Abstract
Little focus has been paid to the role of nutrition among young people regarding mental health in sub-Saharan Africa. This study aimed to examine the relationship between nutrition and adolescent mental health for the promotion of effective school-based interventions in sub-Saharan African countries. The sample consisted of 14,968 11–17-year-old students in Botswana, Kenya, the Seychelles, Uganda, the United Republic of Tanzania, and Zambia participating in the Global School-Based Health Survey (2003–2007). Using bivariate logistic regression analysis, this study found across participating countries that: (1) lower hunger as a protective factor for depression, anxiety, loneliness, and suicidal ideation (except Zambia); (2) lower hunger as a protective factor for suicide attempts (except the United Republic of Tanzania); (3) lower hunger as a risk factor for suicide plan (except the United Republic of Tanzania); (4) higher fruit intake as a risk factor for depression, anxiety (except the United Republic of Tanzania), loneliness, suicidal ideation (except Zambia and Uganda), and suicide attempts (except Botswana); (5) higher fruit intake as a protective factor for suicide plan (except Botswana); (6) higher vegetable consumption as a risk factor for depression, anxiety (except the United Republic of Tanzania and Zambia), loneliness, suicidal ideation, and suicide attempts; and (7) higher vegetable intake as a protective factor for suicide plan. This study suggests school practitioners and school staff to articulate positive mental health by incorporating adequate nutrition components in school-based interventions. Further research should investigate whether such improvements to the nutrition components can foster positive youth mental health.
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Allen, K. N., Taylor, J. S., & Kuiper, R. A. (2007). Effectiveness of nutrition education on fast food choices in adolescents. Journal of School Nursing, 23(6), 337–341.
Bain, L. E., Awah, P. K., Geraldine, N., Kindong, N. P., Sigal, Y., Bernard, N., & Tanjeko, T. A. (2013). Malnutrition in Sub-Saharan Africa: burden, causes and prospects. The Pan African Medical Journal, 15, 120.
Baines, S., Powers, J., & Brown, W. J. (2006). How does the health and well being of young Australian vegetarian and semi-vegetarian women compare with non-vegetarians? Public Health Nutrition, 10(5), 436–442.
Baxter, A. J., Patton, G., Scott, K. M., Degenhardt, L., & Whiteford, H. A. (2013). Global epidemiology of mental disorders: what are we missing? Plos One, 8(6), e65514.
Birnbaum, A. S., Lytle, L. A., Story, M., Perry, C. L., & Murray, D. M. (2002). Are differences in exposure to a multicomponent school-based intervention associated with varying dietary outcomes in adolescents? Health Education & Behavior, 29(4), 427–443.
Breuer, E., Myer, L., Struthers, H., & Joska, J. A. (2011). HIV/AIDS and mental health research in sub-Saharan Africa: a systematic review. African Journal of AIDS Research, 10(2), 101–122.
Brown, D. W., Riley, B., Butchart, A., Medding, D. R., Kann, L., & Harvey, A. P. (2009). Exposure to physical and sexual violence and adverse health behaviours in African children: results from the Global Schoolbased Student Health Survey. Bulletin of the World Health Organization, 87, 447–455.
Centers for Disease Control and Prevention. (2013). Global School-based Student Health Survey. Retrieved from http://www.cdc.gov/gshs/pdf/GSHSOVerview.pdf.
Cluver, L., Gardner, F., & Operario, D. (2007). Psychological distress amongst AIDS-orphaned children in South Africa. Journal of Child Psychology and Psychiatry, 48, 755–763.
Cluver, L., Orkin, M., Boyes, M. E., & Sherr, L. (2015). Child and adolescent suicide attempts, suicide behavior, and adverse childhood experiences in South Africa: a prospective study. Journal of Adolescent Health, 57, 52–59.
Cordeiro, L. S., Wilde, P. E., Semu, H., & Levinson, F. J. (2012). Household food security is inversely associated with undernutrition among adolescents from Kilosa, Tanzania. The Journal of Nutrition, 142, 1741–1747.
Cortina, M. A., Sodha, A., Fazel, M., & Ramchandani, P. G. (2012). Prevalence of child mental health problems in Sub-Saharan Africa: a systematic review. Archives of Pediatrics and Adolescent Medicine, 166(3), 276–281.
Graham, J. (2012). Missing data. Analysis and design. New York: Springer.
Grantham-McGregor, S., Cheung, Y. B., Cueto, S., Glewwe, P., Richter, L., & Strupp, B. (2007). Developmental potential in the first 5 years for children in developing countries. Lancet, 369(9555), 60–70.
Hepburn, L., Azrael, D., Molnar, B., & Miller, M. (2012). Bullying and suicidal behaviors among urban high school youth. Journal of Adolescent Health, 51(1), 93–95.
Hickson, J., & Kriegler, S. (1991). Childshock: the effects of apartheid on the mental health of South Africa’s children. International Journal for the Advancement of Counselling, 14(2), 141–154.
Huang, K.-Y., Nakigudde, J., Calzada, E., Boivin, M. J., Ogedegbe, G., & Brotman, L. M. (2014). Implementing an early childhood school-based mental health promotion intervention in low-resource Ugandan schools: study protocol for a cluster randomized controlled trial. Trials, 15(471), 1–9.
Jacka, F. N., Pasco, J. A., Mykletun, A., Williams, L. J., Hodge, A. M., O’Reilly, S. L., & Nicholson, G. C. (2010). Association of western and traditional diets with depression and anxiety in women. American Journal of Psychiatry, 167(3), 1–7.
Jacka, F. N., Kremer, P. J., Berk, M., de Silva-Sanigorski, A. M., Moodie, M., Leslie, E. R., & Swinburn, B. A. (2011). A prospective study of diet quality and mental health in adolescents. Plos One, 6(9), e24805.
Jacka, F. C., Rothon, C., Taylor, S., Berk, M., & Stansfeld, S. A. (2013). Diet quality and mental health problems in adolescents from East London: a prospective study. Social Psychiatry and Psychiatric Epidemiology, 48, 1297–1306.
Jacka, F. C., Sacks, G., Berk, M., & Allender, S. (2014). Food policies for physical and mental health. BMC Psychiatry, 14(132), 1–6.
Jensen, R., & Thornton, R. (2003). Early female marriage in the developing world. Gender and Development, 11(2), 9–19.
Jylhä, M. (2009). What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Social Science & Medicine, 69(3), 307–316.
Kagotho, N. (2015). Protecting assets for the most vulnerable: the potential for asset-based interventions. Global Social Welfare, 2(2), 43–51.
Kaneta, K., Choudhury, M. A., Hanifi, S. R., & Abbas, B. (2000). Gender inequality and severe malnutrition among children in a remote rural area of Bangladesh. Journal of Health, Population, and Nutrition, 18(3), 123–130.
Kawachi, I., Willett, W. C., Colditz, G. A., Stampfer, M. J., & Speizer, F. E. (1996). A prospective study of coffee drinking and suicide in women. Archives of Internal Medicine, 156, 521–525.
Keino, S., Plasqui, G., Ettyang, G., & van den Borne, B. (2014). Determinants of stunting and overweight among young children and adolescents in sub-Saharan Africa. Food and Nutrition Bulletin, 35(2), 167–178.
Khalid, R. (2012). Suicide ideation and its associated risk factors among adolescent students in the Eastern Mediterranean Region (Master’s thesis). Retrieved from http://scholarworks.gsu.edu/cgi/viewcontent.cgi?article=1252&context=iph_theses
Khasakhala, L. I., Ndetei, D. M., Mutiso, V., Mbwayo, A. W., & Mathai, M. (2012). The prevalence of depressive symptoms among adolescents in Nairobi public secondary schools: association with perceived maladaptive parental behaviour. African Journal of Psychiatry, 15, 106–113.
Khasakhala, L. I., Ndetei, D. M., Mathai, M., & Harder, V. (2013). Major depressive disorder in a Kenyan youth sample: relationship with parenting behavior and parenal psychiatric disorders. Annals of General Psychiatry, 12(15), 1–10.
Klanšček, H. J., Žiberna, J., Korošec, A., Zurc, J., & Albreht, T. (2014). Mental health inequalities in Slovenian 15-year-old adolescents explained by personal social position and family socioeconomic status. International Journal for Equity in Health, 13, 26.
Kleintjes, S., Lund, C., Flisher, A. J., & MHaPP Research Programme Consortium. (2010). A situational analysis of child and adolescent mental health services in Ghana, Uganda, South Africa and Zambia. African Journal of Psychiatry, 13, 132–139.
Kulkarni, A. A., Swinburn, B. A., & Utter, J. (2015). Associations between diet quality and mental health in socially disadvantaged New Zealand adolescents. European Journal of Clinical Nutrition, 69, 79–83.
Leenstra, T., Petersen, L. T., Kariuki, S. K., Oloo, A. J., Kager, P. A., & ter Kuile, F. O. (2005). Prevalence and severity of malnutrition and age at menarche; cross-sectional studies in adolescent schoolgirls in western Kenya. European Journal of Clinical Nutrition, 59, 41–48.
Lehrer, J. A., Shrier, L. A., Gortmaker, S., & Buka, S. (2006). Depressive symptoms as a longitudinal predictor of sexual risk behaviors among US middle and high school students. Pediatrics, 118(1), 189–200.
Lester, D. (2002). Serum cholesterol levels and suicide: a meta-analysis. Suicide & Life Threatening Behavior, 32, 333–346.
Li, Y., Zhang, J., & McKeown, A. E. (2009). Cross-sectional assessment of diet quality in individuals with a lifetime history of attempted suicide. Psychiatry Research, 165, 111–119.
Lien, L. (2007). Is breakfast consumption related to mental distress and academic performance in adolescents? Public Health Nutrition, 10, 422–428.
Lien, L., Lien, N., Heyerdahl, S., Thoresen, M., & Bjertness, E. (2006). Consumption of soft drinks and hyperactivity, mental distress, and conduct problems among adolescents in Oslo, Norway. American Journal of Public Health, 96(10), 1815–1820.
Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The construct of resilience: a critical evaluation and guidelines for future work. Child Development, 71(3), 543–562.
Lwambo, N. J., Brooker, S., Siza, J. E., Bundy, D. A., & Guyatt, H. (2000). Age patterns in stunting and anaemia in African schoolchildren: a cross- sectional study in Tanzania. European Journal of Clinical Nutrition, 54, 36–40.
Lytle, L. A., Varnell, S., Murray, D. M., Story, M., Perry, C., Birnbaum, A. S., & Kubik, M. Y. (2003). Predicting adolescents’ intake of fruits and vegetables. Journal of Nutrition Education and Behavior, 35(4), 170–175.
McMartin, S. E., Jacka, F. N., & Colman, I. (2013). The association between fruit and vegetable consumption and mental health disorders: evidence from five waves of a national survey of Canadians. Preventive Medicine, 56, 225–230.
Miotto, P., & Preti, A. (2007). Eating disorders and suicide ideation: the mediating role of depression and aggresiveness. Comprehensive Psychiatry, 48, 218–224.
Nanri, A., Kimura, Y., Matsushita, Y., Ohta, M., Sato, M., Mishima, N., & Mizoue, T. (2010). Dietary patterns and depressive symptoms among Japanese men and women. European Journal of Clinical Nutrition, 64, 832–839.
Ndetei, D. M., Khasakhala, L., Nyabola, L., Ongecha-Owuor, F., Seedat, S., Mutiso, V., & Odhiambo, G. T. (2008). The prevalence of anxiety and depression symptoms and syndromes in Kenyan adolescents. Journal of Child & Adolescent Mental Health, 20(1), 33–51.
O’Neil, A., Quirk, S. E., Housden, S., Brennan, S. L., Williams, L. J., Pasco, J. A., & Jacka, F. N. (2014). Relationship between diet and mental health in children and adolescents: a systematic review. American Journal of Public Health, 104(10), e31–e42.
Ochola, S., & Masibo, P. K. (2014). Dietary intake of schoolchildren and adolescents in developing countries. Annals of Nutrition & Metabolism, 64, 24–40.
Oddy, W. H., Robinson, M., Ambrosini, G. L., O’Sullivan, T. A., de Klerk, N. H., Beilin, L. J., & Stanley, F. J. (2009). The association between dietary patterns and mental health in early adolescence. Preventive Medicine, 49, 39–44.
Okello, J., Nakimuli-Mpungu, E., Musisi, S., Broekaert, E., & Derluyn, I. (2014). The association between attachment and mental health symptoms among school-going adolescents in northern Uganda: the moderating role of war-related trauma. Plos One, 9(3), e88494.
Olley, B. (2008). Health and behavioural problems of children orphaned by AIDS as reported by their caregivers in Abuja, Nigeria. Nigerian Journal of Psychiatry, 6(2), 70–75.
Omigbodun, O. O., & Olatawura, M. U. (2008). Child rearing practices in Nigeria: implications for mental health. Nigerian Journal of Psychiatry, 6(1), 10–15.
Page, R. (2009). Using the Global-School-Based Student Health Survey to identify correlates of smoking in Chilean youth. The International Electronic Journal of Health Education, 12, 289–302.
Peltzer, K., & Pengpid, S. (2012). Suicidal ideation and associated factors among school-going adolescents in Thailand. International Journal of Environmental Research and Public Health, 9, 462–473.
Population Reference Bureau. (2006). The world’s youth 2006 data sheet. Retrieved from http://www.prb.org/pdf06/WorldsYouth2006Datasheet.pdf
Rani, M. A., Shriraam, V., Zachariah, R., Harries, A. D., Satyanarayana, S., Tetali, S., & Sathiyasekaran, B. W. C. (2013). Does a nutrition education programme change the knowledge and practice of healthy diets among high school adolescents in Chennai, India? Health Education Journal, 72(6), 733–741.
Rwegellera, G. G. (1978). Suicide rates in Lusaka, Zambia: preliminary observations. Psychological Medicine, 8(3), 423–432.
Sherman, J., & Muehlhoff, E. (2007). Developing a nutrition and health education program for primary schools in Zambia. Journal of Nutrition Education and Behavior, 39, 335–342.
Sterne, J. A. C., White, I. R., Carlin, J. B., Spratt, M., Royston, P., Kenward, M. G., & Carpenter, J. C. (2009). Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. British Medical Journal, 338, 1–17.
Swahn, M. H., Palmier, J. B., Kasirye, R., & Yao, H. (2012). Correlates of suicide ideation and attempt among youth living in the slums of Kumpala. International Journal of Environmental Research and Public Health, 9, 596–609.
Takaoka, Y., & Kawakami, N. (2013). Fruit and vegetable consumption in adolescence and health in early adulthood: a longitudinal analysis of the Statistics Canada’s National Population Health Survey. BMC Public Health, 13, 1206.
Thompson, M. P., Ho, C.-h., & Kingree, J. B. (2007). Prospective associations between delinquency and suicidal behaviors in a nationally representative sample. Journal of Adolescent Health, 40(3), 232–237.
Tol, W. A., Song, S., & Jordans, M. J. (2013). Annual research review: resilience and mental health in children and adolescents living in areas of armed conflict—a systematic review of findings in low- and middle-income countries. Journal of Child Psychology and Psychiatry, 54(4), 445–460.
Tunji, A., Djurfeldt, G., Holmen, H., & Isinika, A. C. (2005). Conclusions and a look ahead. In the African food crisis. Cambridge: CABI.
Wang, R. H., Lai, H. J., Hsu, H. Y., & Hsu, T. M. (2011). Risk and protective factors for suicidal ideation among Taiwanese adolescents. Nursing Research, 60(6), 413–421.
Weinreb, L., Wehler, C., Perloff, J., Scott, R., Hosmer, D., Sagor, L., & Gundersen, C. (2012). Hunger: its impact on children’s health and mental health. Pediatrics, 110(4), e41.
Weng, T.-T., Hao, J.-H., Qian, Q.-W., Cao, H., Fu, J.-L., Sun, Y., & Tao, F.-B. (2011). Is there any relationship between dietary patterns and depression and anxiety in Chinese adolescents? Public Health Nutrition, 15(4), 673–682.
Wilson, M. L., Dunlavy, A. C., Viswanathan, B., & Bovet, P. (2012). Suicidal expression among school-attending adolescents in a middle-income sub-saharan country. International Journal of Environmental Research and Public Health, 9, 4122–4134.
Wilson, M. L., Celedonia, K. L., & Kamala, B. A. (2013). Patterns, characteristics, and correlates of adolescent bully-victims in urban Tanzania. Social Sciences, 2, 234–246.
World Bank. (n. d.). The situation faced by young people in Kenya. Retrieved from http://siteresources.worldbank.org/INTUNITFESSD/Resources/Chapter3_Edited_MCMay30_.pdf
World Health Organization. (2008). Eliminating female genital mutilation. An interagency statement. Retrieved from http://www.who.int/reproductivehealth/publications/fgm/9789241596442/en/
World Health Organization. (2013). 2013 GSHS data user’s guide. Retrieved from http://www.cdc.gov/gshsdata-users-guide.pdf
World Health Organization. (2014). Global School-Based Student Health Survey (GSHS) purpose and methodology. Retrieved from www.who.int/chp/gshs/methodology/en/index.html
Wusu, O., & Isiugo-Abanihe, U. C. (2006). Interconnections among changing family structure, childrearing and fertility behaviour among the Ogu, Southwestern Nigeria: a qualitative study. Demographic Research, 14, 139–156.
Zahedi, H., Kelishadi, R., Heshmat, R., Motlagh, M. E., Ranjbar, S. H., Ardalan, G., & Qorbani, M. (2014). Association between junk food consumption and mental health in a national sample of Iranian children and adolescents: the CASPIAN-IV study. Nutrition, 30, 1391–1397.
Zahra, J., Ford, T., & Jodrell, D. (2014). Cross-sectional survey of daily junk food consumption, irregular eating, mental and physical health and parenting style of British secondary school children. Child: Care, Health and Development, 40(4), 481–491.
Zhang, J., Li, Y., & Torres, M. E. (2005). How does a suicide attempter eat differently from others? Comparison of macronutrient intakes. Nutrition, 21, 711–717.
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Arat, G. The Link Between Nutrition and Mental Health in Sub-Saharan African Adolescents: Findings from the Global School-Based Health Survey. Glob Soc Welf 4, 31–40 (2017). https://doi.org/10.1007/s40609-016-0046-4
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DOI: https://doi.org/10.1007/s40609-016-0046-4