Prevalence and Associated Risk Factors of Depression Among Secondary School Students in Multan District, South Punjab, Pakistan: A Cross-Sectional Study
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Background: Depressive symptoms among adolescents may affect educational, interpersonal, and psychological functioning, but evidence from secondary-school students in South Punjab is limited. Objective: To estimate the prevalence of elevated depressive symptoms and examine associated sociodemographic, behavioural, family, social, digital-media, and school-related factors among secondary-school students in Multan District. Methods: This analytical cross-sectional study included 450 students aged 13–17 years from 40 public and private schools selected through multistage probability sampling. Depressive symptoms were assessed using the Revised Children’s Anxiety and Depression Scale, with a depression T-score ≥65 defining the elevated-symptom outcome. Descriptive, univariable, logistic-regression, and multiple-linear-regression analyses were performed. Results: Elevated depressive symptoms were identified in 26 students, corresponding to a prevalence of 5.8% (95% CI 4.0%–8.3%). Prevalence did not differ significantly between public and private schools (7.6% versus 4.0%; OR 1.96, 95% CI 0.86–4.50). In the exploratory adjusted analysis, bullying (AOR 8.14), social-media-related stress (AOR 5.88), school-related stress (AOR 5.19), lower maternal education (AOR 4.02), parents not living together (AOR 3.58), and limited social support (AOR 3.44) were associated with elevated symptoms. Bullying, prolonged social-media use, poor sleep quality, and school stress were associated with higher continuous depression scores, whereas physical activity was associated with lower scores. Conclusion: Elevated depressive symptoms were associated with interconnected family, social, digital, and school-related factors rather than school sector alone. The adjusted findings should be interpreted cautiously because relatively few students met the screening threshold
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