 13 and 17 suffer from diagnosed mental health disorders in India according to the National Mental Health Survey 2015-16. ¹¹

Stress in adolescents also affects their academic performance. ¹² Levels of stress experienced are shown to increase from preadolescence to adolescence. ¹³ Studies have shown that girls tend to experience higher levels of stress compared to boys during adolescence. ¹⁴ There is evidence that shows a positive correlation between stress and depression and anxiety. ¹⁵

Addressing mental health issues is very important for the promotion of positive health in adolescents. It also facilitates a whole generation of adults with sound mental health and leads to a healthy society. And as we couldn’t identify any studies done on mental health issues in this region of Karnataka, there is a need to carry out research and gather more data and facilitate the promotion of positive mental health among adolescents in this part of Karnataka.

As shown in Table 1: a total of 700 adolescents participated in the study. Out of which 350 (50%) adolescents were from urban areas and another 350 (50%) adolescents were from rural areas. Males and females in urban areas were 153 (44%) and 197 (56%) respectively. In rural areas, males and females were 191 (55%) and 159 (45%) respectively.

All our study participants were aged between 16 to 19 years. the mean age of the participants in the urban area was 17.10±0.84 years. In the urban area, the majority of the participants (142) were aged 17 years (40.6%). Participants aged 16 years were 94 (27%), 18 years were 100 (29%) and 19 years were 14 (4%). Similarly in rural areas, the mean age of the participants was 17.10 ±0.76 years. The majority (159) of the participants were aged 17 years (45%). Participants aged 16 years were 60 (17%), 18 years were 121 (35%) and 19 years were 10 (3%).

Among the adolescents in urban areas, 23.1% were depressed, 29.4% had anxiety and 26.6% had stress. Similarly, among the adolescents in rural areas, 19.1% were depressed, 24% had anxiety and 21.1% were stressed.

Among the depressed adolescents, in urban areas the majority (46; 13.1%) had moderate depression, whereas in rural areas the majority (32; 9.1%) had mild depression. Among the adolescents who had anxiety, both in urban and rural areas the majority (71 (20.3%) and 58 (16.6%) respectively) had moderate anxiety. Among the adolescents who were stressed, both in urban and rural areas, the majority (63 (18%) and 54 (15.4%) respectively) had mild stress.

Among the study participants from urban areas of Shivamogga, 33 (21.6%) adolescent males and 48 (24.4%) adolescent females were depressed, 33 (21.6%) adolescent males and 70 (35.5%) adolescent females were anxious, and 55 (35.9%) adolescent males and 38 (19.3) adolescent females were stressed (see Table 2). A significantly greater number of females were anxious and stressed than males.

Among the study participants from rural areas of Shivamogga, 26 (13.6%) adolescent males and 41 (25.8%) adolescent females were depressed, 40 (20.9%) adolescent males and 44 (27.7%) adolescent females were anxious, and 47 (24.6%) adolescent males and 27 (17%) adolescent females adolescents were stressed. A significantly greater number of females were stressed than males; see Table 3.

Our study attempted to find out the prevalence of depression, anxiety, and stress among adolescents in urban and rural areas. The current study found that the prevalence of depression was 23.13% and 19.14% in urban and rural areas respectively. On average, depression among adolescents in Shivamogga is 21.14%. Similar results were found by Kumar K S et al. and Sahoo S, where depression among adolescents was 19.5%. and 18.5% respectively. ^{16 , 18} Depression was seen to be higher in females in both urban and rural areas. The difference was statistically significant in rural areas of Shivamogga. Similar observations were made in other studies across India where depression was seen to be higher among female respondents. ^{16 , 19 , 20} Genetic predisposition and hormonal influences could be the reason why depression was higher in females than males. This could also be due to higher reporting of symptoms by females, whereas fewer males may report symptoms due to societal pressure for males to be more emotionally strong.

Depression was more frequently seen in urban adolescents than rural adolescents in the current study (23.1% and 19.4% respectively). Similar observations were made by Bahl R, and Kumari R in their study, where depression among urban adolescents was about 33.3% and depression among rural adolescents was 20.7%. ²¹ This could be due to higher exposure of adolescents to risk factors like academic competition and failure, anxiety, and substance abuse, etc.

Anxiety among adolescents in the current study was found to be 29.2% and 24% in urban and rural areas of Shivamogga respectively. On average, anxiety was found to be 26.6%. This was similar to the study conducted by Kumar K S et al. and Madasu S et al., who found anxiety among adolescents to be 24.4% and 22.7% respectively. ^{16 , 22} These studies also found that the prevalence of anxiety was higher among females when compared to males. Similar findings were seen in our study in both urban and rural areas. The prevalence of anxiety was significantly higher among females than males in urban areas. Higher anxiety among females could be due to higher exposure to risk factors like academic competition and societal pressure on women to work and prove themselves as equals to males in the modern world.

Anxiety was more frequently seen in urban adolescents than rural adolescents in our study (29.4% and 24% respectively). Similar results were observed by Vs P et al. ²³ This could be due to more academic competitiveness in an urban area than in a rural area. While the parental expectation and societal pressure to perform better academically and excel in the future and have a well-paying job is higher for males than females, in the modern world the same pressure is higher in females as well in urban areas. This could be the reason why anxiety was more prevalent among urban females than males. As this study was conducted during the pandemic, the increased awareness of COVID in urban areas with better education could also be the reason why anxiety was higher among urban adolescents.

Stress among the adolescents in our study was found to be 26.6% and 21.1% in urban and rural areas respectively. On average 23.85% of the adolescents were stressed in Shivamogga. Sahoo and Saddicha, in their study, also found that the prevalence of stress among adolescents was 20%. ¹⁸ Prevalence of stress was found to be higher in urban areas compared to rural areas. Similar observations were made by Dey BK ²⁴ in Bangladesh. No studies from the Indian setting could be found that compared the prevalence of stress in urban and rural areas.

Stress was more frequently seen in males than females in both urban and rural areas of Shivamogga. This was contrary to observations made in other studies, where they found that stress was more prevalent among female participants. ^{16 , 24} This difference could be due to underreporting of symptoms by female participants. The ongoing pandemic at the time of the study could have contributed to these findings.

About a quarter of the adolescent population suffers from depression anxiety and stress. It’s crucial to detect these symptoms among adolescents and take proper action to avoid compromising their education and development. Those detected to have these symptoms must be referred to be seen by a psychiatrist for clinical evaluation. Further studies are necessary to learn about the causative factors of these mental health disorders. Adopting and implementing better education and health policies are necessary to enhance adolescent mental health.