Psychosocial Indicators of Depression among Secondary School Students in Ebonyi State, Nigeria: A Call for Policy Action on Adolescent Mental Health

Introductions

Adolescent depression is now considered to be one of the major public health issues in the 21st century, which has attracted research, clinical, and political attention globally (Petito et al., 2020; Wilson & Dumornay, 2022). The World Health Organization estimates that one in seven adolescents aged 10 to 19 years is affected by a mental disorder and depression accounts for a large proportion of the disease burden in this age group (Piao et al., 2022; Wu et al., 2025). Current global prevalence estimates indicate that depressive disorders affect about 1.3% of adolescents aged ten to fourteen years and 3.4% of those aged fifteen to nineteen years. However, these figures are widely considered to be conservative, especially in low- and middle-income countries where diagnostic infrastructure is limited and cultural barriers to disclosure are pronounced (Yang et al., 2024; Zhang et al., 2025). Recent syntheses of the Global Burden of Disease Study 2021 have illustrated that the burden of adolescent depression increased steadily from 1990 to 2021, with the COVID-19 pandemic acting as an acute accelerant of an already upward trajectory (Marijon et al., 2023).

The Organization for Economic Co-operation and Development (OECD) documented that by the year 2022, 68% of fifteen-year-old girls in its member countries were reporting multiple psychological complaints, in a stark reversal from previous decades (Lamour, Manion, & Smith, 2022). In the year 2024, comprehensive meta-analyses document that more than one in five children and adolescents experience symptoms of depression or qualify for a diagnosis of a depressive episode at some point during their developmental years (Lu, Lin, & Su, 2024). This places the OECD’s 2022 figure at 68% of fifteen-year-old girls across its member countries who are documenting multiple psychological complaints, signaling a sharp reversal from earlier decades. These epidemiological patterns are not uniformly distributed; they reveal stark disparities by gender, with female adolescents approximately twice as likely as their male counterparts to develop major depressive disorder, a differential that emerges around age thirteen and persists through the lifespan (Wirback, 2018). The biological underpinnings of this disparity are thought to involve gonadal hormone fluctuations during puberty, differential stress reactivity mediated by neuroendocrine pathways, and the interaction of these biological processes with gender-differentiated socialization experiences (Moisan, 2021; Zuloaga, Heck, De Guzman, & Handa, 2020). Gender-specific socialization experiences expose girls to higher rates of interpersonal stress, body image dissatisfaction, and sexual victimization.

The psychosocial indicators of adolescent depression have been the focus of research all over the world, with different national and cultural contexts providing consistent core risk factors and important contextual variations (Shorey, Ng, & Wong, 2022; Wahid et al., 2021). Among the most robust psychosocial risk factors are peer victimization and bullying. A landmark meta-analysis of twenty-seven longitudinal studies has shown that peer victimization during adolescence is significantly related to risk for subsequent depression, with effects that persist after controlling for prior mental health symptoms (Lloyd-Williams, Lawrence, & Edwards, 2024). The core risk factors for adolescent depression have been identified consistently across various national and cultural contexts, with some key variations in the same context. A recent meta-analysis of over 100 studies reported positive associations between peer victimization and adolescent depression (Song et al., 2024). New longitudinal evidence suggests that adolescents who are exposed to peer victimization are more than double the risk of developing anxiety or depressive disorders in later years compared to their non-victimized peers (Oncioiu et al., 2023).

The family environment is the second major domain of psychosocial influence on adolescent depression (Wang et al., 2023). The evidence is extensive and cross-culturally robust. Family dysfunction, high conflict, low cohesion, poor communication, and harsh or inconsistent discipline have been consistently linked to elevated depressive symptoms among adolescents in high-income countries. A growing body of evidence from low- and middle-income countries also confirms the generalizability of these findings. The direct effect is through the emotional climate of the home, which shapes adolescents’ developing self-and relational world-schemas, while the indirect effect is through its influence on peer relationship quality, academic engagement, and the development of emotion regulation capacities. Parental mental health, more specifically maternal depression, is a known risk factor for adolescent depression, through genetic vulnerability and the disruptions to parenting quality that often accompany parental mental illness (Aktar et al., 2019; Van Santvoort et al., 2015). How broader socioeconomic forces interact with family-level risks has received increasing scholarly attention as it becomes clear that family dysfunction does not occur in a vacuum but is shaped and exacerbated by the structural conditions in which families are situated.

This brings us to the discussion of socioeconomic inequality, which has recently been identified as a transversal determinant of mental health in adolescents and operates at various ecological levels. Cross-national research has indicated that socioeconomic inequalities in adolescent mental health emerge early in life and increase over the course of development, with adolescents from lower-income households consistently reporting higher levels of depressive symptoms compared to their more advantaged peers (Cadman et al., 2024; McGorry, Gunasiri, Mei, Rice, & Gao, 2025). A study of seventeen countries found that national-level income inequality was associated with stronger socioeconomic gradients in adolescent mental well-being, which indicates that the effects of economic deprivation on mental health are particularly powerful in societies with higher overall levels of inequality (Dierckens et al., 2020). The pathways through which socioeconomic adversity leads to adolescent depression are broad and encompass aspects of both material deprivation (inadequate nutrition, unstable housing, and limited access to health care), and psychosocial stress (parental financial strain, family conflict due to economic pressure) along with diminished access to compensatory resources, such as good schools, safe recreational spaces, and mental health services (Azhar, Saleem, & Iftikhar, 2025; Kirkbride et al., 2024).

In low- and middle-income countries, home to the vast majority of the world”s young people, such pathways are superimposed on a background of chronic system-wide underinvestment in adolescent mental health infrastructure, with a treatment gap of over 90% for most settings in adolescent mental disorders (Sequeira et al., 2022; Simelane, Nassenii, & de Vriesi, 2022). Urgent calls have been made by the Lancet Commission on adolescent health and the WHO for the integration of mental health services in primary care and school-based platforms, as a strategy toward filling this yawning gap. The school context is particularly important, given that most adolescents spend the majority of their waking hours in educational settings (Morton, Atkin, Corder, Suhrcke, & van Sluijs, 2016). Academic pressures have been identified as a significant and increasing risk factor for adolescent depression (Jayanthi, Thirunavukarasu, & Rajkumar, 2015). A study published in 2023 systematically summarized the first comprehensive synthesis of evidence on links between academic pressures and depression, anxiety, self-harm, and suicidality among adolescents (Richardson et al., 2024). Longitudinal evidence published in The Lancet Child and Adolescent Health in early 2026 demonstrated that academic pressures at the age of fifteen were associated with higher depressive symptoms at the age of sixteen, with effects that persisted into early adulthood (Guo et al., 2026). These results indicate that factors at the school level, such as school climate and teacher support, also moderate the relationship between academic pressure and depression. A supportive school environment can, to some extent, lessen the negative impacts of academic stress on mental health (Nawaz, Rashid, Nizamani, & Hameed, 2024). This finding draws our attention to the fact that policy interventions that can reduce academic pressure and improve school-based mental health support may lead to substantial reductions in adolescent depression at the population level.

The present study is based on two theoretical frameworks, which complement each other and explain the individual psychological processes and environmental influences on adolescent depression. Beck’s cognitive theory of depression states that maladaptive schemas created as a result of early negative experiences generate automatic thoughts on the self, the world, and the future; subsequently, this perpetuates depressive feelings and behavior (Beck, 2002). Through this framework, the study empirically examines how family dysfunction, peer victimization, and academic failure can be considered aspects through which such internalization of these factors by adolescents takes place as a relatively stable cognitive vulnerability, especially in a context where cultural and economic stressors compound negative self-appraisals. Complementing the individual-level perspective above, Bronfenbrenner’s ecological systems theory positions adolescent development within nested and interacting environmental systems (Perron, 2017). These include a microsystem of family, school, and peer relationships; mesosystem interactions between microsystems; exosystem community and institutional structures; and macrosystem broader cultural and socioeconomic conditions. This framework presents the analytical architecture to investigate how psychosocial factors at different ecological levels simultaneously converge to shape depression risk among secondary school students in Ebonyi State. That is, the opinion paper will examine how parental warmth and teacher support at the microsystem level converge with poverty and mental health infrastructure at the exosystem and macrosystem levels. These theories, therefore, take the study out of narrow clinical conceptualizations of depression as an individual disorder and position it more as a developmental outcome influenced by the interaction between cognitive processes and environmental contexts, a view that is important in the formulation of policy recommendations for adolescent mental health that can address both individual and structural determinants.

In the African context, particularly in sub-Saharan Africa, these global patterns are expressed under specific sociocultural and structural conditions that increase risk and shape the presentation of adolescent depression. For African adolescents, rapid urbanization, changes in family structures, persistent poverty, high rates of infectious diseases (including HIV/AIDS), and the convergence between traditional cultural values and the values propagated by global media create a unique psychosocial landscape. Mental health literacy is low across the continent; depression is usually perceived as a spiritual problem, hence families seek assistance from traditional and religious healers rather than from biomedical mental health professionals (Jidong et al., 2021; Nanji & Olivier, 2024). In most sub-Saharan African countries, the ratio of mental health professionals to the population is less than one for every 100,000 people; in high-income countries, the ratio is more than fifty for every 100,000 people (Patel, Savaliya, Mehta, & Kataria, 2025). Child and adolescent psychiatrists are almost non-existent. In most African countries, school-based mental health services, which by all accounts should represent the most feasible platform for reaching large numbers of adolescents within such settings, are simply not available. And even where they do exist, such programs are seriously under-resourced. All these structural facts mean that the vast majority of African adolescents with depression go undetected and untreated, with consequences that cascade across educational attainment, social development, and long-term economic productivity.

Adolescent mental health in Nigeria is a relatively new area of academic and policy focus (Ottman et al., 2022). This is more worrisome as Nigeria is home to a disproportionately large adolescent population in the world, with over 220 million citizens, over half of whom are under 18. Research has shown that adolescent depression in Nigeria varies between 12% and 26% in different parts of the country, statistics that match global estimates but are particularly alarming in a region where mental health infrastructure is nearly nonexistent, poverty is rampant, and there are strong cultural stigmas against mental illness (Mbanuzuru et al., 2021; Ogunlade et al., 2025). The World Health Organization estimates that globally, 1.3% of adolescents between 10 and 14 years and 3.4% of those between 15 and 19 years suffer from depression (Zhao et al., 2024). Nevertheless, these rates may be considered an underestimate of the actual burden in low- and middle-income countries, where diagnostic resources are hard to come by and cultural and structural obstacles to seeking help loom large.

This study is significant in many ways. At the big idea level, it adds to our ability to apply Bronfenbrenner’s ecological systems theory and Beck’s cognitive theory in a group that has not been well studied. It tests the applicability of these ideas in different cultures and their efficacy in a place with fewer resources and a different culture, such as Nigeria. At the little idea level, it helps to fill the gaps left by earlier studies. It provides a picture of what goes on in a place that earlier studies omitted from the story on teen mental health in Nigeria. At the policy level, it would be directly relevant to the development of targeted, culturally sensitive school-based mental health interventions in Ebonyi State and the operationalization of the National Mental Health Act of 2021 in Nigeria, where services are to be integrated with primary care and educational settings. More broadly, this opinion paper would support the development of any school-based mental health initiative in the country. At the grassroots level, this evidence would be useful for the Ebonyi State Ministry of Education, as well as for school administrators, guidance counselors, and nongovernmental organizations working in that area.

The problem is articulated in this opinion paper: secondary school students in Ebonyi State transit a developmental phase already characterized by increased vulnerability to depression, neurobiological changes, identity formation, and mounting academic and social demands (EBOMA, 2019). Yet they do so within a context of compounded structural disadvantage. Poverty rates in Ebonyi State are among the highest in Nigeria (Chris, 2020); there is terrible understaffing of guidance counselors in public secondary schools, often over several thousand students to one counselor; mental health literacy among students, parents, and teachers is low; and help-seeking is discouraged by the pervasive stigma and common attribution of psychological distress to spiritual causes (Ehusani, 2025). All these risks have not been systematically explored to understand how the psychosocial factors at the individual, family, school, and community levels relate to depression among secondary school students in Ebonyi State. This lack of knowledge leaves the policymakers and educators without an evidence base to be able to design programs of prevention and intervention, attuned to the specific realities of the adolescents in Ebonyi. This opinion paper will address the above knowledge gap by presenting an analysis of the psychosocial indicators of depression among secondary school students in Ebonyi State, Nigeria, and recommending actionable, evidence-informed policies and practices.

Implications for educational, health policies, and practices

The opinion paper argues that what is now established is that adolescent depression is not just a clinical disorder that should be left to specialists but a developmental and social condition within the environment where young people learn, live, and relate (Bernaras, Jaureguizar, & Garaigordobil, 2019; Thapar, Eyre, Patel, & Brent, 2022). Such a realization would call for a paradigm shift in the conceptualization of policy frameworks from segmented, curative approaches to comprehensive, preventive strategies where the promotion of mental health occupies a place in both the educational and health systems. The implications for educational policy are therefore enormous, and the role of schools must be redefined to offer more than just academic instruction. The evidence from this opinion paper and other parts of the world clearly indicates that the school is not a passive space through which the adolescent develops; rather, it is an active shaper of mental health that can either reduce or increase the psychosocial risks carried by students from their families and communities (Arango et al., 2018; Verhoeven, Poorthuis, & Volman, 2019). Thus, the federal, state, and local educational authorities must recognize promotion of mental health as a fundamental educational mandate, not something ancillary or optional to the curriculum (Hoover & Bostic, 2021; Wiedermann et al., 2023). This starts with the understanding that the existing system of guidance counseling services in Nigerian secondary schools cannot deliver at counselor-to-student ratios that often exceed one to several thousand, with most counselors mired in administrative duties that leave no room for direct student contact and with minimal or no training in evidence-based mental health interventions. The World Health Organization’s Mental Health Gap Action Programme (mhGAP) and its adaptation for humanitarian and school settings provide a framework that could be implemented in the Nigerian context (Gureje et al., 2015; Madaki, 2022). It gives guidance on the identification, assessment, and management of adolescent depression by non-specialist providers, including teachers and school counselors, after appropriate training and under supervision.

International evidence has consistently demonstrated that school-based universal prevention programs can achieve small but meaningful reductions in depressive symptoms at the population level (Hoare et al., 2021). However, targeted interventions for at-risk students achieve larger effect sizes and are more cost-effective. This evidence needs careful translation into the Nigerian educational context because of cultural adaptation issues. The content should relate the programs to the experiences of Nigerian adolescents using examples that are relevant to their lives and culture and addressing sources of stress that are particular to their culture, such as extended family expectations, religious coping mechanisms, and the pressures of the Nigerian examination system (Adeyoyin, 2022; Ottman et al., 2022). The UNESCO Happy Schools framework, which focuses on well-being, belonging, and relationships in the school environment along with academic achievement, provides a policy template that could guide the reorientation of Nigerian secondary education toward a more holistic vision of student development (Tâm, 2021).

The first adult to notice a change in mood, behavior, or academic performance of a student, which could be an indicator for depression, is the teacher (Del Casale, Zocchi, Kotzalidis, Fiaschè, & Girardi, 2021). Unfortunately, they do not have the required training to know these signs accurately and take the right action. It has been found that training which enhances the mental health literacy of teachers improves their confidence and competence in supporting student mental health in various international contexts (Liao et al., 2023). This can be designed as an in-service training module for implementation in Nigeria. This paper highlights the necessity of such training to incorporate the mental health of teachers, as distress among them was noted to affect the quality of the relationship between the student and teacher and thus the efficacy of the initiatives for mental health based in the school.

This paper has major implications for health policy; there is an urgent need to develop the mental health system at the primary care level and to establish effective linkages between health services and schools (Organization, 2022). Adolescent mental health services are very poorly provided in most health systems because there is a gap between child and adolescent health services on the one hand and adult mental health services on the other. Therefore, one of the policy options that WHO has recommended and which is being implemented by one or another country, like Brazil, India, and South Africa, is the integration of adolescent mental health screening and first-line management into primary health care settings, including but not limited to primary health centers and school-based health clinics where they exist, and youth-friendly health services. The National Mental Health Act of 2021 sets the law for the integration of mental health services into primary care and the creation of mental health units at all levels of the health system in Nigeria (Oyinlola, 2025). The evidence to be obtained from this paper at the grassroots level will serve as input to make the above provisions of the National Mental Health Act of 2021 work on the ground.

The policy debate for screening depression in schools is much contested due to issues of accuracy, resource availability, potential stigmatization, and ethical obligations regarding identification with linked accessible treatment (Burns & Rapee, 2021; Radden, 2018). Evidence indicates that school-based depression screening implemented with validated instruments and appropriate cut-off scores for the target population can identify adolescents who need further assessment. However, screening by itself is insufficient and may be harmful if there are no systems for assessment, referral, and treatment. This brings out the policy implications that investment in screening infrastructure should be backed with equal investment in intervention capacity, including counselor training on evidence-based therapeutic approaches for adolescents, such as cognitive-behavioral therapy and interpersonal therapy, and the establishment of referral pathways from schools to primary health care and specialist mental health services (Weisz, Ugueto, Cheron, & Herren, 2018). Investment in the capacity of interventions should therefore be considered inseparable from investment in screening capacity. The delivery of structured psychological interventions by lay counselors and community health workers under the supervision of mental health professionals should include and propose task-sharing models, as well as referral pathways from schools to primary health care and specialist mental health services (Bolton et al., 2023). The authors argue that this can be done through task-sharing models.

This opinion paper speaks directly to policy in health and education and, less directly, to social protection, poverty reduction, and youth initiatives (Abramo, Cecchini, & Morales, 2019). The strong association between socioeconomic disadvantage and depression in adolescents, both in this paper and globally, underscores the nexus between mental health policy and economic and social policies (McGorry et al., 2025; Mewara & Yadav, 2025). Adolescents in low-income families are exposed to a cocktail of psychosocial risks, including food insecurity, unstable housing, family stress, poor-quality schools, and limited access to recreation, which accumulates over time to raise their risk of depression. This provides further justification for school feeding programs, cash transfers, as well as parental employment and employment stability policies indirectly and therefore as interventions in the design and evaluation of policies with respect to their impact on mental health (Bauer et al., 2021; Gibson, Hearty, & Craig, 2020). This paper adds to the discourse on educational assessment policy in developing countries by establishing the link between high academic pressure and depressive symptoms. For instance, it has been reported that high-stakes examination systems, like the West African Senior School Certificate Examination and the Unified Tertiary Matriculation Examination in Nigeria, are setting the stage for chronic stress among adolescents, which will eventually take its toll on their mental health (Omorodion, 2022). Therefore, alternative modes of assessment, examination preparation and stress management support, and the availability of mental health support for students during examination periods should be considered as policy options to reduce such pressure.

Recommendations

The recommendations synthesized from the evidence in this opinion paper form an interconnected set of guidelines that can be applied together to form a coherent framework for the management of adolescent depression in Ebonyi State and other similar settings in sub-Saharan Africa. To start, the federal and state governments should make it mandatory and provide funds for the integration of mental health literacy into the secondary school curriculum. This will ensure that all students receive developmentally appropriate education regarding emotional well-being, stress management, and help-seeking pathways. At the same time, investment should be made in pre-service and in-service training for teachers and guidance counselors, developing their capacity to recognize psychological distress in students, respond supportively, and refer them to the appropriate services. Second, there should be a joint effort between the state ministries of health and education to set up a school mental health task force. The task force should be responsible for coming up with screening protocols, algorithms for referral, and guidelines for intervention, all of which should be based on the WHO mhGAP framework. In addition to these, there should also be clear mechanisms for coordination between the school on one hand and the primary health centers and the limited specialist mental health services available in the state on the other. Third, focused investment should go into models that share tasks, training, and supervision of lay counselors in evidence-based psychological interventions for adolescent depression because the ratio of specialist mental health professionals to the adolescent population in Ebonyi State is critically low and unlikely to improve much in the near future. Fourth, the mental health impact of social protection policies, including school feeding programs, conditional cash transfers, and poverty alleviation initiatives, should be explicitly evaluated.

Adolescent mental health indicators should be included in the monitoring and evaluation frameworks of these programs to ensure that they address the socioeconomic determinants of depression as identified in this study. Fifth, the school should review the assessment policies to identify and address the sources of excessive academic pressure. This can be achieved by diversifying assessment modalities, structured examination preparation and stress management support, and making it accessible to all students during high-stakes examinations. Sixth, ensure that the recommendations are infused with a gender-responsive approach, taking into account the higher prevalence of depression among female adolescents and the necessity of interventions to address pathways of risk specific to gender while also addressing the barriers to help-seeking among boys whose masculine norms do not allow them to seek help. The Ebonyi State Government should, as its own initiative, commission and fund a longitudinal cohort study on adolescent mental health, tracking students through their secondary school years and beyond. This will generate the local evidence base needed to refine policies over time, as well as contribute Nigerian data to the global discourse on prevention and intervention of adolescent depression. These are not supposed to be rules that must be followed, but should be taken as a beginning point for discussions among the people who make policies, educators, health workers, and communities. This should be done because all people should be involved in making a change that lasts a long time and works well for the people involved, including making their own changes to fit their culture and keeping the change going by having their leaders work on it for a long time.

Conclusions

Adolescent depression, as the global evidence and the specific realities of secondary school students in Ebonyi State show, is not a clinical anomaly to be managed by specialists alone but a developmental and social condition greatly influenced by the environments in which young people learn, live, and relate to others. It forms a complex web of risk with family dysfunction, peer victimization, socioeconomic disadvantage, and gender-based vulnerability to high academic pressure. All these cannot be addressed by the fragmented, treatment-based approaches that reach only a small fraction of the affected adolescents. The paper concludes by reiterating that what is needed is not mere reform but a true paradigm shift wherein promotion of mental health becomes an essential element of both the education and health systems, wherein schools are considered not just places for learning lessons from books but active determinants of psychological well-being. It is hoped that the recommendations are not only logically but also practically valid, given the range of doable strategies to integrate mental health literacy in teacher training, apply WHO’s mhGAP framework in schools, create functional linkages between schools and primary health care services, and implement task-sharing models for lay counselors trained under specialist supervision. The National Mental Health Act of 2021 gives Nigeria a legislative base for such change, but laws are not enough without steady political will, good resourcing, and real cultural change to make interventions connect with Nigerian adolescents and their families’ lives. It goes beyond the health and education sectors to include social protection policies, educational assessment reform, and gender-responsive programming, all of which must be pursued in an integrated manner if the burden of adolescent depression is to be meaningfully reduced. The paper ends by calling on policymakers, educators, health professionals, researchers, and communities to adopt a locally sensitive, evidence-based, global best practices-informed, comprehensive, preventive, and multisectoral approach to the governance of adolescent mental health, and to do so with an understanding that investing in adolescent mental health is not an optional expenditure but a fundamental obligation, and one of the most consequential investments any society can make in its own future.

Consent for publication

All authors consented to the publication of this paper.